We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.
Filter by
Specialty
View more
Technologies
View more
Clear filter Media type
View more
Clear filter Category
View more
Publication date
Sort by:
Robotic central pancreatectomy for a well-differentiated neuroendocrine tumor
In this video, we show a robotic central pancreatectomy for a well-differentiated neuroendocrine tumor. This is the case of a 50-year-old patient admitted to the emergency department for acute pancreatitis. CT-scan and MRI demonstrate the presence of a hypervascularized lesion of approximately 15mm in diameter, at the pancreatic isthmus. Scintigraphy does not evidence any intense uptake.
The colon and the omentum are detached and the stomach is suspended laparoscopically. The robot is docked using a lateral approach. A retropancreatic passage is achieved on the mesenteric-portal axis. An intraoperative ultrasonography is performed to visualize the tumor and delimitate the resection margins. After the dissection, the anastomosis is performed between the distal part of the pancreatic remnant and the posterior gastric wall.
A postoperative pancreatic fistula grade B was reported. It was successfully managed. The presence of a well-differentiated neuroendocrine tumor was confirmed. The patient was discharged on postoperative day 22.
P Pessaux, E Felli, T Wakabayashi, Z Cherkaoui, D Mutter, J Marescaux
Surgical intervention
3 months ago
2232 views
4 likes
3 comments
07:01
Robotic central pancreatectomy for a well-differentiated neuroendocrine tumor
In this video, we show a robotic central pancreatectomy for a well-differentiated neuroendocrine tumor. This is the case of a 50-year-old patient admitted to the emergency department for acute pancreatitis. CT-scan and MRI demonstrate the presence of a hypervascularized lesion of approximately 15mm in diameter, at the pancreatic isthmus. Scintigraphy does not evidence any intense uptake.
The colon and the omentum are detached and the stomach is suspended laparoscopically. The robot is docked using a lateral approach. A retropancreatic passage is achieved on the mesenteric-portal axis. An intraoperative ultrasonography is performed to visualize the tumor and delimitate the resection margins. After the dissection, the anastomosis is performed between the distal part of the pancreatic remnant and the posterior gastric wall.
A postoperative pancreatic fistula grade B was reported. It was successfully managed. The presence of a well-differentiated neuroendocrine tumor was confirmed. The patient was discharged on postoperative day 22.
Robotic distal pancreatectomy with splenectomy
This is the case of a 73-year-old asymptomatic female patient who presented with an incidental pancreatic lesion on CT-scan. Her previous medical history was relevant for systemic lupus erythematosus. On the CT-scan, a single hypervascular lesion in the arterial phase was identified in the distal pancreas. The lesion size was 3.1 by 3.3 by 4.3cm. Neither suspicious nodes nor distant metastases were found. The patient was considered to be ASA2 and ECOG0.
The patient was placed in a reverse Trendelenburg position. A 12mm port was placed in the umbilicus for the camera, and three 8mm ports were inserted to accommodate the robotic arms, and another 12mm auxiliary port was used.
The greater curvature of the stomach was released from the transverse colon to expose the supramesocolic area. The neck of the pancreas was dissected close to the splenic-mesenteric confluence. The inferior mesenteric vein opening to the splenic vein was identified, clipped and cut. The splenic artery was dissected, clipped and cut close to the celiac trunk. A stapler was placed in the neck of the pancreas and it was safely stapled. The splenic vein was dissected close to the confluence, and then clipped and cut. The distal pancreas and splenic ligaments were cut and . detached. The specimen was removed using a Pfannenstiel’s incision.
The duration of the procedure was 255 minutes. The estimated blood loss was 100mL. The patient was discharged on postoperative day 5 and no complication was observed over a period of 90 days. Pathology confirmed the presence of a neuroendocrine tumor (grade 2) as a 4cm single lesion and negative margins. One positive node was detected among 10 nodes harvested.
R Araujo, MA Sanctis, F Felippe, D Burgardt, D Wohnrath
Surgical intervention
3 months ago
793 views
2 likes
0 comments
08:04
Robotic distal pancreatectomy with splenectomy
This is the case of a 73-year-old asymptomatic female patient who presented with an incidental pancreatic lesion on CT-scan. Her previous medical history was relevant for systemic lupus erythematosus. On the CT-scan, a single hypervascular lesion in the arterial phase was identified in the distal pancreas. The lesion size was 3.1 by 3.3 by 4.3cm. Neither suspicious nodes nor distant metastases were found. The patient was considered to be ASA2 and ECOG0.
