Cristina R. Harnsberger

Magnetic lower esophageal sphincter augmentation device removal

Implantation of a magnetic lower esophageal sphincter augmentation device is now an alternative to fundoplication in the surgical management of gastroesophageal reflux disease (GERD). Although successful management of GERD has been reported following placement of the device, there are instances when device removal is needed. The details of the technique for laparoscopic magnetic lower esophageal sphincter device removal are presented to assist surgeons should device removal become necessary.

Intraoperative Endoscopic Botox Injection During Total Esophagectomy Prevents the Need for Pyloromyotomy or Dilatation

BACKGROUND Esophagectomy may lead to impairment in gastric emptying unless pyloric drainage is performed. Pyloric drainage may be technically challenging during minimally invasive esophagectomy and can add morbidity. We sought to determine the effectiveness of intraoperative endoscopic injection of botulinum toxin into the pylorus during robotic-assisted esophagectomy as an alternative to surgical pyloric drainage. MATERIALS AND METHODS We performed a retrospective analysis of patients with adenocarcinoma and squamous cell carcinoma of the distal esophagus or gastroesophageal junction who underwent robotic-assisted transhiatal esophagectomy (RATE) without any surgical pyloric drainage. Patients with and without intraoperative endoscopic injection of 200 units of botulinum toxin in 10 cc of saline (BOTOX group) were compared to those that did not receive any pyloric drainage (noBOTOX group). Main outcome measure was the incidence of postoperative pyloric stenosis; secondary outcomes included operative and oncologic parameters, length of stay (LOS), morbidity, and mortality. RESULTS From November 2006 to August 2014, 41 patients (6 females) with a mean age of 65 years underwent RATE without surgical drainage of the pylorus. There were 14 patients in the BOTOX group and 27 patients in the noBOTOX group. Mean operative time was not different between the comparison groups. There was one conversion to open surgery in the BOTOX group. No pyloric dysfunction occurred in the BOTOX group postoperatively, and eight stenoses in the noBOTOX group (30%) required endoscopic therapy (P < .05). There were no differences in incidence of anastomotic strictures or anastomotic leaks. One patient in group noBOTOX required pyloroplasty 3 months after esophagectomy. There was one death in the noBOTOX group postoperatively (30-day mortality 2.4%). Mean LOS was 9.6 days, and BOTOX patients were discharged earlier (7.4 versus 10.7, P < .05). CONCLUSION Intraoperative endoscopic injection of botulinum toxin into the pylorus during RATE is feasible, safe, and effective and can prevent the need for pyloromyotomy.

Masters Program Colon Pathway: Robotic Left Hemicolectomy and Total Colectomy

Surgeons are increasingly applying robotic techniques to colorectal procedures. Although the use of robotics for pelvic surgery has been well defined, the application of robotics for segmental and total abdominal colectomy has only recently began to be described. Marketing data suggest that robotic colectomy is one of the fastest growing areas of robotic surgery. Indications for robotic-assisted colectomy include benign and malignant neoplasms, inflammatory bowel diseases, and infections. Surgeons have become increasingly aware of the importance of surgical technique as it impacts both patient and oncologic outcomes. The use of robotics may enhance the ability to perform mesocolic resection and intracorporeal anastomosis as well as reduce conversions rates. Additionally, new robotic technologies such as the robotic stapler, integrated fluorescence imaging module, and energy tissue sealer have become available which offer advantages that cannot be duplicated with laparoscopic or open techniques. This chapter reviews the current status of robotic-assisted total and segmental left colectomy, technical considerations, and current data on patient outcomes.

Erratum to: Reoperation rates after laparoscopic fundoplication

There is a shared first authorship between the first two authors, T. Zhou and C. Harnsberger, as both contributed equally to this paper. The affiliation for T. Zhou should be: Department of General Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, San Diego, CA, USA The affiliation for C. Harnsberger, R. Broderick, H. Fuchs, G. Jacobsen, S. Horgan, D. Chang, B. Sandler should be: Department of General Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, San Diego, CA, USA The affiliation for M. Talamini should be: Department of Surgery, Health Sciences Center T19-020, Stony Brook Medicine, Stony Brook, NY 11794-8191, USA

Operating Room Setup and General Techniques for Robotic Surgery

In this chapter, we will review equipment, setup, and general techniques in robotic surgery. Robotic techniques are increasingly being applied to colorectal surgery. To date, the most common indication for the use of robotics in colorectal surgery is in the pelvis for rectal dissection. More recently, however, robotic colectomy is gaining momentum. Before incorporating robotic technology into practice, a fundamental knowledge of the system and proper use of the equipment and basic procedure setup are critical to patient safety and optimal outcomes.