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Monthly publications

#May 2014
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Stepwise radical vaginal trachelectomy: Dargent’s operation
Up to 40% of early cervical cancers are diagnosed in young women who might desire fertility preservation. More than 1,000 cases of Radical Vaginal Trachelectomy (RVT) have been published so far, with over 450 pregnancies achieved. Oncological outcomes of this treatment are totally comparable with the ones obtained with radical hysterectomies for similar size lesions. Additionally, these results are similar or superior when compared to the other routes of trachelectomy.
The procedure is always combined with a laparoscopic pelvic lymphadenectomy to rule out the possibility of lymph node metastases.
This video demonstrates the technique of RVT. Interesting parts of the vaginal steps are shown along with their contemporary laparoscopic views for didactic purposes.
E Leblanc, F Narducci, L Bresson, M Puga
Surgical intervention
4 years ago
2820 views
86 likes
0 comments
09:21
Stepwise radical vaginal trachelectomy: Dargent’s operation
Up to 40% of early cervical cancers are diagnosed in young women who might desire fertility preservation. More than 1,000 cases of Radical Vaginal Trachelectomy (RVT) have been published so far, with over 450 pregnancies achieved. Oncological outcomes of this treatment are totally comparable with the ones obtained with radical hysterectomies for similar size lesions. Additionally, these results are similar or superior when compared to the other routes of trachelectomy.
The procedure is always combined with a laparoscopic pelvic lymphadenectomy to rule out the possibility of lymph node metastases.
This video demonstrates the technique of RVT. Interesting parts of the vaginal steps are shown along with their contemporary laparoscopic views for didactic purposes.
da Vinci® Si™ Surgical System: current and future technologies
Since the first robotic case in 1999 with the da Vinci® system, Intuitive Surgical has created three different surgical platforms: the da Vinci Standard, the S and the Si. This presentation first reviews the latest da Vinci® system and instrumentation: the simulator, firefly, suction-irrigation, and the vessel-sealer. It then moves on to show upcoming instruments (the linear stapler) and introduces the possible future application of medical imaging agents (non-specific to the robot). As this presentation was made within the context of the RAMSES congress, a few slides show ongoing work specific to “shallow procedures” as well as ongoing research in that field.
R Bastier
Lecture
4 years ago
305 views
12 likes
0 comments
23:10
da Vinci® Si™ Surgical System: current and future technologies
Since the first robotic case in 1999 with the da Vinci® system, Intuitive Surgical has created three different surgical platforms: the da Vinci Standard, the S and the Si. This presentation first reviews the latest da Vinci® system and instrumentation: the simulator, firefly, suction-irrigation, and the vessel-sealer. It then moves on to show upcoming instruments (the linear stapler) and introduces the possible future application of medical imaging agents (non-specific to the robot). As this presentation was made within the context of the RAMSES congress, a few slides show ongoing work specific to “shallow procedures” as well as ongoing research in that field.
Robotic-assisted latissimus dorsi in delayed immediate breast reconstruction
Background: For two-stage delayed-immediate reconstruction of the radiated breast, robotic-assisted latissimus dorsi harvest (RALDH) is a secondary option for patients who wish to avoid a donor site incision. The purpose of this study was to compare outcomes of RALDH versus a traditional open technique (TOT) for patients undergoing delayed-immediate breast reconstruction following radiation therapy.
Methods: A retrospective analysis of a prospective database of all consecutive patients undergoing latissimus dorsi harvest for radiated breast reconstruction between 2009 and 2013 was performed. Indications, surgical technique, complications and outcomes were assessed.
Results: 146 pedicled latissimus dorsi muscle flaps were performed for breast reconstruction and 17 were performed with robotic assistance during the study period (average follow-up 14.6 ±7.3 months). Latissimus dorsi breast reconstruction following radiation was performed in 64 TOT patients and 12 RALDH patients. Surgical complication rates were 37.5% TOT versus 16.7% RALDH (p=0.31), which included seroma (8.9% vs. 8.3%), infection (14.1 vs. 8.3%), wound healing (7.8% vs. 0), and capsular contracture (4.7% vs. 0).
Conclusion: RALDH is associated with a low complication rate and reliable results for reconstruction of the irradiated breast while obviating the need for a donor site incision.
MW Clemens
Lecture
4 years ago
279 views
9 likes
0 comments
15:39
Robotic-assisted latissimus dorsi in delayed immediate breast reconstruction
Background: For two-stage delayed-immediate reconstruction of the radiated breast, robotic-assisted latissimus dorsi harvest (RALDH) is a secondary option for patients who wish to avoid a donor site incision. The purpose of this study was to compare outcomes of RALDH versus a traditional open technique (TOT) for patients undergoing delayed-immediate breast reconstruction following radiation therapy.
Methods: A retrospective analysis of a prospective database of all consecutive patients undergoing latissimus dorsi harvest for radiated breast reconstruction between 2009 and 2013 was performed. Indications, surgical technique, complications and outcomes were assessed.
Results: 146 pedicled latissimus dorsi muscle flaps were performed for breast reconstruction and 17 were performed with robotic assistance during the study period (average follow-up 14.6 ±7.3 months). Latissimus dorsi breast reconstruction following radiation was performed in 64 TOT patients and 12 RALDH patients. Surgical complication rates were 37.5% TOT versus 16.7% RALDH (p=0.31), which included seroma (8.9% vs. 8.3%), infection (14.1 vs. 8.3%), wound healing (7.8% vs. 0), and capsular contracture (4.7% vs. 0).
Conclusion: RALDH is associated with a low complication rate and reliable results for reconstruction of the irradiated breast while obviating the need for a donor site incision.
Intercostal nerves harvesting through thoracoscopy without da Vinci™ robot
Intercostal nerve transfer is useful in brachial plexus surgery, especially for the restoration of elbow flexion. Freeing of intercostal nerves for nerve transfer, however, requires a long skin incision and can result in damage to the muscles and ribs. Video-assisted thoracoscopic surgery (VATS) has been developed recently as a diagnostic and therapeutic technique for intrathoracic organ diseases. Intercostal nerve transfer to the musculocutaneous nerve (MCN) using the VATS system has been performed in eight patients with brachial plexus injuries.

