Eduardo Parra-Davila

Four-arm single docking full robotic surgery for low rectal cancer: technique standardization

The authors present the four-arm single docking full robotic surgery to treat low rectal cancer. The eight main operative steps are: 1- patient positioning; 2- trocars set-up and robot docking; 3- sigmoid colon, left colon and splenic flexure mobilization (lateral-to-medial approach); 4-Inferior mesenteric artery and vein ligation (medial-to-lateral approach); 5- total mesorectum excision and preservation of hypogastric and pelvic autonomic nerves (sacral dissection, lateral dissection, pelvic dissection); 6- division of the rectum using an endo roticulator stapler for the laparoscopic performance of a double-stapled coloanal anastomosis (type I tumor); 7- intersphincteric resection, extraction of the specimen through the anus and lateral-to-end hand sewn coloanal anastomosis (type II tumor); 8- cylindric abdominoperineal resection, with transabdominal section of the levator muscles (type IV tumor). The techniques employed were safe and have presented low rates of complication and no mortality.

Totally robotic left colectomy

Laparoscopic colectomy has been a challenge for surgeons due to steep learning curves, limited dexterity of instruments and non-depth perception with visualization. Robotics for left colectomy has been described in the past years using mostly single docking or hybrid techniques. With the advantages of the robotic technology including the use of 3D visualization, increase dexterity with 360-degree motion of the instruments, surgeons may see an increase in the adoption of minimally invasive surgery for colectomies. Surgeons know that multi-quadrant dissection can be difficult at best with the current platforms available due to the approach of the angles with the robotic arms and collisions. The use of a single docking technique can be challenging especially for the dissection of the splenic flexure especially in obese patients. We describe a double docking technique for the approach of the left colectomy that may help surgeons in the approach of multi-quadrant colorectal surgery.

Lap colectomy and robotics for colon cancer.

Robotic approaches have seen significant growth in the last 5 years. Taking advantage of three-dimensional visualization, improved articulation, and multiple operating arms provides theoretical and real advantages in colorectal cancer surgery. This article reviews the potential advantages and disadvantages, current outcomes, and future directions for robotic approaches to colon cancer surgery.

Robotic Left Colectomy

Minimally invasive surgery is growing rapidly every day. The benefits to patients have been well documented and analyzed and is gaining acceptance all over the world. Compared to traditional laparoscopic procedures, robotic surgery is now being used in more complex and complicated cases including colorectal surgery. The left colectomy can safely be performed robotically using different docking techniques. Long-term studies are still needed to determine if it will translate into improved clinical outcomes.

Robotic Repair of Lower Abdomen Defects

Laparoscopic ventral hernia repair emerged and resulted in many benefits regarding wound problems and recurrence. However, this approach has issues related to the fascia closure and mesh fixation. Robotic ventral hernia repair (RVHR) overcomes these shortcomings by allowing the operator to offer traditional open repair techniques through minimal access incisions.

Robotic IPOM-Plus Repair

Laparoscopic surgery in ventral hernia repair is evolving rapidly worldwide as the gold standard procedure. Intraperitoneal onlay mesh (IPOM) technique for the treatment of incisional and parastomal hernias has growing in the last years since the first description in 1993.

Open Versus Endoscopic Component Separation: How to Choose One or the Other

The repair of massive ventral hernias has remained a challenging problem for surgeons. Primary repair is rarely successful and has associated recurrence rates of 18–62% depending on the defect size. The addition of synthetic mesh decreases recurrence rates significantly from 2 to 32%. The use of large sheets of synthetic material for hernia repair often results in a rigid, noncompliant, adynamic abdominal wall and in most cases is contraindicated in the setting of contamination. The principles of ventral hernia repair are well established: wound closure should be free of excessive tension, sutures should be placed in healthy tissue, and strong suture material should be used to support the wound through the critical period of healing.

Editorial for special surgical issue

Laparoscopy has dramatically changed the paradigm of surgery. Beliefs that a bigger incision provides better exposure have slowly but assuredly been replaced by the pursuit of smaller and fewer incisions. The advantages of laparoscopy over open surgery were easily demonstrated with less postoperative pain, shorter hospital stays, quicker recovery, and even beyond with demonstrations of decreased adhesion formation and decreased inflammatory response to surgery. Although it has been 13 years since the first robotic general surgery procedure was performed, robotic surgery still remains, to a large extent, a new and relatively unexplored frontier in surgery. Led by urologists and robotic prostatectomy, however, other fields of surgery are slowly starting to follow suit. The challenges have largely been the costs and the availability of the robotic systems; however, acceptance of robotic surgery has also been hampered by attempts to measure the incremental benefits of robotic technology in similar terms to that of laparoscopy. The advantages of the robotic system are obvious to anyone that sits at a console: tremor filtration, scaling of motion, seven degrees of freedom, high definition, and magnified three-dimensional stereoscopic vision. All of these simply translate into the surgeon’s ability to see much better, work more precisely, and accommodate smaller working spaces. However, the benefits of robotic surgery will unlikely be measured by decreased pain, quicker recovery, or even perhaps better clinical outcomes. The impact of robotic surgery will go far beyond that. Robotic surgery heralds a different era of surgery that will profoundly change not only the way a surgeon operates, but also the way the surgeon will interact with the surgical environment and the patient. Integration of data, including stored and real-time imaging, into the surgical procedure; simulation-based presurgical planning; real-time collaboration with peers through console-based links; and further miniaturization and eventual wireless control of the patient-side instruments, will transform the MIS bedside surgeon into a conductor positioned in a surgical ‘‘cockpit’’ separated from the patient with access to a wide breadth of data orchestrating a complex interaction of events that will translate into very efficiently and precisely executed actions. As we stand at the eve of this surgical evolution, we are proud to present some of the global thought leaders of general surgery in robotic surgery with a special robotic general surgery section.