1
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Sánchez A, Rodríguez O, Medina M, Vegas L, Couto F, Mogollon I, Inchausti C, Galvis L. Is YouTube a reliable tool for approaching robotic assisted transabdominal preperitoneal surgery? A critical review of the available resources. Cir Esp 2024; 102:188-193. [PMID: 38224772 DOI: 10.1016/j.cireng.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/08/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION The robotic transabdominal preperitoneal approach (rTAPP) is a relatively recent technique for the treatment of inguinal hernia. To achieve optimal results, the 10 golden rules described must be followed. Surgeons in training often review videos to familiarize themselves with new techniques, YouTube being one of the most used platforms. The objective of this study is to carry out an evaluation of the 10 most viewed videos on YouTube of inguinal hernia repair by transabdominal preperitoneal approach (rTAPP) to determine if the 10 golden rules are met. METHODS Identify and evaluate the 10 videos with the highest number of views related to rTAPP. Three experienced Surgeons evaluated compliance with the 10 golden rules using a Likert scale. Data were analyzed in Excel (Microsoft) and plotted with Tableau (Tableau Inc). The consistency between evaluators was determined using Cronbach's alpha, considering a value >0.7 acceptable. RESULTS The average overall evaluation was 3.63 with a range of 2.6 to 4.9. The scores related to compliance with the rules 1, 2, 9, 10 were satisfactory; on the other hand, rules 3, 4, 5, 7 and 8 were weak, particularly rule number 7. Internal consistency was observed between raters with a Cronbach's alpha of 0.98. CONCLUSIONS The lack of compliance with the 10 golden rules in most of the videos demonstrates that the use of videos (YouTube) is not an adequate resource for learning robot-assisted inguinal hernia cure.
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Affiliation(s)
- Alexis Sánchez
- Director Programa de Cirugía Robótica. Orlando Health, Orlando, USA
| | - Omaira Rodríguez
- Programa de Cirugía Robótica, Hospital de Clínicas Caracas. Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | - Manuel Medina
- Departamento de Cirugía, Hospital Universitario del Henares, Madrid, Spain
| | - Liumariel Vegas
- Departamento de Cirugía, Hospital de Linares, Linares, Chile
| | - Francisco Couto
- Cirujano General, Grupo de Cirugía General. Orlando Health, Orlando, USA
| | - Ivan Mogollon
- Research Fellow, Programa de Cirugía Robótica ORMC, Orlando Health, Orlando, EE.UU
| | - Cristina Inchausti
- Research Fellow, Programa de Cirugía Robótica ORMC, Orlando Health, Orlando, EE.UU.
| | - Luz Galvis
- Unidad de Cirugía Robótica e Invasión minima, Caracas, Venezuela
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2
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Caballero A, Tarascó J, Moreno P, López-Vendrell L, Pellitero S, Martínez E, Bonet G, Balibrea JM. Implementation of a same-day discharge bariatric surgery program and follow-up with a telemonitoring platform. Cir Esp 2023; 101:841-846. [PMID: 37783382 DOI: 10.1016/j.cireng.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/05/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Some groups have initiated outpatient bariatric surgery programs in selected patients, publishing good results after sleeve gastrectomy. Recent studies show that outpatient surgery is also feasible and safe in Roux-en-Y gastric bypass. The aim of this paper is to describe and analyze the results of our initial experience after the implementation of a same-day discharge bariatric surgery program using a telemonitoring system. METHODS We have completed a prospective, observational study with 14 consecutive, selected patients undergoing primary bariatric surgery (sleeve gastrectomy or Roux-en-Y gastric bypass) at a single center from April 2021 to February 2023, with home follow-up using the REVITA® telemonitoring platform (HI Iberia, S.A.) and the Home Hospitalization Unit. RESULTS From April 2021 to February 2023, 14 patients were selected for this program, which meant 7.3% of the total of 191 patients who underwent bariatric surgery during this period. Ten out of the 14 patients selected completed the circuit (71.4%), 4 of whom consulted the emergency department within the first 24 h (40%). There were no serious complications, readmissions or re-operations typical of bariatric surgery. The estimated savings per patient who completed the circuit was 762. CONCLUSION Bariatric surgery without hospital admission is feasible and safe in selected patients using a telemonitoring platform and with the support of a home hospitalization unit.
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Affiliation(s)
- Albert Caballero
- Unidad de Cirugía Endocrino-Metabólica y Bariátrica, Hospital Universitario Germans Trias i Pujol, Spain; Universitat Autònoma de Barcelona, Spain.
| | - Jordi Tarascó
- Unidad de Cirugía Endocrino-Metabólica y Bariátrica, Hospital Universitario Germans Trias i Pujol, Spain; Universitat Autònoma de Barcelona, Spain
| | - Pau Moreno
- Unidad de Cirugía Endocrino-Metabólica y Bariátrica, Hospital Universitario Germans Trias i Pujol, Spain; Universitat Autònoma de Barcelona, Spain
| | - Laura López-Vendrell
- Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Spain
| | - Sílvia Pellitero
- Servicio de Endocrinología, Nutrición y Dietética. Hospital Universitario Germans Trias i Pujol, Spain
| | - Eva Martínez
- Servicio de Endocrinología, Nutrición y Dietética. Hospital Universitario Germans Trias i Pujol, Spain
| | - Glòria Bonet
- Unidad de Hospitalización Domiciliaria, Hospital Universitario Germans Trias i Pujol, Spain
| | - José M Balibrea
- Unidad de Cirugía Endocrino-Metabólica y Bariátrica, Hospital Universitario Germans Trias i Pujol, Spain; Universitat Autònoma de Barcelona, Spain; Cátedra de Investigación en Cirugía iVascular-UAB, Spain
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3
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Acosta-Mérida MA. DATA GOVERNANCE in digital surgery. Cir Esp 2023:S2173-5077(23)00237-5. [PMID: 38042295 DOI: 10.1016/j.cireng.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/12/2023] [Indexed: 12/04/2023]
Abstract
Technological and computer advances have led to a "new era" of Surgery called Digital Surgery. In it, the management of information is the key. The development of Artificial Intelligence requires "Big Data" to create its algorithms. The use of digital technology for the systematic capture of data from the surgical process raises ethical issues of privacy, property, and consent. The use of these out-of-control data creates uncertainty and can be a source of mistrust and refusal by surgeons to allow its use, requiring a framework for the correct management of them. This paper exposes the current situation of Data Governance in Digital Surgery, the challenges posed and the lines of action necessary to resolve the areas of uncertainty that have arisen in the process, in which the surgeon must play a relevant role.
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Affiliation(s)
- María Asunción Acosta-Mérida
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
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Ballesta Martinez B, Kallidonis P, Tsaturyan A, Peteinaris A, Faitatziadis S, Gkeka K, Tatanis V, Vagionis A, Pagonis K, Obaidat M, Anaplioti E, Haney C, Vrettos T, Liatsikos E. Transfer of acquired practical skills from dry lab into live surgery using the avatera robotic system: An experimental study. Actas Urol Esp 2023; 47:611-617. [PMID: 37574013 DOI: 10.1016/j.acuroe.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To evaluate the transfer of the practical skills of robot-assisted surgery acquired in the dry-lab into a real live experimental setting for performing upper and lower urinary tract surgeries. MATERIAL AND METHODS An in vivo experimental study design was utilized. Six urology trainees and fellows; two 2nd year trainees with no previous exposure to laparoscopic surgery (Group 1), two 4th year residents with medium exposure to laparoscopic surgery (Group 2) and two fellows trained to perform laparoscopic surgeries (Group 3) performed ureteral reimplantation into the bladder, pyeloplasty, and radical nephrectomy on three female pigs under general anesthesia. Prior to performing the requested procedures, each participant completed 10-14 h dry-lab robotic training acquiring skills in basic surgical tasks, such as suturing, cutting and needle passage. The recorded variables were the successful completion of the procedures, the console time, and the time to perform different steps and major complications. RESULTS All procedures were completed successfully by all groups except the pyeloplasty by group 1 which was complicated by bleeding from the renal vein, and the procedure was abandoned. Group 3 achieved shorter console time for all successfully completed procedures and for separate surgical steps compared to all groups, followed by Group 2. The slowest group for all procedures and steps analyzed was Group 3. CONCLUSIONS Although further clinical evidence is needed, the robotic-assisted urological procedures and the most challenging steps could be performed safely and effectively after proper training in the dry lab under mentor supervision according to our study.
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Affiliation(s)
- B Ballesta Martinez
- Department of Urology, University of Patras, Patras, Greece; Department of Urology, Hospital Vinalopó, Elche, Spain
| | - P Kallidonis
- Department of Urology, University of Patras, Patras, Greece
| | - A Tsaturyan
- Department of Urology, University of Patras, Patras, Greece
| | - A Peteinaris
- Department of Urology, University of Patras, Patras, Greece
| | - S Faitatziadis
- Department of Urology, University of Patras, Patras, Greece
| | - K Gkeka
- Department of Urology, University of Patras, Patras, Greece
| | - V Tatanis
- Department of Urology, University of Patras, Patras, Greece
| | - A Vagionis
- Department of Urology, University of Patras, Patras, Greece
| | - K Pagonis
- Department of Urology, University of Patras, Patras, Greece
| | - M Obaidat
- Department of Urology, University of Patras, Patras, Greece
| | - E Anaplioti
- Department of Urology, University of Patras, Patras, Greece
| | - C Haney
- Department of Urology, University Hospital of Leipzig, Leipzig, Germany
| | - T Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - E Liatsikos
- Department of Urology, University of Patras, Patras, Greece; Department of Urology, Medical University of Vienna, Vienna, Austria.
