Giuseppe Spinoglio

Robotic Colorectal Surgery: First 50 Cases Experience

PurposeLaparoscopic colorectal surgery is believed to be technically and oncologically feasible. However, some limitation of traditional laparoscopic surgery may cause difficulties. Robotic-assisted surgery may overcome these pitfalls.MethodsFrom December 2005 to July 2007, 50 patients were selected for robotic-assisted colorectal resection mainly for cancer.ResultsOf the 50 patients enrolled, 32 (64 percent) were men and 18 (36 percent) were women. Their mean age was 66.7 (range, 37–92) years. The American Society of Anesthesiologists’ (ASA) class distribution was 13 (26 percent) ASA I, 24 (48 percent) ASA II, 12 (24 percent) ASA III, and 1 (2 percent) ASA IV. Forty-four patients suffered from cancer and six patients from benign disease. Amongst the cancer patients, 3 percent were at UICC (International Union Against Cancer) Stage 0, 36 percent at UICC Stage I, 24 percent at Stage II, 28 percent at Stage III, and 9 percent at Stage IV. The global conversion rate was 4 percent. The mean operative time was 338.8 minutes. It decreased as the experience increased (419 minutes in the first 20 cases vs. 346 minutes in the last 30 cases; P = 0.036). As a gross comparison, the results of a coeval standard laparoscopy group of patients were shown.ConclusionsRobotic laparoscopic colon surgery is feasible and safe. A longer operating time is needed.

Application of Fluorescence in Robotic General Surgery: Review of the Literature and State of the Art

The initial use of the indocyanine green fluorescence imaging system was for sentinel lymph node biopsy in patients with breast or colorectal cancer. Since then, application of this method has received wide acceptance in various fields of surgical oncology, and it has become a valid diagnostic tool for guiding cancer treatment. It has also been employed in numerous conventional surgical procedures with much success and benefit to the patient. The advent of minimally invasive surgery brought with it a new use for fluorescence in helping to improve the safety of these procedures, particularly for single-site procedures. In 2010, a near-infrared camera was integrated into the da Vinci Si System, creating a combination of technical and minimally invasive advantages that have been embraced by several experienced surgeons. The use of fluorescence, although useful, is considered challenging. Only a few studies are currently available on the use of fluorescence in robotic general surgery, whereas many articles have focused on its application in open and laparoscopic surgery. Many of these reports describe promising and satisfactory results, although with some shortcomings. The purpose of this article is to review the current status of the use of fluorescence in general surgery and particularly its role in robotic surgery. We also review potential uses in the future.

Laparoscopic gastrectomies for cancer: The ACOI-IHTSC national guidelines

Abstract Guidelines for laparoscopy and cancer of stomach have been outlined by several scientific societies: The main recommendation being that laparoscopy should be used only by surgeons already highly skilled in gastric surgery. The laparoscopic approach to gastric cancer surgery has become more and more frequent in most Italian centers. On behalf of the Guideline Committee of the Italian Society of Hospital Surgeons and the Italian Hi-Tech Surgical Club, a panel of experts analyzed the highest evidence of all scientific papers focusing on laparoscopic gastrectomies for cancer and published from 2003 to 2011, and drew these national guidelines. Laparoscopic gastrectomy may be considered as a safe procedure with better short-term and comparable long-term results. compared to open gastrectomy (Grade A). There is a general agreement that a laparoscopic approach to the treatment of gastric cancer should be chosen only by surgeons already highly skilled in gastric surgery and other advanced laparoscopic interventions. Furthermore, the first procedures should be carried out during a tutoring program. Diagnostic laparoscopy is strongly recommended as the first step of laparoscopic as well as laparotomic gastrectomies (Grade B). Additional randomized controlled trials (RCT) that compare and investigate the long-term oncological outcomes of laparoscopic assisted gastrectomy are required.

Evaluation of technical feasibility and safety of Single-Site™ robotic right colectomy: three case reports

Robotic Single‐Site™ surgery overcomes the technical constraints of single‐access laparoscopy. After performing over 130 Single‐Site robotic cholecystectomies and stabilizing operative times, we applied this technology to right colon surgery.

