¿Es YouTube una herramienta fiable para la enseñanza de cura de hernia inguinal asistida por robot? Una revisión crítica de los recursos disponibles / Is YouTube a reliable tool for approaching robotic assisted transabdominal preperitoneal surgery? A critical review of the available resources

Introducción: La cirugía transabdominal preperitoneal asistida por robot (rTAPP) es una técnica relativamente reciente para el tratamiento de hernia inguinal. Para alcanzar resultados óptimos se deben cumplir las 10 reglas de oro descritas. Los cirujanos en formación suelen revisar vídeos para familiarizarse con nuevas técnicas siendo YouTube una de las plataformas más utilizada. El objetivo de este estudio es realizar una evaluación de los 10 vídeos más vistos en YouTube de reparación de hernia inguinal por rTAPP para determinar si se cumplen las 10 reglas de oro. Métodos: Identificar y evaluar los 10 vídeos con mayor número de visualizaciones relacionados con la rTAPP. Tres Cirujanos con experiencia evaluaron el cumplimiento de las 10 reglas de oro utilizando una escala de Likert. Los datos fueron analizados en Excel (Microsoft) y graficados con Tableau (Tableau Inc). La consistencia entre evaluadores se determinó mediante el alfa de Cronbach, considerándose aceptable un valor > 0,7. Resultados: La evaluación general promedio fue de 3,63 con un rango de 2,6 a 4,9. Las puntuaciones relacionadas con el cumplimiento de las reglas 1, 2, 9, 10 fueron satisfactorias; en cambio, las reglas 3, 4, 5, 7 y 8 fueron débiles, en particular la regla número 7. Se observó consistencia interna entre los evaluadores con un alfa de Cronbach de 0,98. Conclusiones: La falta de cumplimiento con las 10 reglas del oro en la mayoría de los vídeos demuestra que el uso de vídeos (YouTube) no es un adecuado recurso para el aprendizaje de cura de hernia inguinal asistida por robot.(AU)

Introduction: The robotic transabdominal preperitoneal approach (rTAPP) is a relatively recent technique for the treatment of inguinal hernia. To achieve optimal results, the 10 golden rules described must be followed. Surgeons in training often review vídeos to familiarize themselves with new techniques, YouTube being one of the most used platforms. The objective of this study is to carry out an evaluation of the 10 most viewed vídeos on YouTube of inguinal hernia repair by transabdominal preperitoneal approach (rTAPP) to determine if the 10 golden rules are met. Methods: Identify and evaluate the 10 vídeos with the highest number of views related to rTAPP. Three experienced surgeons evaluated compliance with the 10 golden rules using a Likert scale. Data were analyzed in Excel (Microsoft) and plotted with Tableau (Tableau Inc.). The consistency between evaluators was determined using Cronbach's alpha, considering a value >0.7 acceptable. Results: The average overall evaluation was 3.63 with a range of 2.6–4.9. The scores related to compliance with the rules 1, 2, 9 and 10 were satisfactory; on the other hand, rules 3, 4, 5, 7 and 8 were weak, particularly rule number 7. Internal consistency was observed between raters with a Cronbach's alpha of 0.98.Conclusions: The lack of compliance with the 10 golden rules in most of the vídeos demonstrates that the use of vídeos (YouTube) is not an adequate resource for learning robot-assisted inguinal hernia cure.(AU)

Ampliación vesical pediátrica mediante abordaje robótico puro: ¿por qué no? Primer caso en España / Purely robotic ileocystoplasty in children: why not? First case in Spain

Introducción: Presentamos el primer caso de abordaje robóticopediátrico puro en España. Caso clínico. Varón de 12 años con vejiga neurógena de escasacapacidad y altas presiones sin respuesta al tratamiento conservador,abogando por una ileocistoplastia de aumento. Se lleva a cabo un abordaje robótico puro con 4 puertos robóticos y 2 accesorios, de 380 minutosde duración total sin complicaciones intraoperatorias. Es dado de alta alas 2 semanas previo control cistográfico. Tras 32 meses de seguimientocontinúa continente. Comentarios: La mínima invasión, mayor precisión y ergonomíadel abordaje robótico, hacen de este una opción óptima para técnicasquirúrgicas complejas. Dada la difícil disponibilidad del robot y el escasovolumen pediátrico, resulta un reto su normalización en este campo.Nuestra experiencia coincide con la literatura, mostrando resultados quirúrgicos y estéticos prometedores. Esperamos este reporte contribuya a ladifusión e introducción progresiva de la cirugía robótica en nuestra rutina.(AU)

Introduction: We present the first case of pediatric ileocystoplastyusing a purely robotic approach in Spain. Case report: 12-year-old male with neurogenic bladder of low capacity and high pressures. After failure of conservative treatment, bladderaugmentation with ileum patch was decided upon. Surgery was carriedout using a purely robotic approach with 4 robotic and 2 accessoryports. Surgery duration was 380 minutes in total, without intraoperativecomplications. He was discharged 2 weeks after cystographic control.During 32-months follow-up, he has remained continent. Discussion. The minimal invasion, surgical precision and ergonomics made the robotic approach an optimal option for complex surgicaltechniques. Given the little availability of the robot and the low pediatricvolume, its standardization is a challenge. Our accumulated experienceis consistent with the current literature and shows promising surgical andesthetic results. We hope this case report will contribute to the divulga-tion and progressive introduction of robotic surgery in our daily lives.(AU)

Pentafecta evaluation in robot-assisted radical prostatectomy by risk group.