The patient was placed in a reverse Trendelenburg position. A 12mm port was placed in the umbilicus for the camera, and three 8mm ports were inserted to accommodate the robotic arms, and another 12mm auxiliary port was used.
The greater curvature of the stomach was released from the transverse colon to expose the supramesocolic area. The neck of the pancreas was dissected close to the splenic-mesenteric confluence. The inferior mesenteric vein opening to the splenic vein was identified, clipped and cut. The splenic artery was dissected, clipped and cut close to the celiac trunk. A stapler was placed in the neck of the pancreas and it was safely stapled. The splenic vein was dissected close to the confluence, and then clipped and cut. The distal pancreas and splenic ligaments were cut and . detached. The specimen was removed using a Pfannenstiel’s incision.
The duration of the procedure was 255 minutes. The estimated blood loss was 100mL. The patient was discharged on postoperative day 5 and no complication was observed over a period of 90 days. Pathology confirmed the presence of a neuroendocrine tumor (grade 2) as a 4cm single lesion and negative margins. One positive node was detected among 10 nodes harvested.
Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy
The standard curative treatment for patients with esophageal cancer is perioperative chemotherapy or preoperative chemoradiotherapy followed by open transthoracic esophagectomy (OTE). However, robot-assisted minimally invasive thoracolaparoscopic esophagectomy (RAMIE) resulted in a lower percentage of overall surgery-related and cardiopulmonary complications with lower postoperative pain, better short-term quality of life, and a better short-term postoperative functional recovery as compared to OTE. In this authoritative lecture, Dr. JP Ruurda, MD, PhD addresses his team experience with RAMIE since 2003. He goes through a review of the literature and presents a clinical case describing the operative steps of the robot-assisted minimally invasive thoracolaparoscopic esophagectomy.
JP Ruurda
Lecture
4 months ago
179 views
1 like
0 comments
26:15
Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy
The standard curative treatment for patients with esophageal cancer is perioperative chemotherapy or preoperative chemoradiotherapy followed by open transthoracic esophagectomy (OTE). However, robot-assisted minimally invasive thoracolaparoscopic esophagectomy (RAMIE) resulted in a lower percentage of overall surgery-related and cardiopulmonary complications with lower postoperative pain, better short-term quality of life, and a better short-term postoperative functional recovery as compared to OTE. In this authoritative lecture, Dr. JP Ruurda, MD, PhD addresses his team experience with RAMIE since 2003. He goes through a review of the literature and presents a clinical case describing the operative steps of the robot-assisted minimally invasive thoracolaparoscopic esophagectomy.
Robotic Nissen fundoplication with the da Vinci Xi robotic surgical system
For a long time, laparoscopic Nissen fundoplication has been used to treat gastroesophageal reflux disease (GERD). The main challenges of laparoscopic Nissen fundoplication involve the 2-dimensional visualization, exposure of complex gastroesophageal anatomy, and suturing of the wrap fundoplication. In 1999, robotic Nissen fundoplication, a completely new technique, was introduced, demonstrating advantages over conventional laparoscopic surgery due to improved manual dexterity, ergonomics, and 3-dimensional visualization. However, time spent on robotic platform docking and arm clashing during the procedure are factors that surgeons often find cumbersome and time-consuming. The newest surgical platform, the da Vinci Xi surgical robotic system, can help to overcome such problems. This video shows a stepwise approach of the da Vinci Xi docking process and surgical technique demonstrating fundoplication according to the Nissen technique.
L Marano, A Spaziani, G Castagnoli
Surgical intervention
6 months ago
1331 views
2 likes
0 comments
07:00
Robotic Nissen fundoplication with the da Vinci Xi robotic surgical system
For a long time, laparoscopic Nissen fundoplication has been used to treat gastroesophageal reflux disease (GERD). The main challenges of laparoscopic Nissen fundoplication involve the 2-dimensional visualization, exposure of complex gastroesophageal anatomy, and suturing of the wrap fundoplication. In 1999, robotic Nissen fundoplication, a completely new technique, was introduced, demonstrating advantages over conventional laparoscopic surgery due to improved manual dexterity, ergonomics, and 3-dimensional visualization. However, time spent on robotic platform docking and arm clashing during the procedure are factors that surgeons often find cumbersome and time-consuming. The newest surgical platform, the da Vinci Xi surgical robotic system, can help to overcome such problems. This video shows a stepwise approach of the da Vinci Xi docking process and surgical technique demonstrating fundoplication according to the Nissen technique.
