Operative efficiency: a comparative analysis of Versius and da Vinci robotic systems in abdominal surgery.

Robotic-assisted surgery has gained momentum in the pursuit of improved minimally invasive procedures. The adoption of new robotic platforms, such as the Versius, raises concerns about safety, efficacy, and learning curves. This study compares the Versius to the well-established da Vinci in terms of operative time and patient population. Retrospective data collection was conducted on patient data from inguinal hernia surgery, ventral hernia surgery, and cholecystectomies performed between February 2022 and March 2023 at the American Hospital of Dubai. Only experienced cases were included, ensuring proficiency with robotic technology. Versius had longer procedure times in inguinal and ventral hernia surgeries but not in cholecystectomy. No intraoperative complications were observed in either system. This study demonstrates that Versius can provide comparable outcomes to the da Vinci in abdominal surgery, with no observed intraoperative complications.

Femorocele: A rare clinical entity - A case report.

INTRODUCTION AND IMPORTANCE: A femoral hernia is a protrusion of the peritoneum through a defect in the femoral ring into the femoral canal. A rare form of a femoral hernia is a femorocele, which requires a highly skilled physician for accurate diagnosis and management. Clinical examination is the gold standard for diagnosis, with a CT used to confirm clinical suspicion. Once diagnosed, the only curative option is surgery. This case report provides evidence for the use of robotics to treat a femorocele. CASE PRESENTATION: A 23-year-old female with a two-year history of a non-reducible fluid-filled swelling in the right groin presented to the surgical clinic. Upon clinical suspicion and CT imaging, a femorocele was diagnosed. The surgeon opted for a femoral hernia repair using the da Vinci surgical system. Peritoneal connection with the hernia sac was noted, confirming the diagnosis. The content of the cystic mass was reduced; further to that, the omental content was also reduced and the hernia was repaired. The patient tolerated the procedure with no complications. CLINICAL DISCUSSION: This case highlights the use of robotics to treat a rare clinical entity. Robotics was used for this case as it provided exceptional ergonomics, three-dimensional visualization, and wristed movements. CONCLUSION: A femorocele is a rare form of a femoral hernia that requires accurate diagnosis and proper management. In this case, we demonstrated the possibility of using robotics as a viable option for treatment of a femorocele.

Initial experience with a novel robotic surgical system in abdominal surgery.

The emergence of robotics in surgery has led to a recent boom in the acceptance of such technology. This technology has been rapidly adopted in various fields, with the most prominent being general surgery. The number of abdominal procedures being performed using robotics has increased to around 15.1% as potential advantages continue to be highlighted. We herein report the use of the Versius surgical robotic system for use in common abdominal procedures. Three experienced robotic surgeons first gained experience and became familiar with the robotic system through both online modules and cadaveric training sessions. The initial cases performed using the Versius robotic system at a single center were included in this study. Data reported included demographics as well as perioperative data. Fifty-five procedures were performed using the Versius robotic system. Procedures included various hernia repairs (n = 30), gallbladder surgery (n = 22), as well as appendix surgery (n = 3). Appendectomy had the fastest OR times at 35.81 ± 21.84, while the slowest OR times were seen in the BIH group with an average time of 95.2 ± 24. No complications or conversions were observed throughout this entire series. This is the first report to demonstrate the usage of the Versius robotic surgical system for use in abdominal surgery. Our initial data confirm that regardless of patient demographics, the system is safe to use in such procedures; however, further larger scale studies are required to assess its clinical utility.

Implementation of robotic surgery in Dubai: a focus on outcomes.

