26
|
Gheza F, Huerter ME, Giulianotti PC. Robot-assisted incisional hernia repair in a super obese patient after placement of a ventriculoperitoneal shunt - a video vignette. Colorectal Dis 2017; 19:1037. [PMID: 28980460 DOI: 10.1111/codi.13909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/01/2017] [Indexed: 02/08/2023]
|
27
|
Gheza F, Marsur M, Jacobson D, Giulianotti PC, Benedetti E. Tailored Integrated Training for Robotic Assisted Laparoscopic Kidney Transplantation. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
|
29
|
Daskalaki D, Gonzalez-Heredia R, Brown M, Bianco FM, Tzvetanov I, Davis M, Kim J, Benedetti E, Giulianotti PC. Financial Impact of the Robotic Approach in Liver Surgery: A Comparative Study of Clinical Outcomes and Costs Between the Robotic and Open Technique in a Single Institution. J Laparoendosc Adv Surg Tech A 2017; 27:375-382. [PMID: 28186429 PMCID: PMC5397272 DOI: 10.1089/lap.2016.0576] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND One of the perceived major drawbacks of minimally invasive techniques has always been its cost. This is especially true for the robotic approach and is one of the main reasons that has prevented its wider acceptance among hospitals and surgeons. The aim of our study was to evaluate the clinical outcomes and economic impact of robotic and open liver surgery in a single institution. METHODS Sixty-eight robotic and 55 open hepatectomies were performed at our institution between January 1, 2009 and December 31, 2013. Demographics, perioperative data, and postoperative outcomes were collected and compared between the two groups. An independent company performed the financial analysis. The economic parameters comprised direct variable costs, direct fixed costs, and indirect costs. RESULTS Mean estimated blood loss was significantly less in the robotic group (438 versus 727.8 mL; P = .038). Overall morbidity was significantly lower in the robotic group (22% versus 40%; P = .047). Clavien III/IV complications were also lower, with 4.4% in the robotic versus 16.3% in the open group (P = .043). The length of stay in the intensive care unit (ICU) was shorter for patients who underwent a robotic procedure (2.1 versus 3.3 days; P = .004). The average total cost, including readmissions, was $37,518 for robotic surgery and $41,948 for open technique. CONCLUSIONS Robotic liver resections had less overall morbidity, ICU, and hospital stay. This translates into decreased average costs for robotic surgery. These procedures are financially comparable to open resections and do not represent a financial burden to the hospital.
Collapse
|
30
|
Masrur M, Gonzalez-Ciccarelli LF, Giulianotti PC. Robotic Heller myotomy for achalasia after laparoscopic Roux-en-Y gastric bypass: a case report and literature review. Surg Obes Relat Dis 2016; 12:1755-1757. [PMID: 27692913 DOI: 10.1016/j.soard.2016.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/28/2016] [Accepted: 08/01/2016] [Indexed: 12/12/2022]
|
31
|
Gangemi A, Danilkowicz R, Elli FE, Bianco F, Masrur M, Giulianotti PC. Could ICG-aided robotic cholecystectomy reduce the rate of open conversion reported with laparoscopic approach? A head to head comparison of the largest single institution studies. J Robot Surg 2016; 11:77-82. [PMID: 27435700 DOI: 10.1007/s11701-016-0624-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/11/2016] [Indexed: 01/01/2023]
Abstract
Comparative studies between robotic and laparoscopic cholecystectomy (LC) focus heavily on economic considerations under the assumption of comparable clinical outcomes. Advancement of the robotic technique and the further widespread use of this approach suggest a need for newer comparison studies. 676 ICG-aided robotic cholecystectomies (ICG-aided RC) performed at the University of Illinois at Chicago (UIC) Division of General, Minimally Invasive and Robotic Surgery were compiled retrospectively. Additionally, 289 LC were similarly obtained. Data were compared to the largest single institution LC data sets from within the US and abroad. Statistically significant variations were found between UIC-RC and UIC-LC in minor biliary injuries (p = 0.049), overall open conversion (p ≤ 0.001), open conversion in the acute setting (p = 0.002), and mean blood loss (p < 0.001). UIC-RC open conversions were also significantly lower than Greenville Health System LC (p ≤ 0.001). Additionally, UIC ICG-RC resulted in the lowest percentages of major biliary injuries (0 %) and highest percentage of biliary anomalies identified (2.07 %). ICG-aided cholangiography and the technical advantages associated with the robotic platform may significantly decrease the rate of open conversion in both the acute and non-acute setting. The sample size discrepancy and the non-randomized nature of our study do not allow for drawing definitive conclusions.