Fully robotic Roux-en-Y gastric bypass
Roux-en-Y gastric bypass is becoming increasingly popular. The use of the surgical robot is developing rapidly, and this is especially true for digestive surgery. The aim of this video is to show that Roux-en-Y gastric bypass can be performed using a totally robotic approach. When using the robot, one follows the same steps as for a conventional intervention. The 3D vision and the degrees of freedom of the instruments facilitate the dissection, especially around the cardia, and for suturing procedures. The surgeon takes advantage of the console's user friendly set-up which does not put his/her shoulders or back in a vulnerable position, as they sometimes are when using a laparoscopic approach.
M Vix, B Seeliger, D Mutter, J Marescaux
Surgical intervention
6 months ago
1342 views
4 likes
0 comments
12:00
Fully robotic Roux-en-Y gastric bypass
Roux-en-Y gastric bypass is becoming increasingly popular. The use of the surgical robot is developing rapidly, and this is especially true for digestive surgery. The aim of this video is to show that Roux-en-Y gastric bypass can be performed using a totally robotic approach. When using the robot, one follows the same steps as for a conventional intervention. The 3D vision and the degrees of freedom of the instruments facilitate the dissection, especially around the cardia, and for suturing procedures. The surgeon takes advantage of the console's user friendly set-up which does not put his/her shoulders or back in a vulnerable position, as they sometimes are when using a laparoscopic approach.
Fully robotically assisted transabdominal left adrenalectomy for hypercortisolism due to two left adrenal adenomas
This video demonstrates the case of a female patient who had been followed up by endocrinologists for 6 years. The size of the left adrenal gland had increased and two nodules of 2.5cm were found. Serum chemistries showed a progressive increase in cortisol secretion with a pathological dexamethasone suppression test (DST). Mineralocorticoids and catecholamines were normal. Noriodocholesterol scintigraphy showed an exclusive fixation of the left adrenal gland. Surgery was indicated due to the hypersecretion of the left adrenal gland.
We now have a surgical robot (da Vinci Xi™ robotic surgical system, Intuitive Surgical) and we use it for most of the adrenalectomies we perform. It provides great stability of the operative field. The precise dissection is facilitated by the dexterity of the articulated instruments.
M Vix, B Seeliger, D Mutter, J Marescaux
Surgical intervention
6 months ago
356 views
3 likes
0 comments
13:06
Fully robotically assisted transabdominal left adrenalectomy for hypercortisolism due to two left adrenal adenomas
This video demonstrates the case of a female patient who had been followed up by endocrinologists for 6 years. The size of the left adrenal gland had increased and two nodules of 2.5cm were found. Serum chemistries showed a progressive increase in cortisol secretion with a pathological dexamethasone suppression test (DST). Mineralocorticoids and catecholamines were normal. Noriodocholesterol scintigraphy showed an exclusive fixation of the left adrenal gland. Surgery was indicated due to the hypersecretion of the left adrenal gland.
We now have a surgical robot (da Vinci Xi™ robotic surgical system, Intuitive Surgical) and we use it for most of the adrenalectomies we perform. It provides great stability of the operative field. The precise dissection is facilitated by the dexterity of the articulated instruments.
LIVE INTERACTIVE SURGERY: robotic total gastrectomy highlighting esojejunal anastomosis
This video presents the case of a 71-year-old man with a BMI of 29. He was admitted to the emergency room for fatigue, severe anemia, and abdominal pain. His past medical history was significant for cardiac disease, aortic valve stenosis, and small adrenal adenoma. His past surgical history included a cholecystectomy and a prostatectomy. Work-up started with an endoscopy which showed an ulcer at the antrum, which was biopsied and showed signet cell adenocarcinoma. CT-scan confirmed the presence of a large bulky lesion and ruled out the presence of a metastatic disease. The patient was admitted again for bleeding and hematemesis and he was scheduled for a total gastrectomy. He had an exploratory laparoscopy which showed no signs of carcinomatosis. He also had preoperative chemotherapy.
This live interactive video demonstrates a robotic total gastrectomy for gastric cancer, including a stepwise lymphadenectomy and precise thorough description of esojejunal anastomosis.
WJ Hyung, S Perretta, B Dallemagne, B Seeliger, D Mutter, J Marescaux
Surgical intervention
6 months ago
1645 views
10 likes
0 comments
04:27
LIVE INTERACTIVE SURGERY: robotic total gastrectomy highlighting esojejunal anastomosis
This video presents the case of a 71-year-old man with a BMI of 29. He was admitted to the emergency room for fatigue, severe anemia, and abdominal pain. His past medical history was significant for cardiac disease, aortic valve stenosis, and small adrenal adenoma. His past surgical history included a cholecystectomy and a prostatectomy. Work-up started with an endoscopy which showed an ulcer at the antrum, which was biopsied and showed signet cell adenocarcinoma. CT-scan confirmed the presence of a large bulky lesion and ruled out the presence of a metastatic disease. The patient was admitted again for bleeding and hematemesis and he was scheduled for a total gastrectomy. He had an exploratory laparoscopy which showed no signs of carcinomatosis. He also had preoperative chemotherapy.
