Splenic flexure takedown Xi or Si

According to recent studies, robotic adrenalectomy has proven to be superior to laparoscopic adrenalectomy, with a reduction of blood loss during procedure and a reduced operative time.
The robotic system provides an intraoperative stability to the surgeon, allowing for a perfect handling of sensitive functional adrenal tumors. The main advantage of robotics lies in the ease of dissection, aided by improved visualization, the EndoWrist®, articulated instruments, and reduction of tremors, allowing for more accurate movements.

Indications: hormone-secreting tumors, adrenal masses >5cm, smaller lesions suspicious for malignancy, and lesions increasing in size on serial imaging.
Contraindications: infiltrative adrenal masses and tumors of extremely large size, because the size of adrenal lesions correlates with the potential for adrenal carcinoma.
The da Vinci Robotic Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) and the following robotic instruments are used:30-degree scope, ProGrasp™ forceps, Hot Shears (monopolar curved scissors or a hook), and a Robotic Clip Applier. A monopolar cautery hook and Harmonic ACE® curved shears can also be used when deemed helpful by the surgeon.
Laparoscopic instruments that can be handled by the bedside assistant, a clip applier and a suction device are also used.

This video demonstrates robotic radical prostatectomy performed by a highly experienced surgeon. The additional advantages conferred by the dexterity of the multiple robotic instruments in performing this complex surgery is apparent. This video is recommended for urologists with an interest in prostate surgery.

This video demonstrates the excision of a mesh of rectopexy during a robot-assisted laparoscopic surgery. This mesh has migrated through the anterior wall of the rectum. The first step of procedure shows dissection and mesh removal. The second step shows the suture of the anterior wall of the rectum. No stoma was required during the operation and afterwards.
The objective of this video is to demonstrate the feasibility of a complex pelvic surgery using a robotic laparoscopic approach.

The objective of this film is to demonstrate our operative technique of robotic-assisted laparoscopic radical prostatectomy by Richard Gaston from the Saint Augustin Clinic in Bordeaux. Robotic radical prostatectomy has been performed in our clinic since December 2005. We currently use the Intuitive 4 arm DaVinci system.

Minimally invasive techniques have revolutionized operative surgery. In gastrointestinal surgery, the robotic system is applied to a wide range of procedures. Cholecystectomy, Nissen fundoplication and Heller myotomy are among the most frequently performed procedures. Most studies reported that robotic gastrointestinal surgery is feasible and safe, provides improved dexterity, better visualization, reduced fatigue and high levels of precision when compared to conventional laparoscopic surgery, but costs are high. This video shows a robotic-assisted cholecystectomy performed in teleconference with India. It is a very interesting video that makes us reflect how many could be the possible future applications of computer-assisted robotic surgery.

We present the case of a 76-year-old woman with a low rectal cancer (T3N0 at 7cm) status post-chemoradiation therapy. Using a four-arm DaVinci system, we carry out the dissection in a medial to lateral fashion dividing the inferior mesenteric vessels and mobilizing the splenic flexure. A total mesorectal excision is performed to the level of the pelvic floor. The specimen is delivered through a wound protector covering the anus. The sigmoid colon is divided extracorporeally, an anvil is secured. Using robotic instruments, a purse-string is sutured to the rectal stump and tied around the EEA stapler spike. An end-to-end anastomosis is created under vision. A diverting ileostomy is performed. This novel robotic procedure eliminates the need for an incision for specimen extraction and may facilitate transection of the rectum during RLAR.

Nowadays, indications for gastric band removal are well-standardized. In case of esophageal or gastric dilatation, migration or any injury related to the LAP-BAND® access port or tubing, the band and its access port should be removed. In rare specific cases, part of the LAP-BAND® system (either access port or band) may be preserved.
Before proceeding to the surgical band removal, a complete preoperative radiological and endoscopic work-up should be performed.
Here, we present the case of a 62-year-old woman who benefited from gastric band placement 10 years earlier. The band proved effective. However, for several weeks, she has been suffering from abdominal pain associated with vomiting and hematemesis.
After a work-up which included CT-scanning, water-soluble contrast swallow and gastroscopy, it was decided to remove the band.

In this key lecture, Dr. Laurent Brunaud compares robotic bypass with laparoscopic bypass.

This is the clinical case of a rectal adenocarcinoma located 4cm from the anal verge, following neoadjuvant radiochemotherapy. After initial complete clinical response, during a watch-and-wait protocol, a lesion regrowth was observed 14 months later, necessitating a surgical oncological approach. In this video, authors present a robot-assisted low anterior resection with TME and intersphincteric resection (coloanal anastomosis without ileostomy).