Collapse
|
32
|
Masrur M, Daskalaki D, Vannucchi A, Vannemreddy SN, Gonzalez-Ciccarelli LF, Brown R, Giulianotti PC. Minimally invasive treatment of difficult bleeding lesions of the small bowel. MINERVA CHIR 2016:R06Y9999N00A16071201. [PMID: 27405293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Bleeding Lesions of the small bowel are often difficult to identify due to the obscure symptomatology. Localizing these lesions requires specific techniques. The Double- balloon enteroscopy (DBE) could be used to precisely localize and mark lesions, so that a minimally invasive surgical treatment could be performed. PATIENTS & METHODS 20 robot-assisted small bowel procedures are presented using a combination of DBE for localization and robotic resection. RESULTS There were 10 jejunal resections and 10 ileal resections. Mean age was 58.7 years. Mean operative time was 153.4 minutes, mean blood loss of 46 ml. No conversion-to-open and there were 4 post-operative complications. The 90-day mortality was nil and the median LOS was 4.1 days. Final pathology was consistent with malignancy in 10 cases. CONCLUSIONS The combination of double balloon enteroscopy and robotic technology allows accurate identification and selective treatment of lesions that could be otherwise difficult to treat in a minimally invasive fashion.
Collapse
|
33
|
Kim JH, Gonzalez-Heredia R, Daskalaki D, Rashdan M, Masrur M, Giulianotti PC. Totally replaced right hepatic artery in pancreaticoduodenectomy: is this anatomical condition a contraindication to minimally invasive surgery? HPB (Oxford) 2016; 18:580-5. [PMID: 27346138 PMCID: PMC4925809 DOI: 10.1016/j.hpb.2016.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/22/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The appropriate approach, in the case of an aberrant right hepatic artery (RHA) during open pancreaticoduodenectomy (PD), has already been established. The aim of our study is to analyze the short-term surgical and oncological outcomes after robotic PD in patients with anatomical variants, with a special focus on totally replaced RHA. METHODS This study is a retrospective review of a prospectively maintained database collected from consecutive patients who underwent robotic PD at the University of Illinois Hospital and Health Sciences System between September 2007 and April 2015. RESULTS Fifteen patients (20.5%) presented with an anatomical variation of the RHA. Four patients had an accessory RHA and 11 had a totally replaced RHA. 50% of the cases were recognized by the radiologist preoperatively. There were no significant differences in the pre- and postoperative outcomes of the aberrant and normal RHA group. The mean number of harvested lymph nodes in the totally replaced RHA group was 22.8 ± 11.4. The rate of positive resection margins was 0% in the totally replaced RHA group and 9% in the normal RHA group. CONCLUSIONS This study suggests that robotic PD has no negative impact on surgical and oncological outcomes in patients with a totally replaced RHA.
Collapse
|
34
|
Wang SE, Daskalaki D, Masrur MA, Patton K, Bianco FM, Giulianotti PC. Impact of Obesity on Robot-Assisted Distal Pancreatectomy. J Laparoendosc Adv Surg Tech A 2016; 26:551-6. [PMID: 27248765 DOI: 10.1089/lap.2016.0192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Obesity has been steadily increasing in the United States. The effect of body mass index (BMI) on surgical outcomes in pancreatic surgery is still controversial. Currently, there is no report related to obesity and robotic pancreatic surgery. The purpose of this study was to evaluate the impact of BMI on the surgical outcomes of both nonobese and obese patients undergoing robot-assisted distal pancreatectomy (RADP). METHODS A prospectively collected database for RADP was retrieved for analysis. Patients were categorized as obese (BMI ≥30 kg/m(2)) and nonobese (BMI <30 kg/m(2)). Demographics, perioperative data, American Society of Anesthesiologists score, diagnosis, conversion rate, morbidity, surgical mortality, pancreatic fistula rate, and length of stay were compared. RESULTS A total for 85 RADP were included, with 57 (67%) in the nonobese group and 28 (33%) in the obese group. No differences were found between nonobese and obese patients regarding demographic, preoperative risk, and perioperative parameters and mortality. There was a trend in the obese group associated with a higher rate of postoperative complications, but it was statistically insignificant. Clinically significant pancreatic fistula (grade B) occurred in 28.5% of obese patients and in 7% of nonobese patients, but without statistical significance (P = .064). CONCLUSIONS Obesity does not have a significant impact on the perioperative outcomes and surgical risks for patients undergoing RADP, but high BMI may be a predictor for pancreatic fistula after RADP.