The rapid acceptance of robotic surgery in gallbladder, inguinal, and ventral hernia surgery has led to the growth of robotic surgery programs around the world. As this is new technology, implementation of such programs needs to be done safely, with a focus on patient outcomes. We herein describe the implementation of a new robotic surgery program in a major hospital in the Middle East. A laparoendoscopic surgeon led the program after training and proctoring. Competency based credentialing were created and put in place. To confirm safety of the program, all laparoscopic and robotic cholecystectomy and hernia operations were followed, and perioperative data analyzed. Out of the 304 patients included in this study, 157 were performed using the robotic approach. In the cholecystectomy group (n = 103) the single site approach offered shorter operative times (P < 0.05). Both the single site robotic and the robotic assisted approaches resulted in less pain (P < 0.05). In the inguinal hernia group (n = 146) the laparoscopic approach offered shorter operative times (P < 0.05), but the robotic approach was associated with less pain (P < 0.05). In the ventral hernia group (n = 55), the open approach offered the best operative times, but the robotic approach was associated with the least amount of pain (P < 0.05). This is the first report of the implementation of a robotic program in the MENA region where the primary measure of success is outcomes. We show that monitoring cholecystectomy, inguinal or ventral hernia data can confirm the quality of the program before expansion and moving forward to more complex procedures.

Treatment of an unusual case of Meckel's diverticulum with a new robotic platform.

INTRODUCTION AND IMPORTANCE: Meckel's diverticulum (MD) is a common congenital anomaly of the digestive tract that affects around 4 % of the population. Although it is relatively common, diagnosis still remains very challenging; it requires an astute clinician with a high clinical index of suspicion to achieve the diagnosis. Once a diagnosis is reached, treatment is almost always surgical. This case report provides evidence of the effectiveness of a new robotic surgical system for resection of MD in the elderly. CASE PRESENTATION: 61 year old male presented to the emergency room with recurrent hematochezia. After multiple diagnostic techniques, he was finally diagnosed with MD using Meckel's scan. After diagnosis, surgical resection using the Cambridge Medical Robotics (CMR) Versius robotic system was performed, which yielded good results. CLINICAL DISCUSSION: This case highlights the use of a new robotic system for the treatment of Meckel's Diverticulum. CONCLUSION: Our initial experience with the CMR Versius surgical system in small bowel resection was successful; however, further studies are needed to demonstrate the safety and efficacy of such a system.

[Predictive factors of obstructive sleep apnea syndrome in obesity]. / Facteurs prédictifs du syndrome d'apnées obstructives du sommeil chez les obèses.

BACKGROUND: Obstructive sleep apnea (OSA) syndrome is frequent, and misdiagnosed. THE AIM: Of this study is to assess the prevalence of OSA syndrome in a Tunisian population of obese (body mass index > or = 30 Kg/m2) and to determine its predictive factors. METHODS: It's a transversal study. One hundred patients (63 females, 37 males) were inculded. All patients underwent nocturnal polysomnography or respiratory polygraphy. RESULTS: Sixty-five patients had an OSA syndrome: mild (24.6%), moderate (30.7%) and severe (44.6%). We compared, by a statistical analysis, the group with OSA syndrome and the group without OSA syndrome. There was a predominance of men (81% of men vs 55.5 of women had OSA). Age was higher in the group with OSA syndrome (56.8 years +/- 10 vs 48.1 +/- 12, P = 0.04). Clinical symptoms such as snoring, daytime sleepiness, nocturnal awakening and respiratory pauses were more frequent in the group with OSA syndrome. Morphological abnormalities such as retrognathy and/or short neck were significantly more frequent in the group with OSA syndrome (p = 0.05 and 0.02 respectively). Cardiopathies and diabetes were more frequent in obese with OSA syndrome. CONCLUSION: In obese persons, male gender, comorbidities and /or clinical symptoms such as snoring, daytime sleepiness, nocturnal awakening and respiratory pauses, retrognathy and/or short neck are predictive of OSA syndrome. So, we propose a nocturnal recording in obese presenting at least one of these predictive factors.

Accidental extravascular insertion of a subclavian hemodialysis catheter is signaled by nonvisualization of catheter tip.

Subclavian hemodialysis (HD) catheter placement under fluoroscopy with perforation of the superior vena cava (SVC) is a rare complication that needs to be recognized and treated appropriately. We report the case of a 47-year-old black woman under treatment for end-stage renal disease secondary to HIV-associated nephropathy who sustained an extravascular insertion of fluoroscopy-guided subclavian catheterization for HD. Subsequent successful removal of the extravascularly placed catheter along with repair of the lacerated SVC were effected by open thoracic surgery.