Da Vinci single-port robotic system current application and future perspective in general surgery: A scoping review.

BACKGROUND: The da Vinci Single-Port Robot System (DVSP) allows three robotic instruments and an articulated scope to be inserted through a single small incision. It received FDA approval in 2014 and was first introduced in 2018. The aim of this new system was to overcome the limitations of single-incision laparoscopic and robotic surgery. Since then, it has been approved for use only for urologic and transoral surgeries in some countries. It has been used as part of experimental protocols in general surgery. OBJECTIVE: By obtaining the CE mark at the end of January 2024, DVSP will soon enter the European market. This review aims to comprehensively describe the applications of DVSP in general surgery. DESIGN: A search of PubMed, Embase, and Ebsco databases up to March 2024 was conducted, with registration in PROSPERO (CRD42024536430), following the preferred reporting items for Systematic reviews and Meta-analyses for scoping review (PRISMA-Scr) guidelines. All the studies about the use of DVSP in general surgery were included. RESULTS: Fifty-six studies were included. The following surgical areas of use were identified: transabdominal and transanal colorectal, cholecystectomy, abdominal wall repair, upper gastroesophageal tract, liver, pancreas, breast, and thyroid surgery. The reported surgical and short-term outcomes are promising; a wide range of procedures have been performed safely. Some groups have found advantages, such as faster discharge, shorter operative time, and less postoperative pain compared to multiport robotic surgery. CONCLUSION: Five years after its initial clinical applications, the use of the DVSP in general surgery procedures has demonstrated feasibility and safety. Hernia repair, cholecystectomy, and colorectal surgery emerge as the most frequently conducted interventions with this robotic system. Nevertheless, there is anticipation for further studies with larger sample sizes and extended follow-up periods to provide more comprehensive insights and data on the long-term outcomes, including the incidence of incisional hernia.

Challenges in the surgical treatment and management of the patient with super super obesity.

Obesity is defined by the Body Mass Index (BMI) which is derived by the weight and height of a person (BMI > 30). Furthermore, obesity is classified as super-obesity (BMI >50 kg/m2) and super-super obesity (BMI >60 kg/m2) by the International Bariatric Surgery Registry (Renquist K. Obesity classification. Obes Surg 1997;7:523). Patients with super-super obesity have a greater incidence of comorbid diseases and are at greater risk of postoperative morbidity and mortality and longer length of hospital stay (LOS). Soong et al. described short-term outcomes after weight loss surgery comparing a group of patients with super-obesity with another group of patients with super-super obesity. The authors concluded that experienced surgeons could achieve comparable outcomes in both groups. However, higher BMI is associated with longer operative time, longer LOS, and delayed discharge to chronic care facilities (Soong TC, Lee MH, Lee WJ, et al. Long-term efficacy of bariatric surgery for the treatment of super-obesity: comparison of SG, RYGB, and OAGB. Obes Surg. 2021;31:3391-99. https://doi.org/10.1007/s11695-021-05464-0). The following paradigmatic case report aims at showing the complex management of a patient with super-super obesity, with BMI of 141.2 kg/m2 and associated multiple comorbidities.

Disparities in Bariatric Surgery Outcomes: A Regional Analysis.

PURPOSE: The success of metabolic and bariatric surgery (MBS) is impacted by significant pre-surgical attrition rates and poor postoperative follow-up. This study focused on geographic variations in attrition rates and surgical outcomes for MBS practice for which the patient population is drawn from nine Chicago neighborhoods, to examine whether suboptimal weight loss or reduced adherence to the program varied across neighborhoods. METHODS: Patients who presented for their initial MBS consultation at the University of Illinois (UI) Health's program between January 2019 and December 2020 were identified from electronic medical records. Demographic and medical information was extracted, along with postoperative weight at 3, 6, and 12 months after surgery. The Chicago area was divided into nine geographic regions. The outcomes of interest were preoperative attrition rate, postoperative compliance to follow-up appointments, and postoperative weight loss for each group and by residential neighborhood. RESULTS: A total of 1202 patients were included in this analysis, of whom 423 (35%) underwent surgery and 780 did not, representing a pre-surgical attrition rate of 64.9%. Age, sex, and race/ethnic distribution varied markedly across geographic regions. Postoperative weight loss varied significantly in neighborhoods with higher proportions of residents from racial/ethnic minority backgrounds. Preoperative attrition and postoperative compliance did not differ across geographic regions. CONCLUSION: Patients' residential neighborhoods may influence weight loss after MBS. Preoperative and postoperative compliance did not vary by residential neighborhood.

Use of Fluorescence Imaging in Liver Transplant Surgery.

Liver transplant surgery is a complex procedure that demands high knowledge of surgical anatomy and the precise recognition and preservation of structures. To address this, the use of fluorescence imaging has facilitated the identification of anatomical structures such as biliary ducts, arteries, and liver segmentation. Indocyanine green is among the most commonly utilized fluorescent agents, not just during surgery but also in the pre- and postoperative phases, where it is used to assess graft failure by measuring the plasma disappearance rate. New advancements such as artificial intelligence paired with fluorescence imaging have the potential to enhance patient outcomes. Additionally, technologies such as augmented reality and mixed reality could be integrated into surgical procedures, broadening the scope of possibilities for improving patient safety.

Neoplasia pseudopapilar sólida del páncreas (tumor de Frantz) en una joven de 13 años / Solid pseudopapillary tumor of the pancreas (Frantz tumor) in a 13-year-old girl

RESUMEN El tumor sólido pseudopapilar de páncreas (TSP) es un tumor infrecuente, de bajo grado de malignidad, que representa el 1-3% de todas las neoplasias pancreáticas, con predilección por el sexo femenino, y es el tumor sólido de páncreas más frecuente en la infancia. Mujer de 13 años que consultó por dolor abdominal de 5 días de evolución, en hipocondrio derecho e irradiado a espalda, con náuseas y vómitos. TSP es diagnosticado con ecografía, tomografía computarizada (TC) y resonancia magnética (RM). Se realizó duodenopancreatectomía cefálica. La paciente fue dada de alta. El examen anatomopatológico informó un TSP de páncreas. El abordaje quirúrgico de estos tumores, abierto o laparoscópico, permite una excelente supervivencia alejada.

ABSTRACT Solid pseudopapillary tumor (SPT) of the pancreas is a rare neoplasm with a low malignant potential and represents 1- 3% of all pancreatic tumors. They usually occur in women and are the most common solid pancreatic tumor in children. A 13-year-old girl visited the emergency department due to abdominal pain in the right hypochondrium radiating to the back, nausea and vomiting lasting 5 days. A SPT was diagnosed by ultrasound, computed tomography (CT) scan and magnetic resonance imaging (MRI). The patient underwent cephalic pancreaticoduodenectomy and was discharged. The pathological study reported a SPT of the pancreas. The surgical approach of these tumors through open surgery or laparoscopy offers excellent long-term survival.