Collapse
|
35
|
Fernandes E, Giulianotti PC. Robotic-assisted pancreatic surgery. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 20:583-9. [PMID: 23588851 DOI: 10.1007/s00534-013-0615-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Pancreatic surgery is a challenging application of minimally invasive surgery. Due to the complexity of the surgical technique, requiring dissection along major abdominal vessels as well as delicate reconstruction involving biliary, pancreatic and enteric anastomoses, reports on laparoscopic pancreatic surgery have been scanty. With the advent of robotic-assisted surgery, however, the increased dexterity granted by endo-wristed instruments, the improved three-dimensional vision and the computer filtration of the surgeon's movements have brought minimally invasive pancreatic surgery into a new era. METHODS As the surgical group which has performed the highest number of robotic-assisted pancreatic procedures worldwide, we review the state of the art of minimally invasive robotic-assisted pancreatic surgery. Clinical results from all major robotic-assisted pancreatic surgery series are considered. RESULTS Preliminary reports from the published major pancreatic surgery series show encouraging results, with morbidity and mortality comparable to open surgery. Preliminary data on cancer survival rates also appear to be similar to open series. CONCLUSION Robotic-assisted pancreatic surgery is safe and feasible for all pancreatic diseases. The complexity of pancreatic procedures warrant them to be carried out in specialised centres, where short- and long-term outcomes seem to be similar to the ones achieved in open surgery.
Collapse
|
36
|
Coratti A, Fernandes E, Lombardi A, Di Marino M, Annecchiarico M, Felicioni L, Giulianotti PC. Robot-assisted surgery for gastric carcinoma: Five years follow-up and beyond: A single western center experience and long-term oncological outcomes. Eur J Surg Oncol 2015; 41:1106-13. [PMID: 25796984 DOI: 10.1016/j.ejso.2015.01.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 12/08/2014] [Accepted: 01/13/2015] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Robot-assisted surgery for the treatment of gastric cancer is considered to be safe and feasible with early post-operative outcomes comparable to open and laparoscopic series. However, data regarding long-term oncological outcomes are lacking. Aim of this study is to evaluate long-term oncological outcomes of a cohort of gastric cancer patients treated surgically with the robot-assisted approach. MATERIALS AND METHODS A prospectively collected database of robot-assisted gastrectomies performed for gastric cancer at the 'Misericordia Hospital' between September 2001 and October 2011 was retrospectively analysed. Data regarding surgical procedures, early postoperative course, and long-term follow-up were analysed. RESULTS The study included 98 consecutive robot-assisted gastrectomies. Fifty-nine distal gastrectomies, 38 total gastrectomies, and 1 proximal gastrectomy. Open conversion occurred in seven patients (7.1%) due to locally advanced disease. Postoperative morbidity and mortality were 12.2% and 4.1% respectively. Post-operative staging showed 46 patients (46.9%) with stage I disease, 25 patients (25.5%) with stage II, 26 (26.5%) with stage III and 1 (1.02%) with stage IV. The mean follow-up was 46.9 months. Cumulative 5-year overall survival (OS) was 73.3% (95% CI: 62.2-84.4). Five-year survival by stage subgroups was 100% for patients with stage IA, 84.6% for stage IB, 76.9% for stage II, and 21.5% for stage III. The only patient in stage IV of this series died eight months after surgery. CONCLUSIONS Robot-assisted gastrectomy for the treatment of gastric cancer is safe and feasible. It provides long-term outcomes comparable to most open and laparoscopic series. Further studies are necessary to better define its indication.
