102,199 research outputs found
Transperitoneal Adrenalectomy
No full textLaparoscopic transperitoneal adrenalectomy was first reported in 1992 by Gagner et al. [1]. During the last decade, it has largely replaced the open approach as the standard of care for adrenal gland removal, especially for benign tumors, given the well-known advantages of minimally invasive surgery. Nevertheless, laparoscopy is recognized as associated with a steep learning curve and has some technical constraints. Robotic surgery can potentially provide a solution to these drawbacks
ICG Fluorescence: Current and Future Applications
No full textThe imaging technique based on indocyanine green (ICG) fluorescence has been widely used for more than forty years, especially to study blood flow and microcirculation. This method was first applied in general surgery to perform sentinel lymph node (SLN) biopsies in patients affected by breast and colorectal cancer. In 2010, a near-infrared (NIR) laser light system was integrated with the da Vinci® SiTM HD robotic system (Intuitive Surgical Inc., Sunnyvale, CA, USA). This imaging system is able to provide both white light and near-infrared light images through dedicated endoscopic illuminators and filters by simply pressing a pedal on the surgical console, thus allowing real-time fluorescence-guided surgery
Single-SiteTM Surgery
No full textThe Single-SiteTM platform was primarily designed to work in a narrow operative field and with a specific anatomical target. To date, the most consistent published experiences are regarding the use of this technology to perform cholecystectomy [1–9] but, recently, it has been applied in other fields of general surgery [10–12]. This chapter will focus on its current application in performing cholecystectomy and right colectomy
Right Colectomy with Complete Mesocolic Excision: Four-arm Technique
No full textMinimally invasive surgery is gaining worldwide acceptance in the treatment of colonic cancer and the advantages over the traditional open approach are well known [1–3]. Unfortunately, during recent decades, the outcomes of patients after colon cancer resection have not improved to the same degree as for rectal cancer, whose treatment with total mesorectal excision (TME) is universally accepted as the standard of care. The complete mesocolic excision (CME), first reported by Hohenberger and colleagues in 2008 [4], seems to produce better long-term outcomes when compared to standard lymphadenectomy by following the same embryological-based principles introduced by Heald for rectal cancer more than 20 years ago [5]. However, well-conducted randomized studies are needed to confirm its efficacy
Robotic Surgery for Complicated Diverticulitis
No full textThe severity of complicated diverticulitis includes a broad spectrum of diseases and is classified according to the Hinchey classification system [1]:
Stage I: pericolic abscess, confined to the mesentery of the colon, usually responsive to conservative management, with a radiological drainage in the case of an abscess larger than 5 cm;
Stage II: distant abscess amenable to percutaneous drainage (Stage IIa) or complex and multiple abscesses with or without a digestive fistula (Stage IIb);
Stage III: diffuse purulent peritonitis;
Stage IV: diffuse fecal peritonitis
History of Robotic Surgery
No full textThe history of telerobotic surgery involves a revolutionary approach to minimally-invasive surgery. The concept of “telemanipulation” or “telepresence” emerged in the 1940s and was first used to describe the sensation that a person is in one location willIe being in another. It was driven by the need for certain complex tasks to be perfoffiled by machines in hazardous and unhealthy environment for human beings, such as the bottom of the ocean or in outer space. In Robert Heinlein’s 1942 science fiction , entitled “Waldo”, the lead character, Waldo Farthingwaite-Jones, was bom frail and unable to lift his own body weight. Heilnlein describes a glove and hamess device that allowed Waldo to control a powerful mechanical arm by simply moving his hand and fingers
Robotic Subtotal Gastrectomy: a Modified Korean Technique
No full textThe robotic approach for the treatment of gastric cancer (GC) has been initially adopted mainly in Asia, where this malignant disease is more common than in Western countries and it is diagnosed at earlier stages thanks to a screening program. Among Asian countries, South Korea started to embrace the robotic technique in 2005 and now it has become one of the leading countries in robotic gastric cancer surgery. In this chapter we present our experience of robotic subtotal gastrectomy (RSTG) with D2 lymph node (LN) dissection for GC where the step-by-step procedure is based mostly on the technique of Dr Woo Jin Hyung [1]
Full-robotic Technique for Rectal Cancer
No full textSince the first robotic total mesorectal excision (TME) was reported in 2006 [1], two main methods for robotic rectal surgery, hybrid versus totally robotic technique, have been described
Splenectomy and Hemisplenectomy
No full textMinimally invasive splenectomy has become an established standard of care in general surgery for nontraumatic splenic lesions. Since laparoscopic splenectomy was first reported in 1991 by Delaitre et al. [1], subsequent literature has clearly shown that this approach dramatically improves short-term perioperative outcomes and provides enhanced cosmesis [2]
Challenges with robotic low anterior resection
No full textDramatic improvements in the local recurrence rate of patients with rectal cancer have been observed after the introduction of the embriologically-based concept of total mesorectal excision by Heald more than 30 years ago. During the last decades, advances in multimodal treatment have further contributed to improve outcomes, but surgery still play a major role. Laparoscopic surgery for rectal cancer has been validated in randomized controlled trials to be oncologically as safe and effective as the open approach with better short-term postoperative outcomes. Nevertheless, laparoscopic low anterior resection continues to be challenging because of technical constraints and a steep learning curve. Robotic surgery may potentially offer significant advantages in rectal cancer surgery thanks to its technological features. This paper summarizes the current available evidence and highlights the most challenging aspects of robotic low anterior resection, with supporting data from the literature and from the authors' nearly ten-year experience in the field
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