65 research outputs found
Laparoscopic left colic artery preserving sigmoidectomy for diverticulitis in a patient with urinary tract malformation ‐ a video vignette
No full textRobotic repair of iatrogenic left diaphragmatic hernia. A case report
No full textIntroduction: Iatrogenic diaphragmatic hernia after laparoscopic left adrenalectomy has been rarely reported in adults. Surgery is the preferred treatment because of the risks of incarceration, strangulation and pulmonary complications. Presentation of case: An elderly woman with parasternal diaphragmatic hernia has been successfully treated by robotic repair with mesh placement. The short-term follow-up showed that there was no recurrence or any symptoms after the intervention. Discussion: Iatrogenic diaphragmatic hernia is a rare complication occurring after abdominal or thoracic surgery. The diagnosis could be challenging because of the presence of chronic symptoms. Computed tomography can be considered the gold standard technique to assess the correct diagnosis of diaphragmatic hernias in the majority of cases. Patients with chronic symptomatic hernia should undergo surgical repair of defect. Robotic technology because of its enhanced precision and the endowrist movement of the robotic arms, facilitates the dissection near the esophago-gastric junction and the other important adjacent structures. Conclusion: Robotic technology seems to be a valid approach for the repair of diaphragmatic defects, even if this remains a high cost-related procedure
Robotic cholecystectomy for acute cholecystitis: Three case reports
No full textNowadays laparoscopic cholecystectomy is considered as criterion standard for surgical treatment of acute calculous cholecystitis. During the last few years, there has been growing interest about the robotic approach. Several authors have reported the superiority of robotic cholecystectomy, associated with a lower percentage of conversion especially in patients with intraoperative diagnosis of acute or gangrenous cholecystitis. We report 3 case reports of moderate acute cholecystitis successfully treated by robotic cholecystectomy
Robotic cholecystectomy for acute cholecystitis: Three case reports
No full textIntroduction: Nowadays laparoscopic cholecystectomy is considered as criterion standard for surgical treatment of acute calculous cholecystitis. During the last few years, there has been growing interest about the robotic approach. Several authors have reported the superiority of robotic cholecystectomy, associated with a lower percentage of conversion especially in patients with intraoperative diagnosis of acute or gangrenous cholecystitis. We report 3 case reports of moderate acute cholecystitis successfully treated by robotic cholecystectomy.Patient Concerns: Three patients presented moderate acute calculous cholecystitis with leukocytosis, fever, nausea, vomiting, and pain.Diagnosis: Three patients of our study population had clinical and laboratory suspicion of moderate acute calculous cholecystitis verified by abdominal ultrasound examination, which found out cholelitiasis in all 3 cases. Final diagnosis was confirmed by intraoperative findings and histopathological examination, with two empyematous cholecystitis and one perforated cholecystitis.Interventions: All patients underwent robotic cholecystectomy with the da Vinci Robotic Surgical System. The entire procedure required a mean operation time of 128minutes and the average blood loss was 60 mL, without any intraoperative complications.Outcomes: In all 3 cases postoperative period was uneventfull. All the patients were discharged within 24hours and no readmissions were reported during a 30 days' follow-up.Conclusions: Robotic cholecystectomy for ACC is feasible and safe. Several studies have demonstrated that robotic approach reduces the risk of conversion to open surgery in case of acute or gangrenous cholecystitis. Our results are in line with current literature. In fact, we have successfully treated 2 patients with empyematous acute cholecystitis and 1 with gangrenous cholecystitis with a totally robotic approach, without any complications or need of conversion to open surgery. In conclusion, our results confirm that it is the time to include robotic surgery in the emergency setting
Robotic esophagectomy. A systematic review with meta-analysis of clinical outcomes
No full textBackground: Robot-Assisted Minimally Invasive Esophagectomy is demonstrated to be related with a facilitation in thoracoscopic procedure. To give an update on the state of art of robotic esophagectomy for cancr a systematic review with meta-analysis has been performed. Methods: A search of the studies comparing robotic and laparoscopic or open esophagectomy was performed trough the medical libraries, with the search string ‘robotic and (oesophagus OR esophagus OR esophagectomy OR oesophagectomy)’. Outcomes were: Postoperative complications rate (anastomotic leakage, bleeding, wound infection, pneumonia, recurrent laryngeal nerves paralysis, chylotorax, mortality), intraoperative outcomes (mean blood loss, operative time and conversion), oncologic outcomes (harvested nodes, R0 resection, recurrence) and recovery outcomes (length of hospital stay). Results: Robotic approach is superior to open surgery in terms of blood loss p = 0.001, wound infection rate, p = 0.002, pneumonia rate, p = 0.030 and mean number of harvested nodes, p < 0.0001 and R0 resection rate, p = 0.043. Similarly, robotic approach is superior to conventional laparoscopy in terms of mean number of harvested nodes, p = 0.001 pneumonia rate, p = 0.003. Conclusions: Robotic surgery could be considered superior to both open surgery and conventional laparoscopy. These encouraging results should promote the diffusion of the robotic surgery, with the creation of randomized trials to overcome selection bias
A giant inguinal hernia in a patient with Ehlers-Danlos syndrome
