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Gasless transaxillary robotic thyroidectomy
Robotic technology has recently been applied to minimally invasive thyroid surgery, with the Da Vinci Surgical System robot (Intuitive Surgical, Inc., Sunnyvale, CA, USA). This system provides a three-dimensional magnified view of the surgical area, hand-tremor filtration, fine-motion scaling, and precise and multiarticulated hand-like motions. Several different approaches have been developed with respect to the location of the incisions and whether or not CO2 insufflation is required to keep the operative space open. Robotic gasless transaxillary thyroidectomy has been used clinically in Korea since late 2007. It has been validated for surgical management of the thyroid gland. The initial cases of robotic thyroidectomy was limited to the well-differentiated thyroid carcinoma with a tumor size of ≤ 2cm without definite extrathyroidal tumor invasion (T1 lesion) or follicular neoplasm with a tumor size of ≤5cm. As robotic experience accumulated, the indication of robotic thyroidectomy to include those patients with T3 or larger size lesions has been expanded. The initial robotic thyroidectomy resembled the endoscopic thyroidectomy using two separate incisions, axilla and anterior chest wall. With sufficient experience, the anterior chest wall incision was removed and developed a less invasive transaxillary single-incision robotic thyroidectomy. This procedure has reduced the dissection and the surgical invasiveness with similar surgical outcomes.
Until now, more than 100 cases of compartment-oriented modified radical neck dissection with acceptable postoperative outcomes and excellent cosmesis had been also performed with the Da Vinci robotic system.
WY Chung
Lecture
7 years ago
1757 views
6 likes
0 comments
31:16
Gasless transaxillary robotic thyroidectomy
Robotic technology has recently been applied to minimally invasive thyroid surgery, with the Da Vinci Surgical System robot (Intuitive Surgical, Inc., Sunnyvale, CA, USA). This system provides a three-dimensional magnified view of the surgical area, hand-tremor filtration, fine-motion scaling, and precise and multiarticulated hand-like motions. Several different approaches have been developed with respect to the location of the incisions and whether or not CO2 insufflation is required to keep the operative space open. Robotic gasless transaxillary thyroidectomy has been used clinically in Korea since late 2007. It has been validated for surgical management of the thyroid gland. The initial cases of robotic thyroidectomy was limited to the well-differentiated thyroid carcinoma with a tumor size of ≤ 2cm without definite extrathyroidal tumor invasion (T1 lesion) or follicular neoplasm with a tumor size of ≤5cm. As robotic experience accumulated, the indication of robotic thyroidectomy to include those patients with T3 or larger size lesions has been expanded. The initial robotic thyroidectomy resembled the endoscopic thyroidectomy using two separate incisions, axilla and anterior chest wall. With sufficient experience, the anterior chest wall incision was removed and developed a less invasive transaxillary single-incision robotic thyroidectomy. This procedure has reduced the dissection and the surgical invasiveness with similar surgical outcomes.
Until now, more than 100 cases of compartment-oriented modified radical neck dissection with acceptable postoperative outcomes and excellent cosmesis had been also performed with the Da Vinci robotic system.
Robot-assisted cystoprostatectomy with intracorporeal urinary diversion using a Hautmann technique
It is the case of a 62-year-old man diagnosed with a T2bN0M0 transitional cell adenocarcinoma, which was evidenced by pathological findings after resection of a bladder tumor.
Seven ports are required prior to the installation of the DaVinci® robotic system:
- 12mm port on superior border of umbilicus.
- Right robotic port at the midline between anterior superior iliac spine and umbilicus. - Two 5mm ports on both sides of right robotic port.
- Additional 12mm port between the two 5mm ports once dissection of bladder pedicles has been started.
- Two left robotic ports in left iliac fossa and anterior axillary line.
This video demonstrates the cystoprostatectomy technique with a W-pouch intracorporeal neobladder (Hautmann ileal neobladder), which is feasible in specialized centers.
