P. Addeo

A new post has been published on Clinical Robotics.

P. Addeo

A new post has been published on Clinical Robotics.

P. Addeo

A new post has been published on Clinical Robotics.

P. Addeo, P. Pessaux

A new post has been published on Clinical Robotics.

P. Addeo

A new post has been published on Clinical Robotics.

P. Addeo, N.C. Buchs, F.M. Bianco, P.C. Giulianotti

A new post has been published on Clinical Robotics.

P. Addeo

SUMMARY
This presentation describes a single surgeon ( Prof; PC Giulianotti) experience on robotic pancreaticoduodenectomy over a period of 9 years at two different centers. The intraoperative outcomes of 70 consecutive robotic Whipple’s operation are analyzed and the main technical points of this complex minimally invasive operation underlined.

Background/Hypothesis
Minimally invasive pancreaticoduodenectomy (PD) is a technically demanding procedure performed only in few centers worldwide. Laparoscopy has not gained popularity for this operation due to the technical intrinsic limitations of this approach. Robotic assistance may overcome these difficulties expanding the advantages of minimally invasive surgery for pancreatic surgery.

Materials & Methods
From May 2001 to July 2009 70 robotic PD has been performed. Data of patients undergoing robotic PD at the two different centres by a single surgeon were retrospectively reviewed.

Technique
All the procedures were performed with the da Vinci system. After a preliminary phases consisting of hybrid procedures (laparoscopy-robotic/15 cases), the procedures were performed by a full robotic technique. Six trocars were generally used. Exploratory laparoscopy and ultrasound exploration were performed in all the patients to rule out irresectability. The dissection of the portal vein at retropancreatic tunnel, the exposure and dissection of the uncinate process and the pancreatico-enteric reconstruction resulted particularly facilitated by robotic assistance. The distal pancreatic stump was managed as for open surgery (sclerosis/anastomosis) according to consistency of the pancreatic tissue and the characteristics of the duct.

Results
There were a total of 70 patients (36 women and 34 men) with a mean age of 64 years (range, 28-86). Conversion rate was 15.7 % (11/70). Overall postoperative morbidity was 28.5 % and mortality was 4.2 %. Pancreatic fistula occurred in 20% of patients who underwent a pancreatico-enterico reconstruction. The mean operative time was 420 min (range 240-660 min) and the mean blood loss was 310 ml (range 50-1500). The mean number of retrieved lymph node for malignant lesions was 18 (range 2-45).

Conclusions
Robotic pancreaticoduodenectomy is feasible, safe and with complication and mortality rates comparable to open surgery, while at the same time maintaining the advantages of minimally invasive surgery. A longer follow-up is needed to evaluate the survival rates for this technique.

A new post has been published on Clinical Robotics.

P. Addeo

SUMMARY
Major liver resections still represent a technical challenge for minimally invasive surgery. This presentation describes the intra and postoperative outcomes of one of the larger series of robotic major liver resections. The encouraging results obtained with the robotic approach for major liver resection in term of conversion rate, blood transfusion and postoperative morbidity confirm the feasibility and safety of the technique. Robotic represents a new technical option for performing minimally invasive major liver resections.

Background/Hypothesis
Laparoscopy is gaining widespread acceptance for liver resections. Most of the resections performed laparoscopically are minor or non anatomical resections, while a few of laparoscopic major hepatic resections have been reported until recently. The robotic technology due to some technical advantages could improve the feasibility and the safety of major complex hepatic resections. This study aims to review our experience in robot assisted major and extended hepatic resection.

Materials & Methods
We retrospectively reviewed data of all patients that underwent robotic assisted liver resections at two institutions by a single surgeon. From March 2002 to July 2009 a total of 76 robot-assisted hepatic resections were performed. Of those thirty (39.4%) were major hepatectomies including 22 right hepatectomy, 5 left hepatectomy and 3 right trisectionectomy with biliary reconstruction. There were sixteen man and fourteen women with a mean age of 57 years (range, 21-84 years).
Twenty patients (66.6%) had preoperative abdominal surgery. Eight resections (26.6%) were performed for benign tumors while twenty-two (73.3%) were performed for malignant tumors including liver metastases (sixteen patients), haepatoblastoma (one patient), HCC ( two patient), cholangiocarcinoma (three patients).

Results
All procedures were completed robotically but two (6,8%) that were converted because of bleeding. Nine patient had associate procedure including: main biliary duct resection with left hepaticojejunostomy ( 3), diaphragmatic resection ( 2), extensive adesyolysis ( 2 patients), colectomy( 1 patient), ventral hernia repair( 1). The mean operative time was 357 min (range, 220-660 min) with mean blood loss of 497 ml (range 240-2000 ml). No mortality occurred. Postoperative major morbidity occurred in four patients (13%).

Conclusions
The results of this preliminary experience show that robot-assisted major and extended hepatic resections are feasible and safe. In this experience the rate of conversion is limited and postoperative morbidity is comparable to those of open surgery. Mainly two steps of the robot assisted procedure seem to be improved: the anatomical dissection of the hilum and the hepatocaval preparation with control of the accessories hepatic veins.

A new post has been published on Clinical Robotics.

P. Addeo

SUMMARY
Renal artery aneurysms (RAA) represent a rare disease. Open surgical repair represents the gold standard for RAA not suitable for endovascular treatment. This presentation shows the technique and the results of a new therapeutic option for RAA repair using robotic surgery. This preliminary experience, even though limited by the small sample size, suggests that robotic RAA repair represents a potential alternative to open surgery for RAA repair.

A new post has been published on Clinical Robotics.

P. Addeo

SUMMARY
Central pancreatectomy (CP) represents a valid alternative to standard resection for the treatment of benign and low grade malignant tumors located at neck or proximal part of the pancreatic body.
Few surgeons have adopted a minimally invasive approach for this operation due to the technical complexity. We present a new approach to CP using robotic surgery. In this presentation the surgical technique is showed and the short and long term outcomes of the approach are evaluated.

A new post has been published on Clinical Robotics.