Feasibility of transthoracic esophagectomy with a next-generation surgical robot.

Robot-assisted minimal access surgery (MAS), compared with conventional MAS, has shown a number of benefits across several therapeutic indications but its use for transthoracic esophagectomy (TTE) requires further evaluation. Here, we report the first-in-human series of major esophageal resections performed using a next-generation tele-operated robotic surgical system in a single center. Robot-assisted TTE was performed using the Versius Surgical System by a single surgeon to assess the robotic system's ability to achieve tumor clearance (measured by R0 resection rates) whilst reducing anastomotic leakage rates. Intra- and post-operative outcomes such as median operative time, length of hospitalization, intra-operative blood loss, and the number of complications were also assessed. Fifty-seven patients underwent robot-assisted TTE between August 2019 and June 2021. All procedures were completed successfully with no unplanned conversions to alternative surgical methods. Estimated blood loss was minimal, and no adverse events, complications or deaths were reported. Our experience with the Versius Surgical System demonstrates its safe adoption and implementation for TTE.

Learning Curve of Total Laparoscopic Hysterectomy for a Resident in a High-Volume Resident Training Setup.

Study Objective: To evaluate the resident learning curve, demographic and comparative analysis of total laparoscopic hysterectomy. Design: This retrospective observational study was conducted in a high-volume resident training setup. Setting: Tertiary care center is used in the study. Materials and Methods: Eight hundred and one total laparoscopic hysterectomy patients operated by the residents between July 2013 and June 2019 were evaluated with respect to the learning curve, duplication of the steps, the results in terms of intra- and postoperative complications and the time taken for the surgery. Surgeries were assigned as per the institutional inclusion criteria for the residents. The fellowship program enrolled six residents per year for training period of 1 year. The residents initially performed ten simple cases under the supervision of the director followed by ten cases which were performed independently, and based on their learning curve, they then performed advanced cases independently. Results: TLH was successfully performed in all women by surgical residents in training. The surgical time was 61-120 min in majority (49.3%). 2.99% had intra-operative complications while 7.61% had postoperative complications which were identified and managed. All women recovered uneventfully. Conclusions: Dedicated teaching staff, uniform surgical protocols and high-volume centers contribute to the safety of TLH.

Colorectal cancer surgery: by Cambridge Medical Robotics Versius Surgical Robot System-a single-institution study. Our experience.

With the previous experiences in performing laparoscopic for over a period of 15 years and da Vinci colorectal surgeries from 2010 to 2013, we started operating using the Cambridge Medical Robotics (CMR) Versius Surgical Robot System. The aim of the study is a prospective analysis and evaluation of short-term results of consecutive patients to study the technical feasibility and oncological outcome of robot-assisted low anterior resection (LAR) and ultralow anterior resection (ULAR), using the CMR Versius Surgical Robot System. This study was conducted at single minimal access surgery institute. 31 patients with colorectal adenocarcinoma underwent robot-assisted LAR and ULAR between August 2019 and March 2020. Patient characteristics, perioperative parameters and complications were evaluated. Surgical and pathological outcomes such as quality of Total Mesorectal Excision (TME), free circumferential resection margins and number of lymph nodes dissected were also evaluated. Of 31 patients, 23 were men and 8 women, with mean age of 55.6 years. The mean robotic operative time was 51 min and the mean blood loss was 55 ml. The mean robot docking and undocking time was 17 min and 5 min, respectively. The mean hospital stay was 7 days. The longitudinal and circumferential resection margins were negative in all patients. Histopathological reports of 27 among 31 patients showed complete TME. Splenic flexure of colon mobilization was done laparoscopically. We feel that Versius robot has the qualities in terms of dexterity, vision and intuitive movements, and to translate this technical ability into oncological safety.

Laparoscopic Intracorporeal Pancreaticogastrostomy in Total Laparoscopic Pancreaticoduodenectomy-A Novel Anastomotic Technique.

Novel pancreaticogastric anastomosis technique in laparoscopic pancreaticoduodenectomy which is simple, feasible to perform, provides secure fixation between stomach and pancreas. The aim of our article is to describe our technique of intracorporeal pancreaticogastrostomy as a promising approach for future widespread application.

Novel Anastomotic Technique for Uterine Transplant Using Utero-ovarian Veins for Venous Drainage and Internal Iliac Arteries for Perfusion in Two Laparoscopically Harvested Uteri.

