Hipolito Duran

Does robotic distal pancreatectomy surgery offer similar results as laparoscopic and open approach? A comparative study from a single medical center.

In the field of pancreatic surgery, robotic surgery has yet to be evaluated against open and laparoscopic approaches. The outcomes of robotic surgery for distal pancreatectomy were analysed and the results compared with those of laparoscopic and open procedures.

Factores biológicos implicados en la génesis de la hernia incisional

Resumen En el contexto de la patologia quirurgica de la pared abdominal, la eventracion o hernia incisional sigue siendo una de las afecciones de mayor prevalencia. Su incidencia no ha disminuido en los ultimos anos a pesar de la mejora en los materiales de sutura y tambien en las tecnicas de cierre. Existen factores de indole general que pueden interferir en el proceso cicatricial de las laparotomias, pero hay factores de tipo biologico dependientes del propio individuo que pueden explicar en gran parte la inalterable incidencia de esta afeccion. Asi, los diferentes tipos de colagenos, determinadas enzimas, como las metaloproteinasas, y ciertos habitos, como el tabaquismo, han sido implicados en la aparicion de esta afeccion. Probablemente sea necesario en casos de riesgo y cicatrizacion comprometida realizar los cierres laparotomicos con algun material protesico de apoyo, especialmente en las laparotomias medias.In the context of a surgically treated abdominal wall pathology, eventration of the wall, or incisional hernia, is one of the most prevalent complications. Despite numerous improvements over the years in suture materials and closure techniques, the incidence of incisional hernia has not diminished. Several general factors can influence the wound healing process after a laparotomy, but there are also biological factors that depend on the individual patient that can to a great extent explain the un-changing incidence of this pathology. Thus, different types of collagen, certain enzymes such as metalloproteinases and factors such as smoking have been attributed a role in the appearance of incisional hernia. These features suggest the need for a biomaterial to strengthen laparotomy closures, especially midline closures, in high-risk patients and/or in those where wound healing is compromised.

Pancreatic disease, panniculitis, polyarthrtitis syndrome successfully treated with total pancreatectomy: Case report and literature review

Highlights • PPP (pancreatic disease, panniculitis, polyarthritis) syndrome is a rare disease caused by pancreatitis or pancreatic cancer.• Panniculitis and polyarthritis are the main characteristics of the syndrome.• A high mortality rate and chronic sequel are reported.• Surgical and endoscopic treatment may improve the prognosis of this condition.

Sigue representando la infiltración arterial un criterio de irresecabilidad en el carcinoma de páncreas

As surgical resection remains the only hope for cure in pancreatic cancer (PC), more aggressive surgical approaches have been advocated to increase resection rates. Venous resection demonstrated to be a feasible technique in experienced centers, increasing survival. In contrast, arterial resection is still an issue of debate, continuing to be considered a general contraindication to resection. In the last years there have been significant advances in surgical techniques and postoperative management which have dramatically reduced mortality and morbidity of major pancreatic resections. Furthermore, advances in multimodal neo-adjuvant and adjuvant treatments, as well as the better understanding of tumor biology and new diagnostic options have increased overall survival. In this article we highlight some of the important points that a modern pancreatic surgeon should take into account in the management of PC with arterial involvement in light of the recent advances.

Robot-assisted resection of gastrointestinal stromal tumors (GIST): a single center case series and literature review.

Robotic techniques are claimed to be an alternative to laparoscopic and open approaches for gastrointestinal stromal tumors (GIST) treatment. Our aim is to present our single center experience and a literature review.

Arterial Pseudoaneurysms Following Hepato-Pancreato-Biliary Surgery: A Single Center Experience

CONTEXT Arterial pseudoaneurysm is an uncommon lethal complication following hepato-pancreato-biliary surgery. OBJECTIVE Aim of this study is to present and discuss the experience of a high volume oncological center. METHODS Since 2007 all major surgeries performed at Sanchinarro Oncological Center have been included in a prospective database looking for postoperative arterial pseudonaurysm. RESULTS Until June 2014, among 559 hepato-pancreato-biliary procedures, a total of 14 arterial pseudoaneurysms have been identified (2.5%). Sentinel bleeding was in 57% of cases. Failed arterial embolization occurred in 2 cases. Overall mortality rate was 28.5%. We also identified 3 asymptomatic pseudoaneurysms, one of them managed without embolization, developing a sudden bleeding and died after surgery. CONCLUSIONS According to our experience, pseudoaneurysm incidence is higher than reported in current literature and it can be successfully managed through arterial embolization. Furthermore, we found 3 asymptomatic pseudoaneurysms, whose management is still controversial.