OBJECTIVE: Radical prostatectomy is a therapeutic option in organ-confined prostate cancer. As the development of robotic systems progresses, the approach with this technology has begun to impact the functional and oncological outcomes of urological patients. The objective is to report the rate of pentafecta in patients undergoing robot-assisted radical prostatectomy (RARP) stratified by risk groups. METHOD: Retrospective, observational, descriptive study from 2013 to 2020 that included 112 patients undergoing RARP. RESULTS: A rate of pentafecta at 12 months of follow-up of 35.7% (n = 40) was obtained. In the subanalysis by risk groups, at 1-year follow-up, was obtained an index of 43% (n = 26), 26% (n = 9) and 22% (n = 4) in low-, intermediate-, and high-risk patients, respectively. CONCLUSIONS: Prostatectomy showed functional and oncological results similar to those reported in the literature with robotic approach, regardless of the risk group for prostate cancer.

OBJETIVO: La prostatectomía radical es la alternativa terapéutica de elección en el cáncer de próstata confinado al órgano. Conforme avanza el desarrollo de los sistemas robóticos, el abordaje con esta tecnología ha comenzado a impactar en los desenlaces funcionales y oncológicos de los pacientes urológicos. El objetivo es reportar el índice de pentafecta en pacientes sometidos a prostatectomía radical asistida por robot (PRRA) estratificados por grupos de riesgo. MÉTODO: Estudio retrospectivo, observacional, descriptivo, de 2013 a 2020, que incluyó 112 pacientes sometidos a PRAR. RESULTADOS: Se obtuvo un índice de pentafecta a 12 meses de seguimiento del 35.7% (n = 40). En el subanálisis por grupos de riesgo, al año de seguimiento, se obtuvieron unos índices del 43% (n = 26), el 26% (n = 9) y el 22% (n = 4) en los pacientes de bajo, intermedio y alto riesgo, respectivamente. CONCLUSIONES: La prostatectomía demostró resultados funcionales y oncológicos similares a lo reportado en la literatura con abordaje robótico independientemente del grupo de riesgo del cáncer de próstata.

Telesurgery and telementoring.

Telemedicine has revolutionized the field of surgery, with telemonitoring and telesurgery being 2 of its most promising applications. Telesurgery and telemonitoring are revolutionary applications that have the potential to change the way surgical operations are performed. These applications can allow surgeons to perform operations, enable surgeons to perform operations by assisting or supervising others through mentoring from a different location (telementoring). Despite the potential benefits of telemedicine and telementoring, there are still challenges that must be overcome before they can be widely used in clinical practice. For example, latency in data transmission can be a problem in telemedicine, as even a small delay in data transmission can affect the accuracy of the operation. Additionally, a sophisticated and expensive technological infrastructure is required, which can limit their use in some clinical settings. Although we need to work on its development technologically, ethically and legally, it is a promising tool.

Ausencia de toracotomía mediante la sutura manual intratorácica y la extracción transabdominal de la pieza quirúrgica durante la esofagectomía robótica de Ivor Lewis / Absence of thoracotomy by intrathoracic manual suture and transabdominal removal of surgical specimen during Ivor Lewis robotic esophagectomy

En el tratamiento quirúrgico del cáncer de esófago, la cirugía robótica permite realizar una anastomosis manual intratorácica de manera más sencilla, rápida y cómoda para el cirujano que la cirugía abierta y la cirugía mínimamente invasiva tradicional. Con ello evitamos el uso de instrumentos de autosutura, algunos de los cuales precisan una pequeña toracotomía para su introducción. No obstante, la extracción de la pieza exige la práctica de esa toracotomía, de tamaño variable, y que puede asociar dolor torácico intenso. Describimos una sencilla modificación técnica del Ivor Lewis robótico clásico que permite la extracción de la pieza quirúrgica por una mínima incisión abdominal, evitando la necesidad de fracturar costillas de forma controlada, así como las posibles secuelas de practicar una incisión en la pared torácica.(AU)

In the surgical treatment of esophageal cancer, robotic surgery allows performing an intrathoracic hand-sewn anastomosis in a simpler, faster and more comfortable way for the surgeon than open surgery and traditional minimally invasive surgery. With this, we avoid the use of self-suture instruments, some of which require a small thoracotomy for their introduction. However, the retrieval of the specimen requires the practice of this thoracotomy, of variable size, that can be associated with intense chest pain. We describe a technical modification of the classic robotic Ivor Lewis that allows removal of the surgical piece through a minimal abdominal incision, thus avoiding controlled rib fracture, as well as the possible sequelae of making an incision in the chest wall.(AU)

Absence of thoracotomy by intrathoracic manual suture and transabdominal removal of surgical specimen during Ivor Lewis robotic esophagectomy.

In the surgical treatment of esophageal cancer, robotic surgery allows performing an intrathoracic handsewn anastomosis in a simpler, faster and more comfortable way for the surgeon than open surgery and traditional minimally invasive surgery. With this, we avoid the use of self-suture instruments, some of which require a small thoracotomy for their introduction. However, the retrieval of the specimen requires the practice of this thoracotomy, of variable size, that can be associated with intense chest pain. We describe a technical modification of the classic robotic Ivor Lewis that allows removal of the surgical piece through a minimal abdominal incision, thus avoiding controlled rib fracture, as well as the possible sequelae of making an incision in the chest wall.

