Colorectal Surgery Department, Hospital Central Militar, México City, México (Dr. M. Gurieb-Trueba)
Advanced Endoscopy Department, Hospital Central Militar, México City, México (Dr. V. M. Rivera-Méndez)
Hospital San Ángel Inn Chapultepec, México City, México (Dr. J. C. Sánchez-Robbles)

ABSTRACT

Colorectal cancer prevention relies on effective screening through colonoscopy and polypectomy. Several techniques and methods have been described to manage complex colonic polyps such as the ones that are endoscopically unresectable. Across time, we have been able to perform less invasive techniques that include different types of colonic resections, ranging from partial thickness, full-thickness and, segmental colectomies, however, none has proven to be the treatment of choice for these lesions. The technique presented here is an attractive alternative to segmental colectomy using a robotic platform to perform a full-thickness resection.

Key Words: Robotic surgery, Combined approach, Polyp, Colon, Colonoscopy, Colon cancer, Minimally invasive surgery.

The post Combined Endoscopic-Robotic Resection of a Giant Polyp to Avoid Colorectal Resection first appeared on JSLS.

Department of Surgery, Duke University Health System, Durham, North Carolina, USA (all authors).

ABSTRACT

Introduction: Single-incision techniques limit triangulation, surgeon mobility, and organ visualization. The use of robot-assisted platforms has addressed several of these difficulties; however, it has also generated new challenges. To overcome these problems, we used a magnetic organ-retraction system recently approved by the U. S. Food and Drug Administration. In the present study, we report the first single-incision cholecystectomy performed combining magnetic and robotic technologies.

Case Description: The patient was a 48-year-old woman (BMI, 33 kg/m2) with cholelithiasis, who was scheduled for elective cholecystectomy with a single-incision magnetic robot-assisted procedure. The total procedure took 89 minutes (including docking); operative time was 58 minutes, where magnetic coupling was 51 minutes. Estimated blood loss was minimal. There were no complications. The patient was discharged home on the same day and was entirely satisfied with the surgery results.

Conclusion: The combination of these technologies is feasible and simplifies single-incision techniques.

Key Words: Cholecystectomy, Innovation, Magnetic surgery, Robotic surgery, Single incision.

The post Magnetic Robot–Assisted Single-Incision Cholecystectomy 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.

[gview file=”https://crsls.sls.org/wp-content/uploads/2015/04/jls101153490001.pdf”]

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

OB/GYN Hospitalist, Department of Obstetrics & Gynecology, Northwest Community Hospital, Arlington Heights, IL, USA (Dr. Markuly). Director, Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA and Director, AAGL/SRS Fellowship in Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, USA (Dr. Miller). Undergraduate, Northwestern University, Evanston, IL, USA (Szela).

ABSTRACT

Introduction: Uterine rupture is an acute obstetric emergency requiring a rapid response by a multidisciplinary team of physicians and allied health care professionals to minimize the risk of both maternal and neonatal morbidity and death. A risk factor is previous myomectomy. Robotic-assisted laparoscopic myomectomy is a technologically cutting-edge approach to a common surgical procedure, myomectomy. Pregnancy after robotic-assisted laparoscopic myomectomy has been reported in the literature.

Case Description: We report a case of spontaneous uterine rupture in a subsequent pregnancy after robotic-assisted laparoscopic myomectomy.

Discussion: With use of robotic assistance, the technique changes when compared with standard laparoscopic myomectomy. Areas of potential concern are the amount and type of energy required to excise the fibroid from the myometrial bed.

Key Words: Myomectomy, Uterine Rupture, Robotic Surgery, Laparoscopy, Spontaneous, Pregnancy.

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The post Uterine Rupture After Robotic-Assisted Laparoscopic Myomectomy first appeared on JSLS.

Chirurgie Digestive A, Département de Chirurgie Digestive, Hôpital Universitaire de St Eloi, Université de Montpellier, Montpellier, France (both authors).

ABSTRACT

Background: Esophageal submucosal gastrointestinal stromal tumors (GISTs) are rare. Resection is indicated due to their malignant potential.

Case Description: A 76-year-old woman complained of mild dysphagia. A submucosal tumor of the lower thoracic esophagus was found endoscopically. Computed tomography (CT) scan revealed a 40-mm anterolateral submucosal tumor. Endoscopic ultrasound revealed a hypoechoic and inhomogeneous lesion, developed from the fourth layer of the lower esophagus. In the prone position, the patient underwent robot-assisted right thoracoscopic enucleation of the esophageal submucosal tumor. The procedure was successfully completed with three trocars. No surgical complications occurred during the intervention or the postoperative stay. The patient was discharged on postoperative. Pathologic examination of the specimen revealed a GIST.

Conclusion: To the best of our knowledge, this is the first report of esophageal submucosal GIST enucleation with a patient in the prone position using robotic surgery platform. This approach, which complements the prone position by allowing amore precise dissection, is particularly appropriate for submucosal tumor enucleation and needs to be further evaluated.

Key Words: esophageal submucosal tumor, enucleation, robotic surgery, prone position, gastrointestinal stromal tumor.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/14-00045.pdf”]

The post Robotic Enucleation of an Esophageal Submucosal Tumor in the Prone Position 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.

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.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00097.pdf”]

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