Full robot-assisted gastrectomy: surgical technique and preliminary experience from a single center

The treatment of gastric cancer requires a multidisciplinary approach in which surgery plays the main role. The diffusion of minimally invasive surgery for gastric cancer treatment is limited by the complexity of performing an extended lymphadenectomy. This surgical step can be facilitated through the use of a robot-assisted system. To date, there are few published articles discussing a full robotic approach that precisely show the different surgical steps. The aim of this study is to describe our experience, surgical techniques and the short-term results of a consecutive series of full robotic gastrectomies using the Da Vinci Surgical System. From November 2011 to January 2015, 17 patients with gastric cancer underwent curative resection by robotic approach for locally advanced tumors. In summary, there were 15 total gastrectomies with a Roux-en-Y esophagojejunostomy, one total gastrectomy with transverse colectomy and one sub-total gastrectomy. Resection margins were negative in all cases. Conversions occurred in two patients. Robot-assisted gastrectomy with extended lymphadenectomy is a safe technique and successfully allows an adequate lymph node harvest and optimal R0-resection rates with low postoperative morbidity. The learning curve appears to be shorter than in laparoscopic surgery. Further follow-up and randomized clinical trials are required to confirm the role of a robotic approach in gastric cancer surgery.

Papel de la cirugía en las metástasis del cáncer de mama

Resumen Siempre se ha considerado que el cancer de mama con metastasis a distancia es una enfermedad incurable y, consecuentemente, la paciente es candidata a recibir solo tratamiento medico paliativo. Sin embargo, la obtencion de mayores exitos de supervivencia tras los nuevos regimenes terapeuticos en el cancer de mama diseminado y la existencia de un 5% de enfermas con cancer de mama metastasico confinado a un solo organo solido (estado oligometastasico) son dos aspectos determinantes en la introduccion de la cirugia como parte integral en el tratamiento multidisciplinario de las metastasis hepaticas, pulmonares y oseas de origen mamario. Esta revision actualiza las diferentes series publicadas centrando la discusion en dos aspectos: la seleccion de las candidatas ideales para la cirugia exeretica de higado, pulmon o partes oseas y la identificacion de los factores pronosticos de recurrencia y/o supervivencia tras la extirpacion de tales metastasis.

Robotic assisted gastrectomy compared with open resection: a case-matched study

In recent years, increasingly sophisticated tools have allowed for more complex robotic surgery. Robotic gastrectomy, however, is adopted in only a few selected centers. The goals of this study were to examine the adoption of robotic gastrectomy and to compare outcomes between open and robotic gastric resections. This is a case-matched analysis of patients who underwent robotic and open gastric resection performed at Sanchinarro University Hospital, Madrid from November 2011 to February 2017. Patient data were obtained retrospectively. Clinicopathologic characteristics and perioperative and postoperative outcomes were recorded and analyzed. Two groups of demographically similar patients were analyzed: the robotic group (n = 20) and the open surgery group (n = 19). The patient characteristics of the two groups have been compared. Robotic resection resulted in less blood loss, shorter postoperative hospital stay, and a longer operating time. The two groups had similar complication rates. Pathological data were similar for both procedures. Robotic gastrectomy for locally advanced gastric carcinoma is safe, and long-term outcomes are comparable to those patients who underwent open resection. Robotic gastrectomy resulted in a shorter hospital stay, less blood loss and morbidity comparable with the outcomes of open gastrectomy.

First Case of ROLL Technique for Mesorectal Recurrence Excision

The radio-guided occult lesion localization (ROLL) technique has been in use since the mid-1990s, mainly in breast surgery. Today, ROLL is used for numerous oncologic pathologies, including parathyroid lesions, melanomas, and colorectal tumors. We report a patient with an 11-mm left mesorectal solitary recurrence of a primary ovarian cancer in whom the ROLL technique was used to identify the implant. A radioisotope was introduced through a 22-gauge needle with endoscopic ultrasound technique using an linear echo endoscope. On the day of surgery, the patients perianal region was scanned with a gamma probe to identify the area of maximal radioactivity, to determine the optimal placement of the incision over the lesion. After macroscopic excision of the lesion, radioactivity was measured in the lesion bed to ensure complete removal of affected tissues. In our case, the ROLL technique was performed safely for the detection and excision of a recurrent lesion of difficult identification. To our knowledge, this is the first reported case involving use of the ROLL technique to aid the excision of a mesorectal lesion.