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Espin Alvarez F, García-Domingo MI, Cremades Pérez M, Pardo Aranda F, Vidal Piñeiro L, Herrero Fonollosa E, Navinés López J, Zárate Pinedo A, Camps-Lasa J, Cugat Andorrà E. Laparoscopic and robotic distal pancreatectomy: the choice and the future. Cir Esp 2023; 101:765-771. [PMID: 37119949 DOI: 10.1016/j.cireng.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/03/2023] [Accepted: 02/21/2023] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Distal pancreatectomy (DP) is currently well established as a minimally invasive surgery (MIS) procedure, using either a laparoscopic (LDP) or robotic (RDP) approach. METHODS Out of 83 DP performed between January 2018 and March 2022, 57 cases (68.7%) were performed using MIS: 35 LDP and 22 RDP (da Vinci Xi). We have assessed the experience with the two techniques and analyzed the value of the robotic approach. Cases of conversion have been examined in detail. RESULTS The mean operative times for LDP and RDP were 201.2 (SD 47.8) and 247.54 (SD 35.8) minutes, respectively (P = NS). No differences were observed in length of hospital stay or conversion rate: 6 (5-34) vs. 5.6 (5-22) days, and 4 (11.4%) vs. 3 (13.6%) cases, respectively (P = NS). The readmission rate was 3/35 patients (11.4%) treated with LDP and 6/22 (27.3%) cases of RDP (P = NS). There were no differences in morbidity (Dindo-Clavien ≥ III) between the two groups. Mortality was one case in the robotic group (a patient with early conversion due to vascular involvement). The rate of R0 resection was greater and statistically significant in the RDP group (77.1% vs. 90.9%) (P = .04). CONCLUSION Minimally invasive distal pancreatectomy (MIDP) is a safe and feasible procedure in selected patients. Surgical planning and stepwise implementation based on prior experience help surgeons successfully perform technically demanding procedures. RDP could be the approach of choice in distal pancreatectomy, and it is not inferior to LDP.
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Affiliation(s)
- Francisco Espin Alvarez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain.
| | - María Isabel García-Domingo
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Manel Cremades Pérez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Fernando Pardo Aranda
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Laura Vidal Piñeiro
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Eric Herrero Fonollosa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Jordi Navinés López
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Alba Zárate Pinedo
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Judith Camps-Lasa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Esteban Cugat Andorrà
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain; Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
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6
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Alonso Casado O, Nuñez Mora C, Ortega Pérez G, López Rojo I. Robotic pelvic exenteration in males: systematization of the technique. Cir Esp 2023; 101:555-560. [PMID: 37487944 DOI: 10.1016/j.cireng.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/08/2023] [Indexed: 07/26/2023]
Abstract
Male pelvic exenteration is a challenging procedure with high morbidity. In very selected cases, the robotic approach could make dissection easier and decrease morbidity due to the better vision provided and higher range of movements. In this paper, we describe port placement, instruments, minilaparotomy location, and the stepwise sequence of these procedures. We address 3 different situations: total pelvic exenteration with abdominoperineal resection, colostomy and urostomy; pelvic exenteration with colorectal/anal anastomosis and urostomy; and pelvic exenteration with abdominoperineal resection, colostomy and urinary tract reconstruction.
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Affiliation(s)
- Oscar Alonso Casado
- Unidad de Oncología Quirúrgica Digestiva, MD Anderson Cancer Center, Madrid, Spain.
| | | | - Gloria Ortega Pérez
- Unidad de Oncología Quirúrgica Digestiva, MD Anderson Cancer Center, Madrid, Spain
| | - Irene López Rojo
- Unidad de Oncología Quirúrgica Digestiva, MD Anderson Cancer Center, Madrid, Spain
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7
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Andreou C, Maksimovic S, Riboni C, Eisner L, Kudsi OY, Dietz UA. Laparoscopic TAPP to treat inguinal hernia. Is the robot preferable? A review and cohort-study on anatomical landmarks of robotic-assisted transabdominal preperitoneal groin hernia repair (r-TAPP). Cir Esp 2023; 101 Suppl 1:S3-S10. [PMID: 38042590 DOI: 10.1016/j.cireng.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/14/2023] [Indexed: 12/04/2023]
Abstract
In this review, the advantages of the robotic platform in rTAPP are presented and discussed. Against the background of the unchanged results of conventional TAPP for decades (approx. 10% chronic pain and approx. 3.5% recurrence), a new anatomy-guided concept for endoscopic inguinal hernia repair with the robot is presented. The focus is on the identification of Hesselbach's ligament. The current results give hope that the results of TAPP can be improved by rTAPP and that rTAPP is not just a more expensive version of conventional TAPP. To support the rationale presented here, we analyzed 132 video recordings of rTAPP's for the anatomical structures depicted therein. The main finding is, that in all cases (132/132 or 100%) Hesselbach's ligament was present and following its lateral continuity with the ileopubic tract offered a safe framework to develop all the critical anatomical structures for clearing the myopectineal orifice, repair the posterior wall of the groin and perform a flawless mesh fixation. Future studies are needed to integrate all the resources of the robotic platform into an rTAPP concept that will lead out of the stalemate of the indisputably high rate of chronic pain and recurrences.
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Affiliation(s)
- Christos Andreou
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, CH-4600 Olten, Switzerland
| | - Sladjana Maksimovic
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, CH-4600 Olten, Switzerland
| | - Cristiana Riboni
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, CH-4600 Olten, Switzerland
| | - Lukas Eisner
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, CH-4600 Olten, Switzerland
| | - Omar Yusef Kudsi
- Department of Surgery, Good Samaritan Medical Center, 235 North Pearl St., Brockton, MA 02301, USA
| | - Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, CH-4600 Olten, Switzerland.
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Morales-Conde S, Balla A, Navarro-Morales L, Moreno-Suero F, Licardie E. Is laparoscopic TAPP the preferred approach for the treatment of inguinal hernia? Technique, indications and future perspectives. Cir Esp 2023; 101 Suppl 1:S11-S18. [PMID: 37951466 DOI: 10.1016/j.cireng.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/14/2023] [Indexed: 11/14/2023]
Abstract
The repair of inguinal hernia is one of the most frequently performed surgeries in General Surgery units. The laparoscopic approach for these hernias will be clearly considered as the gold standard, based on its advantages over the open approach. There are no clear advantages of the transabdominal preperitoneal approach (TAPP) over the totally preperitoneal approach (TEP), although it has been shown to be more reproducible, presenting a shorter learning curve, although it presents more possibilities of developing trocar site hernias. Laparoscopic TAPP could be superior to TEP in the following indications: incarcerated hernias, emergencies, previous preperitoneal surgery, previous Pfanestiel-type incision, recurrent hernias, inguinoscrotal hernias and obese, being also a better alternative for females. Robotic TAPP is a safe approach with similar results to laparoscopy; however, it is related to an increase in costs and operating time. The value of this technology for the repair of complex hernias (multiple recurrences, inguino-scrotal or after previous preperitoneal surgery) remains to be determined, since they represent a certain challenge for the conventional laparoscopic approach. On the other hand, robotic repair of inguinal hernias may be a way to reduce the learning curve before addressing complex ventral hernias. Finally, artificial intelligence applied to the laparoscopic approach to inguinal hernia will undoubtedly have a significant impact in the future especially to determine the best the indications for this approach, on the performance of a safer technique, on the correct selection of meshes and fixation mechanisms, and on learning curve.
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Affiliation(s)
- Salvador Morales-Conde
- Unidad de Innovación de Cirugía Mínimamente Invasiva, Servicio de Cirugía General y del Aparato Digestivo del Hospital Virgen del Rocío, Sevilla, Spain; Servicio de Cirugía General y del Aparato Digestivo, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain
| | - Andrea Balla
- Unidad de Innovación de Cirugía Mínimamente Invasiva, Servicio de Cirugía General y del Aparato Digestivo del Hospital Virgen del Rocío, Sevilla, Spain
| | - Laura Navarro-Morales
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain
| | - Francisco Moreno-Suero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain
| | - Eugenio Licardie
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain; Servicio de Cirugía General y del Aparato Digestivo, Hospital Infanta Elena, Huelva, Spain.
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9
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Alberich Prats M, Bettonica Larrañaga C, Miró Martín M, Aranda Danso H, Estremiana García F, Farran Teixidor L. Robotic surgery for the treatment of achalasia. Cir Esp 2022; 100:410-415. [PMID: 35550447 DOI: 10.1016/j.cireng.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/17/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe the experience of the robotic approach for achalasia surgery in a tertiary center. MATERIAL AND METHODS Patients with achalasia who underwent robotic surgery between May 2010 and April 2019 were analyzed. The study variables were collected in a prospective database and a descriptive analysis was performed. RESULTS 45 patients (55.6% male) with a mean age of 44 years were included. The main symptom at diagnosis was dysphagia. 19 patients (42.2%) received endoscopic treatment prior to surgery, mostly pneumatic dilation (84.2%). Heller's myotomy associated with Toupet fundoplication was the surgical technique of choice, with a mean operative time of 211 min. The average stay was 5 days. There were 2 postoperative perforations (4.4%). Perioperative mortality was 0%. The mean follow-up was 64 months. At 3 and 5 years, a significant decrease in the Eckardt score was observed and the manometric study showed a decrease in the lower esophageal sphincter pressure at rest of 58% and 70%, respectively, with persistence of hypomotility of the esophageal body. Pathological gastroesophageal reflux was diagnosed in two patients (5.4%) and 4 (10.8%) presented recurrence of symptoms, requiring endoscopic pneumatic dilations. In 2 cases, the dilations were not effective, so an endoscopic myotomy was considered. CONCLUSIONS In our experience, robotic surgery is a safe and effective procedure for the treatment of achalasia.
