Luca Matteo Lenti

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.

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.

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%.

ICG Fluorescence: Current and Future Applications

The imaging technique based on indocyanine green (ICG) fluorescence has been widely used for more than forty years, especially to study blood flow and microcirculation. This method was first applied in general surgery to perform sentinel lymph node (SLN) biopsies in patients affected by breast and colorectal cancer. In 2010, a near-infrared (NIR) laser light system was integrated with the da Vinci® Si™ HD robotic system (Intuitive Surgical Inc., Sunnyvale, CA, USA). This imaging system is able to provide both white light and near-infrared light images through dedicated endoscopic illuminators and filters by simply pressing a pedal on the surgical console, thus allowing real-time fluorescence-guided surgery.

Single-Site™ Surgery

The Single-Site™ platform was primarily designed to work in a narrow operative field and with a specific anatomical target. To date, the most consistent published experiences are regarding the use of this technology to perform cholecystectomy [1, 2, 3, 4, 5, 6, 7, 8, 9] but, recently, it has been applied in other fields of general surgery [10, 11, 12]. This chapter will focus on its current application in performing cholecystectomy and right colectomy.

Full-robotic Technique for Rectal Cancer

Since the first robotic total mesorectal excision (TME) was reported in 2006 [1], two main methods for robotic rectal surgery, hybrid versus totally robotic technique, have been described.

Splenectomy and Hemisplenectomy

Minimally invasive splenectomy has become an established standard of care in general surgery for nontraumatic splenic lesions. Since laparoscopic splenectomy was first reported in 1991 by Delaitre et al. [1], subsequent literature has clearly shown that this approach dramatically improves short-term perioperative outcomes and provides enhanced cosmesis [2].