Luis Malavé

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.

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.

Hepatobilio-pancreatic robotic surgery: initial experience from a single center institute

The use of robotic surgery in the hepatobilio-pancreatic (HBP) field is still limited. Our aim is to present our early experience of robotic liver resection. A retrospective review of robotic pancreatic and liver resection was performed at Sanchinarro University hospital from October 2010 to April 2016. Since the beginning of the robotic program in our center, 22 hepatic procedures and 45 pancreatic robotic procedures have been performed. Of the 21 patients subjected to liver resection, 13 (65%) were for malignancy. There were two left hepatectomies, one right hepatectomy, one associated liver partition and portal vein ligation staged procedure (both steps by robotic approach), three bisegmentectomies and three segmentectomies, eight wedge resections, and three pericystectomies. The mean operating time was 282xa0min. The overall conversion rate and postoperative complication rate were 4.7 and 19%, respectively. The mean length of hospital stay was 13.4 days (range 4–64xa0days). Of the 45 patients subjected to pancreatic resection, 22 were male and 23 female. The average age of all patients was 62 years (range 31–82xa0years). The mean operating room (OR) time was 370 minxa0(120–780xa0min). Among the procedures performed were 15 pancreatico-duodenectomies, 19 distal pancreatectomies, and 11 enucleations. All procedures in the HBP area were R0. Our early experience shows that robotic surgery is a safe and feasible procedure in the HBP area. The complication and mortality rates are comparable to those of open surgery, but with the advantages of minimally invasive surgery.

Robotic versus laparoscopic distal pancreatectomy: A comparative study of clinical outcomes and costs analysis

BACKGROUNDnThe robotic surgery cost presents a critical issue which has not been well addressed yet. This study aims to compare the clinical outcomes and cost differences of robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP).nnnMETHODSnData were abstracted prospectively from 2011 to 2017. An independent company performed the financial analysis.nnnRESULTSnA total of 28 RDP and 26 LDP were included. The mean operative time was significantly lower in the LDP (294 vs 241xa0min; pxa0=xa00.02). The main intra and post-operative data were similar, except for the conversion rate (RDP: 3.6% vs LDP: 19.2%; pxa0=xa00.04) and hospital stay (RDP: 8.9 vs LDP 13.1 days; pxa0=xa00.04). The mean total costs were similar in both groups (RDP: 9198.64 € vs LDP: 9399.74 €; pxa0>xa00.5).nnnCONCLUSIONSnRDP showed lower conversion rate and shorter hospital stay than LDP at the price of longer operative time. RDP is financially comparable to LDP.

A prospective randomized study comparing laparoscopic transabdominal preperitoneal (TAPP) versus Lichtenstein repair for bilateral inguinal hernias

BACKGROUNDnIn literature, only a few studies have prospectively compared the results of laparoscopic with open inguinal hernia repair yet none have compared bilateral inguinal hernia repair. The aim of this study is to compare the open Lichtenstein repair (OLR) with laparoscopic trans-abdominal preperitoneal (TAPP) repair in patients undergoing surgery for bilateral inguinal hernia.nnnMETHODSnPatients were prospectively randomized between March 2013 and March 2015. Outcome parameters included hospital stay, operation time, postoperative complications, immediate postoperative pain and chronic pain, recurrence and quality of life.nnnRESULTSnSixty-one patients underwent TAPP repair and 73 underwent OLR. TAPP procedure had less early post-operative pain up to 7 days from surgery (pxa0=xa00.003), a shorter length of hospital stay (pxa0=xa00.001), less postoperative complications (pxa0=xa00.012) and less chronic pain (0.04) when compared with the OLR approach.nnnCONCLUSIONSnTAPP procedure for bilateral inguinal hernia effectively reduces early postoperative pain, hospital stay and postoperative complications.

Predictive prognostic value of local and distant recurrence of F-fluorodeoxyglucose positron emission tomography for pancreatic neuroendocrine tumors with reference to World Health Organization classifications (2004, 2010). Case series study.

BACKGROUNDnF-flurodeoxyglucose positron emission tomography (FDG-PET) have been claimed to be an important prognostic tool in different malignancies. However, its predictive prognostic value on pancreatic neuroendocrine tumors (PNETs) is still under investigation.nnnAIMnWe study the prognostic impact of FDG-PET scan in neuroendocrine pancreatic tumors.nnnMETHODOLOGYnBetween 2007 and 2012, 26 patients with no metastastatic histologically confirmed PNETs (mean age: 57 years) were examined with FDG-PET. We studied its captation in relation with the well established hystopathological prognostic markers assessed in the tumoral resected specimen according to the WHO 2004 and ENETS/WHO 2010 classification.nnnRESULTSnFDG-PET captation was positive in 17 cases (65.4%). The median follow-up period was 34.4 months and recurrences occurred in 4 cases (15.4%). We found a significant correlation between this captation and Ki 67 index (pxa0=xa00.032), mitotic index (pxa0=xa00.002), tumor grade (pxa0=xa00.017) and tumor size (pxa0=xa00.01).nnnCONCLUSIONSnFDG-PET provides a good prognostic value for PNETs. Present results must be further validated with larger sample studies.