Is YouTube a reliable tool for approaching robotic assisted transabdominal preperitoneal surgery? A critical review of the available resources.

INTRODUCTION: The robotic transabdominal preperitoneal approach (rTAPP) is a relatively recent technique for the treatment of inguinal hernia. To achieve optimal results, the 10 golden rules described must be followed. Surgeons in training often review videos to familiarize themselves with new techniques, YouTube being one of the most used platforms. The objective of this study is to carry out an evaluation of the 10 most viewed videos on YouTube of inguinal hernia repair by transabdominal preperitoneal approach (rTAPP) to determine if the 10 golden rules are met. METHODS: Identify and evaluate the 10 videos with the highest number of views related to rTAPP. Three experienced Surgeons evaluated compliance with the 10 golden rules using a Likert scale. Data were analyzed in Excel (Microsoft) and plotted with Tableau (Tableau Inc). The consistency between evaluators was determined using Cronbach's alpha, considering a value >0.7 acceptable. RESULTS: The average overall evaluation was 3.63 with a range of 2.6 to 4.9. The scores related to compliance with the rules 1, 2, 9, 10 were satisfactory; on the other hand, rules 3, 4, 5, 7 and 8 were weak, particularly rule number 7. Internal consistency was observed between raters with a Cronbach's alpha of 0.98. CONCLUSIONS: The lack of compliance with the 10 golden rules in most of the videos demonstrates that the use of videos (YouTube) is not an adequate resource for learning robot-assisted inguinal hernia cure.

DATA GOVERNANCE in digital surgery.

Technological and computer advances have led to a "new era" of Surgery called Digital Surgery. In it, the management of information is the key. The development of Artificial Intelligence requires "Big Data" to create its algorithms. The use of digital technology for the systematic capture of data from the surgical process raises ethical issues of privacy, property, and consent. The use of these out-of-control data creates uncertainty and can be a source of mistrust and refusal by surgeons to allow its use, requiring a framework for the correct management of them. This paper exposes the current situation of Data Governance in Digital Surgery, the challenges posed and the lines of action necessary to resolve the areas of uncertainty that have arisen in the process, in which the surgeon must play a relevant role.

Robotic transversus abdominis release: A paradigm shift in complex abdominal wall surgery?

Abdominal wall reconstruction techniques have evolved significantly over the last fifty years and continue to do so at an increasing pace. Beginning with open incisional hernia repair with bilateral rectus myofascial release, multiple techniques to offset tension at the midline by exploring options of layered myofascial release have been described. This article reviews the history, technique, advancements, and future of myofascial release in abdominal wall reconstruction leading from the open Rives-Stoppa repair to the robotic-assisted iteration of the transversus abdominis release.

Laparoscopic TAPP to treat inguinal hernia. Is the robot preferable? A review and cohort-study on anatomical landmarks of robotic-assisted transabdominal preperitoneal groin hernia repair (r-TAPP).

In this review, the advantages of the robotic platform in rTAPP are presented and discussed. Against the background of the unchanged results of conventional TAPP for decades (approx. 10% chronic pain and approx. 3.5% recurrence), a new anatomy-guided concept for endoscopic inguinal hernia repair with the robot is presented. The focus is on the identification of Hesselbach's ligament. The current results give hope that the results of TAPP can be improved by rTAPP and that rTAPP is not just a more expensive version of conventional TAPP. To support the rationale presented here, we analyzed 132 video recordings of rTAPP's for the anatomical structures depicted therein. The main finding is, that in all cases (132/132 or 100%) Hesselbach's ligament was present and following its lateral continuity with the ileopubic tract offered a safe framework to develop all the critical anatomical structures for clearing the myopectineal orifice, repair the posterior wall of the groin and perform a flawless mesh fixation. Future studies are needed to integrate all the resources of the robotic platform into an rTAPP concept that will lead out of the stalemate of the indisputably high rate of chronic pain and recurrences.

Implementación de un programa de cirugía bariátrica sin ingreso hospitalario y seguimiento con plataforma de telemonitorización / Implementation of a same-day discharge bariatric surgery program and follow-up with a telemonitoring platform

Introducción: Existe experiencia previa en programas de cirugía bariátrica ambulatoria en pacientes seleccionados, que reportan buenos resultados tras gastrectomía vertical. Estudios recientes demuestran que la cirugía ambulatoria también es factible y segura en el bypass gástrico en Y de Roux. El objetivo del presente trabajo es describir y analizar los resultados de nuestra experiencia inicial tras la implementación de un programa de cirugía bariátrica sin ingreso hospitalario, con la utilización del sistema de telemonitorización. Métodos: Estudio observacional prospectivo con 14 pacientes consecutivos seleccionados, intervenidos de cirugía bariátrica primaria (gastrectomía vertical o bypass gástrico en Y de Roux) en un único centro, desde abril de 2021 hasta febrero 2023, con seguimiento en domicilio mediante la plataforma de telemonitorización REVITA® (HI Iberia, S.A.) y la unidad de hospitalización a domicilio. Resultados: Desde abril de 2021 a febrero 2023 fueron seleccionados para este programa 14 pacientes, lo cual significa el 7,3% del total de 191 pacientes intervenidos de cirugía bariátrica durante este periodo. Llegaron a completar el circuito 10 de los 14 pacientes seleccionados (71,4%). Cuatro de los 10 pacientes que completaron el circuito consultaron a urgencias en las primeras 24h (40%). No hubo complicaciones graves, reingresos, ni reintervenciones propias de la cirugía bariátrica. Se ha estimado un ahorro de 762€ por cada paciente que completa el circuito. Conclusiones: La cirugía bariátrica sin ingreso hospitalario es factible y segura en pacientes seleccionados usando una plataforma de telemonitorización y con el apoyo de una unidad de hospitalización a domicilio. (AU)