References:
1. Kaufman DS, Shipley WU, Feldman AS. Bladder cancer. Lancet 2009;374(9685):239-49.
2. Lee DJ, Rothberg MB, McKiernan JM, Benson MC, Badani KK. Robot-assisted radical cystoprostatectomy in complex surgical patients: single institution report. Can J Urol 2009;16(3):4664-9.
3. Tunuguntla HS, Nieder AM, Manoharan M. Neobladder reconstruction following radical cystoprostatectomy for invasive bladder cancer. Minerva Urol Nefrol 2009;61(1):41-54.
4. Barocas DA, Patel SG, Chang SS, Clark PE, Smith JA Jr, Cookson MS. Outcomes of patients undergoing radical cystroprostatectomy for bladder cancer with prostatic involvement on final pathology. BJU Int 2009;104(8):1091-7.
5. Pruthi RS, Stefaniak H, Hubbard JS, Wallen EM. Robotic anterior pelvic exenteration for bladder cancer in the female: outcomes and comparisons to their male counterparts. J Laparoendosc Adv Surg Tech A 2009;19(1):23-7.
6. Kefer JC, Campbell SC. Current status of prostate-sparing cystectomy. Urol Oncol 2008;26(5):486-93.
7. Rawal S, Raghunath SK, Khanna S, Jain D, Kaul R, Kumar P, Chhabra R, Brushan K. Minilaparotomy radical cystoprostatectomy (Minilap RCP) in the surgical management of urinary bladder carcinoma: early experience. Jpn J Clin Oncol 2008;38(9):611-6.
8. Park SY, Cho KS, Ham WS, Choi HM, Hong SJ, Rha KH. Robot-assisted laparoscopic radical cystoprostatectomy with ileal conduit urinary diversion: initial experience in Korea. J Laparoendosc Adv Surg Tech A 2008;18(3):401-4.
9. Gregori A, Galli S, Goumas I, Scieri F, Stener S, Gaboardi F. A cost comparison of laparoscopic versus open radical cystoprostatectomy and orthotopic ileal neobladder at a single institution. Arch Ital Urol Androl 2007;79(3):127-9.
10. Young JL, Finley DS, Ornstein DD. Robotic-assisted laparoscopic cystoprostatectomy for prostatic carcinosarcoma. JSLS 2007;11(1)109-
12.
11. Nuñez-Mora C, Cabrera P, Garcia-Mediero JM, de Fata FR, Gonzalez J, Angulo J. Laparoscopic radical cystectomy and orthotopic urinary diversion in the malepatient: technique. Arch Esp Urol 2011;64(3):195-206.
12. Rehman J, Sangalli MN, Guru K, de Naeyer G, Schatteman P, Carpentier P, Mottrie A. Total intracorporeal robot-assisted laparoscopic ileal conduit (Bricker) urinary diversion: technique and outcomes. Can J Urol 2011;18(1):5548-56.
13. Canda AE, Asil E, Balbay MD. An unexpected resident in the ileum detected during robot-assisted laparoscopic radical cystoprostatectomy and intracorporeal Studer pouch formation: Taenia saginata parasite. J Endourol 2011;25(2):301-3.
14. Lin T, Huang J, Han J, Xu K, Huang H, Jiang C, Liu H, Zhang C, Yao Y, Xie W, Shah AK, Huang L. Hybrid laparoscopic endoscopic single-site surgery for radical cystoprostatectomy and orthotopic ileal neobladder: an initial experience of 12 cases. J Endourol 2011;25(1):57-63.
15. Josephson DY, Chen JA, Chan KG, Lau CS, Nelson RA, Wilson TG. Robotic-assisted laparoscopic radical cystoprostatectomy and extracorporeal continent urinary diversion: highlight of surgical techniques and outcomes. Int J Med Robot 2010;6(3):315-23.