Robotic versus standard open pancreatectomy: a propensity score-matched analysis comparison

Interest in robotic pancreatectomy has been greatly increasing over the last decade. However, evidence supporting the benefits of robotic over open pancreatectomy is still outstanding. This study aims to assess the safety and efficacy of robotic pancreatectomy compared with the conventional open surgical approach. Propensity score-matched (1:1) was used to balance age, sex, BMI, ASA, tumor size, and malignancy of 17 robotic pancreaticoduodenectomies (PD), 12 pancreatic enucleations (PE), and 28 distal pancreatectomies (DP); and was compared with the open standard approach. Robotic PD was associated with longer operative time (594 vs. 413xa0min; pu2009=u20090.03) and decreased blood loss (190 vs. 394xa0ml; pu2009=u20090.001). Robotic PE showed a lower mean length of hospital stay (8.4 vs. 12.8xa0days; pu2009=u20090.04) and, in addition, robotic DP showed less blood loss (175 vs. 375xa0ml; pu2009=u20090.01), less severe morbidities (7.14 vs. 17.9%; pu2009=u20090.02), and a reduced mean length of hospital stay (8.9 vs. 15.1; pu2009=u20090.001). Overall, conversion rate was 4 (7%). Robotic pancreatectomy is as safe and effective as the standard open surgical approach with reduced blood loss in PD and DP, length of hospital stay in PE and DP, and severe morbidity in DP.

First case of complete full robotic surgical resection of leiomyosarcoma of the right renal vein

BackgroundLeiomyosarcomas present high postoperative morbidity and poor prognosis [1]. In the literature, only few cases of localized small leiomyosarcoma have been described [2, 3]. These cases might benefit from a minimally invasive approach. Robotic surgery has been claimed to have several advantages over laparoscopy such as enhanced vision and instruments movements which might make more feasible the execution of this type of surgery where partial renal resection is required.MethodsA 53-year-old female with a medical history of myeloid leukemia and with chronic renal failure (creatinine: 2.6) was referred to our hospital for an incidental finding of right perirenal tumor of almost 3xa0cm compatible with leiomyosarcoma arising from the right renal vein.ResultsThe operation was performed using a Da Vinci Robotic Surgical System model Si (Intuitive Surgical, Sunnyvale, CA, USA).Robotic ports were placed in a standard configuration for minimally invasive right nephrectomy. The dissection started with the partial mobilization of the right liver and Kocher maneuver. After the identification of the inferior vena cava the tumor was finally localized and dissected. Resection ended with a partial right vein resection and suture. Pathological final exam confirmed the diagnosis with margins free from tumor.ConclusionsIn selected cases, robotic resection of leiomyosarcoma might be a safe and feasible procedure in experienced hands.

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.

Role of robotic-assisted pancreatic surgery: lessons learned from our initial experience

BACKGROUNDnMinimally invasive surgery has achieved worldwide acceptance in various fields, however, pancreatic surgery remains one of the most challenging abdominal procedures. In fact, the indication for robotic surgery in pancreatic disease has been controversial. The present study aimed to assess the safety and feasibility of robotic pancreatic resection.nnnMETHODSnWe retrospectively reviewed our experience of robotic pancreatic resection done in Sanchinarro University Hospital. Clinicopathologic characteristics, and perioperative and postoperative outcomes were recorded and analyzed.nnnRESULTSnFrom October 2010 to April 2016, 50 patients underwent robotic-assisted surgery for different pancreatic pathologies. All procedures were performed using the da Vinci robotic system. Of the 50 patients, 26 were male and 24 female. The average age of all patients was 62 years. Operative time was 370 minutes. Among the procedures performed were 16 pancreaticoduodenectomies (PD), 23 distal pan-createctomies (DP), 11 tumor enucleations (TE). The mean hospital stay was 17.6 days in PD group, 9.0 days in DP group and 8.4 days in TE group. Pancreatic fistula occurred in 10 cases (20%), 2 after PD, 3 after DP, and 5 after TE. Four patients had postoperative transfusion in PD group and one in DP group. Conversion to open laparotomy occurred in four patients (8%). No serious intraoperative complications were observed.nnnCONCLUSIONSnFrom our early experience, robotic pancreatic surgery is a safe and feasible procedure. Further experience and follow-up are required to confirm the role of robotic approach in pancreatic surgery.