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Affiliation(s)
- Marta Alberich Prats
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
| | - Carla Bettonica Larrañaga
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica Miró Martín
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Humberto Aranda Danso
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando Estremiana García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Leandre Farran Teixidor
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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10
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Valdés Olmos R, Vidal-Sicart S, Fuertes Cabero S, Goñi Gironés E, Paredes P. Interventional nuclear medicine's contribution to molecularly targeted precision surgery. Rev Esp Med Nucl Imagen Mol 2022; 41:179-187. [PMID: 35484078 DOI: 10.1016/j.remnie.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022]
Abstract
The surgical approach to different pathologies, not only oncological, has evolved. As Veronesi's group has coined very graphically, we are moving from "maximum tolerable treatments to minimum effective treatments" and this journey cannot be carried out in any other way than through a multidisciplinary and multimodality approach. Multidisciplinary, because collaboration between surgeons, oncologists, radiologists, nuclear physicians, pathologists, and all those involved in patient follow-up is necessary, and multimodality, because we must move towards precision surgery tailored to each patient in which, on the part of Nuclear Medicine, hybrid imaging (SPECT/CT and PET/CT), bimodal tracers, the use of new allies such as ultrasound or our own adaptation to robotic surgery have a great deal to say. A wide range of possibilities is built on the solid foundation of preoperative scintigraphy, which makes it possible to identify the target tissues and whose knowledge prior to surgery allows the necessary surgical approach to be considered for each patient.
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Affiliation(s)
- R Valdés Olmos
- Interventional Molecular Imaging Laboratory and Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - S Vidal-Sicart
- Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, Spain; Servicio de Medicina Nuclear, Imatge Mèdica Intercentres S. L. (IMI), Parc de Salut Mar, Barcelona, Spain
| | - S Fuertes Cabero
- Servicio de Medicina Nuclear, Hospital Vall d'Hebron, Barcelona, Spain
| | - E Goñi Gironés
- Servicio de Medicina Nuclear, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - P Paredes
- Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, Spain; Facultad de Medicina, Universitat de Barcelona (UB), Barcelona, Spain.
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Moreno Llorente P, Francos Martínez JM, García Barrasa A, Pascua Solé M. Transoral endoscopic thyroidectomy vestibular approach (TOETVA). Cir Esp 2022; 100:234-239. [PMID: 35431161 DOI: 10.1016/j.cireng.2022.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/16/2021] [Indexed: 06/14/2023]
Abstract
Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is a novel technique that allows the thyroid to be approached without visible scars, as it is performed through a natural orifice. It was first described and developed in Asia where due to sociocultural reasons neck scars are considered a stigma. This technique, as we now nowadays, and its preliminary results, were first reported by Angkoon Anuwong in August 2015 at the International Association of Endocrine Surgeons (IAES) world surgery congress held in Bangkok. Here we present the TOETVA approach, step-by-step, in order it could be safely replicated, aiming also it can be spread within the therapeutic framework of endocrine surgery. However, it is important to remark that, as happens in most of remote approaches, it is only suitable for a small percentage of patients.
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Affiliation(s)
- Pablo Moreno Llorente
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - José Manuel Francos Martínez
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arantxa García Barrasa
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mireia Pascua Solé
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain
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12
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García-Baquero R, Fernández-Ávila CM, Salvatierra Pérez C, García Álvarez TM, Ledo Cepero MJ, Álvarez-Ossorio Fernández JL. [Living-donor renal transplant. State of the art.]. ARCH ESP UROL 2021; 74:979-990. [PMID: 34851313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Living donor kidney transplantation is the best therapeutic option in a patient with end-stage renal failure, because it provides excellent functionality and graft survival. Laparoscopic living donor nephrectomyis the gold-standard for obtaining the graft. In exper thands, different minimally invasive surgeries can be offered with the main advantage of improving the a esthetic results. Although there may be controversy regarding laparoscopic devices for vascular ligation during living donor nephrectomy, both endostaplers and locking clips have proven to be safe as long as the proper techniqueis performed. Living donor nephrectomy has minimal morbidity and mortality. Age and glomerular filtration rate of the donor candidate are prognostic factor of long-term renal failure. In relation to the implant surgery,robotic kidney transplantation is now probably at the beginning of its development. Published series still do not allow to clearly establish its role compared to conventional open surgery.
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13
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Territo A, Diana P, Gaya JM, Gallioli A, Piana A, Breda A. Robot-assisted kidney transplantation: State of art. ARCH ESP UROL 2021; 74:970-978. [PMID: 34851312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Nowadays, Robotic assistedkidney transplantation (RAKT) is considered a lessinvasive alternative to the Open Kidney Transplantation(OKT) with several advantages such as image magnification,3D vision and articulated instruments and with arelatively short learning curve for an experienced surgeon.RAKT has shown comparable outcomes with theOKT literature data in terms of surgical and functionalresults. RAKT may decrease the complication rate, meanhospital stay, postoperative pain, and also improve aestheticoutcomes. The aim of this study was to perform asystematic review of the literature on this novel approachof KT. MATERIALS AND METHODS A systematic review was performed in accordance with the Preferred ReportingItems for Systematic Reviews and Meta-Analyses (PRISMA)statement. The search was conducted using the databases PubMed/Medline, including as outcomes: (1) indications, (2) step-by-step technique for RAKT, (3) RAKT in special cases (4) surgical and functional outcomes,and (5) future perspectives in RAKT. RESULTS The indications for RAKT are expanding, sothat including obese recipients, graft with multiple vesselsand graft from deceased donor. To date, the two absolute contraindications to RAKT are patients unfitfor pneumoperitoneum and presenting advanced atheromatic plaques where vessel clamping could result challenging. As far as the outcomes, the surgical and functional results are in line with the OKT experience.Complication rate is low in RAKT, particularly in terms of arterial and venous thrombosis (1%), lymphocele (3%),ureteral stricture (2%), and wound infection (0.3%). Arobotic assisted kidney auto-transplantation (RAKAT) has been recently described, as novel approach in case of complex proximal benign ureteral stenosis. Despite great advances in this field, some limits still need to be approached such as the modality to main tain the graft to a constant low temperature ( <20 ºC) and to find the proper location of arteriotomy in advanced atheromatic disease without the tactile feedback. CONCLUSION The present review has confirmed that RAKT is as safe and feasible as OKT with comparable surgical and functional results. Complication rate is lower in RAKT than OKT and the indications are expanding quickly. Furthermore, new technologies are being introduced in order to improve the surgical performances and to expand more the indications for robotic surgery.However, a prospective randomized study in order to compare RAKT versus OKT is still required.
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Affiliation(s)
- Angelo Territo
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona. Spain
| | - Pietro Diana
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona. Spain. Department of Urology. Humanitas Clinical and Research Institute IRCCS. Rozzano. Italy
| | - Josep M Gaya
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona. Spain
| | - Andrea Gallioli
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona. Spain
| | - Alberto Piana
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona. Spain. Department of Urology. Humanitas Clinical and Research Institute IRCCS. Rozzano. Italy. Department of Urology. San Luigi Gonzaga Hospital. University of Turin. Orbassano. Italy
| | - Alberto Breda
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona. Spain
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Muysoms F, Nachtergaele F, Pletinckx P, Dewulf M. ROBotic Utility for Surgical Treatment of hernias (ROBUST hernia project). Cir Esp 2021; 99:629-634. [PMID: 34749923 DOI: 10.1016/j.cireng.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 10/19/2022]
Abstract
We describe the evolution in hernia repair approaches in our practice during the first 3 years of adopting robotic assisted laparoscopic surgery. For inguinal hernia repair, we began using the robotic platform for complex hernias, and the use of open repair decreased from 17% to 6%. For primary ventral hernias, open procedures decreased from 59% to 10% and for incisional ventral hernias, from 48% to 11%. Moreover, a large shift in mesh position for ventral hernias was seen, with an increase of the retromuscular position from 20% to 82% and a decrease of intraperitoneal mesh position from 48% to 10%. The robotic platform seems to hold a significant potential for complex inguinal hernias, in addition to ventral and incisional hernias which require component separation. A shorter hospital stay and less postoperative complications might make the adoption of the robotic platform for abdominal wall surgery a valuable proposition.
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Affiliation(s)
- Filip Muysoms
- Department of Surgery, Maria Middelares Ghent, Belgium.
| | | | | | - Maxime Dewulf
- Department of Surgery, Maria Middelares Ghent, Belgium; Department of Hepatobiliary Surgery, Maastricht UMC+, The Netherlands
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15
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Moreno Llorente P, Francos Martínez JM, García Barrasa A, Pascua Solé M. Transoral endoscopic thyroidectomy vestibular approach (TOETVA). Cir Esp 2021; 100:S0009-739X(21)00247-5. [PMID: 34538620 DOI: 10.1016/j.ciresp.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/23/2022]
Abstract
Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is a novel technique that allows the thyroid to be approached without visible scars, as it is performed through a natural orifice. It was first described and developed in Asia where due to sociocultural reasons neck scars are considered a stigma. This technique, as we now nowadays, and its preliminary results, were first reported by Angkoon Anuwong in August 2015 at the International Association of Endocrine Surgeons (IAES) world surgery congress held in Bangkok. Here we present the TOETVA approach, step-by-step, in order it could be safely replicated, aiming also it can be spread within the therapeutic framework of endocrine surgery. However, it is important to remark that, as happens in most of remote approaches, it is only suitable for a small percentage of patients.
