Telemicrosurgery: robot-assisted microsurgery

In this key lecture, Dr. Giulianotti outlines the indications for robotic biliary reconstruction, especially in case of a small common bile duct. He presents his experience with the robotic approach providing advantages and benefits.

Objective:
Leiomyomas represent approximately 70% of all benign esophageal tumors. In most cases, patients are asymptomatic, but others can present chest pain, dysphagia or weight loss. Even if malignization is rare, surgery is indicated. Laparoscopy is the most common approach because of the frequency of leiomyoma localization on the lower esophagus. However, thoracoscopy is also commonly performed with some difficulties in case of large tumors.
Our objective is to demonstrate the robotic approach and the bipolar Maryland forceps used for such a specific lesion.

Case presentation:
We present the case of a 58-year-old woman with no particular co-morbidity. On CT-scan, she was incidentally diagnosed with a leiomyoma for Guillain-Barre syndrome. A homogeneous 7cm tumor was found on the left side of the middle esophagus with a horseshoe-shaped aspect typical of leiomyoma. Check-up was completed by MRI and endoscopic ultrasonography, which tended to confirm the diagnosis.
In this video, the robot-assisted thoracic enucleation of the tumor performed by a left approach shows the quality of esophageal exposure and tumor dissection by means of a bipolar Maryland forceps. Blood loss was less than 30mL, and the postoperative period was uneventful. Histological analysis confirmed the diagnosis of leiomyoma.

Conclusion:
Robot-assisted resection of benign esophageal tumors is a safe procedure, especially for intrathoracic tumors. This technique provides a better view and easier dissection. The use of a bipolar Maryland forceps allows for a safer procedure. Day care surgery could then be expected for smaller lesions.

Gastric bypass is one of the most common procedures in bariatric surgery. The main steps of this procedure are well codified, namely fashioning of a small-sized gastric pouch in contact with the esophagus, measuring of a biliary limb and of an alimentary limb, gastrojejunal anastomosis and jejunojejunal anastomosis at the foot of the loop. The Da Vinci™ robotic Surgical System is particularly suited for manual anastomoses. This video demonstrates the use of the robot to perform gastrojejunal and jejunojejunal anastomoses.

In this key lecture, Dr. Parra-Davila focuses on robotic transanal TME (taTME).

The video entitled "Robot-assisted Roux-en-Y gastric bypass, Sonicision™ cordless ultrasonic dissection device", authored by M Vix, KH Liu, and J Marescaux is analyzed by John Morton, MD, MPH, FACS (Stanford Hospital and Clinics, Stanford, CA, USA), sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

In this key lecture, Dr. Laurent Brunaud compares robotic bypass with laparoscopic bypass.

In this live interactive surgery, Dr. Parra-Davila demonstrates a robotic low anterior resection for a local recurrence of transanally excised rectal cancer. The operative technique shown includes a robotic oncological ‘en bloc’ resection and intracorporeal anastomosis. In the patient’s history, an ulcerated villous polyp too large for endoscopic removal was addressed to surgery. Preoperative biopsies had failed to detect malignancy. The surgical procedure consisted in a transanal full-thickness resection including partial TME for lymph node sampling. Since the operative specimen revealed a pT2N1a (1/8) rectal adenocarcinoma, the patient underwent adjuvant radiochemotherapy. The following year, a single hepatic metastasis was resected, complemented by postoperative chemotherapy. After 7 years of uneventful follow-up, an anastomotic recurrence was diagnosed. Following oncologic committee discussion, the patient was advised to undergo surgery.

This video shows a case of robotically assisted cholecystectomy for symptomatic lithiasis, complemented with fluorescence and augmented reality guidance. The use of robotics and sequential multimodal imaging protocol for cholecystectomy, should be interpreted as a model evocative of the upcoming paradigm shift towards cybernetic surgery rather than a state-of-the-art application.

In this lecture, Dr. Vaessen presents the current indications and benefits of robotic nephrectomy.

In this key lecture, Dr. Lorincz presents the main principles of nerve monitoring and vagal automatic periodic stimulation (APS) in robotic thyroid surgery. He provides a brief description of the identification of external branch of the superior laryngeal nerve (SLN) & describes the main principles of the electrophysiologic changes in APS and compares it to the normal procedures without APS, referring to meta-analyses & research data.