Introduction: Some groups have initiated outpatient bariatric surgery programs in selected patients, publishing good results after sleeve gastrectomy. Recent studies show that outpatient surgery is also feasible and safe in Roux-en-Y gastric bypass. The aim of this paper is to describe and analyze the results of our initial experience after the implementation of a same-day discharge bariatric surgery program using a telemonitoring system. Methods: We have completed a prospective, observational study with 14 consecutive, selected patients undergoing primary bariatric surgery (sleeve gastrectomy or Roux-en-Y gastric bypass) at a single center from April 2021 to February 2023, with home follow-up using the REVITA® telemonitoring platform (HI Iberia, S.A.) and the home hospitalization unit. Results: From April 2021 to February 2023, 14 patients were selected for this program, which meant 7.3% of the total of 191 patients who underwent bariatric surgery during this period. Ten out of the 14 patients selected completed the circuit (71.4%), 4 of whom consulted the emergency department within the first 24h (40%). There were no serious complications, readmissions or re-operations typical of bariatric surgery. The estimated savings per patient who completed the circuit was €762. Conclusion: Bariatric surgery without hospital admission is feasible and safe in selected patients using a telemonitoring platform and with the support of a home hospitalization unit. (AU)

Is laparoscopic TAPP the preferred approach for the treatment of inguinal hernia? Technique, indications and future perspectives.

The repair of inguinal hernia is one of the most frequently performed surgeries in General Surgery units. The laparoscopic approach for these hernias will be clearly considered as the gold standard, based on its advantages over the open approach. There are no clear advantages of the transabdominal preperitoneal approach (TAPP) over the totally preperitoneal approach (TEP), although it has been shown to be more reproducible, presenting a shorter learning curve, although it presents more possibilities of developing trocar site hernias. Laparoscopic TAPP could be superior to TEP in the following indications: incarcerated hernias, emergencies, previous preperitoneal surgery, previous Pfanestiel-type incision, recurrent hernias, inguinoscrotal hernias and obese, being also a better alternative for females. Robotic TAPP is a safe approach with similar results to laparoscopy; however, it is related to an increase in costs and operating time. The value of this technology for the repair of complex hernias (multiple recurrences, inguino-scrotal or after previous preperitoneal surgery) remains to be determined, since they represent a certain challenge for the conventional laparoscopic approach. On the other hand, robotic repair of inguinal hernias may be a way to reduce the learning curve before addressing complex ventral hernias. Finally, artificial intelligence applied to the laparoscopic approach to inguinal hernia will undoubtedly have a significant impact in the future especially to determine the best the indications for this approach, on the performance of a safer technique, on the correct selection of meshes and fixation mechanisms, and on learning curve.

BRAZILIAN HERNIA AND ABDOMINAL WALL SOCIETY STATEMENT ON LARGE HIATAL HERNIAS MANAGEMENT / Posição da Sociedade Brasileira de Hérnia e Parede Abdominal sobre o tratamento de grandes hérnias de hiato

Large hiatal hernias (LHH) besides being more prevalent in the elderly, have different clinical presentation: fewer reflux, more mechanical symptoms and a greater possibility of acute, life-threatening complications such as gastric volvulus, ischemia and visceral mediastinal perforation. Thus, surgical indications are distinct from gastroesophageal reflux disease (GERD-related), sliding hiatal hernias. Heartburn tends to be less intense, while symptoms of chest pain, cough, discomfort, and tiredness are reported more frequently. Complaints of vomiting and dysphagia may suggest the presence of associated gastric volvulus. Signs of iron deficiency and anemia are found. Surgical indication is still controversial and was previously based on high mortality reported in emergency surgeries for gastric volvulus. Postoperative mortality is especially related to three factors: body mass index (BMI above 35), age over 70 years and presence of comorbidity. Minimally invasive elective surgery should be offered to symptomatic individuals with good or reasonable performance status, regardless of age group. In asymptomatic and oligosymptomatic patients, besides obviously identifying the patient's desire, case-by-case analysis of surgical risk factors such as age, obesity and comorbidities, should be taken under consideration. One should also pay attention to situations with greater technical difficulty and risks of acute migration due to increased abdominal pressure (abdominoplasty, manual workers, spastic diseases). Technical alternatives such as partial fundoplication and anterior gastropexy can be considered. We emphasize the importance of performing surgical procedures in cases of LHH in high-volume centers, with experienced surgeons.

