Julia Samamé

Fully Robotic-Assisted Technique for Total Pancreatectomy with an Autologous Islet Transplant in Chronic Pancreatitis Patients: Results of a First Series

Received November 7, 2013; Revised December 3, 2 December 9, 2013. From the Section of Minimally Invasive and Robotic Su Samame), Institute for Cellular Transplantation (Rilo), a Transplantation and Hepatopancreaticobiliary Surgery (P Gruessner), Department of Surgery, University of Arizona, Correspondence address: Carlos A Galvani, MD, Section Invasive and Robotic Surgery, Department of Surgery, Arizona, College of Medicine, 1501 N Campbell Ave, PO Tucson, AZ 85724-5066. email: cgalvani@surgery.arizona.e

Robotic-Assisted Paraesophageal Hernia Repair: Initial Experience at a Single Institution

BACKGROUND Laparoscopic surgery is considered the standard approach for the treatment of paraesophageal hernias (PEHs). Despite its advantages, this approach is technically demanding with a significant learning curve. Data about the safety and utility of the robotically assisted paraesophageal hernia repair (RA-PEHR) are scarce. The aim of this study is to assess the feasibility and safety of robotic assistance for the treatment of PEH. MATERIALS AND METHODS Between June 2010 and December 2015, patients who underwent elective RA-PEHR were included in a prospectively collected database. Demographic data, American Society of Anesthesiologists (ASA) classification, preoperative testing, operative time (OT), length of hospital stay (LOS), conversion rate, morbidity, and mortality were recorded and reviewed retrospectively. RESULTS Sixty-one patients underwent RA-PEHR with mesh, 72% were female (mean age of 63 and mean body mass index [BMI] of 30). ASA classification was 2.6 (57% of patients had an ASA III). With respect to the type of the hernia, the preoperative diagnosis was: Type II 26%, III 64%, and IV 13%. OT averaged 186 minutes (88-360), including robot setup time. After the 16th case, OT significantly decreased by 4.09 minutes (P = .01). There were no conversions. The average blood loss was 51 mL. Perioperative complications, including intraoperative and 30-day complications, were 6% and 23%, respectively. The mean length of hospitalization was 2.6 (1-18) days. There were no deaths. Forty patients (66%) were available for follow-up, and length of follow-up was 17 ± 15 months. Anatomic recurrence was observed in 42% of patients and only 23% of patients were symptomatic. CONCLUSIONS This report represents the largest series to date of RA-PEHR. RA-PEHR has proved to be feasible and safe with a learning curve comparable to the standard laparoscopic approach.

Multipurpose internal retractor for Single-incision surgery (SIS): single-institution case series.

Single-incision laparoscopic surgery (SIS) is less invasive than standard laparoscopic surgery; however, it is more difficult due to restriction of motion and the impossibility to use assistants. To overcome these obstacles, we developed a self-sustaining multipurpose internal retractor by attaching a Lone Star retractor hook to a laparoscopic bulldog clamp. Herein, we report our SIS experience using our novel retractor. Between October 2008 and April 2011, 104 patients underwent SIS using the internal retractor: 67 bandings (43% simultaneous hiatal hernia repair), 8 sleeve gastrectomies, 27 cholecystectomies, and 2 Nissen fundoplication. Mean age was 40 (range, 21 to 85) and mean body mass index was 40 kg/m2 (range, 20 to 64 kg/m2). No intraoperative complications were observed from the use of the retractor but 2 cases required additional retraction due to liver size. This retractor has been successfully used for different SIS procedures showing to be safe, adaptable, and easy to use, lessening some challenges of SIS.

Bariatric Surgery: The Less, The Better

Bariatric surgery has proven to be the most effective long-term treatment for morbid obesity. However, only a very small fraction of all potential candidates undergo surgery, mainly because of the invasiveness and the perioperative risks and complications that the procedure entails. Moreover, there is no effective option yet for those patients who do not qualify for bariatric surgery but still need a treatment for morbid obesity. It is no coincidence that the resurgence and rapid evolution of bariatric surgery coincided with the introduction of the laparoscopic approach and the adjustable gastric band, showing that the less, the better.

Treatment of Morbid Obesity

Prevalence of obesity is increasing and approaching a pandemic. It is largely driven by changes in living environment and behavior as a result of technological modernization. These factors change our diets and lifestyles and promote a state of positive energy balance. Weight loss is the key treatment in patients with obesity and related complications, and it cannot be achieved without having a positive change in behavior and lifestyle. Bariatric surgery is effective treatment with long-term results for the treatment of morbid obesity, resolution of comorbidities, and improved life expectancy. This comprehensive review includes new insights and concepts in lifestyle interventions and bariatric surgery for the treatment of morbid obesity.