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Affiliation(s)
- Pablo Moreno Llorente
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España.
| | - José Manuel Francos Martínez
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - Arantxa García Barrasa
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - Mireia Pascua Solé
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
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Vásquez-Lastra C, Decanini-Terán C, Maffuz-Aziz A, Alfaro-Alfaro J, Huante-Pérez JA, Wolpert-Barraza E, Sánchez-Marle LF, Gutiérrez-Hernández A. Robotic surgery at ABC Medical Center: first 500 procedures experience. GAC MED MEX 2021; 157:181-186. [PMID: 34270532 DOI: 10.24875/gmm.m21000545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Robotic surgery is a technological advance that is used in multiple surgical specialties in the world. Its acceptance in various areas has been supported by comparative studies with laparoscopic surgery and open surgery. Objective To document the robotic surgery program initial experience in a private hospital of Mexico City by analyzing its results and complications. Material and method The first 500 robotic surgeries practiced at ABC Medical Center were included, covering a three-year period (January 2017 to December 2019). The following was documented: specialties involved, surgeries broken down by specialty and type of surgery, surgical times, complications and number of doctors involved in the initial experience. Results Out of 500 patients, 367 (73.4 %) were males and 133 (26.4 %) were females. The three most common surgeries were radical prostatectomy (269), hysterectomy (64) and inguinal repair (33). Average age was 58 years (range: 18 to 90 years). A total of 40 certified surgeons from five specialties performed all the procedures. Conclusions Starting a program in a private medical center has several implications. The creation of a robotic surgery committee made up of certified robotic surgery specialists from each specialty and hospital authorities for the accreditation of guidelines for both certification and recertification of their doctors can benefit programs like ours by creating a center of excellence in robotic surgery and thus reduce complications and improve results.
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17
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Alberich Prats M, Bettonica Larrañaga C, Miró Martín M, Aranda Danso H, Estremiana García F, Farran Teixidor L. Robotic surgery for the treatment of achalasia. Cir Esp 2021; 100:S0009-739X(21)00161-5. [PMID: 34059311 DOI: 10.1016/j.ciresp.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/09/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe the experience of the robotic approach for achalasia surgery in a tertiary center. MATERIAL AND METHODS Patients with achalasia who underwent robotic surgery between May 2010 and April 2019 were analyzed. The study variables were collected in a prospective database and a descriptive analysis was performed. RESULTS 45 patients (55.6% male) with a mean age of 44 years were included. The main symptom at diagnosis was dysphagia. 19 patients (42.2%) received endoscopic treatment prior to surgery, mostly pneumatic dilation (84.2%). Heller's myotomy associated with Toupet fundoplication was the surgical technique of choice, with a mean operative time of 211minutes. The average stay was 5 days. There were 2 postoperative perforations (4.4%). Perioperative mortality was 0%. The mean follow-up was 64 months. At 3 and 5 years, a significant decrease in the Eckardt score was observed and the manometric study showed a decrease in the lower esophageal sphincter pressure at rest of 58% and 70%, respectively, with persistence of hypomotility of the esophageal body. Pathological gastroesophageal reflux was diagnosed in two patients (5.4%) and 4 (10.8%) presented recurrence of symptoms, requiring endoscopic pneumatic dilations. In 2 cases, the dilations were not effective, so an endoscopic myotomy was considered. CONCLUSIONS In our experience, robotic surgery is a safe and effective procedure for the treatment of achalasia.
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Affiliation(s)
- Marta Alberich Prats
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España.
| | - Carla Bettonica Larrañaga
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Mónica Miró Martín
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Humberto Aranda Danso
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Fernando Estremiana García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Leandre Farran Teixidor
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
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18
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Muysoms F, Nachtergaele F, Pletinckx P, Dewulf M. ROBotic Utility for Surgical Treatment of hernias (ROBUST hernia project). Cir Esp 2021; 99:S0009-739X(21)00038-5. [PMID: 33602554 DOI: 10.1016/j.ciresp.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
We describe the evolution in hernia repair approaches in our practice during the first 3 years of adopting robotic assisted laparoscopic surgery. For inguinal hernia repair, we began using the robotic platform for complex hernias, and the use of open repair decreased from 17% to 6%. For primary ventral hernias, open procedures decreased from 59% to 10% and for incisional ventral hernias, from 48% to 11%. Moreover, a large shift in mesh position for ventral hernias was seen, with an increase of the retromuscular position from 20% to 82% and a decrease of intraperitoneal mesh position from 48% to 10%. The robotic platform seems to hold a significant potential for complex inguinal hernias, in addition to ventral and incisional hernias which require component separation. A shorter hospital stay and less postoperative complications might make the adoption of the robotic platform for abdominal wall surgery a valuable proposition.
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Affiliation(s)
- Filip Muysoms
- Department of Surgery, Maria Middelares Ghent, Belgium.
| | | | | | - Maxime Dewulf
- Department of Surgery, Maria Middelares Ghent, Belgium; Department of Hepatobiliary Surgery, Maastricht UMC+, The Netherlands
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19
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Luna R, Luna-Jaspe C, Pérez-Hoyos AK, Cabrera LF, Pedraza M, Pudilo JA, Padilla LT, Santafé M, Aparicio S. Reparación de hernias paraesofágicas gigantes asistida por robot en un hospital de cuarto nivel en Bogotá, Colombia, Clínica Shaio: serie de casos y revisión de la literatura. CIR CIR 2020; 88:732-737. [PMID: 33254194 DOI: 10.24875/ciru.19001664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Giant paraesophageal hernias have a surgical indication in case of symptoms. Since twenty years ago robot-assisted repair was incorporated to overcome the limitations of the laparoscopic surgery, and to offer new advantages. Objective To report the experience on repairing giant paraesophageal hernias assisted by robot in a fourth level hospital in Bogotá, Colombia, Shaio Clinic. Method Retrospective and descriptive study of five cases of giant paraesophageal hernia type III or IV, taken to robotic correction during August 2016 to June 2018. Evaluation of post-surgery outcomes. Results Five paraesophageal robot-assisted repair were performed. Mean surgical time was 146 minutes, one conversion to open surgery, the average intraoperative bleeding was 100 mL, hospital stay time of 2.2 days. Morbidity, mortality and recurrence percentages in the short time were equal to 0%. Conclusions Robot-assisted repair of giant paraesophageal hernias, has shown advantages that overcome the limitations of the laparoscopic approach such as dissections in difficult-to-reach angles, increased accuracy, ergonomics, three-dimensional, and closer view of the workspace. In addition, robot-assisted repair promotes better surgical and postoperative outcomes; these advantages have been demonstrated mainly in the repair of giant paraesophageal hernias.
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Affiliation(s)
- Rubén Luna
- Departamento de Cirugía General, de Trasplantes y Robótica, Clínica Shaio, Colombia.,Escuela de Medicina, Universidad El Bosque, Clínica Shaio, Colombia
| | - Carlos Luna-Jaspe
- Escuela de Medicina, Universidad El Bosque, Clínica Shaio, Colombia.,Departamento de Cirugía General y Bariátrica, Clínica Shaio, Colombia
| | - Angie K Pérez-Hoyos
- Escuela de Medicina, Universidad El Bosque, Clínica Shaio, Colombia.,Departamento de Cirugía General, Universidad El Bosque. Bogotá, Colombia
| | - Luis F Cabrera
- Escuela de Medicina, Universidad El Bosque, Clínica Shaio, Colombia.,Departamento de Cirugía General, Los Cobos Medical Center. Bogotá, Colombia
| | - Mauricio Pedraza
- Escuela de Medicina, Universidad El Bosque, Clínica Shaio, Colombia.,Departamento de Cirugía General, Universidad El Bosque. Bogotá, Colombia
| | - Jean A Pudilo
- Escuela de Medicina, Universidad El Bosque, Clínica Shaio, Colombia.,Departamento de Cirugía General, Universidad El Bosque. Bogotá, Colombia
| | - Laura T Padilla
- Escuela de Medicina, Universidad El Bosque, Clínica Shaio, Colombia.,Departamento de Cirugía Pediátrica, Hospital de la Misericordia. Bogotá, Colombia
| | - Marcia Santafé
- Escuela de Medicina, Universidad El Bosque, Clínica Shaio, Colombia.,Departamento de Cirugía General, Universidad El Bosque. Bogotá, Colombia
| | - Steven Aparicio
- Escuela de Medicina, Universidad El Bosque, Clínica Shaio, Colombia.,Departamento de Cirugía General, Universidad El Bosque. Bogotá, Colombia
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20
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Rodrigues V, López-Cano M. TARUP technique. Advantages of minimally invasive robot-assisted abdominal Wall surgery. Cir Esp 2020; 99:302-305. [PMID: 33223122 DOI: 10.1016/j.ciresp.2020.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/26/2020] [Accepted: 10/11/2020] [Indexed: 11/28/2022]
Abstract
The use of robot-assisted minimally invasive surgery in ventral/incisional hernia repair has increased exponentially in recent years. This increase is probably related to the advantages of robotic surgery, among which are better visualization, the implementation of articulated instruments and better ergonomics for the surgeon. The TARUP (Robotic Transabdominal Retromuscular Umbilical Prosthetic Hernia Repair) technique combines the benefits of minimally invasive surgery, in terms of less wound-related morbidity, also allowing the placement of a mesh in a retromuscular position facilitated by the use of the robotic platform.