No full textBACKGROUND: Inguinal hernia formation is a common event in patients with Ehlers-Danlos syndrome. Minimally invasive surgical technique for inguinal hernia repair is the same used in patients without EDS but it is related to more intraoperative and postoperative complications. AIM: Inour study, we present a case of inguinal hernia in a EDS patient successfully treated with a robotic transabdominal preperitoneal procedure (TAPP procedure). MATERIAL AND METHODS: We decided to perform a robotic TAPP with the DaVinci Xi® platform (Intuitive Surgical, Sunnyvale, USA) under general anaesthesia. A robotic docking was performed and three arms were positioned in the abdomen. Total operative timing was 45 mins. RESULTS: During the robotic procedure no intraoperative complications were recorded and no drains were applied. The postoperative period was uneventful and the patient was discharged in the first postoperative day. DISCUSSION: Inguinal hernia occurs more frequently in patients with EDS, mainly men. Many surgeons believe that EDS may have a negative effect on the clinical outcome of hernioplasty because of postoperative complication and recurrence rates. Our strategy has been robotic technology to facilitate the surgical approach. CONCLUSION: Robotic technology is feasible and associated with a shorted recovery and better cosmetic results. The endowrist movement of the robotic arms allows wide instrument articulation in a confined space, bypassing the limitis of laparoscopic instruments. In this way, it is possible to realize an accurate dissection of important elements, to reduce operative timing and intraoperative and postoperative complications. KEY WORDS: Ehlers-Danlos syndrome, Inguinal hernia, TAPP
Circular versus linear stapling oesophagojejunostomy after laparoscopic total gastrectomy. A systematic review and meta-analysis
No full textBackground: To assess which anastomosis technique is the most appropriate after laparoscopic total gastrectomy, a systematic review with meta-analysis has been performed to evaluate safety and efficacy of the linear versus circular stapler performing the oesophagojejunostomy. Methods: A systematic search was performed using the string: total AND gastrectomy AND (circular OR linear OR stapler). Extracted data were patients’ number, gender, age, BMI, ASA Score, tumor stage. Outcomes were leakages, stenoses and bleedings, number of overall anastomotic complications, mortality, operative time, time to first flatus and diet resumption and length of stay of each group. A meta-analysis among the included studies was performed. A subgroup analysis, including the studies in which the Authors considered a single technique to perform each type of anastomosis (LS and CS), was performed. Meta-regression analyses were performed to assess if one or more demographic and clinical variables significantly impacted on the obtained results. Results: 12 articles were included in the final analysis. A significant difference was observed in terms of “overall anastomotic complications” in favour of linear stapling (RD = 0.06, p = 0.01). No significant differences were observed in terms of postoperative complications anastomosis-related, even if a trend towards advantages of linear stapling have been found (stenosis: RD = 0.04, p = 0.06; bleeding: RD = 0.02, p = 0.05). However, all the study was retrospective and there was high heterogeneity among the studies. Conclusion: Linear stapler seems to be related with lesser number of complication if compared with circular stapler. However, further high-quality studies are needed to obtain definitive conclusions
Segmental transverse colectomy. Minimally invasive versus open approach: results from a multicenter collaborative study
No full textThe role of minimally invasive surgery in the treatment of transverse colon cancer is still controversial. The aim of this study is to investigate the advantages of a totally laparoscopic technique comparing open versus laparoscopic/robotic approach. Three hundred and eighty-eight patients with transverse colon cancer, treated with a segmental colon resection, were retrospectively analyzed. Demographic data, tumor stage, operative time, intraoperative complications, number of harvested lymph nodes and recovery outcomes were recorded. Recurrences and death were also evaluated during the follow-up. No differences were found between conventional and minimally invasive surgery, both for oncological long-term outcomes (recurrence rate p = 0.28; mortality p = 0.62) and postoperative complications (overall rate p = 0.43; anemia p = 0.78; nausea p = 0.68; infections p = 0.91; bleeding p = 0.62; anastomotic leak p = 0.55; ileus p = 0.75). Nevertheless, recovery outcomes showed statistically significant differences in favor of minimally invasive surgery in terms of time to first flatus (p = 0.001), tolerance to solid diet (p = 0.017), time to first mobilization (p = 0.001) and hospital stay (p = 0.004). Compared with laparoscopic approach, robotic surgery showed significantly better results for time to first flatus (p = 0.001), to first mobilization (p = 0.005) and tolerance to solid diet (p = 0.001). Finally, anastomosis evaluation confirmed the superiority of intracorporeal approach which showed significantly better results for time to first flatus (p = 0.001), to first mobilization (p = 0.003) and tolerance to solid diet (p = 0.001); moreover, we recorded a statistical difference in favor of intracorporeal approach for infection rate (p = 0.04), bleeding (p = 0.001) and anastomotic leak (p = 0.03). Minimally invasive approach is safe and effective as the conventional open surgery, with comparable oncological results but not negligible advantages in terms of recovery outcomes. Moreover, we demonstrated that robotic approach may be considered a valid option and an intracorporeal anastomosis should always be preferred
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