Department of Surgery, SUNY Downstate University Medical Center, Brooklyn, New York, USA (Drs Radvinsky, Chung, Kennedy, and Sugiyama).
SUNY Downstate College of Medicine, Brooklyn, NY (Herman).

ABSTRACT

Introduction: The incidence of incisional hernias after hand-assisted laparoscopic surgery (HALS) ranges from 3 to 10%. Robotic-assisted ventral hernia repair is technically feasible and gaining popularity as an acceptable alternative to open repair.

Case Description: We report a case of a robot-assisted repair for an incisional hernia from a hand-assist port site in a 50-year-old man after a hand-assisted laparoscopic nephrectomy (HALN).

Conclusion: We present a novel approach for recreating the anterior abdominal wall using the robotic platform.

Key Words: Hernia, Robotic, Ventral, Pre-peritoneal.

The post Ventral Hernia After Hand-Assisted Laparoscopic Nephrectomy first appeared on JSLS.

Department of Hepato-pancreato-biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia (Drs. Efanov, Alikhanov, Kazakov, Melekhina, Kim, and Vankovich and Prof. Cvirkun). Moscow Clinical Scientific Center, Moscow, Russia (Prof. Khatkov).

ABSTRACT

Introduction: Radical surgery is the only curative method for liver alveolar echinococcosis (AE). To date, there is no information about the efficacy of laparoscopy including robot-assisted liver resection in radical treatment of AE. This is a case report of a robot-assisted radical liver resection for AE.

Case Description: A 51-year-old man was admitted to the clinic with complaints of weakness and pain in the right abdomen. Computed tomography (CT) revealed a lesion measuring 46 52 86 mm, located in liver segments VI and VII, and robot-assisted resection of those segments was performed. The surgery lasted for 485 minutes, and intraoperative blood loss was 1000 mL. The position of the patient, sites of trocars placement, and details of the surgery are described. The patient had an uneventful postoperative course and was discharged on day 10. Albendazole, was administered for 2 years as antiparasitic chemotherapy. Dynamic monitoring for more than 13 months showed no recurrence of the disease.

Discussion: Publications on the use of laparoscopic and robotic resection of posterior liver segments are scarce, but experience has shown that the learning curve for the use of the robotic system is shortened in comparison with that for other approaches. After the case reported herein, we have performed similar procedures and have seen a marked decrease in blood loss and operative time. This case and our growing experience in performing radical robot-assisted liver resections demonstrate the feasibility of using robotic laparoscopic approaches for radical treatment of early diagnosed liver AE, particularly when the affected liver segment is difficult to reach.

Key Words: Alveolar echinococcosis, Hepatectomy, Liver resection, Radical treatment, Robotic surgical procedures

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The post Radical Robot-Assisted Liver Resection for Alveolar Echinococcosis first appeared on JSLS.

Robotic Surgery Program, University Hospital of Caracas, Caracas, Venezuela (all authors).

ABSTRACT

Introduction: Unsolved choledocholithiasis by endoscopic retrograde cholangiopancreatography is a complicated condition to manage. The incorporation of robotic surgery, a choledochoscope, and a holmium laser as therapeutic tools is likely to increase surgery effectiveness. Our purpose is to present the first Latin American case report of the combined use of these tools to extract a large impacted bile duct stone.

Case Description: A 42-year-old man with obstructive jaundice syndrome underwent endoscopic retrograde cholangiopancreatography. Bile duct dilatation was evidenced by a 1.5-cm-diameter stone that could not be extracted, and biliary prosthesis placement was not possible. Given that stone clearance was not achieved, robot-assisted laparoscopic common bile duct exploration using a holmium laser for lithotripsy was performed. The entire procedure was performed with a robot-assisted technique. The docking time and console time were 10 minutes and 120 minutes, respectively. The patient progressed satisfactorily and was discharged after 48 hours without complications. He had no evidence of residual common bile duct stones or duct strictures after 12 months of follow-up.

Discussion: Laparoscopic common bile duct exploration is an excellent option for the treatment of common bile duct stones. The holmium laser is a useful tool for the treatment of complex choledocholithiasis. Incorporation of the da Vinci System (Intuitive Surgical, Sunnyvale, California) allows greater precision and effectiveness, thus increasing surgery success rates.

Key Words: Robotic surgery, Choledocholithiasis, Holmium laser.