STUDY OBJECTIVE: To evaluate 2 cases of uterine transplant surgery that used utero-ovarian veins as outflow channels, internal iliac arteries for perfusion, and the organ harvest surgery performed laparoscopically. DESIGN: Case study (Canadian Task Force Classification III). SETTING: An urban, private, tertiary care hospital. PATIENTS: Two patients, ages 30 and 24years, diagnosed with absolute uterine factor infertility secondary to Mayer-Rokitansky-Küster-Hauser syndrome underwent related living donor uterine transplants; donors were their mothers with normal menses. INTERVENTIONS: Retrieval of organs through minilaparotomy and laparoscopic harvest of donor internal iliac arteries and ovarian veins. MEASUREMENTS AND MAIN RESULTS: Anastomosis was completed with bilateral donor internal iliac arteries to recipient internal iliac arteries in an end-to-end manner and with bilateral donor ovarian veins to recipient external iliac veins in an end-to-side manner. The lengths of utero-ovarian veins of both donors were 11 and 11cm on both sides; the lengths of the internal iliac arteries of both donors were 10 and 7.5cm on the left side and 10 and 6cm on the right side. The operative times for harvest surgery, bench surgery and transplant surgery were 2:40 and 3:20 hours, 34:32 and 33:30 min and 4:00 and 4:30 hours respectively for recipients 1 and 2. Daily postoperative uterine Doppler was completed through day 8 and then every other day and showed good intrauterine blood flow (i.e., low resistance arcuate vessel flow; resistance index < .5). Cervical biopsies on postoperative days 7 and 14 showed no evidence of rejection in either recipient. Both recipients started menstruating within 2 months of surgery. CONCLUSION: By using ovarian veins as outflow channels, the challenges involved in dissection along the internal iliac vein are avoided, and harvesting the donor internal iliac artery reduces the tension on vascular anastomosis. The selection of vessels to be harvested could make the technique reproducible, although larger studies are warranted to confirm results.

Evaluation of 5-year results of laparoscopic transhiatal oesophagectomy as a single-centre experience.

INTRODUCTION: Minimal Invasive Surgery of oesophageal cancers is gaining popularity. We have published our Thoracoscopic Esophagectomy results. The present study focuses on our expertise of TransHiatal Esophagectomy. MATERIALS AND METHODS: 287 patients underwent Esophagectomies for Cancer of Esophagus at Galaxy Care Laparoscopy Institute from January 2010 to December 2014 after thorough assesment. Out of these, 81 patients underwent laparoscopic trans hiatal esophagectomies. Their charts were reviewed retrospectively for intraoperative and postoperative results. The median follow up was 28 months. RESULTS: Out of 81 patients,76 patients had R0 resection and 5 had R1. The average lymphnode yield was 20,average survival was 28months. 3 patients had local recurrence,18 had regional recurrence and 30 had distant recurrence. Average operating time was 140 min,mean blood loss was 80 ml. Average Post-operative ICU stay was 1 day and hospital stay 7 days. CONCLUSION: Classic THE has limitations which can be overcome by the use of laparoscopic techniques. Laparoscopic approach for THE has better magnified vision facilitating better clearance under vision. Hence we recommend laparoscopic technique for THE to minimize morbidity and improve oncologic results.

Laparoscopic-Assisted Uterus Retrieval From Live Organ Donors for Uterine Transplant: Our Experience of Two Patients.