16. Kasraeian A, Barret E, Cathelineau X, Rozet F, Galiano M, Sánchez-Salas R, Vallancien G. Robot-assisted laparoscopic cystoprostatectomy with extended pelvic lymphadenectomy, extracorporeal enterocystoplasty, and intracorporeal enterourethral anastomosis: initial Montsouris Experience. J Endourol 2010;24(3):409-13.
17. Varinot J, Camparo P, Roupret M, Bitker MO, Capron F, Cussenot O, Witjes JA, Compérat E. Full analysis of the prostatic urethra at the time of radical cystoprostatectomy for bladder cancer: impact on final disease stage. Virchows Arch 2009;455(5):449-53.
18. Palou Redorta J, Gaya Sopena JM, Gausa Gascon K, Sanchez-Martin F, Rosales Bordes A, Rodriguez Faba O, Villavicencio Mavrich H. Robotic radical cystoprostatectomy: oncological and functional analysis. Actas Urol Esp 2009;33(7):759-66.
D Rey, VE Corona Montes, T Piéchaud
Surgical intervention
7 years ago
5000 views
100 likes
0 comments
10:22
Robot-assisted cystoprostatectomy with intracorporeal urinary diversion using a Hautmann technique
It is the case of a 62-year-old man diagnosed with a T2bN0M0 transitional cell adenocarcinoma, which was evidenced by pathological findings after resection of a bladder tumor.
Seven ports are required prior to the installation of the DaVinci® robotic system:
- 12mm port on superior border of umbilicus.
- Right robotic port at the midline between anterior superior iliac spine and umbilicus. - Two 5mm ports on both sides of right robotic port.
- Additional 12mm port between the two 5mm ports once dissection of bladder pedicles has been started.
- Two left robotic ports in left iliac fossa and anterior axillary line.
This video demonstrates the cystoprostatectomy technique with a W-pouch intracorporeal neobladder (Hautmann ileal neobladder), which is feasible in specialized centers.
References:
1. Kaufman DS, Shipley WU, Feldman AS. Bladder cancer. Lancet 2009;374(9685):239-49.
2. Lee DJ, Rothberg MB, McKiernan JM, Benson MC, Badani KK. Robot-assisted radical cystoprostatectomy in complex surgical patients: single institution report. Can J Urol 2009;16(3):4664-9.
3. Tunuguntla HS, Nieder AM, Manoharan M. Neobladder reconstruction following radical cystoprostatectomy for invasive bladder cancer. Minerva Urol Nefrol 2009;61(1):41-54.
4. Barocas DA, Patel SG, Chang SS, Clark PE, Smith JA Jr, Cookson MS. Outcomes of patients undergoing radical cystroprostatectomy for bladder cancer with prostatic involvement on final pathology. BJU Int 2009;104(8):1091-7.
5. Pruthi RS, Stefaniak H, Hubbard JS, Wallen EM. Robotic anterior pelvic exenteration for bladder cancer in the female: outcomes and comparisons to their male counterparts. J Laparoendosc Adv Surg Tech A 2009;19(1):23-7.
6. Kefer JC, Campbell SC. Current status of prostate-sparing cystectomy. Urol Oncol 2008;26(5):486-93.
7. Rawal S, Raghunath SK, Khanna S, Jain D, Kaul R, Kumar P, Chhabra R, Brushan K. Minilaparotomy radical cystoprostatectomy (Minilap RCP) in the surgical management of urinary bladder carcinoma: early experience. Jpn J Clin Oncol 2008;38(9):611-6.
8. Park SY, Cho KS, Ham WS, Choi HM, Hong SJ, Rha KH. Robot-assisted laparoscopic radical cystoprostatectomy with ileal conduit urinary diversion: initial experience in Korea. J Laparoendosc Adv Surg Tech A 2008;18(3):401-4.
9. Gregori A, Galli S, Goumas I, Scieri F, Stener S, Gaboardi F. A cost comparison of laparoscopic versus open radical cystoprostatectomy and orthotopic ileal neobladder at a single institution. Arch Ital Urol Androl 2007;79(3):127-9.