This live interactive video demonstrates a robotic total gastrectomy for gastric cancer, including a stepwise lymphadenectomy and precise thorough description of esojejunal anastomosis.
Fully robotically assisted transabdominal right adrenalectomy for a right adrenal incidentaloma
This video presents the case of a female patient in whom a right adrenal incidentaloma was found. It was 40mm in size and was found incidentally during a pancreatitis treatment.
Endocrinologists controlled the absence of abnormal secretion. The size of the lesion increased slightly over a period of 6 months and allowed to establish an indication for surgery. Our team performs adrenalectomies using a transabdominal laparoscopic approach with the patient in a lateral decubitus position. In order to facilitate the intervention, we asked the Visible Patient company to use the CT-scan images to make a 3D model. This reconstruction allowed to better indentify the relationships of the gland, to improve resection, and confirm the operative strategy. During the intervention, the surgeon can use it to better understand the anatomy hidden by peri-adrenal adipose tissue and operate accordingly. We now have a surgical robot (da Vinci Xi™ robotic surgical system, Intuitive Surgical) and we use it for most of the adrenalectomies we perform. It provides great stability of the operative field. The precise dissection is facilitated by the dexterity of the articulated instruments.
M Vix, B Seeliger, L Soler, D Mutter, J Marescaux
Surgical intervention
6 months ago
1187 views
2 likes
0 comments
11:41
Fully robotically assisted transabdominal right adrenalectomy for a right adrenal incidentaloma
This video presents the case of a female patient in whom a right adrenal incidentaloma was found. It was 40mm in size and was found incidentally during a pancreatitis treatment.
Endocrinologists controlled the absence of abnormal secretion. The size of the lesion increased slightly over a period of 6 months and allowed to establish an indication for surgery. Our team performs adrenalectomies using a transabdominal laparoscopic approach with the patient in a lateral decubitus position. In order to facilitate the intervention, we asked the Visible Patient company to use the CT-scan images to make a 3D model. This reconstruction allowed to better indentify the relationships of the gland, to improve resection, and confirm the operative strategy. During the intervention, the surgeon can use it to better understand the anatomy hidden by peri-adrenal adipose tissue and operate accordingly. We now have a surgical robot (da Vinci Xi™ robotic surgical system, Intuitive Surgical) and we use it for most of the adrenalectomies we perform. It provides great stability of the operative field. The precise dissection is facilitated by the dexterity of the articulated instruments.
LIVE INTERACTIVE SURGERY: robotic low anterior resection for a local recurrence of rectal cancer
In this live interactive surgery, Dr. Parra-Davila demonstrates a robotic low anterior resection for a local recurrence of transanally excised rectal cancer. The operative technique shown includes a robotic oncological ‘en bloc’ resection and intracorporeal anastomosis. In the patient’s history, an ulcerated villous polyp too large for endoscopic removal was addressed to surgery. Preoperative biopsies had failed to detect malignancy. The surgical procedure consisted in a transanal full-thickness resection including partial TME for lymph node sampling. Since the operative specimen revealed a pT2N1a (1/8) rectal adenocarcinoma, the patient underwent adjuvant radiochemotherapy. The following year, a single hepatic metastasis was resected, complemented by postoperative chemotherapy. After 7 years of uneventful follow-up, an anastomotic recurrence was diagnosed. Following oncologic committee discussion, the patient was advised to undergo surgery.
E Parra-Davila, M Ignat, L Soler, B Seeliger, D Mutter, J Marescaux
Surgical intervention
7 months ago
1430 views
2 likes
0 comments
32:48
LIVE INTERACTIVE SURGERY: robotic low anterior resection for a local recurrence of rectal cancer
In this live interactive surgery, Dr. Parra-Davila demonstrates a robotic low anterior resection for a local recurrence of transanally excised rectal cancer. The operative technique shown includes a robotic oncological ‘en bloc’ resection and intracorporeal anastomosis. In the patient’s history, an ulcerated villous polyp too large for endoscopic removal was addressed to surgery. Preoperative biopsies had failed to detect malignancy. The surgical procedure consisted in a transanal full-thickness resection including partial TME for lymph node sampling. Since the operative specimen revealed a pT2N1a (1/8) rectal adenocarcinoma, the patient underwent adjuvant radiochemotherapy. The following year, a single hepatic metastasis was resected, complemented by postoperative chemotherapy. After 7 years of uneventful follow-up, an anastomotic recurrence was diagnosed. Following oncologic committee discussion, the patient was advised to undergo surgery.