As grandes hérnias de hiato (HHG), além de serem mais prevalentes em idosos, têm apresentação clínica diferente: menos refluxo, mais sintomas mecânicos e maior possibilidade de complicações agudas e potencialmente fatais, como vólvulo gástrico, isquemia e perfuração mediastinal visceral. Assim, as indicações cirúrgicas são distintas das hérnias de hiato por deslizamento, relacionadas à doença do refluxo gastroesofágico (DRGE). A azia tende a ser menos intensa, enquanto os sintomas de dor no peito, tosse, desconforto e cansaço são relatados com maior frequência. Queixas de vômitos e disfagia podem sugerir a presença de volvo gástrico associado. São encontrados sinais de deficiência de ferro e anemia. A indicação cirúrgica ainda é controversa e foi anteriormente baseada na alta mortalidade relatada em cirurgias de emergência para volvo gástrico. A mortalidade pós-operatória está especialmente relacionada a três fatores: índice de massa corporal (IMC acima de 35), idade superior a 70 anos e presença de comorbidades. A cirurgia eletiva minimamente invasiva deve ser oferecida a indivíduos sintomáticos, com desempenho bom ou razoável, independentemente da faixa etária. Em pacientes assintomáticos e oligossintomáticos, além de obviamente identificar o desejo do paciente, deve-se levar em consideração a análise caso a caso dos fatores de risco cirúrgico, como idade, obesidade e comorbidades. Deve-se atentar também para situações de maior dificuldade técnica e riscos de migração aguda por aumento da pressão abdominal (abdominoplastia, trabalhos manuais, doenças espásticas). Alternativas técnicas como fundoplicatura parcial e gastropexia anterior podem ser consideradas. Ressaltamos a importância da realização de procedimentos cirúrgicos nos casos de GHH em centros de grande volume, com cirurgiões experientes.

Cirugía robótica hepática: una nueva realidad. Análisis descriptivo de 220 casos de cirugía hepática mínimamente invasiva en 182 pacientes / Robotic liver surgery: A new reality. Descriptive analysis of 220 cases of minimally invasive liver surgery in 182 patients

Introducción El nivel de recomendación del abordaje robótico en la cirugía hepática es controvertido. Se realiza un análisis descriptivo, retrospectivo yunicéntrico de los resultados a corto plazo de la cirugía hepática robótica y laparoscópica en un mismo periodo.MétodosAnálisis descriptivo del abordaje robótico y laparoscópico sobre 220 resecciones en 182 pacientes sometidos a cirugía hepática mínimamente invasiva.ResultadosEntre abril de 2018 y junio de 2022 se realizaron 92 resecciones hepáticas robóticas (RHR) en 83 pacientes y 128 laparoscópicas (RHL) en 99 pacientes. Se observaron más resecciones mayores (p<0,001) y más resecciones múltiples (p=0,002) en el grupo CHL. El porcentaje de resecciones anatómicas fue similar (RHR: 64,1 vs. RHL: 56,3%). En el grupo CHL el tiempo medio operatorio fue de 212min (DE: 52,1), las pérdidas hemáticas de 276,5ml (100-1.000) y la tasa de conversión del 12,1%. La estancia media hospitalaria fue de 5,7 días (DE: 4,9), la morbilidad fue del 27,3%, con un 2% de mortalidad. En el grupo CHR el tiempo medio operatorio fue de 217min (DE: 53,6), las pérdidas hemáticas fueron de 169,5ml (100-900) y la tasa de conversión del 2,5%. La estancia media hospitalaria fue de 4,1 días (DE: 2,1) y la morbilidad fue del 15%, con mortalidad nula.ConclusiónLa cirugía mínimamente invasiva hepática es una técnica segura y reproducible. La CHR permite realizar resecciones hepáticas con seguridad y parece ser una técnica no inferior a la CHL, pero para determinar el abordaje mínimamente invasivo de elección en cirugía hepática se requieren estudios aleatorizados. (AU)

Introduction The level of recommendation of the robotic approach in liver surgery is controversial. The objective of the study is to carry out a single-center retrospective descriptive analysis of the short-term results of the robotic and laparoscopic approach in liver surgery during the same period.MethodsDescriptive analysis of the short-term results of the robotic and laparoscopic approach on 220 resections in 182 patients undergoing minimally invasive liver surgery.ResultsBetween April 2018 and June 2022, a total of 92 robotic liver resections (RLR) were performed in 83 patients and 128 laparoscopic (LLR) in 99 patients. The LLR group showed a higher proportion of major surgery (P<.001) and multiple resections (P=.002). The two groups were similar in anatomical resections (RLR 64.1% vs. LLR 56.3%). In the LLS group, the average operating time was 212min (SD 52.1). Blood loss was 276.5ml (100-1000) and conversion 12.1%. Mean hospital stay was 5.7 (SD 4.9) days. Morbidity was 27.3% and 2% mortality. In the RLS group, the mean operative time was 217min (SD 53.6), blood loss 169.5ml (100.900), and conversion 2.5%. Mean hospital stay was 4.1 (SD 2.1) days. Morbidity was 15%, with no mortality.ConclusionMinimally invasive liver surgery is a safe technique, and in particular, RLS allows liver resections to be performed safely and reproducibly; it appears to be a non-inferior technique to LLS, but randomized studies are needed to determine the minimally invasive approach of choice in liver surgery. (AU)

Pancreatectomía corporocaudal laparoscópica y robótica, de elección y de futuro / Laparoscopic and robotic distal pancreatectomy: The choice and the future

