Robotic right colectomy suprapubic approach using da Vinci Xi

In this key lecture, Dr. Aidan describes the safety & feasibility of robotic parathyroid surgery. He briefly demonstrates the surgical techniques and the localization for parathyroid surgery. He briefly compares conventional, endoscopic and robotic thyroid surgery approaches with their advantages and limitations. He thoroughly describes the transaxillary robotic surgery approach for parathyroid surgery and compares outcomes with open surgery.

In this key lecture, Dr. Gyu-Seog Choi (MD, PhD) focuses on ICG fluorescence 3D CT image-guided robotic colorectal surgery.

In this key lecture, Dr. Parra-Davila focuses on robotic transanal TME (taTME).

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.

Minimally invasive techniques were revolutionary and provided evident clinical benefits. Robotic-assisted surgery may be useful in advanced laparoscopic procedures such as pancreatic resections. In this lecture, Professor Giulianotti presents a robotic distal pancreatectomy.

Laparoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal conditions. The benefits of a minimally invasive approach to adrenal resection such as decreased hospital stay, shorter recovery time and improved patient satisfaction are widely accepted. In this lecture, Dr. Brunaud presents the indications of robotic assistance for transperitoneal adrenalectomy.

The EndoWrist® One vessel sealer is a wristed, single-use instrument of the da Vinci surgical robotic system intended for bipolar coagulation and mechanical transection of vessels up to 7mm in diameter and tissue bundles. It could be a potential instrument to overcome the limitation of straight energy-based devices. Although it has the advantage of having an endowrist function which allows easy access to the surgical planes in ideal directions, it requires special caution and know-how to use the device safely and effectively, because of a relatively blunt tip and the absence of an active blade at the tip.
This video of the robotic distal gastrectomy for early gastric cancer shows how to harmonize the use of a sharp instrument with conventional bipolar electricity and of the vessel sealer device to maximize the advantages of such devices and to ensure safety. A conventional bipolar forceps is used to make entrance holes on the tissue for a safe application of the vessel sealer, and to perform fine dissections of small tissues, which are difficult to manage using a vessel sealer. Once the access hole has been made, the vessel sealer is applied in an ideal axis to the avascular tissue plane, thanks to the free wrist function. This technique combined with a sharp instrument using conventional bipolar electricity seems to be helpful for a safe and effective operation, which can use the benefit of the vessel sealer to its full potential, for instance with a high degree of freedom of the movement and secure sealing of lymphovascular structures.

In this key lecture, Dr. Pessaux presents the first liver robotic resection guided by real time augmented reality.

Objective:
When small pulmonary lesions are discovered on CT-scan during cancer surveillance, the differentiation between primary cancer metastasis and another metachronous carcinoma is impossible on frozen section. In this context, segmentectomy as sparing-lung resection is probably a valuable option to treat both lesions. However, segmentectomy is a complex procedure when using video thoracoscopy. Robotic segmentectomy, as described by Ninan (1) and Melfi (2), could be a more accurate and easier approach. Our objective is to show this reproducible technique.

Bibliographic references:
1. Ninan M, Dylewski MR. Total port-access robot-assisted pulmonary lobectomy without utility thoracotomy. Eur J Cardiothorac Surg 2010;38:231-2.
2. Melfi FM, Menconi GF, Mariani AM, Angeletti CA. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg 2002;21:864-8.
Materials and methods:
In 2006, a 78-year-old man was found with a medical history of asbestos exposure and colonic adenocarcinoma with lymph node metastasis treated by hemi-colectomy and adjuvant chemotherapy. During colon cancer surveillance, a centrimetric pulmonary mass of the left upper lobe was found on CT-scan in September 2012. In this context, the lesion was suggestive of metastasis, but primary lung cancer could not be ruled out (due to the patient’s history of smoking). As a result, trisegmentectomy of the left upper lobe was decided upon instead of wedge resection, for diagnosis and treatment of the lesion.
Results: The postoperative course was uneventful, with a medical discharge on the fourth day following trisegmentectomy. Pathological findings concluded to a primary lung carcinoma without lymph node invasion.
Conclusion: Complete and precise segmentectomy can be performed safely by means of the da Vinci™ robotic system, without using a utility thoracotomy. This diagnostic and therapeutic option must be considered in case of small pulmonary lesions occurring during cancer surveillance.