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Affiliation(s)
- Victor Rodrigues
- Unidad de Cirugía de Pared Abdominal, Hospital Universitario Vall d'Hebron, Universidad Autonóma de Barcelona, Barcelona, España
| | - Manuel López-Cano
- Unidad de Cirugía de Pared Abdominal, Hospital Universitario Vall d'Hebron, Universidad Autonóma de Barcelona, Barcelona, España.
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21
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García-Jiménez ML, Castro-Diez L, Aguirrezabalaga-González J, Noguera-Aguilar JF. Robotic-like suturing with FlexDex Surgical System® for difficult laparoscopic suture. Cir Esp 2021; 99:222-8. [PMID: 33198944 DOI: 10.1016/j.ciresp.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/02/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
The field of laparoscopic surgery has experienced an exponential growth in recent years. Despite great progress in this field, standard laparoscopic tools have not been optimally developed and still has some deficiencies when it comes to mobility and ergonomics. Robotic surgery has attempted to solve these problems by improving the articulation of surgical instruments. However, it presents a series of disadvantages, among which are its high cost, low availability and the need of a specific training, which conditions its profitability and hinders a widespread use. We present the results of a prospective clinical series of 20 cases in which the safety, efficacy and ergonomics of FlexDex® have been tested for performing laparoscopic intracorporeal sutures. The result is a safe and functional tool that offers both control and precision in its handling, while improves the ergonomics of the surgeon. This device represents an alternative that combines the precision and range of movements of robotic surgery with the greater availability of conventional laparoscopy.
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22
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Moreno Llorente P, A Gonzales Laguado E, Alberich Prats M, Francos Martínez JM, García Barrasa A. Surgical approaches to thyroid. Cir Esp 2020; 99:267-275. [PMID: 33069356 DOI: 10.1016/j.ciresp.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 01/03/2023]
Abstract
Thyroidectomy is the most frequent procedure in endocrine surgery. The conventional approach through a collar incision, as described by Kocher in XIXth century, has become the "gold standard". It is continuously evolving in spite of, many years ago, it showed to be safe and efficient with quality standards difficult to beat. Endoscopic and robotic surgery have developed "new approaches" to thyroid in order to improve the cosmetic results, looking even for invisible scars. We have done a thoughtful review of most of them trying to understand their benefits and drawbacks. Currently none of these "new approaches" have been shown to be better than conventional open thyroidectomy beyond offering a better cosmetic result. Besides, only a small percentage of patients can benefit of them. However, most of these approaches will remain if they treat the diseased thyroid and also improve the quality of life of our patients.
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Affiliation(s)
- Pablo Moreno Llorente
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España.
| | - Erick A Gonzales Laguado
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - Marta Alberich Prats
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - José Manuel Francos Martínez
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - Arantxa García Barrasa
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
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23
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Carracedo D, Alcaraz A, Allona A, Gutierrez JL, López-Fando L, Medina RA, Moncada I, Moreno J, Palou J, Pereira JG, Ruibal M, Sánchez MD, Trilla E, Sánchez M. [Robotic and laparosocpic urological surgery during COVID-19 pandemia.]. ARCH ESP UROL 2020; 73:463-470. [PMID: 32538818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE SARS-CoV-2 pandemic hashigh repercussion on urologic minimally invasive surgery (MIS). Controversy about safety of MIS procedures during COVID-19 pandemic has been published. Nowadays, our priority should be create agreement in order to restart and organize MIS with safety conditions for patients and healthcare workers. METHODS: Pubmed and web search was conducted with following terms: "SARS-CoV-2", "COVID19", "COVID19 Urology", COVID19 Surgery", "COVID19 transmission", "SARS-CoV-2 transmission", "COVID19 nd minimally invasive surgery", "SARS-CoV-2 and CO 2insuflation". A narrative review of available literature and scientific evidence summary was done. A modify nominal group technique was used to achieve an expert consensus. First draft was circulated amongst authors. Definitive document was approved in May 26th. RESULTS: Non evidence supports higher risk of SARSCoV-2 healthcare workers infection with MIS compared to open surgery. MIS is associated with shorter hospital stay than open surgery. Modify MIS indications to open surgery, with no scientific evidence, could spend valuable resources in detriment to COVID-19 patients. MIS indications should be prioritized attending to available resources and pandemic intensity. SARS-CoV-2screening 72 hours prior to surgery by clinical and epidemiological questionnaire and nasopharyngeal PCRis recommended, in order to prevent nosocomial transmission, professional infections and to minimize postoperative complications. Intraoperative steps should be established to reduce professional exposure to surgical aerosols, including: surgical room reorganization, adequate personal protective equipment, surgical technique optimization and management of CO2 and surgical smoke. CONCLUSIONS In COVID-19 pandemic de-escalation, MIS carried out with optimal safety measurements, could contribute to reduce hospital resources utilization. With current evidence, MIS should not be limited or reconverted to open surgery during COVID-19 pandemic.
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Affiliation(s)
- David Carracedo
- Servicio de Urología. Hospital Universitario Rey Juan Carlos. Móstoles. Madrid. España
| | - Antonio Alcaraz
- Servicio de Urología. Hospital Clinic. Universitat de Barcelona. Barcelona. Cataluña. España
| | - Antonio Allona
- Unidad Urología Hospital Ruber Internacional. Madrid. España
| | - José Luis Gutierrez
- Servicio de Urología. Hospital Universitario Marqués de Valdecilla. Santander. Cantabria. España
| | - Luis López-Fando
- Servicio de Urología. Hospital Universitario Ramón y Cajal. Madrid. España
| | - Rafael Antonio Medina
- Servicio de Urología. Director UGC Urología-Nefrología. Hospital Universitario Virgen del Rocío. Sevilla. Andalucía. España
| | - Ignacio Moncada
- Servicio de Urología. Hospital Universitario La Zarzuela. Madrid. España
| | - Jesús Moreno
- Instituto de Investigación Sanitaria (IdISSC). Hospital Clínico San Carlos. Universidad Complutense. Madrid. España
| | - Joan Palou
- Servicio de Urología. Fundació Puigvert. Barcelona. Cataluña. España
| | | | - Manuel Ruibal
- Servicio de Urología. Complexo Hospitalario de Pontevedra. Pontevedra. Galicia. España
| | - María Dolores Sánchez
- Servicio de Urología. Hospital Infanta Sofía. San Sebastian de los Reyes. Madrid. España
| | - Enrique Trilla
- Servicio de Urología. Hospital Universitario Vall d´Hebron. Barcelona. Cataluña. España
| | - Miguel Sánchez
- Servicio de Urología. Hospital Universitario Rey Juan Carlos. Móstoles. Madrid. España
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Abstract
Background Robotic surgery carries with it the potential to transform laparoscopic surgery by providing, for the 1st time, instruments with distal ends that mimic the intricate movements of the human hand while at the same time providing the surgeon with a high-definition, three-dimensional view of the operative field. Objective To describe the clinical application of robotic surgery in benign gynecological conditions, as well as the components of the Da Vinci Si robotic system, analyzing the advantages and disadvantages of this type of surgical approach that it provides to the patient and in turn to the surgeon. Method Review of the literature in PubMed and UpToDate where the keywords of our review were searched. Inclusion criteria: Articles of cases or series containing the sections of the application of robotic surgery in gynecology and clinical results. Results We found 50 scientific articles that included in their titles the key words of our review. 22 articles were discarded, 14 because they were inaccessible, 3 because they were published in bulletins without an impact factor and 5 because no information was obtained about the researcher's results, their volume, visibility and structure. A total of 28 articles were chosen for this review. Conclusions Robotic surgery has evolved to be a separate field, with enormous potential for future development. The results show until now that this technology is applicable and capable of offering an adequate treatment to selected patients.
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Díez Del Val I, Loureiro González C, Asensio Gallego JI, Bettonica Larrañaga C, Leturio Fernández S, Eizaguirre Letamendia E, Miró Martín M, García Fernández MM, Martí Gelonch L, Aranda Danso H, Barrenetxea Asua J, Estremiana García F, Ortiz Lacorzana J, Farran Teixidó L. Minimally invasive and robotic surgery in the surgical treatment of esophagogastric junction cancer. Cir Esp 2019; 97:451-458. [PMID: 31047649 DOI: 10.1016/j.ciresp.2019.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 11/24/2022]
Abstract
Minimally invasive surgery provides for the treatment of esophagogastric junction tumors under safe conditions, reducing respiratory and abdominal wall complications. Recovery is improved, while maintaining the oncological principles of surgery to obtain an optimal long-term outcome. It is important to have a sufficient volume of activity to progress along the learning curve with close expert supervision in order to guarantee R0 resection and adequate lymphadenectomy. Minimal invasiveness ought not become an objective in itself. Should total gastrectomy be performed, the risk of a positive proximal margin makes intraoperative biopsy compulsory, without ruling out a primary open approach. Meanwhile, minimally invasive esophagectomy has been gaining ground. Its main difficulty, the intrathoracic anastomosis, can be safely carried out either with a mechanical side-to-side suture or a robot-assisted manual suture, thanks to the 3-D vision and versatility of the instruments.
