Cirugía robótica colorectal, en un hospital de comunidad cerrada: experiencia inicial leído en sesión SACP, 11 de octubre de 2019 / Colorectal robotic surgery in a closed community hospital: initial experience read in SACP session, october 11, 2019

Introducción: La introducción del sistema Da Vinci, ha revolucionado el campo de la cirugía mínima invasiva en el cual el cirujano tiene control de la cámara 3D y los instrumentos son de gran destreza y confort ergonómico, acortando la curva de aprendizaje quirúrgica. Objetivo: Describir nuestra experiencia inicial de cirugía robótica colorectal en un hospital de comunidad cerrada de la Ciudad Autónoma de Buenos Aires. Materiales y Método: Estudio retrospectivo descriptivo sobre una base prospectiva de cirugías colorectales robóticas realizadas por el mismo equipo quirúrgico desde mayo de 2016 a abril de 2019. Resultados: Se operaron 41 pacientes. Trece de ellos fueron colectomías derechas, 17 colectomías izquierdas y 11 cirugías de recto. El tiempo quirúrgico promedio fue de 170 minutos (90-330), la estadía hospitalaria de 4 días (3-30), la tasa de conversión de 7,31% (3/41 pacientes) y la tasa de dehiscencia anastomótica del 9,75% (4/41 pacientes). Morbilidad global del 19.5% (8/41 pacientes). Conclusión: Hemos repasado los resultados iniciales de nuestra experiencia en cirugía robótica colorectal en un número reducido de casos, pero suficiente para evaluar la seguridad y reproducibilidad del método al comienzo de una curva de aprendizaje.

Introduction: The introduction of the Da Vinci System, has revolved the field of invasive minimal surgery in which the surgeon has control of the 3d camera and the instruments are of great strength and ergonomic comfort by cutting the surgical learning curve. Objective: Of this preliminary presentation is to describe our initial experience of colorectal robotic surgery in a closed community hospital of the Autonomous City of Buenos Aires. Materials and Method: Retrospective descriptive study on a prospective basis of robotic colorectal surgeries performed by the same surgical team from May 2016 to April 2019.Results: 41 patients were operated. 13 of them were right colectomies, 17 left colectomies and 11 rectum surgeries. The average surgical time was 170 minutes (90-330), the average hospital stay of 4 days (3-30), the conversion rate of 7.31% (3/41 patients) and the anastomotic dehiscence rate of 9 , 75% (4/41 patients). Overall morbidity of 19.5% (8/41 patients).Conclusion: We have reviewed the initial results of our experience in colorectal robotic surgery in a reduced number of cases but sufficient to evaluate the security and reproducibility of the methodic learning of a learning curve.

Robotically Assisted Mitral Valve Repair as the Treatment of Choice for Patients with Difficult Anatomies / 대한흉부외과학회지

Robotically assisted mitral valve repair has proven its efficacy during the last decade. The most suitable approach for patients with difficult anatomies, such as morbid obesity, sternal deformities, cardiac rotation, or vascular anomalies, represents a current challenge in cardiac surgery. Herein, we present the case of a 71-year-old patient affected by severe degenerative mitral valve regurgitation with pectus excavatum and a right aortic arch with an anomalous course of the left subclavian artery who was successfully treated using a Da Vinci–assisted approach.

Initial Experiences using Robot-assisted Distal Pancreatectomy: A Single Institution Study of 28 Patients

PURPOSE: Surgical procedures using robot-assisted surgery, including pancreatic surgery, have recently become popular. This study aimed to report our initial experiences with distal pancreatectomy procedures using the robot-assisted surgery system. METHODS: The clinical records of 28 patients who underwent robot-assisted distal pancreatectomy (RDP) between July 2012 and January 2016 were reviewed. RESULTS: Of the 28 patients, 5 (17.9%) were male and 23 (82.1%) were female. Their ages ranged from 11 to 78 years, with a median age of 44.5 years. The mean diameter of the pancreatic tumors was 3.6 cm. The median operative time was 192.5 (range, 100~390) minutes, and the median blood loss was 200 (range, 50~1,900) ml. All of the 28 RDPs were successfully completed. Spleen preservation was achieved in 16 (57.1%) patients. Clinically significant postoperative pancreatic fistula was detected in 4 (14.3%) patients. Postoperative complications were evident in 5 (17.9%) of the 28 patients. CONCLUSION: Our experiences suggest that RDP is feasible for patients with benign or borderline tumors at the body or tail of the pancreas. It may be considered as an effective surgical procedure for benign or borderline tumors of the pancreas in the future; however, further studies to confirm this are warranted.

The Current Robotic da Vinci System has Limitations for Colorectal Surgical Procedures.

Since the introduction of the robotic da Vinci Surgical System, several advantages have been demonstrated in all surgical specialties, particularly in pelvic surgery. However, the current system still has several limitations; one is technically related. In this article, we give our opinion on this limitation and present our recommendations for improvement of robotic surgery in relation to colorectal surgery.