Robotic triple docking ultralow anterior resection with intersphincteric resection and coloanal anastomosis
The da Vinci™ surgical robotic system with its increased instrument stability, magnified tridimensional view, and dexterity with 7 degrees of wristed motion of its instruments offers a distinct surgical advantage over traditional laparoscopic instruments. This is especially true in the deep pelvis, where the limited space and visibility make it extremely challenging to perform distal rectal dissection. Additionally, the complete control of the surgeon over the stable surgical platform allows fine and accurate dissection in this area.
For very low rectal tumors close to the anorectal junction, if a sphincter-saving procedure is to be attempted, surgeons will frequently perform an intersphincteric resection (ISR) with a handsewn coloanal anastomosis. If successful, the patient will be able to avoid an abdominoperineal resection and its resulting permanent stoma.
ISR is a technically challenging procedure to perform, especially in male and obese patients. It is because the approach to the intersphincteric plane from the abdominal approach is deep within the pelvis and frequently curves anteriorly, which makes the intersphincteric plane challenging to approach laparoscopically. In addition, ISR from the perineum is also difficult as the anus has a small opening; as a result, when the surgeon sits directly in front of the perineum, assistants will be unable to adequately visualize the operating field, making it very challenging to properly assist for the dissection. It may potentially result in some blind dissection, which may lead to entry into the wrong plane and a poor oncological specimen.
With the da Vinci™ surgical robotic system, this problem can potentially be minimized. First, via the transabdominal approach, the robotic system is able to access deep into the pelvic cavity and dissect down to the intersphincteric plane beyond the puborectalis sling. Secondly, docking the robot and approaching the ISR perineally, the robotic system can also provide a magnified vision, a fine dissection and allow the assistant a good viewing position sitting in front of the perineum to assist in a more productive manner. These advantages of the robotic system will facilitate ISR dissection and retrieval of a superior oncological specimen.
This video features a totally robotic triple docking approach for an ultralow anterior resection with intersphincteric resection and handsewn coloanal anastomosis in a male patient with a low rectal cancer.
SAE Yeo
Surgical intervention
9 months ago
1681 views
5 likes
0 comments
15:36
Robotic triple docking ultralow anterior resection with intersphincteric resection and coloanal anastomosis
The da Vinci™ surgical robotic system with its increased instrument stability, magnified tridimensional view, and dexterity with 7 degrees of wristed motion of its instruments offers a distinct surgical advantage over traditional laparoscopic instruments. This is especially true in the deep pelvis, where the limited space and visibility make it extremely challenging to perform distal rectal dissection. Additionally, the complete control of the surgeon over the stable surgical platform allows fine and accurate dissection in this area.
For very low rectal tumors close to the anorectal junction, if a sphincter-saving procedure is to be attempted, surgeons will frequently perform an intersphincteric resection (ISR) with a handsewn coloanal anastomosis. If successful, the patient will be able to avoid an abdominoperineal resection and its resulting permanent stoma.
ISR is a technically challenging procedure to perform, especially in male and obese patients. It is because the approach to the intersphincteric plane from the abdominal approach is deep within the pelvis and frequently curves anteriorly, which makes the intersphincteric plane challenging to approach laparoscopically. In addition, ISR from the perineum is also difficult as the anus has a small opening; as a result, when the surgeon sits directly in front of the perineum, assistants will be unable to adequately visualize the operating field, making it very challenging to properly assist for the dissection. It may potentially result in some blind dissection, which may lead to entry into the wrong plane and a poor oncological specimen.
With the da Vinci™ surgical robotic system, this problem can potentially be minimized. First, via the transabdominal approach, the robotic system is able to access deep into the pelvic cavity and dissect down to the intersphincteric plane beyond the puborectalis sling. Secondly, docking the robot and approaching the ISR perineally, the robotic system can also provide a magnified vision, a fine dissection and allow the assistant a good viewing position sitting in front of the perineum to assist in a more productive manner. These advantages of the robotic system will facilitate ISR dissection and retrieval of a superior oncological specimen.
This video features a totally robotic triple docking approach for an ultralow anterior resection with intersphincteric resection and handsewn coloanal anastomosis in a male patient with a low rectal cancer.