Eight patients (seven males, one female, 17-32 y.o.) underwent intercostal nerve transfer to the MCN using the VATS system between 2005 and 2012. Two patients were converted from thoracoscopic surgery to open surgery. Power of the biceps was recovered to M3 or more in five out of seven patients, who were followed for more than two years postoperatively. No respiratory complications occurred.
Although this technique is challenging, the da Vinci® system will make the procedure easier and improve its accuracy and safety.
Y Mikami
Lecture
4 years ago
68 views
2 likes
0 comments
09:50
Intercostal nerves harvesting through thoracoscopy without da Vinci™ robot
Intercostal nerve transfer is useful in brachial plexus surgery, especially for the restoration of elbow flexion. Freeing of intercostal nerves for nerve transfer, however, requires a long skin incision and can result in damage to the muscles and ribs. Video-assisted thoracoscopic surgery (VATS) has been developed recently as a diagnostic and therapeutic technique for intrathoracic organ diseases. Intercostal nerve transfer to the musculocutaneous nerve (MCN) using the VATS system has been performed in eight patients with brachial plexus injuries.

Eight patients (seven males, one female, 17-32 y.o.) underwent intercostal nerve transfer to the MCN using the VATS system between 2005 and 2012. Two patients were converted from thoracoscopic surgery to open surgery. Power of the biceps was recovered to M3 or more in five out of seven patients, who were followed for more than two years postoperatively. No respiratory complications occurred.
Although this technique is challenging, the da Vinci® system will make the procedure easier and improve its accuracy and safety.
Robotic subinguinal varicocelectomy
Purpose: To determine if robot-assisted varicocelectomy can be safely and effectively performed when compared to microscopic inguinal varicocelectomy.
Material and Methods: Ten patients with an average age of 28.4 years underwent 11 microscopic subinguinal varicocelectomies. Ten patients with an average age of 23.1 years underwent 11 robot-assisted varicocelectomies.
Results: The average operative time for microscopic inguinal varicocelectomy was 69.2 minutes, whereas the robot-assisted technique took 70.3 minutes. There were no difficulties in identifying and isolating vessels and the vas deferens with robotic-assisted subinguinal varicocelectomy. Hand tremor was eliminated with the robotic procedure. Robotic patients were able to resume daily activities on the day of surgery and full activities within two weeks. There were no complications or recurrences of varicocele.
Conclusions: From our experience, we believe that robot-assisted varicocelectomy can be safely and effectively performed when compared to microscopic surgery, with the added benefit of reducing hand tremor.
T Shu
Lecture
4 years ago
655 views
29 likes
0 comments
08:03
Robotic subinguinal varicocelectomy
Purpose: To determine if robot-assisted varicocelectomy can be safely and effectively performed when compared to microscopic inguinal varicocelectomy.
Material and Methods: Ten patients with an average age of 28.4 years underwent 11 microscopic subinguinal varicocelectomies. Ten patients with an average age of 23.1 years underwent 11 robot-assisted varicocelectomies.
Results: The average operative time for microscopic inguinal varicocelectomy was 69.2 minutes, whereas the robot-assisted technique took 70.3 minutes. There were no difficulties in identifying and isolating vessels and the vas deferens with robotic-assisted subinguinal varicocelectomy. Hand tremor was eliminated with the robotic procedure. Robotic patients were able to resume daily activities on the day of surgery and full activities within two weeks. There were no complications or recurrences of varicocele.
Conclusions: From our experience, we believe that robot-assisted varicocelectomy can be safely and effectively performed when compared to microscopic surgery, with the added benefit of reducing hand tremor.