Laparoscopic and Robotic Total Mesorectal Excision in the Treatment of Rectal Cancer. Brief Review and Personal Remarks

The current standard treatment for rectal cancer is based on a multimodality approach with preoperative radiochemotherapy in advanced cases and complete surgical removal through total mesorectal excision (TME). The most frequent surgical approach is traditional open surgery, as laparoscopic TME requires high technical skill, a long learning curve, and is not widespread, still being confined to centers with great experience in minimally invasive techniques. Nevertheless, in several studies, the laparoscopic approach, when compared to open surgery, has shown some better short-term clinical outcomes and at least comparable oncologic results. Robotic surgery for the treatment of rectal cancer is an emerging technique, which could overcome some of the technical difficulties posed by standard laparoscopy, but evidence from the literature regarding its oncologic safety and clinical outcomes is still lacking. This brief review analyses the current status of minimally invasive surgery for rectal cancer therapy, focusing on oncologic safety and the new robotic approach.

A Single Centre Retrospective Evaluation of Laparoscopic Rectal Resection with TME for Rectal Cancer: 5-Year Cancer-Specific Survival

Laparoscopic colon resection has established its role as a minimally invasive approach to colorectal diseases. Better long-term survival rate is suggested to be achievable with this approach in colon cancer patients, whereas some doubts were raised about its safety in rectal cancer. Here we report on our single centre experience of rectal laparoscopic resections for cancer focusing on short- and long-term oncological outcomes. In the last 13 years, 248 patients underwent minimally invasive approach for rectal cancer at our centre. We focused on 99 stage I, II, and III patients with a minimum follow-up period of 5 years. Of them 43 had a middle and 56 lower rectal tumor. Laparoscopic anterior rectal resection was performed in 71 patients whereas laparoscopic abdomino-perineal resection in 28. The overall mortality rate was 1%; the overall morbidity rate was 29%. The 5-year disease-free survival rate was 69.7%, The 5-year overall survival rate was 78.8%.

Structured training and competence assessment in colorectal robotic surgery. Results of a consensus experts round table

A structured training is a key element for the learning of techniques with a high level of complexity, such as robotic colorectal surgery.

History of Robotic Surgery

The history of telerobotic surgery involves a revolutionary approach to minimally-invasive surgery. The concept of “telemanipulation” or “telepresence” emerged in the 1940s and was first used to describe the sensation that a person is in one location willIe being in another. It was driven by the need for certain complex tasks to be perfoffiled by machines in hazardous and unhealthy environment for human beings, such as the bottom of the ocean or in outer space. In Robert Heinlein’s 1942 science fiction , entitled “Waldo”, the lead character, Waldo Farthingwaite-Jones, was bom frail and unable to lift his own body weight. Heilnlein describes a glove and hamess device that allowed Waldo to control a powerful mechanical arm by simply moving his hand and fingers.

Robotic right colectomy with complete mesocolic excision: bottom-to-up suprapubic approach - a video vignette

Complete Mesocolic Excision (CME) with central vascular ligation has been reported to potentially improve oncological results in right colectomy [1-4]. However, along with the intracorporeal anastomosis, it represents a challenging step of the laparoscopic procedure [2,3,5]. The video describes a novel bottom-to-up suprapubic approach for robotic right colectomy with CME and intracorporeal anastomosis using the DaVinci Xi Surgical System. This article is protected by copyright. All rights reserved.

Right Colectomy with Complete Mesocolic Excision: Four-arm Technique

Minimally invasive surgery is gaining worldwide acceptance in the treatment of colonic cancer and the advantages over the traditional open approach are well known [1, 2, 3]. Unfortunately, during recent decades, the outcomes of patients after colon cancer resection have not improved to the same degree as for rectal cancer, whose treatment with total mesorectal excision (TME) is universally accepted as the standard of care. The complete mesocolic excision (CME), first reported by Hohenberger and colleagues in 2008 [4], seems to produce better long-term outcomes when compared to standard lymphadenectomy by following the same embryological-based principles introduced by Heald for rectal cancer more than 20 years ago [5]. However, well-conducted randomized studies are needed to confirm its efficacy.