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The post Robot-Assisted Surgery and Holmium Laser in Complex Choledocholithiasis first appeared on JSLS.

Gynecologic Oncology Division, Ob/Gyn and Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA (Drs. Mahdi, Woessner, Gonzalez-Ramos, Moslemi-Kebria). Touro College of Osteopathic Medicine, New York, NY, USA (Dr. Malekzadeh).

ABSTRACT

Introduction: Colonic resection in gynecologic surgery, most commonly in the field of gynecologic oncology, is traditionally performed through open laparotomy. Most cases are performed during cancer debulking in either primary or recurrent settings. Other less common indications include resection of ovarian remnants or endometriotic lesions densely adherent to the large bowel, commonly the rectosigmoid colon.

Case Description: We describe 3 patients with ovarian remnant syndrome and 1 patient with ovarian cancer who underwent successful robotic surgery that included colonic resection and reanastomosis. The mean operative time, blood loss, and hospital stay were 216 minutes, 162.5 mL, and 6.25 days, respectively, with no significant perioperative complications.

Discussion: Minimally invasive robotic colonic resection with reanastomosis is a feasible and safe approach in appropriately selected cases when performed by an experienced surgeon.

Key Words: Robotic, Colon resection, Ovarian remnant syndrome, Ovarian cancer.

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The post Robotic Colonic Resection and Reanastomosis in Gynecologic Surgery: Report of 4 Cases first appeared on JSLS.

Department of Urology, Naval Medical Center San Diego, San Diego, CA, USA (Drs Santomauro, Stroup, Masterson, Auge, Crain, J. L’Esperance, and Ms A. L’Esperance). Division of Urology, University of California, San Diego, CA, USA (Drs Stroup and Derweesh).

ABSTRACT

Background and Objectives: Robotic-assisted laparoscopic retroperitoneal lymph node dissection (RPLND) using a lower abdominal approach for testicular cancer is an advanced and relatively new surgical technique. Herein we describe technical modifications, review benefits, and report our initial series.

Methods: A retrospective review of 16 patients from Jan 1, 2010 to Dec 31, 2012 who underwent robotic RPLND for nonseminomatous germ cell tumors was performed. Patients were positioned in 15° of Trendelenburg and tilted 15° to the right. An infraumbilical midline camera port, 3 robotic ports, and 2 assistant ports were placed in a lower abdominal configuration. Patient demographic and perioperative outcomes were assessed.

Results: Twelve patients underwent staging, prospective nerve-sparing RPLNDs, and 4 underwent postchemotherapy RPLNDs. Mean age was 26.4 years with a mean body mass index of 27.4 kg/m2. The cohort had a mean operative time of 357 minutes, mean estimated blood loss of 205 mL, mean hospital stay of 3.6 days, and mean postoperative morphine equivalent use of 47.1 mg. There were no conversions to open RPLND in this cohort. An average of 26.2 lymph nodes were sampled.

Conclusions: Inferior approach for robotic RPLND enables a thorough dissection of the retroperitoneum, without repositioning, to meet oncologic goals. Further study to evaluate long-term outcomes is warranted.

Key Words: Retroperitoneal lymph node dissection, Robotic surgery, Surgical approaches, Technical modifications, Testicular cancer.

The post Supine Robotic-Assisted Retroperitoneal Lymph Node Dissection for Testicular Cancer first appeared on JSLS.

The post Retained Vaginal Foreign Body in Minimally Invasive Gynecological Surgeries first appeared on JSLS.

USC Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (all authors).

ABSTRACT

Introduction: Pelvic lymphoceles are a known complication of pelvic lymph node dissection after robotic-assisted radical prostatectomy (RARP). However, large symptomatic inguinal lymphoceles after RARP have hitherto not been reported.

Case Description: We present the case of a 71-year-old morbidly obese man who developed large, symptomatic, bilateral inguinal lymphoceles after RARP and pelvic lymph node dissection. The surgery itself was uneventful, as was the hospital stay. The patient returned 3 weeks postoperatively with bilateral inguinal pain and swelling, which was confirmed on imaging to be bilateral inguinal lymphoceles. These were initially treated with bilateral percutaneous pigtail catheter drainage, but this treatment was complicated by repeated tube blockages, fever, and conversion of the lymphoceles into multiloculated abscesses. Definitive treatment consisted of open left lymphocele excision first. After excision of the left inguinal lymphocele, the right lymphocele became infected and formed a large inflammatory phlegmon, necessitating open right inguinal lymphocele excision with right orchiectomy. Culture demonstrated gram-negative Prevotella bivia.

