A. Parisi

Pancreatic surgery presents such difficulties in the anatomical approach so as to preclude, to date, a reproducible and shared minimally invasive approach due to the necessity of having a wide exposure of the operative field. The implementation of robotic systems applied to abdominal surgery has led surgeons inclined towards minimally invasive surgery to test a new approach in those procedures severely limited in laparoscopy, mainly due to two-dimensional view and poor dexterity of the instruments. We believe that the development of robotic technology has expanded the indications for a minimally invasive approach in complex interventions such as pancreaticoduodenectomy, which appears, to date, more feasible and safe in selected patients and to experienced surgeons within dedicated teams. In this video we decided to add the two approaches that are performed at our Institution, comparing the open surgery versus the robotic technique, especially highlighting the characteristics of the robotic system in the reconstruction phase.

A new post has been published on Clinical Robotics.

A. Parisi

Repair of hiatal hernia is recommended in symptomatic patients. Surgical strategies and the best approach that can permit a long term success are still under debate. Robotic surgery begins to play an important role in digestive surgery and several studies on the use of the robot for esophageal diseases have underlined the effectiveness and feasibility of this approach. The robotic system adds precision in the movements and greatly increases the comfort of the surgeon dealing with a delicate reconstructive phase. The Da Vinci Surgical System instrumentation allows for the use of a large and three-dimensional viewing field, a steady traction, tremor suppression and flexibility of the instruments, and, thus, safe suturing.

A new post has been published on Clinical Robotics.

A. Parisi

An extended right colectomy with an anastomosis between the ileum and the distal transverse is the procedure to perform for cancer of the hepatic flexure or proximal transverse colon. The ileocolic, right colic and middlecolic vessels are sectioned with their mesentery. The robot adds safety in the dissection phase and allows to properly identify the different anatomical planes. The Endowrist enables up to seven degrees of freedom of the robotic instruments and the surgeon can perform a secure intracorporeal closure of the anastomosis.

A new post has been published on Clinical Robotics.

A. Parisi

An intrathoracic esophago-gastric anastomosis has the potential to reduce morbidity and mortality in patients undergoing minimally invasive esophagectomy for cancer. The robotic system, in centres with expertise in minimally invasive surgery, may be an option that allows improving surgical accuracy and safety in patients with esophageal cancer in positions that do not allow limited resections and require technical accuracy. The Da Vinci Surgical System is equipped with a three dimensional view, a steady traction, and flexible instruments, so allows to perform sutures in tight spaces in an easier manner that seems incomparable with the traditional thoracoscopic approach.

A new post has been published on Clinical Robotics.

A. Parisi

The stomach is the most common site for the development of gastrointestinal stromal tumours. The minimally invasive procedure is debated and must be evaluated based on the risk of breakage and fragmentation of the neoplasm. The surgical treatment consists in resectioning the entire neoplastic mass and a section of the gastric wall enough to bring down the resection margins on the healthy tissue. The type of technique used depends on the location and size of the tumour. GISTs that are localised along the large gastric curve can be treated easily with limited resections such as a wedge resection. On the contrary, for damage occurring at the antral or pre-pyloric level, it is risky to remove only the tumour because it could generate a cicatricial stenosis of the gastric lumen that in this portion has reduced dimensions. In this case, the best strategy is to implement distal gastrectomy. The role of mini-invasive surgery in treating GIST is not debated because of the difficulties in performing the procedure, but because of the fragility of the lesion to be treated, and, therefore, the need to avoid intraoperative breakage and the intraperitoneal dissemination of the tumour. Robotic surgery begins to play an important role in digestive surgery and several studies on the use of robots for gastric diseases have underlined the effectiveness and feasibility of this minimally invasive approach. In this video content, we report a laparoscopic approach for a GIST of the greater curvature of the stomach and the use of the Da Vinci robotic surgical system to perform a distal gastrectomy in a case of pyloric GIST. In particular, we intend to highlight the utility of the robot in performing the reconstructive phase after gastric resection.

A new post has been published on Clinical Robotics.

V. Obias

A new post has been published on Clinical Robotics.

A. Parisi

Minimally invasive gynecologic surgery has obtained a great development since the introduction of the robotic systems. In this video, we show an oophorectomy in a 62 year-old woman with a giant ovarian cyst. Ovarian cysts are traditionally labeled as giant when they reach a diameter of 15 cm. In this situation, the characteristics of the robot are emphasized. The use of the robotic system may support the action of the surgeon in minimally invasive interventions that require a precise dissection. The Da Vinci surgical system allows for the use of a large and three-dimensional viewing field, a steady traction, tremor suppression and flexibility of the instruments. Management of giant intraabdominal cysts has traditionally required a midline laparotomy. Otherwise, the robot provides various benefits including less pain, shorter hospital stay, a significantly better cosmetic result.

A new post has been published on Clinical Robotics.

A. Parisi

Right colectomy with intracorporeal anastomosis is believed as one of the most difficult procedures to perform laparoscopically. The robotic system has allowed an evolution of the traditional minimally invasive surgery, increasing feasibility and safety of surgical maneuvers. In particular, Complete Mesocolic Excision (CME) is considered the gold standard technique in order to achieve the better oncological outcomes for colon cancer. Laparoscopy is a technically demanding procedure and an appropriate learning curve is necessary to perform this procedure correctly. On the contrary, and according to the recent literature, the use of the robot facilitates the execution of a precise and safe CME in right colon cancer, especially if compared with laparoscopic approach, favoring an extended lymphadenectomy with high vascular tie.

A new post has been published on Clinical Robotics.

A. Parisi

Liver cysts occur in approximately 5% of the western population. cysts are thin-walled structures that can contain fluid. Only a small percentage of patients will develop ymptoms including upper abdominal pain, discomfort, mass, early satiety. Liver cyst may also be an incidental finding on ultrasound or computed tomography. Symptomatic patients should be treated removing a large portion of the cyst wall. The procedure can be done easier through minimally invasive surgery and if some technical principles are adhered to, the success rate is high. The Da Vinci Surgical System instrumentation allows for the use of a large and three-dimensional viewing field, a steady traction, tremor suppression and flexibility of the instruments, which result in greater dexterity and precision of the movements of dissection.

A new post has been published on Clinical Robotics.

A. Parisi

Gallbladder cancer is a rare malignancy, associated with a poor prognosis because patients often present with advanced stage at the diagnosis. In patients with resectable disease, extensive liver resection, portal lymphadenectomy and bile duct resection may be required, but is associated with high morbidity. In many cases gallbladder cancers are discovered incidentally after cholecystectomy. In particular, according to the American Joint Committee on Cancer (AJCC) staging system, simple cholecystectomy alone is considered definitive treatment in case of T in situ or T1a. However, surgical management remains still controversial especially in a case of radiological suspicion of gallbladder cancer. The video shows a case of patient with suspected gallbladder cancer as a result of radiological examinations. After multidisciplinary evaluation, it was decided to perform an exploratory laparoscopy with intraoperative ultrasound and robotic cholecystectomy combined with liver resection. During the procedure, in contradiction to the preoperative findings, since there was no signs of neoplastic infiltration of the liver parenchyma, after cholecystectomy was agreed to wait a definitive histological examination of the specimen for diagnostic certainty and if necessary, run in a second stage an hepatic radical resection.

A new post has been published on Clinical Robotics.