Collapse
|
37
|
Tzvetanov I, Giulianotti PC, Bejarano-Pineda L, Jeon H, Garcia-Roca R, Bianco F, Oberholzer J, Benedetti E. Robotic-Assisted Kidney Transplantation. Surg Clin North Am 2013; 93:1309-23. [DOI: 10.1016/j.suc.2013.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Ayloo SM, Fernandes E, Masrur MA, Giulianotti PC. Adjustable gastric banding: a comparison of models. Surg Obes Relat Dis 2013; 10:1097-103. [PMID: 24342037 DOI: 10.1016/j.soard.2013.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 05/06/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There are several models of adjustable gastric banding in use with little evidence for choosing a particular model. The objective of this study was to evaluate factors for selecting a particular type of band in terms of weight loss, complications, and co-morbidities. METHODS From July 2006 to May 2012, 222 patients underwent laparoscopic adjustable gastric banding (LAGB) by a single surgeon. Patient demographic characteristics, weight loss, body mass index (BMI), percentage of weight loss (%EWL), complications, and co-morbidities were retrospectively reviewed. Patients were grouped according to the band model into 6 categories: 27 LAP-BAND Adjustable Gastric Banding System VG, 25 Allergan-LAGB, 20 LAP-BAND AP(M) Standard, 18 LAP-BAND AP(M) Large, 34 Realize Band, and 98 Realize-C band. RESULTS At 60 months follow up, in the LAP-BAND VG Group, the mean %EWL was 41%, percentage of co-morbidity improvement was 66%, and percentage of complications was 14.3%; the same percentages in the Allergan-LAGB Group were 41%, 0%, and 52%, respectively; in the LAP-BAND AP Standard Group were 42%, 20%, and 40%, respectively; in the LAP-BAND AP Large group were 38% , 12.5%, and 27.8%, respectively (at 48 months); in the Realize Band Group were 37%, 60%, and 0%, respectively (at 48 months); and in the Realize-C Band Group were 48%,12.5%, and 12.2%, respectively (at 36 months). CONCLUSIONS In terms of weight loss and co-morbidities, no differences were found supporting the choice of one model over the others. Short-term and long-term band-related complications occurred without any clear predilection. The port-related complications were significantly lower in the Realize bands.
Collapse
|
39
|
Elli EF, Masrur MA, El Zaeedi M, Galvani CA, Bozorgui N, Giulianotti PC. Four-year experience with outpatient laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2013; 9:693-5. [DOI: 10.1016/j.soard.2012.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 06/21/2012] [Accepted: 08/28/2012] [Indexed: 11/17/2022]
|
40
|
Ayloo SM, Masrur MA, Contino G, El Zaeedi M, Giulianotti PC. Two-year follow-up of wound complications associated with laparoendoscopic single-site adjustable gastric banding. Surg Obes Relat Dis 2013; 9:696-700. [DOI: 10.1016/j.soard.2012.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 07/16/2012] [Accepted: 07/16/2012] [Indexed: 11/30/2022]
|
41
|
Milone L, Coratti A, Daskalaki D, Fernandes E, Giulianotti PC. [Robotic hepatobiliary and gastric surgery]. Chirurg 2013; 84:651-64. [PMID: 23942961 DOI: 10.1007/s00104-013-2581-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Hepatobiliary surgery is a challenging surgical subspecialty that requires highly specialized training and an adequate level of experience in order to be performed safely. As a result, minimally invasive hepatobiliary surgery has been met with slower acceptance as compared to other subspecialties, with many surgeons in the field still reluctant about the approach. On the other hand, gastric surgery is a very popular field of surgery with an extensive amount of literature especially regarding open and laparoscopic surgery but not much about the robotic approach especially for oncological disease. Recent development of the robotic platform has provided a tool able to overcome many of the limitations of conventional laparoscopic hepatobiliary surgery. Augmented dexterity enabled by the endowristed movements, software filtration of the surgeon's movements, and high-definition three-dimensional vision provided by the stereoscopic camera, allow for steady and careful dissection of the liver hilum structures, as well as prompt and precise endosuturing in cases of intraoperative bleeding. These advantages have fostered many centers to widen the indications for minimally invasive hepatobiliary and gastric surgery, with encouraging initial results. As one of the surgical groups that has performed the largest number of robot-assisted procedures worldwide, we provide a review of the state of the art in minimally invasive robot-assisted hepatobiliary and gastric surgery.The English full-text version of this article is available at SpringerLink (under supplemental).