Discussion: This case was unique because the patient presented with bilateral, large, symptomatic, recurrent inguinal lymphoceles, as opposed to the more common pelvic lymphoceles. To our knowledge, this is the first reported case of bilateral, symptomatic inguinal lymphoceles after RARP with pelvic lymph node dissection.

Key Words: Lymphocele, Radical prostatectomy, Robotics, Complications.

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The post Bilateral Inguinal Lymphoceles Following Robotic Radical Prostatectomy first appeared on JSLS.

Department of Urology, Room no-331, Maszid Moth Hostel, Ansari Nagar, All India Institute of Medical Sciences, New Delhi, India (all authors).

ABSTRACT

Vesical stone formation over migrated Hem-o-lok clips (Weck Surgical Instruments [Teleflex Medical], Durham, North Carolina) after robot-assisted laparoscopic radical prostatectomy is rare. We report our experience in 2 patients who presented with lower urinary tract symptoms after robot-assisted laparoscopic radical prostatectomy and were found to have vesical stones formed over migrated Hem-o-lok clips.

Key Words: RALRP, Intravesical clip, Hem-o-lok clip.

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The post Intravesical Migration of Hem-o-Lok Clips Presenting as Vesical Calculus After Robot-Assisted Laparoscopic Radical Prostatectomy first appeared on JSLS.

Department of Urology, Memorial Sisli Hospital, Okmeydanı, Sis¸li-; Istanbul, Turkey (Drs. Alkan, Balbay). Department of Anesthesiology, Memorial Sisli Hospital, Okmeydanı, Sisli-; Istanbul, Turkey (Dr. Ozkanli).

ABSTRACT

Introduction: We present the feasibility of flexible ureteroscopic lithotripsy concomitant with robot-assisted radical prostatectomy and bilaterally extended pelvic lymphadenectomy.

Methods: Two patients underwent flexible ureteroscopic lithotripsy, robot-assisted radical prostatectomy, and pelvic lymphadenectomy at one anesthesia session. Flexible ureteroscopic lithotripsy was performed first. Later, robotic prostatectomy and lymphadenectomy were performed with the patient in the exaggerated 30° Trendelenburg position. All relevant preoperative clinical details, intraoperative details, problems encountered, complications, hospital stay, postoperative recovery, pathologic findings, and clinical follow-up were assessed.

Results: Both patients were discharged uneventfully from the hospital on the third postoperative day. In the postoperative first month, the double-J stents were removed. Both patients were prescribed hormonal treatment and were also referred for radiotherapy due to final pathology and postoperative prostate-specific antigen levels.

Conclusion: Combining robot-assisted radical prostatectomy and flexible ureteroscopy is feasible in patients with urinary stone disease and prostate cancer concomitantly.

Key Words: Flexible ureterorenoscopy, Urolithiasis, Robotic surgery, Prostate cancer, One anesthesia session.

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The post Flexible Ureterorenoscopy and Robotic Surgery first appeared on JSLS.

Department of Surgery, Mercy Hospital and Medical Center, Chicago, IL, USA (all authors).

ABSTRACT

Background: Mesenteric venous thrombosis has been a reported rare postoperative complication after laparoscopic surgery and may lead to increased patient morbidity and possible mortality.

Methods: We report a case highlighting the postoperative presentation of mesenteric venous thrombosis after laparoscopic robotic-assisted colectomy and its management.

Results: We present a case of a 52-year-old woman who underwent robotic-assisted right colectomy after screening colonoscopy found an adenocarcinoma in the cecum. She was discharged on postoperative day 4 and returned to the emergency department on postoperative day 20 with diffuse abdominal pain and nausea/vomiting. A computed tomography scan showed thrombosis and complete occlusion of her superior mesenteric vein extending to the portal vein.

Conclusion: Mesenteric venous thrombosis is a rare but highly morbid postoperative complication after laparoscopic surgery. It should be considered in the differential diagnosis of delayed postoperative presentation with abdominal pain.

Key Words: Mesenteric venous thrombosis, Laparoscopic surgery, Colectomy, Robotic surgery.

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The post Mesenteric Venous Thrombosis After Laparoscopic Robotic-Assisted Colectomy first appeared on JSLS.