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Affiliation(s)
- Ismael Díez Del Val
- Sección de Cirugía esofagogástrica, Hospital Universitario Basurto, Bilbao, España.
| | | | | | - Carla Bettonica Larrañaga
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Mónica Miró Martín
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Laura Martí Gelonch
- Sección de Cirugía esofagogástrica, Hospital Universitario Donostia, Donostia-San Sebastián, España
| | - Humberto Aranda Danso
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Fernando Estremiana García
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Leandre Farran Teixidó
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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26
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Regis L, Salazar A, Cuadras M, Miret E, Roche S, Celma A, Planas J, Lorente D, Placer J, Trilla E, Morote J. Preoperative magnetic resonance imaging in predicting early continence recovery after robotic radical prostatectomy. Actas Urol Esp 2019; 43:137-142. [PMID: 30420112 DOI: 10.1016/j.acuro.2018.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND AIMS Urinary incontinence is a common complication after radical prostatectomy. The aim of our study was to describe the preoperative anatomical features using magnetic resonance imaging in order to predict early continence recovery after robotic radical prostatectomy. MATERIAL AND METHODS 72 patients who underwent robotic radical prostatectomy were prospectively analysed. EPIC questionnaire (1, 6 and 12 mo) and first self-reported continence were used to assess functional outcomes. Membranous urethral length (MUL) and MUL-prostate axis angle (aMULP) were assessed preoperatively on T2 weighted sagittal images. RESULTS Continence rate was 67.2%, 92.6% and 95.2% at 1, 6 and 12 months, respectively. Early continence was achieved in patients with the lower aMULP. At 1 month, average aMULP in continent patients was 107.21° (IC 95% 90.3-124.6) vs. 118.5° (IC 95% 117.7-134) in incontinent ones (P=.014). At 6 month differences in aMULP among groups were found: 114.24° (IC 95% 104.6-123.9) in continents vs. 142° (IC 95% 126.5-157.6) in incontinents (P=0.015). At 12 month, continent group showed a significantly higher preoperative aMULP. aMULP was revealed as the only independent predictor of urinary continence at 6 mo in multivariate analysis, OR 0.007 (IC 95% 0.002-0.012), P=0.012. CONCLUSIONS Preoperative anatomical parameters assessment prior surgery can help to identified those patients will achieve early continence recovery and it supports therapeutic decisions making.
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Affiliation(s)
- L Regis
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España.
| | - A Salazar
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - M Cuadras
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - E Miret
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - S Roche
- Institut de Imatge i Diagnostic, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - A Celma
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - J Planas
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - D Lorente
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - J Placer
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - E Trilla
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - J Morote
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
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Martínez-Alonso IA, Valdez-Flores RA, Padrón-Lucio S, Campos Salcedo JG, Gutierrez-Aceves J, Cathelineau X, Sánchez-Salas R. Robotic-assisted radical prostatectomy: The teaching. ARCH ESP UROL 2019; 72:239-246. [PMID: 30945650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE OF THE REVIEW Robot assisted Radical prostatectomy (RARP) has generated a new trend in the binomial teaching/learning, grouping these techniques in training modules such as theoretical learning, practice, personalized counseling, and modern tools like simulation and practice in virtual models. This review summarizes the current trend in the teaching process of RARP. RECENT FINDINGS: Current trends in the acquisition of the RARP learning curve is to provide the Urologist with a well-structured teaching process, implementing gradual training modules, which make possible to understand all aspects of the development of prostate surgery with a robotic system. This process consists in analyzing the theoretical aspects, perform training with high quality simulators and proctorization, in both cases in vivo and as assistant, until completion of the advanced phase in console with haptic training and proctor's direct advice, while the learning curve is being completed. The evidence shows that student and proctor feedback with the use of virtual models, immediately post-procedure video analysis, and a high-volume center are able to shorten the teaching process. The learning process never culminates, in other words, the final phase of the student, is when he is prepared to teaching the multiplier effect of his learning curve. CONCLUSIONS Virtual models in Robotic surgery has changed the perspective teaching process of medicine. Theoretical knowledge, virtual training and Proctor's advice are essential steps in the learning curve. Future directions,evolution of virtual models in a similar fashion to the real scenario.
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Affiliation(s)
| | | | | | | | - Jorge Gutierrez-Aceves
- Departamento de Urología. Wake Forest Baptist Medical Center. Wake Forest University. Winston-Salem. North Carolina. USA
| | - Xavier Cathelineau
- Departamento de Urología. L´Institute Mutualiste Montsouris. París. Francia
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Moncada I, López I, Ascencios J, Krishnappa P, Subirá D. Complications of robot assisted radical prostatectomy. ARCH ESP UROL 2019; 72:266-276. [PMID: 30945653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The urology community has adopted robot-assisted radical prostatectomy (RARP) as the most preferred surgical therapeutic approach in the management of localized prostate cancer. Safety and potential complications of RARP should be clearly known prior to attempting the surgery. The complications have been categorized as anesthesia & patient positioning related, vascular, non-vascular and delayed. European Associationof Urology guidelines recommend the use of Clavien-Dindo grading to report surgical complications.The median rate of over all complications of RARP is12.6%, with a range of 3.1-42%. Most of the complications are minor (Clavien-Dindo grades 1 and 2). With a dedicated approach, increasing experience, being aware of possible complications, and strict adherence to safety measures, most complications are preventable. RARP is a safe and reproducible technique.
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Affiliation(s)
- Ignacio Moncada
- Head of Service. Urology and Robotic Surgery. University Hospital La Zarzuela. Francisco de Vitoria University. Associate Professor of Urology. Francisco de Vitoria University. Madrid. Spain
| | - Iñigo López
- Urology and Robotic Surgery. University Hospital La Zarzuela. Madrid. Spain
| | - Julmar Ascencios
- Urology and Robotic Surgery. University Hospital La Zarzuela. Madrid. Spain
| | - Pramod Krishnappa
- European Society of Sexual Medicine Fellow. University Hospital La Zarzuela. Madrid. Spain. Senior Registrar. Department of Urology. NU Hospitals. Bangalore. India
| | - David Subirá
- Co-Head Robotic and Laparoscopic Surgery. Department of Urology. University Hospital La Zarzuela. Madrid. Spain
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Gaya JM, Vila-Reyes H, Gavrilov P, Territo A, Breda A, Palou J. Robotic radical cystectomy. ARCH ESP UROL 2019; 72:293-298. [PMID: 30945656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Radical cystectomy (RC) is one of the most complex and morbid surgical procedures in Urology. Several retrospective and prospective studies have demonstrated that robotic-assisted RC (RARC) represents a minimally invasive alternative to open surgery, showing non-inferiority in mid-term oncological outcomes. Moreover, important advantages related with perioperative complications have also been published. The aim of this article is to describe RARC surgical steps and to review the most relevant ndings in the eld of RARC, focusing on its strengths and weaknesses when compared with open RC. METHODS We performed a detailed step-by-step description of the RARC surgical technique, paying particular attention to its specific surgical details and adding our tips and tricks for an out standing performance. We also conducted a review of the most relevant articles in literature in terms of oncological, pathological and perioperative results. All these findings have been compared with the classical open radical cystectomy (ORC) technique. RESULTS None of the studies published have demonstrated RARC to have worse oncological outcomes (PSM,RFS, CSS, OS) compared to ORC. RARC shows a decrease in blood loss and transfusion rates. No differences have been observed in complications rate, length of hospital stay, quality of life, and time to bowel movement between both approaches. The two disadvantages of RARC compared to ORC are a longer operative time and increased cost. Operating time can be reduced with surgeons gaining experience and technique standardization. The cost disparities and operative time between ORC and RARC at high-volume academic centers are less pronounced than in the general medical community. CONCLUSIONS RARC is a technically feasible and safe approach, with oncological, pathological and perioperative results, at least, equivalent to ORC.
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Affiliation(s)
- Josep M Gaya
- Department of Urology. Fundació Puigvert. Universitat Autonoma de Barcelona. Barcelona. Spain
| | - Helena Vila-Reyes
- Department of Urology. Fundació Puigvert. Universitat Autonoma de Barcelona. Barcelona. Spain
| | - Pavel Gavrilov
- Department of Urology. Fundació Puigvert. Universitat Autonoma de Barcelona. Barcelona. Spain
| | - Angelo Territo
- Department of Urology. Fundació Puigvert. Universitat Autonoma de Barcelona. Barcelona. Spain
| | - Alberto Breda
- Department of Urology. Fundació Puigvert. Universitat Autonoma de Barcelona. Barcelona. Spain
| | - Joan Palou
- Department of Urology. Fundació Puigvert. Universitat Autonoma de Barcelona. Barcelona. Spain
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Vidal-Sicart S, Fuertes Cabero S, Danús Lainez M, Valdés Olmos R, Paredes Barranco P, Rayo Madrid JI, Rioja Martín ME, Díaz Expósito R, Goñi Gironés E. Update on radioguided surgery: from international consensus on sentinel node in head and neck cancer to the advances on gynaecological tumors and localization of non-palpable lesions. Rev Esp Med Nucl Imagen Mol 2019; 38:173-82. [PMID: 30579916 DOI: 10.1016/j.remn.2018.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 11/23/2022]
Abstract
The aim of this review is to provide an updated perspective on different fields of radioguided surgery. With reference to the sentinel lymph node biopsy in oral squamous cell carcinoma, we present the results of the interactive debate held at the recent Congress of our specialty about the more relevant aspects of the London Consensus. Drainage peculiarities and indications according to the current guidelines on gynaecological tumours, endometrial and cervical cancer, are detailed and new scenarios for nuclear medicine physicians are presented; robotic surgery and hybrid tracers, for instance. Moreover, the notable growth in radioguided surgery indications for non-palpable lesions, widely used in mammary pathology, make it advisable to update two procedures which have shown satisfying results, such as the solitary pulmonary nodule and the osteoid osteoma.
