Robotic Cholecystectomy Remains Safe and Effective After Regular Staffing Hours.

Background Robotic-assisted surgery continues to grow in popularity. Access during evenings and weekends for non-elective operations can be restricted out of safety concerns. We sought to analyze and compare outcomes of patients undergoing robotic cholecystectomy, a common urgent procedure for acute calculous cholecystitis, during regular hours versus evenings or weekends. Based on this comparison, we sought to determine if this restriction is justified. Methods We performed a retrospective analysis of 46 patients who underwent robotic cholecystectomy for acute calculous cholecystitis per 2018 Tokyo criteria by a single surgeon at a single institution between 2021 and 2022. Patients were grouped as undergoing "after-hours" cholecystectomy if the operation started at five pm or later, or anytime during the weekend (Saturday, Sunday). Demographic, perioperative, and outcome variables were tabulated and analyzed. For illustrative purposes, the data presented as median ± standard deviation were applicable. Results After-hours cholecystectomy occurred in 26 patients and regular-hours cholecystectomy occurred in 20 patients. There were no significant differences in perioperative variables between the two cohorts in terms of body mass index, age, gender, cirrhotic status, American Society of Anesthesiology score, white blood cell count, or neutrophil percentage. The after-hours group had more prior abdominal operations. There were no significant differences between the two groups in terms of operative time, estimated blood loss, or length of stay. There were no mortalities. There was one readmission in the after-hours cohort unrelated to the operation. Conclusion Robotic cholecystectomy can be safely performed on the weekends and evenings. Hospitals should make the robotic platform available during this time.

The weight of BMI in impacting postoperative and oncologic outcomes in pancreaticoduodenectomy is attenuated by a robotic approach.

This study was undertaken to observe the effect of body mass index (BMI) on perioperative outcomes and survival when comparing robotic vs 'open' pancreaticoduodenectomy. With IRB approval, we prospectively followed 505 consecutive patients who underwent either robotic or 'open' pancreaticoduodenectomy from 2012 to 2021. For illustrative purposes, patients were separated based on the Center for Disease Control and Prevention BMI table but regression analysis was utilized to identify significant relationships involving BMI. Data are presented as median (mean ± SD). Significance was determined at p ≤ 0.05. 205 and 300 patients underwent 'open' and robotic pancreaticoduodenectomy, respectively. Neither sex nor age correlated with BMI in patients undergoing 'open' nor robotic operation. Operative duration correlated with increasing BMI in each operational approach, which was statistically significant for those receiving the 'open' operation (p = 0.02). There were statistically significantly fewer lymph nodes harvested with rising BMI in patients that had an 'open' operation (p = 0.01), but no such difference was found in patients undergoing the robotic approach. Length of stay (LOS) and in-hospital mortality were statistically significantly associated with rising BMI when an 'open' operation was undertaken (p = 0.02 and p = 0.0002, respectively) but not when the robotic platform was utilized. Patients with higher BMI had significantly longer operative duration, smaller lymph node harvest, greater LOS, and increased in-hospital mortality rate when undergoing 'open' pancreaticoduodenectomy, but not robotic pancreaticoduodenectomy. Thus, the robotic platform may attenuate the increased technical and oncologic difficulties associated with a greater BMI in patients undergoing pancreaticoduodenectomy.

Fluorescence-Guided Robotic Segment 8 Superior Liver Resection. Technical Approach to Sectoral Inflow Occlusion.

In the past decade, precision hepatectomy which requires the understanding of segmental and subsegmental liver anatomy has gained popularity due to its parenchymal-sparing benefits. The importance of this concept has led liver surgeons to a consensus conference and its guideline in regards to precision anatomy in minimally invasive liver resection, held in Tokyo in 2020. A precise control of the sectoral hepatic artery and portal vein allows for a bloodless liver resection, without the use of Pringle maneuver. In the literature, technical description of the right anterior portal pedicle dissection during minimally invasive robotic liver surgery is limited. In this study, we therefore demonstrate such a technique using fluorescence guidance during robotic segment 8 superior liver resection.

Robotic Systematic Portal Lymphadenectomy. Description of Surgical Technique.

Portal lymphadenectomy is an integral part of gallbladder, intrahepatic cholangiocarcinoma, and perihilar cholangiocarcinoma resection to improve staging and prognostication. This is also believed by many oncologists to potentially serve as therapy to remove cancer containing nodes. While the current guideline requires removal of at least 6 portal lymphnodes, many surgeons face technical difficulty in performing the systematic portal lymphadenectomy especially in minimally invasive fashion. The anatomical complexity of biliovascular structures within the porta hepatis contributes to this technical challenge. In this video, we demonstrate our robotic technique of systematic portal lymphadenectomy for the treatment of gallbladder cancer.

Open Parenchymal Sparing Posterosuperior Liver Tumor Resection for Colorectal Liver Metastasis With Proximity to Hepatic Veins.

Liver resection for stage 4 colorectal cancer with liver metastasis is the standard of care, in combination with systemic chemotherapy. R-0 complete resection for colorectal liver metastasis is a curative-intent operation, which is considered the only chance for cure in this disease. The location and proximity of the tumor to major intrahepatic vessels such as hepatic and portal vein determine technical difficulty. Tumors located in the posterosuperior segments of the liver (segments 7 and 8) are technically challenging to resect using a minimally invasive fashion; therefore, conventional open resection is still the technique of choice today. In this video, we demonstrated our approach of an open parenchymal-sparing posterosuperior liver resection for a colorectal liver metastasis.

Robotic Resection of Retroperitoneal Perinephric Tumor. Application of Intraurethral Indocyanine Green Injection As an Adjunct to Avoid Ureteral Injury.

The majority of retroperitoneal mass excision is performed via conventional "open" laparotomy due to concerns of technical difficulty and adequate oncological margins in cases of a malignant sarcoma. A very few cases of minimally invasive resection by laparoscopy had been reported in the literature. Despite the rapid adoption of robotic technology in general surgery and surgical oncology, the robotic technique has not been applied for this pathology. We discussed a complete resection of a large perinephric tumor using a robotic platform. To our knowledge, this is the first study to report the robotic technique of retroperitoneal tumor excision, highlighting the application and usefulness of intraurethral indocyanine green (ICG) injection.