Introducción La pancreatectomía distal (PD) mínimamente invasiva (MIS) está actualmente bien establecida, ya sea mediante técnica laparoscópica (PDL) o robótica (PDR).MétodosDe 83 PD realizadas entre enero del 2018 y marzo del 2022, se realizaron 57 casos (68,7%) mediante MIS, 35 PDL y 22 PDR (da Vinci Xi). Se evalúa la experiencia de ambos procedimientos y el valor del abordaje robótico. Se analizan en detalle los casos de conversión.ResultadosEl tiempo quirúrgico medio en las PDL y PDR fue de 201,2 (DE 47,8) y 247,54 (DE 35,8) min, (p=0,486). No se observaron diferencias en estancia hospitalaria ni en tasa de conversión, 6 (5-34) vs. 5,6 (5-22) días y 4 (11,4%) vs. 3 (13,6%) casos, respectivamente, (p=0.126). La tasa de reingresos fue de 3/35 (11,4%) y 6/22 (27,3%) casos, PDL vs. PDR respectivamente, (p=0.126).No existieron diferencias en morbilidad (Dindo-Clavien ≥ III) entre ambos grupos. La mortalidad fue de un caso en el grupo robótico (un paciente con conversión precoz por afectación vascular). La tasa de resecciones R0 fue mayor en el grupo robótico (77,1% vs. 90,9%) alcanzando la significación estadística, p=0,04.ConclusionesLa PDMIS es un procedimiento seguro y factible en pacientes seleccionados. Una planificación quirúrgica y la implementación escalonada basada en la experiencia previa ayudan a afrontar procedimientos técnicamente exigentes. Se sugiere que la PDR podría ser el abordaje de elección en la pancreatectomía corporocaudal, no siendo inferior a la PDL. (AU)

Introduction Distal pancreatectomy (DP) is currently well established as a minimally invasive surgery (MIS) procedure, using either a laparoscopic (LDP) or robotic (RDP) approach.MethodsOut of 83 DP performed between January 2018 and March 2022, 57 cases (68.7%) were performed using MIS: 35 LDP and 22 RDP (da Vinci Xi). We have assessed the experience with the 2techniques and analyzed the value of the robotic approach. Cases of conversion have been examined in detail.ResultsThe mean operative times for LDP and RDP were 201.2 (SD 47.8) and 247.54 (SD 35.8)min, respectively (p=0,486). No differences were observed in length of hospital stay or conversion rate: 6 (5–34) vs. 5.6 (5–22) days, and 4 (11.4%) vs. 3 (13.6%) cases, respectively (p=0.126). The readmission rate was 3/35 patients (11.4%) treated with LDP and 6/22 (27.3%) cases of RDP (p=0.126).There were no differences in morbidity (Dindo-Clavien≥III) between the 2groups. Mortality was one case in the robotic group (a patient with early conversion due to vascular involvement). The rate of R0 resection was greater and statistically significant in the RDP group (77.1% vs. 90.9%) (P=,04).ConclusionsMinimally invasive distal pancreatectomy (MIDP) is a safe and feasible procedure in selected patients. Surgical planning and stepwise implementation based on prior experience help surgeons successfully perform technically demanding procedures. RDP could be the approach of choice in distal pancreatectomy, and it is not inferior to LDP. (AU)

Triple neurectomía transperitoneal laparoscópica y con asistencia robótica para el tratamiento del dolor inguinal crónico: descripción de la técnica, nuestra experiencia y resultados preliminares / Robot-assisted laparoscopic triple neurectomy for chronic inguinal pain: Description of the technique, our experience and preliminary results

Introducción. El dolor inguinal crónico o inguinodinia posthernioplastia es una complicación relativamente común y que puede llegar a ser muy incapacitante. El tratamiento quirúrgico mediante triple neurectomía es una opción terapéutica ante el fracaso de tratamientos previos (terapia oral, local o neuromodulación).ObjetivoDescripción retrospectiva de la técnica quirúrgica y resultados de la triple neurectomía laparoscópica y con asistencia robótica en el tratamiento de la inguinodinia crónica.Material y métodosSe describen los criterios de inclusión/exclusión, así como la técnica quirúrgica empleada en 7 pacientes intervenidos en el Complejo Asistencial Universitario de León (Servicio de Urología) tras no responder a otras alternativas terapéuticas.ResultadosLos pacientes presentaban dolor crónico inguinal reportando una valoración en la escala EVA del dolor prequirúrgica de 7,43 sobre 10. Tras la cirugía, dicha valoración se redujo a 3,71 al primer día postoperatorio y a 4,2 puntos al año de la intervención. El alta hospitalaria se produjo a las 24h de la cirugía y no se reportaron complicaciones relevantes.ConclusionesLa triple neurectomía laparoscópica o con asistencia robótica es una técnica segura, reproducible y eficaz en el tratamiento del dolor inguinal crónico refractario a otros tratamientos. (AU)

Introduction. Chronic inguinal pain or inguinodynia following hernioplasty is a relatively common complication that can be very incapacitating. Surgical treatment by triple neurectomy is a therapeutic option when previous treatments (oral/local therapy or neuromodulation) have failed.ObjectiveRetrospective description of the surgical technique and results of laparoscopic and robot-assisted triple neurectomy for chronic inguinodynia.Material and methodsWe describe the inclusion/exclusion criteria as well as the surgical technique applied in 7 patients operated on at the University Health Care Complex of León (Urology Department) after failure of other treatment options.ResultsThe patients presented chronic groin pain, reporting a preoperative pain VAS of 7.43 out of 10. After surgery, this score was reduced to 3.71 on the first postoperative day and to 4.2 points one year after surgery. Hospital discharge occurred 24hours after surgery with no relevant complications being reported.ConclusionsLaparoscopic or robot-assisted triple neurectomy is a safe, reproducible, and effective technique for the treatment of chronic groin pain refractory to other treatments. (AU)

