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surgical intervention video

Résection hépatique robotisée guidée par vert d'indocyanine des segments 4b et 5 avec lymphadénectomie du ligament hépatoduodénal pour le cancer de la vésicule biliaire de stade II

Aims: Gallbladder cancer (GBC) is the fifth most common neoplasm of the gastrointestinal tract and the most common cancer of the biliary tract. GBC is suspected preoperatively in only 30 to 40% of patients. The other 60 to 70% are discovered incidentally (IGBC) by the pathologist on a gallbladder specimen following cholecystectomy for benign diseases such as polyps, gallstones, and cholecystitis. Recent guidelines suggest different surgical treatments according to the TNM classification. IGBC at stage 0 or I do not require any surgical re-resection, as the 5-year survival rate ranges from 60 to 100%. Patients with stage III and IV gallbladder cancers present a lower 5-year survival rate (1-25%) despite extensive surgery. Multiple studies have shown that a radical cholecystectomy in a GBC stage II may improve patient survival (50-80%) as compared to a simple cholecystectomy. Authors present a video of a robotic radical cholecystectomy in a patient with stage II IGBC. 

Methods: A 55-year-old man underwent laparoscopic cholecystectomy, in a first hospital. The gallbladder was removed intact, inside a plastic retrieval bag. At pathology, a T2 IGBC was diagnosed. No secondary liver lesions nor peritoneal metastatic disease were detected on a PET and CT-scan. The multidisciplinary board recommended a radical liver re-resection. Hence, a robotic hepatic resection bisegmentectomy (segments 4b and 5) and an extended hilar lymphadenectomy were planned. 

Results: Intraoperative ultrasounds showed a 7mm hepatic nodule in segment 5, not detected at the preoperative work-up. Characterization of this lesion was difficult due to its small size and to the high risk of false negatives in case of an intraoperative liver biopsy. As R0 surgery was achievable, the planned resection was performed. Operative time was 5 hours, with an estimated blood loss of 150mL. Recovery was uneventful and the patient was discharged on postoperative day 5. Final pathology showed no lymph node metastasis but revealed a 7mm liver metastasis in segment 5 with cancer-free surgical margins. The multidisciplinary tumor board stated that adjuvant chemoradiation therapy was required. 

Conclusions: Robotic liver resection of segments 4b and 5 combined with lymphadenectomy of the hepatoduodenal ligament is safe, feasible, and oncologically appropriate, provided it is performed in a specialized center with experience in hepatobiliary surgery and advanced robotic surgery.

Robotic ICG-guided liver resection of segments 4b and 5 combined with lymphadenectomy of the hepatoduodenal ligament for stage II gallbladder cancer

This video presents a simple robotically assisted prostatectomy using the Versius surgical robotic system (CMR Surgical) for a benign prostatic hyperplasia. Surgery was indicated due to high residual with low flow, associated with bladder thickening, which was unresponsive to drug treatment.

Robotic assisted prostatectomy using Versius surgical robotic system 

Prostatectomie assistée par robot (système Versius)

Robotic assistance offers several benefits in adrenal surgery, including providing 3D visualization in a narrow space, greater visual stability, and excellent precision. This video demonstrates these advantages during a right adrenalectomy for a pheochromocytoma. 

The patient is a 58-year-old male, heavy smoker, who underwent a chest CT-scan for chest pain to remove a pulmonary lesion. An adrenal lesion was discovered, measuring 80 mm on its longest axis. Biological work-up showed a suspected pheochromocytoma with normetanephrine levels 20 times higher than normal. An (18)F-FDG PET/CT-scan was performed and showed no additional fixation. A 99mTc-MIBI scan specific to pheochromocytomas showed a single fixation.

The video shows the dissection of this lesion with primary approach to the main adrenal vein.

Robotic right adrenalectomy for pheochromocytoma

Surrénalectomie robotique droite pour phéochromocytome

In this live educational broadcast, Dr. Luiz Alfredo Vieira d'Almeida, MD demonstrates a redo Roux-en-Y gastric bypass (RYGB) after laparoscopic sleeve gastrectomy (LSG) using a fully robotic approach, highlighting the key stages, and providing tips and tricks in a stepwise didactic fashion.

A patient with BMI 52 and consequently complex anatomy underwent a laparoscopic sleeve gastrectomy (LSG) as a first attempt for weight loss and comorbidity resolution (obstructive sleep apnea). After 2 years, the patient experienced weight regain and a RYGB was proposed.

This live video outlines the primary key steps for a fully robotic RYGB, providing details about the patient cart and the surgeon’s console. Tips and tricks for revisional surgery including adhesiolysis and appropriate tissue manipulation are provided. In addition, Dr. Vieira d'Almeida emphasizes ways to manipulate the robotic stapler and stresses the advantages of robotic platforms compared to laparoscopic surgery, including manual anastomosis, in a stepwise didactic fashion. Critical aspects of preoperative management are also discussed.

Redo Roux-en-Y gastric bypass after laparoscopic sleeve gastrectomy (LSG): a live educational procedure using a fully robotic approach

Reprise de bypass gastrique avec anse de Roux en Y  après sleeve gastrectomie laparoscopique : une intervention live entièrement robotisée

In this live surgery, Professor Giuseppe Spinoglio demonstrates a robotic low anterior resection for a rectal cancer of approximately 7 cm in diameter located at the rectosigmoid junction. 



This was a typical case of robotic low anterior resection for advanced rectal cancer. However, this patient had a history of ischemic heart disease and cardiac failure. This video is of high educational value since it is a challenging case with easy bleeding and fragile tissue. 



Robotic low anterior resection (LAR): a live educational demonstration

Résection antérieure basse robotisée : démonstration pédagogique en direct

video lecture

In this key lecture, Dr. Kazuhiro Yasufuku, MD, PhD, FRCSC outlines team training and crisis management in robotic surgery.

Team training and crisis management in robotic surgery

In this key lecture, Prof. Dean Koh, MBBS, FRCS, FRCSEd, FAMS looks into ways to smoothly adopt robotic surgery, focusing on his experience and highlighting the benefits of robotics for right and left colectomies. 

How to smoothly adopt robotic surgery - my experience, benefits of robotics for right and left colectomies

In this key lecture, Dr.  Patrick Bagan, MD addresses robotic surgery using the CMR Surgical robotic platform, introducing his early experience in robotic thoracic surgery

Focus on Robotic Surgery