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Moscatiello P, Carracedo Calvo D, Yupanqui Guerra L, Rivera Martínez ME, Mendiola de la Hoza A, Sánchez Encinas M. Robot-assisted pudendal neurolysis in the treatment of pudendal nerve entrapment syndrome. Actas Urol Esp 2018; 42:344-9. [PMID: 29526251 DOI: 10.1016/j.acuro.2018.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Pudendal nerve entrapment syndrome (PNE) is characterised by the presence of neuropathic pain in the pudendal nerve (PN) territory, associated or not with urinary, defecatory and sexual disorders. Surgical PN decompression is an effective and safe alternative for cases when conservative treatment fails. The aim of this study is to describe the first robot-assisted pudendal neurolysis procedure performed in our country. MATERIAL AND METHODS We describe step by step the technique of robot-assisted laparoscopic neurolysis of the left PN performed with intraoperative neurophysiological monitoring on a 60-year-old patient diagnosed with left PNE. RESULTS The procedure was performed satisfactorily without complications. After 24h, the patient was discharged from the hospital. We observed a 50% reduction in pain measured using the visual analogue scale 2 weeks after the procedure, which remained after 10 weeks of the neurolysis. CONCLUSIONS Robot-assisted neurolysis of the PN constitutes a feasible and safe approach, enabling better visualisation and accuracy in the dissection of the PN. Intraoperative neurophysiological monitoring is useful for locating the PN and for detecting intraoperative changes after the release of the nerve.
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Velilla G, Redondo C, Sánchez-Salas R, Rozet F, Cathelineau X. Visceral and gastrointestinal complications in robotic urologic surgery. Actas Urol Esp 2018; 42:77-85. [PMID: 28478913 DOI: 10.1016/j.acuro.2016.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION with the widespread use of minimally invasive techniques, robot-assisted urologic surgery has become widely adopted. Despite their infrequency, visceral and gastrointestinal complications could be life-threatening. OBJECTIVES To identify the main gastrointestinal injuries that occur in a robot-assisted urologic surgery. To know the overall incidence and how is their management. ACQUISITION OF THE EVIDENCE Search in PubMed of articles related to visceral and gastrointestinal complications in robot-assisted urology surgery, written in English or Spanish. Relevant publications as well literature reviews and chapters from books were reviewed. SYNTHESIS OF THE EVIDENCE Along with vascular injuries, visceral and gastrointestinal lesions are among most dangerous complications. A complete preoperative study to individualize each patient characteristics and the correct use of imaging could help us to avoid complications in the first place. To know all the risky steps in the different robotic urologic procedures will let us anticipate the damage. Knowledge of main and most dangerous injuries in the different abdominal and pelvic organs is fully recommended. Early diagnosis and evaluation of lesions will let us an acute management during surgery. Recognition delay could change a repairable injury into a life-threatening situation. CONCLUSIONS Despite the undeniable benefits of robotic approach, there are minor and major gastrointestinal injuries that all urologic surgeons must know. Those related with trocar placement are especially important. Immediate diagnosis and management is mandatory.
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Gómez Ruiz M, Cagigas Fernández C, Alonso Martín J, Cristobal Poch L, Manuel Palazuelos C, Barredo Cañibano FJ, Gómez Fleitas M, Castillo Diego J. Robotic Assisted Transanal Polypectomies: Is There Any Indication? Cir Esp 2017; 95:601-609. [PMID: 29146073 DOI: 10.1016/j.ciresp.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 09/04/2017] [Accepted: 09/11/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Robotic assisted transanal polipectomy may have advantages compared with the conventional transanal minimally invasive surgery technique. We evaluate the safety, feasibility and advantages of this technique. METHODS Between February 2014 and October 2015, 9patients underwent robotic transanal polypectomy. We performed a retrospective study in which we analyse prospectively collected data regarding patient and tumor characteristics, perioperative outcomes, pathological report, morbidity and mortality. RESULTS A total of 5 male and 4 female patients underwent robotic TAMIS. Lesions were 6,22cm from the anal verge. Mean size was 15,8cm2. All procedures were performed in the lithotomy position. Closure of the defect was performed in all cases. Mean blood loss was 39,8ml. Mean operative time was 71,9min. No severe postoperative complications or readmissions occured. Median hospital stay was 2,5 days. CONCLUSIONS Robotic TAMIS is useful to treat complex rectal lesions. Our transanal platform allowed a wider range of movements of the robotic arms and to perform all procedures in the lithotomy position.
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Affiliation(s)
- Marcos Gómez Ruiz
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - Carmen Cagigas Fernández
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Joaquín Alonso Martín
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Lidia Cristobal Poch
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Carlos Manuel Palazuelos
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Francisco Javier Barredo Cañibano
- Anestesiología en Cirugía General, Servicio de Anestesiología, Reanimación y Unidad del Dolor, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Manuel Gómez Fleitas
- Departamento de Innovación y Cirugía Robótica, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Julio Castillo Diego
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
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Zubieta-O'Farrill G, Ramírez-Ramírez M, Villanueva-Sáenz E. [Robot assisted Frykman-Goldberg procedure. Case report]. CIR CIR 2017; 85 Suppl 1:84-88. [PMID: 28104280 DOI: 10.1016/j.circir.2016.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 09/26/2016] [Accepted: 10/17/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rectal prolapse is defined as the protrusion of the rectal wall through the anal canal; with a prevalence of less than 0.5%. The most frequent symptoms include pain, incomplete defecation sensation with blood and mucus, fecal incontinence and/or constipation. The surgical approach can be perineal or abdominal with the tendency for minimal invasion. Robot-assisted procedures are a novel option that offer technique advantages over open or laparoscopic approaches. CASE REPORT 67 year-old female, who presented with rectal prolapse, posterior to an episode of constipation, that required manual reduction, associated with transanal hemorrhage during defecation and occasional fecal incontinence. A RMI defecography was performed that reported complete rectal and uterine prolapse, and cystocele. A robotic assisted Frykman-Goldberg procedure wass performed. DISCUSSION There are more than 100 surgical procedures for rectal prolapse treatment. We report the first robot assisted procedure in Mexico. Robotic assisted surgery has the same safety rate as laparoscopic surgery, with the advantages of better instrument mobility, no human hand tremor, better vision, and access to complicated and narrow areas. CONCLUSION Robotic surgery as the surgical treatment is a feasible, safe and effective option, there is no difference in recurrence and function compared with laparoscopy. It facilitates the technique, improves nerve preservation and bleeding. Further clinical, prospective and randomized studies to compare the different minimal invasive approaches, their functional and long term results for this pathology are needed.
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Affiliation(s)
| | - Moisés Ramírez-Ramírez
- Cirugía general, SSA, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, Estado de México, México
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Villanueva-Sáenz E, Ramírez-Ramírez MM, Zubieta-O'Farrill G, García-Hernández L. [Initial experience in robot-assisted colorectal surgery in Mexico]. CIR CIR 2017; 85:284-91. [PMID: 27855992 DOI: 10.1016/j.circir.2016.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 09/09/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Colorectal surgery has advanced notably since the introduction of the mechanical suture and the minimally invasive approach. Robotic surgery began in order to satisfy the needs of the patient-doctor relationship, and migrated to the area of colorectal surgery. An initial report is presented on the experience of managing colorectal disease using robot-assisted surgery, as well as an analysis of the current role of this platform. MATERIAL AND METHODS A retrospective study was conducted in order to review five patients with colorectal disease operated using a robot-assisted technique over one year in the initial phase of the learning curve. Gender, age, diagnosis and surgical indication, surgery performed, surgical time, conversion, bleeding, post-operative complications, and hospital stay, were analysed and described. A literature review was performed on the role of robotic assisted surgery in colorectal disease and cancer. RESULTS The study included 5 patients, 3 men and 2 women, with a mean age of 62.2 years. Two of them were low anterior resections with colorectal primary anastomoses, one of them extended with a loop protection ileostomy, a Frykman-Goldberg procedure, and two left hemicolectomies with primary anastomoses. The mean operating time was 6hours and robot-assisted 4hours 20minutes. There were no conversions and the mean hospital stay was 5 days. CONCLUSION This technology is currently being used worldwide in different surgical centres because of its advantages that have been clinically demonstrated by various studies. We report the first colorectal surgical cases in Mexico, with promising results. There is enough evidence to support and recommend the use of this technology as a viable and safe option.
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Sivaraman A, Sanchez-Salas R, Prapotnich D, Barret E, Mombet A, Cathala N, Rozet F, Galiano M, Cathelineau X. Robotics in urological surgery: evolution, current status and future perspectives. Actas Urol Esp 2015; 39:435-41. [PMID: 25801676 DOI: 10.1016/j.acuro.2014.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/04/2014] [Accepted: 10/07/2014] [Indexed: 11/29/2022]
Abstract
CONTEXT Robotic surgery is rapidly evolving and has become an essential part of surgical practice in several parts of the world. Robotic technology will expand globally and most of the surgeons around the world will have access to surgical robots in the future. It is essential that we are updated about the outcomes of robot assisted surgeries which will allow everyone to develop an unbiased opinion on the clinical utility of this innovation. OBJECTIVE In this review we aim to present the evolution, objective evaluation of clinical outcomes and future perspectives of robot assisted urologic surgeries. ACQUISITION OF EVIDENCE A systematic literature review of clinical outcomes of robotic urological surgeries was made in the PUBMED. Randomized control trials, cohort studies and review articles were included. Moreover, a detailed search in the web based search engine was made to acquire information on evolution and evolving technologies in robotics. SYNTHESIS OF EVIDENCE The present evidence suggests that the clinical outcomes of the robot assisted urologic surgeries are comparable to the conventional open surgical and laparoscopic results and are associated with fewer complications. However, long term results are not available for all the common robotic urologic surgeries. There are plenty of novel developments in robotics to be available for clinical use in the future. CONCLUSION Robotic urologic surgery will continue to evolve in the future. We should continue to critically analyze whether the advances in technology and the higher cost eventually translates to improved overall surgical performance and outcomes.
