Robotic surgery across Latin America: a bibliometric analysis of research trends from 2009 to 2022.

The rise of robotic surgery throughout the world, particularly in Latin America, justifies an objective evaluation of research in this field. This study aimed to use bibliometric techniques to identify the research trends and patterns of robotic surgery in Latin America. The research strategy used the terms "Robotic," "Surgery," and the name of all the Latin American countries, in all fields and collections of Web of Science database. Only original articles published between 2009 and 2022 were included. The software Rayyan, Bibliometric in the R Studio, and VOSViewer were used to develop the analyses. After screening, 96 articles were included from 60 different journals. There was a 22.51% annual increase in the scientific production of robotic surgery in the period studied. The more frequent topics by specialty were: Urology (35.4%), General Surgery (34.4%), and Obstetrics and Gynecology (12%). International cooperation was observed in 65.62% of the studies. The Latin American institution with the highest production of manuscripts was the Pontificia Universidad Católica de Chile. Mexico, Chile, and Brazil were, in descending order, the nations with the highest number of corresponding authors and total citations. When considering the total number of articles, Brazil ranked ahead of Chile. Scientific production regarding robotic surgery in Latin America has experienced accelerated growth since its beginning, supported by the high degree of collaboration with leading countries in the field.

Feasibility of robotic cholecystectomy at an academic center with a young robotic surgery program: a retrospective cohort study with umbrella review.

Laparoscopic cholecystectomy (LC) has been standard of care for surgical treatment of benign gallbladder pathology for decades. With the advent of robotic surgical technology, robotic cholecystectomy (RC) has gained attention as an alternative to conventional laparoscopy. This study introduces a single-surgeon experience with laparoscopic versus robotic cholecystectomy and an umbrella systematic review of the outcomes of both approaches. A retrospective chart review was performed at a single institution on a prospectively maintained database of patients undergoing laparoscopic or robotic cholecystectomy for benign gallbladder pathology. An umbrella systematic review was conducted using PRISMA methodology. A total of 103 patients were identified; 61 patients underwent LC and 42 underwent RC. In the RC cohort, 17 cases were completed using a four-port technique while 25 were completed using a three-port technique. Patients undergoing RC were older compared to the LC group (44.78 vs 57.02 years old; p < 0.001) and exhibited lower body mass index (29.37 vs 32.37 kg/m2, p = 0.040). No statistically significant difference in operative time or need for postoperative ERCP was noted. Neither this series nor the umbrella systematic review revealed significant differences in conversion to open surgery or readmissions between the LC and RC cohorts. Three-port RC was associated with reduced operative time compared to four-port RC (101.28 vs 150.76 min; p < 0.001). Robotic cholecystectomy is feasible and safe at a young robotic surgery program in an academic center setting and comparable to laparoscopic cholecystectomy clinical outcomes.

Laparoscopic versus full robotic Roux-en-Y gastric bypass: retrospective, single-center study of the feasibility and short-term results.

Robotic bariatric surgery is an alternative to laparoscopy. It gives the surgeon an accurate three-dimensional view, allowing complex maneuvers while maintaining full control of the theater. We report our experience with this innovative surgery compared with laparoscopy during Roux-en-Y gastric bypass, to demonstrate its safety and feasibility. Our single-center study retrospectively identified obese patients who underwent either laparoscopic or robot-assisted gastric bypass procedures over a 2-year period. Demographics, intraoperative outcomes, mortality and morbidity data were collected. Of the 343 gastric bypass procedures identified, 147 were laparoscopic and 196 robotic-assisted. There were significant differences in age and BMI, being younger and more obese in the robotic group (p = 0.001). The mean operative time was longer in the robotic group; the mean additional time was required for docking, otherwise, the surgical time between groups was comparable. Operative time decreased in line with increasing skills. The conversion rate to laparotomy was 1% (robotic group). Morbidity was generally lower in the robotic group compared with laparoscopy, (hemorrhages 2.5% vs. 6.8%, respectively; anastomotic fistulas 0.5% vs. 2.7%). Statistically, results seem to favor robotic assistance. No mortality was observed in either group. The mean hospital stay was significantly shorter in the robotic group (p = 0.007). Robotic gastric bypass is feasible and, within the reach of every laparoscopic surgeon. Its results are comparable to laparoscopy and surgery is facilitated in higher BMI patients. Randomized, prospective studies are necessary to support our results.

[Confidentiality and law in Lebanon]. / Le secret médical fait-il loi au Liban?

Everyone is entitled to one's privacy and cannot be denied this right. Illness affects human beings, exposing them to outside influences. The physician is given access to the patient's privacy, only because of his professional status. The relation between the patient and his physician is based on full trust. Confidentiality is a must that should be protected by law. The related Lebanese law includes incoherence, subject to abuse. The physician must protect the interests of his patient without misleading insurance companies. Physicians, hospitals, insurance companies and all health organisms should talk and work together for a global health policy to preserve confidentiality, and the interests of all actors. A campaign should be launched to promote a better understanding of the concept of confidentiality in order to finally bring about its enforcement in Lebanon.

[The responsibility of the physician in preventing harm]. / La responsabilité médicale loin de la condamnation de principe du médecin.

"Being responsible" means to assume the decision, the organization, the accomplishment and the consequences of its own behavior. This is true for a person disposing of his freewill. Every physician is responsible for the specific act he undertakes. He is free to make decisions, and should act according to the scientific data currently admitted. A specific diagnosis is not a must to perform a medical procedure, which should be accomplished with the smallest error margin. Its results cannot be guaranteed, other than surgery performed for cosmetic purposes. Facing his conscience, the physician has a great responsibility. He is also responsible for his acts towards the law. This is true in cases of presumptive harm, and when a complaint is lodged with either a civil or a penal court. A disciplinary procedure can be undertaken by the Order of physicians. The civil court should be privileged, to enable better financial compensation for the victim. The presumption of guilt and the pre-established condemnation of the physician should be avoided by initiating a real trust status with the patient, and providing better clinical information. The latter should be honest, sincere, understandable, and precise. The consent of the patient should be obtained.