Robotic Heller myotomy with Dor fundoplication for esophageal achalasia
Achalasia is an esophageal motility disorder characterized by an incomplete or absent esophagogastric junction (EGJ) relaxation associated with loss of peristalsis or uncoordinated contractions of the esophageal body in response to swallowing. All available treatments for achalasia are palliative, directed towards the elimination of the outflow resistance caused by abnormal lower esophageal sphincter (LES) function and aiming to improve the symptoms related to esophageal stasis, such as dysphagia and regurgitation. Laparoscopic Heller myotomy with partial fundoplication is the current standard of care for the treatment of achalasia. It is associated with symptom improvement or relief in about 90% of patients. However, it is a challenging procedure with the potential risk of esophageal perforation reported in up to 10% of cases. Interestingly, laparoscopic myotomy has some limitations which depend on the laparoscopic technique (bidimensional vision, poor range of movement) and on the surgeon’s experience. Recently, the use of the robotic technology has been proposed claiming that it might reduce intraoperative esophageal perforation rates and improve postoperative quality of life after Heller myotomy, mainly due to the 3D view and enhanced dexterity of the surgeon. Despite significant improvements in surgical treatment, the length of myotomy is still a matter of debate to date. Substantially, although some authors proposed a limited myotomy on the lower esophagus preserving a small portion of the LES to prevent postoperative reflux, most authors recommended a myotomy extending 4 to 6cm on the esophagus and 1 to 2cm on the gastric side. In this video, we performed a 6cm long esophagogastric myotomy, with a 2.5cm proximal extension above the Z-line (endoscopically recognized) and a 3.5cm distal extension below the same landmark. In a previous experimental study with intraoperative computerized manometry, we observed that myotomy of the esophageal portion of the LES (without dissection of the gastric fibers) did not lead to any significant variation in sphincteric pressure. Instead, the dissection of the gastric fibers for at least 2 to 2.5cm on the anterior gastric wall created a significant modification of the LES pressure profile. This may be due to the interruption of the anterior portion of gastric semicircular clasp and sling fibers, with consequent loss of their hook properties on the LES pressure profile.
L Marano, A Spaziani, G Castagnoli
Surgical intervention
1 year ago
1307 views
6 likes
0 comments
08:13
Robotic Heller myotomy with Dor fundoplication for esophageal achalasia
Achalasia is an esophageal motility disorder characterized by an incomplete or absent esophagogastric junction (EGJ) relaxation associated with loss of peristalsis or uncoordinated contractions of the esophageal body in response to swallowing. All available treatments for achalasia are palliative, directed towards the elimination of the outflow resistance caused by abnormal lower esophageal sphincter (LES) function and aiming to improve the symptoms related to esophageal stasis, such as dysphagia and regurgitation. Laparoscopic Heller myotomy with partial fundoplication is the current standard of care for the treatment of achalasia. It is associated with symptom improvement or relief in about 90% of patients. However, it is a challenging procedure with the potential risk of esophageal perforation reported in up to 10% of cases. Interestingly, laparoscopic myotomy has some limitations which depend on the laparoscopic technique (bidimensional vision, poor range of movement) and on the surgeon’s experience. Recently, the use of the robotic technology has been proposed claiming that it might reduce intraoperative esophageal perforation rates and improve postoperative quality of life after Heller myotomy, mainly due to the 3D view and enhanced dexterity of the surgeon. Despite significant improvements in surgical treatment, the length of myotomy is still a matter of debate to date. Substantially, although some authors proposed a limited myotomy on the lower esophagus preserving a small portion of the LES to prevent postoperative reflux, most authors recommended a myotomy extending 4 to 6cm on the esophagus and 1 to 2cm on the gastric side. In this video, we performed a 6cm long esophagogastric myotomy, with a 2.5cm proximal extension above the Z-line (endoscopically recognized) and a 3.5cm distal extension below the same landmark. In a previous experimental study with intraoperative computerized manometry, we observed that myotomy of the esophageal portion of the LES (without dissection of the gastric fibers) did not lead to any significant variation in sphincteric pressure. Instead, the dissection of the gastric fibers for at least 2 to 2.5cm on the anterior gastric wall created a significant modification of the LES pressure profile. This may be due to the interruption of the anterior portion of gastric semicircular clasp and sling fibers, with consequent loss of their hook properties on the LES pressure profile.
Robotic left lateral sectionectomy in cirrhotic liver
Background: Laparoscopy for cirrhotic patients can reduce intraoperative bleeding and postoperative morbidity when compared to open surgery. Liver robotic surgery remains a work in progress and only few series reported this approach for cirrhotic patients.
