Robotic rectal cancer surgery

Nowadays, indications for gastric band removal are well-standardized. In case of esophageal or gastric dilatation, migration or any injury related to the LAP-BAND® access port or tubing, the band and its access port should be removed. In rare specific cases, part of the LAP-BAND® system (either access port or band) may be preserved.
Before proceeding to the surgical band removal, a complete preoperative radiological and endoscopic work-up should be performed.
Here, we present the case of a 62-year-old woman who benefited from gastric band placement 10 years earlier. The band proved effective. However, for several weeks, she has been suffering from abdominal pain associated with vomiting and hematemesis.
After a work-up which included CT-scanning, water-soluble contrast swallow and gastroscopy, it was decided to remove the band.

This video demonstrates robotic radical prostatectomy performed by a highly experienced surgeon. The additional advantages conferred by the dexterity of the multiple robotic instruments in performing this complex surgery is apparent. This video is recommended for urologists with an interest in prostate surgery.

In this lecture, Dr. Lemelle discusses the interest of robotic surgery in pyeloplasty.

In this key lecture, Dr. Brunaud demonstrates the application of robotics in endocrine surgery, highlighting indications and contraindications.

We present the case of a 16-year-old female patient who has had an autoimmune myasthenia gravis for 8 months.

Symptoms are generalized to her four arms. Anti-acetylcholine antibodies and the therapeutic test of Mestinon® (Pyridostigmine) are positive.
In recent months, her symptoms worsened with the onset of swallowing disorders.

Immunoglobulin treatment was poorly effective and was complicated by the appearance of jaundice. CT-scan showed a mediastinal thymic hyperplasia.
Thymectomy is indicated. To do so, a left thoracoscopy is performed and assisted by means of the Da Vinci™ robot.

Pathological findings demonstrated the presence of a lymphoid thymic hyperplasia.

The use of the Da Vinci® robot for this type of intervention has been recognized many years ago now with the works of Federico Rea and Jens Ruckert among others. The advantage of this technique is the possibility to proceed with a radical thymectomy enlarged to the mediastinal fat exactly in the same way as for a median sternotomy, which is the standard technique. When compared to thoracoscopy, the advantage stems from 3D vision, segmentation of the operator’s movements, and exceptional maneuverability of the instruments which have 7 degrees of freedom. These instruments allow for an access to the lower cervical area without the use of a cervicotomy. The choice of the left side is explained by the need to identify the phrenic nerve’s position, which is more difficult to predict than the right nerve’s position, which can be easily identified on the right lateral aspect of the superior vena cava.

Amongst bariatric procedures, mini gastric bypass has been described by Rutledge in 2001 with the objective of simplifying the gastric bypass technique (1). Mini gastric bypass only requires one anastomosis instead of 2 and should reduce complications related to the anastomosis at the foot of the loop in a conventional gastric bypass procedure. A few specificities should be pointed out. The gastric pouch is longer and more narrow. The landmark used to start the gastric division corresponds to the area separating the body of the stomach from the antrum at the level of the angulus. The biliary limb is also much longer and should reach 2cm in order to avoid the undiluted biliary fluid effects on the anastomosis. In this intervention, it is crucial to closue Petersen’s defect between the mounted loop and the transverse mesocolon. According to Himpens, this procedure could well reduce the incidence of hypoglycemias that might occur after a gastric bypass. This video outlines the different steps of the intervention. The use of a surgical robot allows to very easily perform a manual gastrojejunostomy.

(1). Rutledge, R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg 2001;11:276-80.

In this authoritative lecture, Professor Choi outlines robotic rectal cancer surgery.

In this key lecture, Prof. WY Chung briefly describes his experience and his own technique to perform robotic thyroid surgery. He presents advances in surgical indications and compares the main differences of single incision robotic thyroidectomy and LND with novel techniques, e.g. BABA, facelift thyroidectomy, and transoral periosteal thyroidectomy. He demonstrates the advantages and limitations using research data to describe the future of robotic thyroidectomy as a minimally invasive surgery. He highlights new technologies and newly developed robotic systems with current improvements, which focus on haptic feedback, tactile sensation, and single orifice surgery, which will make AI robotic automation surgery possible in the future.

In this authoritative lecture, Dr. Duh outlines the different applications of robotic surgery in abdominal and neck procedures.