10. Young JL, Finley DS, Ornstein DD. Robotic-assisted laparoscopic cystoprostatectomy for prostatic carcinosarcoma. JSLS 2007;11(1)109-
12.
11. Nuñez-Mora C, Cabrera P, Garcia-Mediero JM, de Fata FR, Gonzalez J, Angulo J. Laparoscopic radical cystectomy and orthotopic urinary diversion in the malepatient: technique. Arch Esp Urol 2011;64(3):195-206.
12. Rehman J, Sangalli MN, Guru K, de Naeyer G, Schatteman P, Carpentier P, Mottrie A. Total intracorporeal robot-assisted laparoscopic ileal conduit (Bricker) urinary diversion: technique and outcomes. Can J Urol 2011;18(1):5548-56.
13. Canda AE, Asil E, Balbay MD. An unexpected resident in the ileum detected during robot-assisted laparoscopic radical cystoprostatectomy and intracorporeal Studer pouch formation: Taenia saginata parasite. J Endourol 2011;25(2):301-3.
14. Lin T, Huang J, Han J, Xu K, Huang H, Jiang C, Liu H, Zhang C, Yao Y, Xie W, Shah AK, Huang L. Hybrid laparoscopic endoscopic single-site surgery for radical cystoprostatectomy and orthotopic ileal neobladder: an initial experience of 12 cases. J Endourol 2011;25(1):57-63.
15. Josephson DY, Chen JA, Chan KG, Lau CS, Nelson RA, Wilson TG. Robotic-assisted laparoscopic radical cystoprostatectomy and extracorporeal continent urinary diversion: highlight of surgical techniques and outcomes. Int J Med Robot 2010;6(3):315-23.
16. Kasraeian A, Barret E, Cathelineau X, Rozet F, Galiano M, Sánchez-Salas R, Vallancien G. Robot-assisted laparoscopic cystoprostatectomy with extended pelvic lymphadenectomy, extracorporeal enterocystoplasty, and intracorporeal enterourethral anastomosis: initial Montsouris Experience. J Endourol 2010;24(3):409-13.
17. Varinot J, Camparo P, Roupret M, Bitker MO, Capron F, Cussenot O, Witjes JA, Compérat E. Full analysis of the prostatic urethra at the time of radical cystoprostatectomy for bladder cancer: impact on final disease stage. Virchows Arch 2009;455(5):449-53.
18. Palou Redorta J, Gaya Sopena JM, Gausa Gascon K, Sanchez-Martin F, Rosales Bordes A, Rodriguez Faba O, Villavicencio Mavrich H. Robotic radical cystoprostatectomy: oncological and functional analysis. Actas Urol Esp 2009;33(7):759-66.
Robotic thymectomy for autoimmune myasthenia gravis
We present the case of a 27-year-old woman who has had an autoimmune myasthenia gravis for 6 months. The current treatment essentially includes anticholinesterasics, but no use of corticosteroids. Thymectomy is indicated in the presence of thymic hyperplasia visible on a thorax CT-scan with contrast injection. The use of the da Vinci robot for this type of intervention has been recognized many years ago now with the work of Federico Rea and Jens Ruckert amongst others. The advantage of this technique is the possibility to proceed with a radical thymectomy enlarged to the mediastinal fat exactly in the same way as for a median sternotomy which is the standard technique. When compared with thoracoscopy, the advantage stems from 3D vision, segmentation of the operator’s movements and exceptional maneuverability of the instruments which have 7 degrees of freedom. These instruments allow for an access to the lower cervical area without the use of a cervicotomy. The choice of the left side is explained by the need to identify the phrenic nerve’s position, which is more difficult to predict than the right nerve’s position, which can be easily identified on the right lateral aspect of the superior vena cava.