Methods: This is the case of a 62-year-old man with hepatitis C virus and alcoholic cirrhosis (MELD score 10, Child-Pugh score A6) with a single lesion in liver segment III and close to its pedicle.
Results: Intraoperative ultrasound was used to confirm findings on preoperative imaging.
Parenchymal transection was made with an ultrasonic scalpel, monopolar and bipolar cautery with no Pringle’s maneuver. Linear staplers were used to control left lobe inflow and outflow. The specimen was removed through a Pfannenstiel incision. The estimated blood loss was 100mL, and the postoperative course was uneventful. Pathological findings confirmed a 2.5cm hepatocellular carcinoma, with negative margins, and a cirrhotic parenchyma.
Conclusion: Robotic left lateral sectionectomy seems to be as feasible as the conventional laparoscopic approach in selected cirrhotic patients.
R Araujo, LA de Castro, F Felippe, D Burgardt, D Wohnrath
Surgical intervention
1 year ago
1527 views
165 likes
0 comments
07:47
Robotic left lateral sectionectomy in cirrhotic liver
Background: Laparoscopy for cirrhotic patients can reduce intraoperative bleeding and postoperative morbidity when compared to open surgery. Liver robotic surgery remains a work in progress and only few series reported this approach for cirrhotic patients.
Methods: This is the case of a 62-year-old man with hepatitis C virus and alcoholic cirrhosis (MELD score 10, Child-Pugh score A6) with a single lesion in liver segment III and close to its pedicle.
Results: Intraoperative ultrasound was used to confirm findings on preoperative imaging.
Parenchymal transection was made with an ultrasonic scalpel, monopolar and bipolar cautery with no Pringle’s maneuver. Linear staplers were used to control left lobe inflow and outflow. The specimen was removed through a Pfannenstiel incision. The estimated blood loss was 100mL, and the postoperative course was uneventful. Pathological findings confirmed a 2.5cm hepatocellular carcinoma, with negative margins, and a cirrhotic parenchyma.
Conclusion: Robotic left lateral sectionectomy seems to be as feasible as the conventional laparoscopic approach in selected cirrhotic patients.
Is robotic thyroid surgery a real progress?
In this key lecture, Prof. WY Chung briefly describes his experience and his own technique to perform robotic thyroid surgery. He presents advances in surgical indications and compares the main differences of single incision robotic thyroidectomy and LND with novel techniques, e.g. BABA, facelift thyroidectomy, and transoral periosteal thyroidectomy. He demonstrates the advantages and limitations using research data to describe the future of robotic thyroidectomy as a minimally invasive surgery. He highlights new technologies and newly developed robotic systems with current improvements, which focus on haptic feedback, tactile sensation, and single orifice surgery, which will make AI robotic automation surgery possible in the future.
WY Chung
Lecture
2 years ago
402 views
50 likes
0 comments
13:32
Is robotic thyroid surgery a real progress?
In this key lecture, Prof. WY Chung briefly describes his experience and his own technique to perform robotic thyroid surgery. He presents advances in surgical indications and compares the main differences of single incision robotic thyroidectomy and LND with novel techniques, e.g. BABA, facelift thyroidectomy, and transoral periosteal thyroidectomy. He demonstrates the advantages and limitations using research data to describe the future of robotic thyroidectomy as a minimally invasive surgery. He highlights new technologies and newly developed robotic systems with current improvements, which focus on haptic feedback, tactile sensation, and single orifice surgery, which will make AI robotic automation surgery possible in the future.
Complex robotic resection of a large middle mediastinal thymoma
A 62-year-old man had an asymptomatic middle mediastinal tumor with a 4.5cm diameter, opposite to the superior vena cava and the azygos vein in the Barety’s space, which was discovered on thoracic CT-scan performed during an urothelial tumor follow-up.
Past history includes an urothelial carcinoma grade I treated with transurethral cystectomy, an ischemic cardiopathy with a single medical treatment, a prostate hypertrophy, and a sigmoid diverticulosis.
After a multidisciplinary review of the case, a mediastinoscopy was performed. It demonstrated the presence of a thymoma.
The patient was well informed of the operative risks and of the possibility of conversion, but thanks to our experience and national recommendations, we were able to perform a radical robotic assisted thymectomy.
The operation took during 3 hours with less than 100cc of bleeding.
The postoperative course was uneventful and the patient was discharged on postoperative day 3.
Histopathological analysis showed a type AB thymoma according to the OMS 2015 classification. The staging was IIb according to Masaoka. No adjuvant radiotherapy was indicated.