Collapse
|
42
|
Masrur M, Gheza F, Raimondi P, D'Ugo S, Calatayud D, Giulianotti PC. Robot-assisted subtotal pancreas-preserving duodenectomy. JSLS 2013; 16:654-9. [PMID: 23484581 PMCID: PMC3558909 DOI: 10.4293/108680812x13517013316591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Angiodysplasia of the duodenum is a rare disorder, often requiring surgical resection. Technical difficulties have made the use of the minimally invasive approach uncommon. Herein, we present a subtotal pancreas-preserving duodenectomy using robotic assistance. METHODS The patient is a 60-y-old female with a long medical history including chronic gastrointestinal bleeding due to angiodysplasia with intermittent melena, and requiring multiples blood transfusions. A capsule endoscopy and double-balloon upper endoscopy showed angiectasis, which appeared to be limited to the third and fourth portion of the duodenum and the proximal loops of the jejunum. Despite multiple endoscopic cauterizations, the patient continued to require blood transfusion for several years. The patient underwent a robot-assisted subtotal pancreas-preserving duodenectomy. RESULTS The operation lasted 420 min with minimal blood loss. The postoperative course was uneventful. The pathology report showed multiple small bowel mucosal and submucosal distorted and dilated vasculature, consistent with angiodysplasia. At 2-mo follow-up, the patient was totally asymptomatic. A barium swallow study showed contrast passed antegrade through the duodenojejunostomy with no evidence of obstruction, stricture, or leakage. CONCLUSION The use of robotic assistance to perform a subtotal pancreas-preserving duodenectomy for the treatment of benign duodenal disease, such as angiodysplasia, is feasible and safe. The technical advantages include a high degree of freedom offered by the robotic instruments, as well as enhanced visualization, which allows for precise microdissection and microsuture, thereby preserving the benefits of minimally invasive surgery. The use of robotic technology allows for a wider range of indications for minimally invasive surgery.
Collapse
|
43
|
Buchs NC, Addeo P, Bianco FM, Gorodner V, Ayloo SM, Elli EF, Oberholzer J, Benedetti E, Giulianotti PC. Perioperative risk assessment in robotic general surgery: lessons learned from 884 cases at a single institution. ACTA ACUST UNITED AC 2012; 147:701-8. [PMID: 22508668 DOI: 10.1001/archsurg.2012.496] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess factors associated with morbidity and mortality following the use of robotics in general surgery. DESIGN Case series. SETTING University of Illinois at Chicago. PATIENTS AND INTERVENTION Eight hundred eighty-four consecutive patients who underwent a robotic procedure in our institution between April 2007 and July 2010. MAIN OUTCOMES MEASURES Perioperative morbidity and mortality. RESULTS During the study period, 884 patients underwent a robotic procedure. The conversion rate was 2%, the mortality rate was 0.5%, and the overall postoperative morbidity rate was 16.7%. The reoperation rate was 2.4%. Mean length of stay was 4.5 days (range, 0.2-113 days). In univariate analysis, several factors were associated with increased morbidity and included either patient-related (cardiovascular and renal comorbidities, American Society of Anesthesiologists score ≥ 3, body mass index [calculated as weight in kilograms divided by height in meters squared] <30, age ≥ 70 years, and malignant disease) or procedure-related (blood loss ≥ 500 mL, transfusion, multiquadrant operation, and advanced procedure) factors. In multivariate analysis, advanced procedure, multiquadrant surgery, malignant disease, body mass index of less than 30, hypertension, and transfusion were factors significantly associated with a higher risk for complications. American Society of Anesthesiologists score of 3 or greater, age 70 years or older, cardiovascular comorbidity, and blood loss of 500 mL or more were also associated with increased risk for mortality. CONCLUSIONS Use of the robotic approach for general surgery can be achieved safely with low morbidity and mortality. Several risk factors have been identified as independent causes for higher morbidity and mortality. These can be used to identify patients at risk before and during the surgery and, in the future, to develop a scoring system for the use of robotic general surgery
Collapse
|
44
|