Transferencia de habilidades prácticas desde el laboratorio a cirugía in vivo utilizando el sistema robótico Avatera: Estudio experimental / Transfer of acquired practical skills from dry lab into live surgery using the Avatera robotic system: an experimental study

Objetivo Evaluar la transferencia de habilidades adquiridas en el laboratorio a un entorno experimental real para realizar cirugía robótica. Material y métodos Se utilizó un modelo experimental in vivo. Seis residentes y fellows de urología; dos R2 sin exposición previa a cirugía laparoscópica (Grupo 1), dos R4 con exposición intermedia (Grupo 2) y dos fellows formados en cirugía laparoscópica (Grupo 3) realizaron reimplantes ureterales distales, pieloplastia, y nefrectomía radical en tres cerdos hembra. Previamente a realizar los procedimientos, cada participante completó entre 10 y 14 h de formación en cirugía robótica en laboratorio hasta adquirir habilidades para realizar maniobras quirúrgicas básicas (sutura, corte y paso de agujas). Las variables analizadas fueron completar o no con éxito los procedimientos, el tiempo de consola y el tiempo para realizar las maniobras solicitadas y. presencia de complicaciones. Resultados Los tres grupos completaron con éxito todos los procedimientos excepto la pieloplastia, que no la completó el Grupo 1 por sangrado de la vena renal. El Grupo 3 logró un tiempo de consola más corto para todos los procedimientos y para los pasos quirúrgicos por separado, seguido por el Grupo 2. El grupo más lento para completar los procedimientos y los pasos fue el Grupo 1. Conclusiones A pesar de que es necesaria evidencia clínica al respecto, nuestros resultados sugieren que los procedimientos urológicos con asistencia robótica y los pasos más difíciles técnicamente podrían realizarse de manera segura y efectiva después de un entrenamiento adecuado en el laboratorio bajo la supervisión de un mentor. (AU)

Objective To evaluate the transfer of the practical skills of robot-assisted surgery acquired in the dry-lab into a real live experimental setting for performing upper and lower urinary tract surgeries. Material and methods An in vivo experimental study design was utilized. Six urology trainees and fellows; two 2nd year trainees with no previous exposure to laparoscopic surgery (Group 1), two 4th year residents with medium exposure to laparoscopic surgery (Group 2) and two fellows trained to perform laparoscopic surgeries (Group 3) performed ureteral reimplantation into the bladder, pyeloplasty, and radical nephrectomy on three female pigs under general anesthesia. Prior to performing the requested procedures, each participant completed 10-14 hours dry-lab robotic training acquiring skills in basic surgical tasks, such as suturing, cutting and needle passage. The recorded variables were the successful completion of the procedures, the console time, and the time to perform different steps and major complications. Results All procedures were completed successfully by all groups except the pyeloplasty by Group 1 which was complicated by bleeding from the renal vein, and the procedure was abandoned. Group 3 achieved shorter console time for all successfully completed procedures and for separate surgical steps compared to all groups, followed by Group 2. The slowest group for all procedures and steps analyzed was Group 3. Conclusions Although further clinical evidence is needed, the robotic-assisted urological procedures and the most challenging steps could be performed safely and effectively after proper training in the dry lab under mentor supervision according to our study. (AU)

Implementation of a same-day discharge bariatric surgery program and follow-up with a telemonitoring platform.

INTRODUCTION: Some groups have initiated outpatient bariatric surgery programs in selected patients, publishing good results after sleeve gastrectomy. Recent studies show that outpatient surgery is also feasible and safe in Roux-en-Y gastric bypass. The aim of this paper is to describe and analyze the results of our initial experience after the implementation of a same-day discharge bariatric surgery program using a telemonitoring system. METHODS: We have completed a prospective, observational study with 14 consecutive, selected patients undergoing primary bariatric surgery (sleeve gastrectomy or Roux-en-Y gastric bypass) at a single center from April 2021 to February 2023, with home follow-up using the REVITA® telemonitoring platform (HI Iberia, S.A.) and the Home Hospitalization Unit. RESULTS: From April 2021 to February 2023, 14 patients were selected for this program, which meant 7.3% of the total of 191 patients who underwent bariatric surgery during this period. Ten out of the 14 patients selected completed the circuit (71.4%), 4 of whom consulted the emergency department within the first 24 h (40%). There were no serious complications, readmissions or re-operations typical of bariatric surgery. The estimated savings per patient who completed the circuit was 762. CONCLUSION: Bariatric surgery without hospital admission is feasible and safe in selected patients using a telemonitoring platform and with the support of a home hospitalization unit.