Abordaje laparoscópico de hernia paraesofágica asistido por robot reporte de un caso / Laparoscopic approach to robot-assisted paraesophageal hernia report of a case

Paciente femenino de 55 años con antecedente de trauma torácico izquierdo con disfagia, disnea, dolor retroesternal y epigástrico, la serie contrastada de esófago estomago duodeno muestra la presencia de hernia paraesofágica que igualmente se corrobora en endoscopia digestiva superior y los estudios tomográficos se plantea la necesidad de la resolución quirúrgica y para ello se realiza abordaje laparoscópico asistido por sistema da Vinci®, se evidencia elongación de pilares del hiato esofágico y desplazamiento a través del fundus gástrico cubierto por peritoneo hacia el tórax izquierdo, se realiza, liberación de los elementos del saco herniario y posterior escisión del mismo, cierre del defecto y reforzado con una banda de politetrafluoroetileno expandido de 5 x 8 cm. Después de la cirugía la paciente se recupera satisfactoriamente inicia dieta a las 24 horas de postoperatorio, la estancia hospitalaria es de 3 días. El abordaje laparoscópico se presenta como una opción que ofrece mayores beneficios al paciente en comparación con el abordaje abierto. Informes sobre corrección de hernia paraesofágica asistida por sistema Da Vinci son limitados y serán tratados en este informe de caso(AU)

Female patient 55 years female with a history of left thoracic trauma with dysphagia, dyspnea, retrosternal and epigastric pain, esophageal contrasted series esophagus stomach duodenum shows the presence of paraesophageal hernia which is also corroborated by upper endoscopy and CT scans raises the need for surgical resolution and it is performed laparoscopic-assisted da Vinci robotic mark, elongation evidenced esophageal hiatus pillars and scrolling through the gastric fundus covered by peritoneum to the left chest, is performed, release of the elements of the sac and subsequent cleavage of the same defect closure and reinforced with a strip of expanded polytetrafluoroethylene 5 x 8 cm. following surgery the patient is recovering diet started at 24 hours after surgery, the hospital stay is 3 days. The laparoscopic approach is presented as an option that provides greater benefits to patients compared with the open approach. Reports paraesophageal hernia correction aided brand da vinci robotic system are limited and will be discussed in this case report(AU)

Robotic Adrenalectomy Using a Lateral Transperitoneal Approach: Initial Experience of Fifteen Consecutive Cases / 대한내분비외과학회지

PURPOSE: In this study, we report on our initial experience using the da Vinci-S® robotic surgical system in performance of laparoscopic adrenalectomy. METHODS: Fifteen patients, 11 with left adrenal tumors and four with right adrenal tumors, underwent robotic adrenalectomies using the lateral transperitoneal approach with the da Vinci-S® surgical system at the Korea University Anam Hospital, Seoul, Korea, between October 2009 and May 2012. RESULTS: The mean age of the patients was 45.5 (22~61) years, and the mean body mass index was 23.81 (18.0~28.57) kg/m². Eleven left adrenalectomies, four for primary aldosteronisms, four for pheochromocytomas, two for primary adrenal Cushing's adenoma, and one for myelolipoma, and four right adrenalectomies, two for the primary adrenal Cushing's adenomas, one for pheochromocytoma, and one for primary aldosteronism, were performed robotically. There was no conversion to traditional laparoscopic or open surgery. The mean size of the tumor was 2.54 (1.0~5.5) cm. The mean operative time was 208.2 (120~320) minutes, and the mean console time was 127.6 (75~212) minutes. No major postoperative morbidity was observed, and the mean length of hospital stay was 5.86 days. CONCLUSION: We found that the robotic systems, with magnified stereoscopic three-dimensional vision, elimination of tremor, and the ability to articulate and rotate the instruments, were ideal surgical tools for operation of adrenal lesion. Robotic adrenalectomy may be a safe and effective alternative to traditional laparoscopic adrenalectomy.

Robotic-Assisted Resection of Primary Rectal Cancer: An Analysis of Consecutive 185 Cases / 대한내시경복강경외과학회지

PURPOSE: Although some limitations of conventional laparoscopy have been overcome by the enhanced dexterity of a robotic system, few studies have reported the use of robotic surgery for rectal cancer. This study analyzed prospectively the safety, morbidity, mortality and operation time of a robotic rectal resection for rectal cancer. METHODS: The data of 185 consecutive patients, who had undergone robotic rectal resection for rectal cancer at Korea University Aanam Hospital from July 2007 to April 2011, was analyzed prospectively. The postoperative outcomes and operative times were evaluated. RESULTS: Robotic rectal resection using a da Vinci surgical system was performed on 185 patients. There were 115 low anterior resections, 5 anterior resections, 1 Hartmann's operation, 10 ultra-low anterior resections, 43 intersphincteric resections and 11 abdominoperineal resections. The median hospital stay was 9 days. The overall morbidity rate was 33.4%. There was one conversion to open surgery. The mean passage of flatus was noted on postoperative day 2.0, diet was started on postoperative day 2.3 and the mean postoperative hospital stay was 13.7 days. The mean number of retrieved lymph nodes was 16. The total operation time decreased with increasing operator experience (306 min vs 285 min vs 268 min, p=0.009). CONCLUSION: A robotic rectal resection is feasible and safe for rectal cancer patients. The data showed an acceptable morbidity and mortality rate compared to the short term results of conventional laparoscopic and open surgery reported previously. Nevertheless, the oncologic and functional benefits of robotic colorectal surgery should be evaluated through a large scale study.

Robotic Surgery in Gastrointestinal Surgery / 대한소화기학회지

Robotic surgery is an emerging technology. After adoption of robotic surgery for cholecystectomy in 1997, various general surgical procedures have been performed using surgical robot. In general surgery, robotic surgery is applied to wide range of procedures, however, it is still in its early years. Cholecystectomy, Nissen fundoplication, Heller myotomy, and Roux-en-Y gastric bypass are the most frequently performed robotic operations. Most reports proved that application of robotic technology for general surgery is technically feasible and safe with the help of improved dexterity, better visualization, and high level of precision. However, still the absence of tactile sense and extremely high costs are the problems to be solved. Although robotic surgery has demonstrated some clear benefits compared to conventional surgeries including laparoscopy, it remains to be seen whether these benefits will outweigh the associated disadvantages or problems of robot surgery. Therefore, more prospective randomized study comparing the shot-term and long-term surgical outcomes between robotic and conventional laparoscopic surgery is needed to further define the impact of robotic surgical technology in general surgery.