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Affiliation(s)
- A Sivaraman
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - R Sanchez-Salas
- Department of Urology, Institute Mutualiste Montsouris, París, Francia.
| | - D Prapotnich
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - E Barret
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - A Mombet
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - N Cathala
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - F Rozet
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - M Galiano
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - X Cathelineau
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
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Trugeda Carrera MS, Fernández-Díaz MJ, Rodríguez-Sanjuán JC, Manuel-Palazuelos JC, de Diego García EM, Gómez-Fleitas M. [Initial results of robotic esophagectomy for esophageal cancer]. Cir Esp 2015; 93:396-402. [PMID: 25794776 DOI: 10.1016/j.ciresp.2015.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 12/28/2014] [Accepted: 01/05/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION There is scant experience with robot-assisted esophagectomy in cases of esophageal and gastro-esophageal junction cancer. Our aim is to report our current experience. PATIENTS AND METHODS Observational cohort study of the first 32 patients who underwent minimally invasive esophagectomy for esophageal cancer from September 2011 to June 2014. The gastric tube was created laparoscopically. In the thoracic field, a robot-assisted thoracoscopic approach was performed in the prone position with intrathoracic robotic hand-sewn anastomosis. Patient and tumour characteristics, surgical technique, short-term outcomes (morbidity and mortality) and oncological results (radicality and number of removed nodes) were evaluated. RESULTS Thirty-two patients, with a mean age of 58 years (34-74) were treated by a totally minimally invasive esophagectomy: robotic laparoscopy and thoracoscopy (11 McKeown and 21 Ivor-Lewis). Twenty-nine received neoadjuvant chemoradiotherapy. There were no conversions to open surgery. Console time was 218minutes (190-285). Blood loss was 170ml (40-255). One patient died from cardiac disease. Nine patients had a major complication (Dindo-Clavien grade II or higher). There was no case of respiratory complication or recurrent laryngeal nerve palsy. Five patients had intrathoracic fistula, 4 radiological and one clinical. Three had chylothorax, 2 cervical fistula and one gastric tube necrosis. The median hospital stay was 12 days (8-50). All the resections were R0 and the median of removed lymph nodes was 16 (2-23). CONCLUSIONS Our results suggest that minimally invasive esophagectomy with robot-assisted thoracoscopy is safe and achieves oncological standards.
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Affiliation(s)
- M Soledad Trugeda Carrera
- Unidad de Cirugía Esófago-Gástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España.
| | - M José Fernández-Díaz
- Unidad de Cirugía Esófago-Gástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España
| | - Juan Carlos Rodríguez-Sanjuán
- Unidad de Cirugía Esófago-Gástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España
| | - José Carlos Manuel-Palazuelos
- Unidad de Cirugía Esófago-Gástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España
| | - Ernesto Matias de Diego García
- Unidad de Cirugía Esófago-Gástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España
| | - Manuel Gómez-Fleitas
- Unidad de Cirugía Esófago-Gástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España
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Castillo O, Cabrera W, Aleman E, Vidal-Mora I, Yañez R. Laparoscopic pyeloplasty: technique and results in 80 consecutive patients. Actas Urol Esp 2014; 38:103-8. [PMID: 23910728 DOI: 10.1016/j.acuro.2013.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 04/12/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To present our long-term results with the Anderson-Hynes laparoscopic pyeloplasty, performed by a single surgeon. MATERIAL AND METHODS Between August 1999 and December 2009, 79 patients (80 procedures) were operated for primary ureteropelvic junction obstruction. We use the Anderson-Hynes technique by a transperitoneal approach. Patients were evaluated with Ultrasound, Excretory urography and dynamic renal scintigraphy (Mag-3). The perioperative characteristics, complications and results were reviewed. RESULTS We performed 80 laparoscopic pyeloplasties in 79 patients. Mean operative time was 93.2 minutes (60-180). Crossing vessels were found in 38 of 82 (46.3%) renal units. Kidney abnormalities occurred in 4 patients (1 double ureteropelvic system, one associated retrocaval ureter, 1 horseshoe kidney and one pelvic kidney). Complications occurred in 5 procedures (6.5%): an immediately postoperative bleeding (Clavien 3b), 1 cecal volvulus (Clavien 3b), 1 urosepsis (Clavien 4th) and 1 urinary fistula (Clavien 3a). In this series there was neither mortality nor conversion to open surgery There was recurrence in 3 out of 80 patients (3.7%). They were resolved as follows: 1 percutaneous antegrade endopyelotomy, 1 secondary laparoscopic pyeloplasty and 1 robotic pyeloplasty. There was a 96.3%. of primary overall success rate. CONCLUSIONS Our results show that laparoscopic pyeloplasty compares favorably with the result achieved by open surgery. We believe that laparoscopic pyeloplasty is a good surgical alternative for the management of primary ureteropelvic junction obstruction.
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Gómez Ruiz M, Palazuelos CM, Martín Parra JI, Alonso Martín J, Cagigas Fernández C, del Castillo Diego J, Gómez Fleitas M. New technique of transanal proctectomy with completely robotic total mesorrectal excision for rectal cancer. Cir Esp 2014; 92:356-61. [PMID: 24589418 DOI: 10.1016/j.ciresp.2013.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/19/2013] [Indexed: 12/15/2022]
Abstract
Anterior resection with total mesorectal excision is the standard method of rectal cancer resection. However, this procedure remains technically difficult in mid and low rectal cancer. A robotic transanal proctectomy with total mesorectal excision and laparoscopic assistance is reported in a 57 year old male with BMI 32 kg/m2 and rectal adenocarcinoma T2N1M0 at 5 cm from the dentate line. Operating time was 420 min. Postoperative hospital stay was 6 days and no complications were observed. Pathological report showed a 33 cm specimen with ypT2N0 adenocarcinoma at 2 cm from the distal margin, complete TME and non affected circumferential resection margin. Robotic technology might reduce some technical difficulties associated with TEM/TEO or SILS platforms in transanal total mesorectal excision. Further clinical trials will be necessary to assess this technique.
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Affiliation(s)
- Marcos Gómez Ruiz
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - Carlos Manuel Palazuelos
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - José Ignacio Martín Parra
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Joaquín Alonso Martín
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Carmen Cagigas Fernández
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Julio del Castillo Diego
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Manuel Gómez Fleitas
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Marqués de Valdecilla, Santander, España
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Giedelman C, Abdul-Muhsin H, Schatloff O, Palmer K, Lee L, Sanchez-Salas R, Cathelineau X, Dávila H, Cavelier L, Rueda M, Patel V. The impact of robotic surgery in urology. Actas Urol Esp 2013; 37:652-7. [PMID: 23618511 DOI: 10.1016/j.acuro.2012.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 10/22/2012] [Accepted: 11/27/2012] [Indexed: 10/26/2022]
Abstract
INTRODUCTION More than a decade ago, robotic surgery was introduced into urology. Since then, the urological community started to look at surgery from a different angle. The present, the future hopes, and the way we looked at our past experience have all changed. METHODS Between 2000 and 2011, the published literature was reviewed using the National Library of Medicine database and the following key words: robotic surgery, robot-assisted, and radical prostatectomy. Special emphasis was given to the impact of the robotic surgery in urology. We analyzed the most representative series (finished learning curve) in each one of the robotic approaches regarding perioperative morbidity and oncological outcomes. RESULTS This article looks into the impact of robotics in urology, starting from its background applications before urology, the way it was introduced into urology, its first steps, current status, and future expectations. By narrating this journey, we tried to highlight important modifications that helped robotic surgery make its way to its position today. We looked as well into the dramatic changes that robotic surgery introduced to the field of surgical training and its consequence on its learning curve. CONCLUSION Basic surgical principles still apply in Robotics: experience counts, and prolonged practice provides knowledge and skills. In this way, the potential advantages delivered by technology will be better exploited, and this will be reflected in better outcomes for patients.
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Castillo OA, Rodriguez-Carlin A, Lopez-Fontana G, Aleman E. Robotic partial nephrectomy with selective parenchymal compression (Simon clamp). Actas Urol Esp 2013; 37:425-8. [PMID: 23433637 DOI: 10.1016/j.acuro.2012.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/17/2012] [Accepted: 11/27/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To present our initial experience using selective renal parenchymal ischemia, without hilar clamping, in robotic-assisted partial nephrectomy. MATERIAL AND METHODS In four patients with T1a renal tumor we performed robotic-assisted partial nephrectomy, using the Simon's clamp (Aesculap). It provides selective parenchymal compression without the need of vascular clamping. All patients had exofitic renal tumors in polar location. Renal parenchymal reconstruction was done as the standard technique. RESULTS The median age was 49.6 years (42-59), 3 male and 1 female patient. Median operative time was 71,6 minutes (40-120). Mean stimated bleeding was 250 ml (50-400). Average tumor size was 3,25 cm (1,5-5,3). There were no complications and the average hospital stay was 3,5 days (1-7). The pathology was informed as renal cell carcinoma in three patients and one hemorrhagic cyst. The surgical margins were negative. CONCLUSION Our preliminary results shows that selective renal parenchymal compression, with the Simon's clamp, provides an alternative to vascular control in selected patients with polar renal tumors.
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Affiliation(s)
- O A Castillo
- Unidad de Urología y Centro de Cirugía Robótica, Clínica INDISA, Santiago, Chile; Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile.
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