Lobectomías robóticas y cáncer de pulmón. Experiencia inicial en nuestro centro / Robotic lobectomies and lung cancer. Initial experience in our center

Objetivo: Analizar la seguridad y factibilidad en términos de resultados obtenidos en las primeras lobectomías robóticas realizadas en nuestro centro. Metodología: Estudio prospectivo desde mayo hasta diciembre de 2021 en 13 pacientes (11 hombres y 2 mujeres, edad media 59 años) con carcinoma de pulmón en estadios precoces tributarios de lobectomía robótica.Se utilizó el sistema da Vinci Xi con cuatro puertos y uno asistente. Resultados: Se realizaron 13 lobectomías robóticas. La conversión a cirugía videoasistida fue necesaria en 2 pacientes (15,4%). Se produjeron complicaciones en 3 pacientes (23%). La mediana de tiempo quirúrgico fue180 minutos [IQR 150-210]. La mediana de estancia hospitalaria fue de 4 días [IQR 3 - 6]. La mediana de duración del drenaje pleural fue de 4 días [IQR3 - 6]. La histología predominante fue carcinoma epidermoide en5 pacientes (39%). La media de ganglios linfáticos resecados fue de 15 (IC 95%: 11 - 19) y la de estaciones ganglionares de 5 (IC 95%: 4 - 5). No hubo mortalidad postoperatoria. El estadio postquirúrgico fue IA2 en 4 pacientes (31%), IB en 3 (23%), IIB en 2 (15%), y IIIA en 1 (7%). No se establecen diferencias estadísticamente significativas entre el IMC, el lóbulo resecado y la presencia de complicaciones (p = 0,5; p = 0,2), ni entre el número de ganglios resecados/número de estaciones ganglionares, y el estadio tumoral (p = 0,4; p = 0,9). Conclusiones: La lobectomía robótica con linfadenectomía hiliomediastínica es factible y segura. Es necesaria mayor experiencia y seguimiento a largo plazo para una adecuada evaluación de los resultados postoperatorios, la eficacia oncológica, y la comparación con las vías de abordaje convencionales. (AU)

Objectives: analyze the safety and feasibility in terms of results obtained in the first robotic lobectomies performed in our center. Method: prospective study from May to December 2021 in 13 patients (11 men and 2 women, mean age 59 years) with lung carcinoma in early stages requiring robotic lobectomy. The da Vinci Xi system was used with four ports and one assistant. Results: 13 robotic lobectomies were performed. Conversion to video-assisted surgery was necessary in 2 patients (15.4%). Complications occurred in 3 patients (23%). The median surgical time was 180 minutes [IQR 150-210]. The median hospital stay was 4 days [IQR 3 - 6]. The median duration of pleural drainage was 4 days [IQR3 - 6]. The predominant histology was squamous cell carcinoma in 5 patients (39%). The mean number of lymph nodes resected was 15 (95% CI: 11 - 19) and the number of lymph nodes resected was 5 (95% CI: 4 - 5). There was no postoperative mortality. The postsurgical stage was IA2 in 4 patients (31%), IB in 3 (23%), IIB in 2 (15%), and IIIA in 1 (7%). No statistically significant differences were established between BMI, the resected lobe and the presence of complications (p = 0.5; p = 0.2), nor between the number of resected lymph nodes/number of lymph node stations, and the tumor stage ( p = 0.4; p = 0.9).Conclusions: robotic lobectomy with hiliomediastinal lymphadenectomy is feasible and safe. Greater experience and long-term follow-up are necessary for an adequate evaluation of postoperative results, oncological efficacy, and comparison with conventional approaches. (AU)

Efectividad de la tecnología robótica y la realidad virtual para la rehabilitación de la función motora en la parálisis cerebral. Revisión sistemática / Effectiveness of robotic technology and virtual reality for the rehabilitation of motor function in cerebral palsy. Systematic review

Introducción: La parálisis cerebral (PC) es una condición de salud secundaria a daños no progresivos que ocurren durante el desarrollo del cerebro en la etapa fetal o infantil. Evaluar la efectividad de la tecnología robótica y la realidad virtual de la función motora en pacientes con PC en comparación con estrategias convencionales de rehabilitación como fisioterapia, terapia ocupacional, intervención de neurodesarrollo y estimulación transcraneal. Se llevó a cabo una revisión de ensayos controlados aleatorizados de los últimos 5 años. Para la evaluación de la calidad metodológica de los estudios incluidos se utilizó la escala PEDro, con evaluación del nivel de evidencia y grado de recomendación según la clasificación de Oxford. Resultados: Diecisiete artículos cumplieron con los criterios de elegibilidad. La tecnología robótica y la realidad virtual demostraron ser efectivas para la mejora de la función motora, las habilidades manuales y las destrezas perceptivo-visuales de los pacientes con PC, en comparación con el uso de estrategias convencionales de rehabilitación.(AU)

Introduction: Cerebral palsy (CP) is a health condition secondary to non-progressive damage that occurs during brain development in the fetal or infant stage. To evaluate the effectiveness of robotic technology and virtual reality on motor function in patients with CP compared to conventional rehabilitation strategies such as physical therapy, occupational therapy, neurodevelopmental intervention, and transcranial stimulation. A review of randomized controlled trials of the last 5 years was carried out. For the evaluation of the methodological quality of the included studies, the PEDro scale was used, with evaluation of the level of evidence and degree of recommendation according to the Oxford classification. Results: Seventeen articles met the eligibility criteria. Robotic technology and virtual reality proved to be effective in improving motor function, manual skills, and visual–perceptual skills in patients with CP, compared to the use of conventional rehabilitation strategies.(AU)