The video is followed by an interview with Professor Marescaux (MD, FACS, Hon FRCS, Hon JSES) and Doctor Santelmo (MD, FETCS) about robotic thymectomy, comparing it with Novellino's procedure and discussing the ways in which this technique pushes robotic surgery forward.
N Santelmo, S Renaud, J Marescaux
Surgical intervention
8 years ago
1962 views
18 likes
0 comments
12:14
Robotic thymectomy for autoimmune myasthenia gravis
We present the case of a 27-year-old woman who has had an autoimmune myasthenia gravis for 6 months. The current treatment essentially includes anticholinesterasics, but no use of corticosteroids. Thymectomy is indicated in the presence of thymic hyperplasia visible on a thorax CT-scan with contrast injection. The use of the da Vinci robot for this type of intervention has been recognized many years ago now with the work of Federico Rea and Jens Ruckert amongst others. The advantage of this technique is the possibility to proceed with a radical thymectomy enlarged to the mediastinal fat exactly in the same way as for a median sternotomy which is the standard technique. When compared with thoracoscopy, the advantage stems from 3D vision, segmentation of the operator’s movements and exceptional maneuverability of the instruments which have 7 degrees of freedom. These instruments allow for an access to the lower cervical area without the use of a cervicotomy. The choice of the left side is explained by the need to identify the phrenic nerve’s position, which is more difficult to predict than the right nerve’s position, which can be easily identified on the right lateral aspect of the superior vena cava.
The video is followed by an interview with Professor Marescaux (MD, FACS, Hon FRCS, Hon JSES) and Doctor Santelmo (MD, FETCS) about robotic thymectomy, comparing it with Novellino's procedure and discussing the ways in which this technique pushes robotic surgery forward.
Laparoscopic robotic-assisted Heller procedure for esophageal achalasia
This video demonstrates a robotic-assisted Heller procedure for treatment of esophageal achalasia. The surgeon starts by dissecting the gastroesophageal junction. The mobilization of the stomach is limited to the anterior and lateral aspect, leaving the posterior attachments intact. The myotomy is started just above the gastroesophageal junction and extended 6 cm proximally and 2 cm distally onto the stomach using robotic articulated scissors. The extension of the myotomy on the gastric side continues to be the most difficult part of the dissection. The change in direction of the muscular fibers, from circular at the esophagus, to oblique at the stomach, makes it difficult to develop the necessary submucosal plane for dividing the muscular fibers. The video demonstrates the freedom of movement of the articulated robotic instruments that allow the surgeon to divide each individual muscular fiber achieving a precise dissection of the gastroesophageal junction. Once the myotomy is completed a standard Dor Fundoplication is performed.
B Dallemagne
Surgical intervention
13 years ago
643 views
59 likes
0 comments
12:18
Laparoscopic robotic-assisted Heller procedure for esophageal achalasia
This video demonstrates a robotic-assisted Heller procedure for treatment of esophageal achalasia. The surgeon starts by dissecting the gastroesophageal junction. The mobilization of the stomach is limited to the anterior and lateral aspect, leaving the posterior attachments intact. The myotomy is started just above the gastroesophageal junction and extended 6 cm proximally and 2 cm distally onto the stomach using robotic articulated scissors. The extension of the myotomy on the gastric side continues to be the most difficult part of the dissection. The change in direction of the muscular fibers, from circular at the esophagus, to oblique at the stomach, makes it difficult to develop the necessary submucosal plane for dividing the muscular fibers. The video demonstrates the freedom of movement of the articulated robotic instruments that allow the surgeon to divide each individual muscular fiber achieving a precise dissection of the gastroesophageal junction. Once the myotomy is completed a standard Dor Fundoplication is performed.
Computer-assisted robotic cholecystectomy
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.
J Leroy, M Smith-Savu, J Marescaux
Surgical intervention
14 years ago
5928 views
56 likes
0 comments
15:43
Computer-assisted robotic cholecystectomy
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.