STUDY OBJECTIVE: To report the first ever laparoscopic-assisted live donor uterus retrieval in 2 patients for uterus transplant. DESIGN: Case study (Canadian Task Force classification III). SETTING: Galaxy CARE Laparoscopy Institute, Pune, India. PATIENTS: Two patients with absolute uterine factor infertility with their mothers as donors. INTERVENTIONS: In vitro fertilization and uterine transplant. MEASUREMENTS AND MAIN RESULTS: A 12-member team was formed, and approval for transplant was obtained from the institutional review board. Pretransplant, in vitro fertilization for both patients was done. Two consecutive uterine transplants were done on 2 successive days. Vessels were harvested laparoscopically in both donors. Uterus and harvested vessels were retrieved by a small abdominal incision to prevent injury and infection. The uterus was transplanted in the recipients by end to side anastomosis of the harvested vessels to external iliac vessels, followed by anchoring of supports of the donor uterus to those of the recipients. Surgical intra- and postoperative parameters, postoperative investigations, and follow-up data of 6 months were measured. Operative time for laparoscopic donor surgery was 4 hours. Bench surgery took 45 minutes. Recipient surgery time was 4 hours. There were no intraoperative or immediate postoperative complications. Both the recipients started menstruating after 34 days and 48 days, respectively, and have had 6 cycles of menses at regular intervals. Uterine artery Doppler showed good flow in both patients. Hysteroscopy-guided cervical biopsies were used as a method of surveillance of graft rejection after uterine transplant. Office hysteroscopy was done after 2 months in both patients, and hysteroscopy-guided endometrial and cervical biopsies were taken. Minimal slough was seen on the endometrium in the patient with Mayer-Rokitansky-Küster-Hauser syndrome, which was removed. Repeat hysteroscopy after 10 days showed a healthy endometrium. CONCLUSIONS: Laparoscopic-assisted uterus donor retrieval is feasible and affords all the advantages of a minimally invasive technique, thereby reducing the morbidity of the procedure. It helps in better dissection of the vessels, shortens the operative time, and helps to minimize tissue handling of the harvested uterus and vessels.

Laparoscopic-Assisted Uterus Retrieval From Live Organ Donors for Uterine Transplant.

STUDY OBJECTIVE: The authors present the first ever laparoscopic-assisted uterus retrieval in a live donor for uterus transplant. DESIGN: A step-by-step surgical demonstration. SETTING: Galaxy CARE Laparoscopy Institute, Pune, India. PATIENTS: Two patients, ages 21 and 26 years, with Mayer-Rokitansky-Küster-Hauser syndrome and Asherman syndrome, respectively, with their mothers as donors. INTERVENTIONS: A 12-member team was formed. After a review of the available literature on uterine transplant, a protocol was formulated and submitted to the Institutional Review Board (IRB). Approval from the Institutional Review Board was obtained. Thorough screening of the candidates was done. Two consecutive uterine transplants were done on 2 successive days. Vessels were harvested laparoscopically in both donors. Uterus was retrieved through a small abdominal incision, to prevent any injury to the uterus and harvested vessels. Uterus was transplanted in the recipients by end-to-side anastomosis of the harvested vessels to the external iliac vessels, followed by anchoring of supports of the donor uterus to those of the recipients. MEASUREMENTS AND MAIN RESULTS: Surgical intra- and postoperative parameters, postoperative investigations, and follow-up data of 4 months. The operative time for laparoscopic donor surgery was 4 hours. Bench surgery took 45 minutes. The recipient surgery was completed in 4 hours. There were no intraoperative or immediate postoperative complications. Both recipients started menstruating after 34 days and 48 days, respectively, and have had 3 cycles of menses at regular intervals to date. After discharge, follow-up cervical biopsies at 3 weekly intervals showed no signs of rejection. Uterine artery Doppler ultrasound showed good flow in both patients. CONCLUSION: Laparoscopic-assisted donor retrieval is feasible and affords all advantages of a minimally invasive technique. It helps in better dissection of vessels, shortens the operative time, and helps minimize tissue handling, thereby reducing the morbidity of the procedure.

Management of Large Size MNGs and STNs Using 3D Endoscopic Technique: a Review of 10 Cases.

The role of endoscopic thyroidectomy has shown clear cosmetic benefits in the past. In this current study of 10 patients, we have tried to highlight the importance and benefits of 3D endoscopy in the management of large size multinodular goitres (MNGs) and solitary thyroid nodules (STNs). From March 2014 to July 2014, patients having a large volume of thyroid (>70 cc for one lobe) and nodule size (>6 cm) were enrolled for this study. A total of 10 patients underwent the procedure using the Karl Storz(TM) 3D endoscope system. Out of the 10 patients, 9 were females and 1 was male who underwent total, subtotal, and hemithyroidectomy. Three out of 10 turned out to be malignant for whom completion thyroidectomies were done endoscopically. The average blood loss was 29.5 cc and the mean operative time was 72 min. The average thyroid specimen volume was 115.4 cc with an average nodule size of 6.7 cm. Patients were discharged on the first post-operative day except one on the second post-op day. Post-operative scar was evaluated on the 14th day. 3D endoscopic thyroidectomy is definitely a step ahead in the management of large size MNGs and STNs. It gives excellent depth perception and magnification which helps in identification and preservation of important nerves and vessels which ensures safe removal of the thyroid from its bed.