A Boutin, M Sarsam, M Lair, N Piton, C Peillon, JM Baste
Surgical intervention
3 years ago
748 views
64 likes
0 comments
07:38
Complex robotic resection of a large middle mediastinal thymoma
A 62-year-old man had an asymptomatic middle mediastinal tumor with a 4.5cm diameter, opposite to the superior vena cava and the azygos vein in the Barety’s space, which was discovered on thoracic CT-scan performed during an urothelial tumor follow-up.
Past history includes an urothelial carcinoma grade I treated with transurethral cystectomy, an ischemic cardiopathy with a single medical treatment, a prostate hypertrophy, and a sigmoid diverticulosis.
After a multidisciplinary review of the case, a mediastinoscopy was performed. It demonstrated the presence of a thymoma.
The patient was well informed of the operative risks and of the possibility of conversion, but thanks to our experience and national recommendations, we were able to perform a radical robotic assisted thymectomy.
The operation took during 3 hours with less than 100cc of bleeding.
The postoperative course was uneventful and the patient was discharged on postoperative day 3.
Histopathological analysis showed a type AB thymoma according to the OMS 2015 classification. The staging was IIb according to Masaoka. No adjuvant radiotherapy was indicated.
Robotic left lateral sectionectomy with biliary disobstruction
We present the case of a 61-year-old woman followed up for the past 7 years for a dilation of the left biliary tract at the level of the left liver lobe with 3 episodes of angiocholitis. The robot is positioned at the level of the patient’s head. Four ports are put in place. The intervention is begun with placement of the hepatic pedicle on a tape. The liver is then mobilized and the falciform ligament is divided. The hepatotomy is performed at about 1cm to the left of the falciform ligament. The hepatotomy is begun. It is performed by means of the CUSA ultrasonic dissector, and hemostasis and biliostasis are performed using a bipolar grasper. The different elements of the portal pedicle are dissected and controlled. Once the biliary tract has been dissected, it is opened using scissors. As soon as it has been opened, an intrabiliary lithiasis is found. Each stone is progressively extracted to prevent any spillage within the peritoneum. Simple suctions are initiated. A Dormia basket is then placed through the left tract to clear both the convergence and the right biliary tract. Control intraoperative choledochoscopy is performed. New maneuvers are carried out using a series of lavage, allowing for the complete clearance of the biliary tract. Once the voiding of the biliary tract has been controlled, the left biliary tract is closed by means of a PDS 5/0 running suture. The hepatotomy is pursued in order to complete the left lateral sectionectomy. The left supra-hepatic vein is divided by means of an Endo GIA™ linear stapler. The suture and hemostasis are completed by means of different fastened stitches. The tape is removed. The bag containing the stones is extracted by means of a Pfannenstiel’s incision. The postoperative outcome was uneventful and the patient was discharged on postoperative day 6. Final pathological findings ruled out the presence of any malignancy.
P Pessaux, R Memeo, V De Blasi, D Mutter, T Piardi, J Marescaux
Surgical intervention
3 years ago
690 views
18 likes
0 comments
16:09
Robotic left lateral sectionectomy with biliary disobstruction
We present the case of a 61-year-old woman followed up for the past 7 years for a dilation of the left biliary tract at the level of the left liver lobe with 3 episodes of angiocholitis. The robot is positioned at the level of the patient’s head. Four ports are put in place. The intervention is begun with placement of the hepatic pedicle on a tape. The liver is then mobilized and the falciform ligament is divided. The hepatotomy is performed at about 1cm to the left of the falciform ligament. The hepatotomy is begun. It is performed by means of the CUSA ultrasonic dissector, and hemostasis and biliostasis are performed using a bipolar grasper. The different elements of the portal pedicle are dissected and controlled. Once the biliary tract has been dissected, it is opened using scissors. As soon as it has been opened, an intrabiliary lithiasis is found. Each stone is progressively extracted to prevent any spillage within the peritoneum. Simple suctions are initiated. A Dormia basket is then placed through the left tract to clear both the convergence and the right biliary tract. Control intraoperative choledochoscopy is performed. New maneuvers are carried out using a series of lavage, allowing for the complete clearance of the biliary tract. Once the voiding of the biliary tract has been controlled, the left biliary tract is closed by means of a PDS 5/0 running suture. The hepatotomy is pursued in order to complete the left lateral sectionectomy. The left supra-hepatic vein is divided by means of an Endo GIA™ linear stapler. The suture and hemostasis are completed by means of different fastened stitches. The tape is removed. The bag containing the stones is extracted by means of a Pfannenstiel’s incision. The postoperative outcome was uneventful and the patient was discharged on postoperative day 6. Final pathological findings ruled out the presence of any malignancy.