Calatayud D, Milone L, Elli EF, Giulianotti PC. ICG-fluorescence identification of a small aberrant biliary canaliculus during robotic cholecystectomy. Liver Int 2012; 32:602. [PMID: 22292449 DOI: 10.1111/j.1478-3231.2012.02757.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
45
|
Ayloo SM, Buchs NC, Bianco FM, Giulianotti PC. Cost and validity of early postoperative contrast swallow after laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2012; 8:176-80. [DOI: 10.1016/j.soard.2011.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/26/2010] [Accepted: 02/02/2011] [Indexed: 11/17/2022]
|
46
|
Elli EF, Masrur MA, Giulianotti PC. Robotic sleeve gastrectomy after liver transplantation. Surg Obes Relat Dis 2012; 9:e20-2. [PMID: 22365186 DOI: 10.1016/j.soard.2012.01.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 01/15/2012] [Indexed: 12/11/2022]
|
47
|
Ayloo SM, Buchs NC, Addeo P, Bianco FM, Giulianotti PC. Traditional versus single-site placement of adjustable gastric banding: a comparative study and cost analysis. Obes Surg 2012; 21:815-9. [PMID: 20809350 DOI: 10.1007/s11695-010-0259-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In bariatric surgery, laparoscopic adjustable gastric banding (LAGB) has proven effective in reducing weight and improving obesity-associated comorbidities. Recently, however, laparoendoscopic single-site (LESS) surgery has been proposed to minimize the invasiveness of laparoscopic surgery. The aim of this study is to compare the operative cost and peri-operative outcomes of these two approaches. We undertook a retrospective review of a prospectively maintained database of patients undergoing either LAGB or LESS between March 2006 and October 2009. The outcomes and cost of 25 LESS gastric bandings were compared to 121 standard LAGB. Costs included operative time, consumables, and laparoscopic tower depreciation. Both groups had similar patient demographics, body mass index, and comorbidities; with the exception of age (37 year for single site vs. 44 years for standard; P=0.002). There were no statistical differences for operative time (78 vs. 76 min, P=0.69), blood loss (8.4 vs. 9 ml, P=0.76), pain score (0.81 vs. 0.84 at 1 week, P=0.95) or complication rates (12% vs. 14%, P=1). Length of stay was shorter for the LESS group (0.5 day vs. 1.5 days, P=0.02). The mean operative cost for the LESS banding was $20,502/case vs. $20,346/case for the standard LAGB, with no statistically significant difference between the approaches (P=0.73). Operative costs and peri-operative outcomes of LESS gastric banding are comparable with those of the standard LAGB procedure. As a result, single-site surgery can be proposed as a valid alternative to the standard procedure with cosmetic advantage and comparable complication rate.
Collapse
|
48
|
Ayloo SM, Masrur MA, Bianco FM, Giulianotti PC. Robotic Roux-en-Y Duodenojejunostomy for Superior Mesenteric Artery Syndrome: Operative Technique. J Laparoendosc Adv Surg Tech A 2011; 21:841-4. [DOI: 10.1089/lap.2011.0070] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
|
49
|
Giulianotti PC, Buchs NC, Addeo P, Ayloo S, Bianco FM. Robot-assisted partial and total splenectomy. Int J Med Robot 2011; 7:482-8. [PMID: 21954176 DOI: 10.1002/rcs.409] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND The interest of robotics in performing partial and total splenectomy is poorly reported so far. We report herein our experience. METHODS From November 2001 to November 2009, 24 consecutive robotic splenectomies were performed by the same surgeon. All data were prospectively collected and reviewed retrospectively. RESULTS Twelve men and 12 women with a median age of 48 years underwent a robotic splenectomy, three of which were partial splenectomies. The indications were: ABO incompatibility for kidney transplantation (n = 7), haematological disease (n = 7) and miscellaneous pathologies (n = 10). Mean operative time was 199 ± 65 min. Median blood loss was 75 (range 5-300) ml. There was one intraoperative complication and two conversions. The postoperative morbidity was 8.3% with no mortality. Median hospital stay was 5.5 days. CONCLUSIONS This series reports the safety and feasibility of robotic partial and total splenectomy. Its use as an alternative to the standard laparoscopic approach is particularly beneficial in more challenging cases.
Collapse
|
50
|
Giulianotti PC, Buchs NC, Coratti A, Sbrana F, Lombardi A, Felicioni L, Bianco FM, Addeo P. Robot-Assisted Treatment of Splenic Artery Aneurysms. Ann Vasc Surg 2011; 25:377-83. [DOI: 10.1016/j.avsg.2010.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 06/08/2010] [Accepted: 09/26/2010] [Indexed: 01/17/2023]
|