Nicolas C. Buchs

Robotic liver surgery: results for 70 resections.

BACKGROUNDnRobotic surgery is gaining popularity for digestive surgery; however, its use for liver surgery is reported scarcely. This article reviews a surgeons experience with the use of robotic surgery for liver resections.nnnMETHODSnFrom March 2002 to March 2009, 70 robotic liver resections were performed at 2 different centers by a single surgeon. The surgical procedure and postoperative outcome data were reviewed retrospectively.nnnRESULTSnMalignant tumors were indications for resections in 42 (60%) patients, whereas benign tumors were indications in 28 (40%) patients. The median age was 60 years (range, 21-84) and 57% of patients were female. Major liver resections (≥ 3 liver segments) were performed in 27 (38.5%) patients. There were 4 conversions to open surgery (5.7%). The median operative time for a major resection was 313 min (range, 220-480) and 198 min (range, 90-459) for minor resection. The median blood loss was 150 mL (range, 20-1,800) for minor resection and 300 mL (range, 100-2,000) for major resection. The mortality rate was 0%, and the overall rate of complications was 21%. Major morbidity occurred in 4 patients in the major hepatectomies group (14.8%) and in 4 patients in the minor hepatectomies group (9.3%). All complications were managed conservatively and none required reoperation.nnnCONCLUSIONnThis preliminary experience shows that robotic surgery can be used safely for liver resections with a limited conversion rate, blood loss, and postoperative morbidity. Robotics offers a new technical option for minimally invasive liver surgery.

Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution

BackgroundMinimally invasive pancreaticoduodenectomy (PD) remains one of the most challenging abdominal procedures, and its application is poorly reported in the literature so far. To date, few data are available comparing a minimally invasive approach to open PD. The aim of the present study is to compare the robotic and open approaches for PD at a single institution.MethodsData from 83 consecutive PD procedures performed between January 2002 and May 2010 at a single institution were retrospectively reviewed. Patients were stratified into two groups: the open group (nxa0=xa039; 47%) and the robotic group (nxa0=xa044; 53%).ResultsPatients in the robotic group were statistically older (63xa0years of age versus 56xa0years; pxa0=xa00.04) and heavier (body mass index: 27.7 vs. 24.8; pxa0=xa00.01); and had a higher American Society of Anesthesiologists (ASA) score (2.5 vs. 2.15; pxa0=xa00.01) when compared to the open group. Indications for surgery were the same in both groups. The robotic group had a significantly shorter operative time (444 vs. 559xa0min; pxa0=xa00.0001), reduced blood loss (387 vs. 827xa0ml; pxa0=xa00.0001), and a higher number of lymph nodes harvested (16.8 vs. 11; pxa0=xa00.02) compared to the open group. There was no significant difference between the two groups in terms of complication rates, mortality rates, and hospital stay.ConclusionsThe authors present one of the first studies comparing open and robotic PD. While it is too early to draw definitive conclusions concerning the long-term outcomes, short-term results show a positive trend in favor of the robotic approach without compromising the oncological principles associated with the open approach.

Totally Robotic Right Hepatectomy Surgical Technique and Outcomes

HYPOTHESISnRobotic surgery for performance of right hepatectomy is safe and effective.nnnDESIGNnCase series from 2 medical institutions.nnnSETTINGnUniversity of Illinois at Chicago and Misericordia Hospital, Grosseto, Italy.nnnPATIENTSnTwenty-four patients underwent right hepatectomy between March 1, 2005, and January 31, 2010, using a robotic surgical system.nnnMAIN OUTCOME MEASURESnIntraoperative blood loss, operative time, morbidity, mortality, and long-term oncologic follow-up.nnnRESULTSnThe procedure was converted to open surgery in 1 patient (4.2%). The overall mean (SD) operative time was 337 (65) minutes (range, 240-480 minutes), and the mean (SD) intraoperative blood loss was 457 (401) mL (range, 100-2000 mL). Three patients (12.5%) underwent blood transfusion. There were no perioperative deaths and no reoperations. Six patients (25.0%) experienced postoperative morbidity, including transitory liver failure in 2 patients and pleural effusion, bile leak, fluid collection, and deep venous thrombosis in 1 patient each. The patients diagnoses included colorectal liver metastases (n = 11), noncolorectal liver metastases (n = 4), hemangioma (n = 4), adenoma (n = 2), hepatocellular carcinoma (n = 1), hepatoblastoma (n = 1), and biliary amartoma (n = 1). At a mean follow-up duration of 34 months, no port site metastases were observed in patients with malignant pathologic findings.nnnCONCLUSIONSnThe zero mortality and acceptable morbidity of our series indicate that in experienced hands, robotic right hepatectomy is feasible and safe. Robotic surgery offers a new technical option for minimally invasive major hepatic resections. Long-term results seem to confirm oncologic effectiveness of the procedure.

Robotic extended pancreatectomy with vascular resection for locally advanced pancreatic tumors

Objectives: Limited involvement of the major peripancreatic vessels is no longer considered a contraindication for resection in cases of locally advanced pancreatic cancer. Extended open pancreatectomies associated with vascular resection are performed in experienced centers with mortality and morbidity rates comparable to standard pancreatic resection. We evaluate the safety, feasibility, and outcomes of robotic extended pancreatectomy with vascular resection. Methods: We reviewed data of 5 patients with a median age of 60 years (range, 52-74 years) who underwent robotic surgery for pancreatic tumors with vascular involvement between May 2007 and March 2010 at our institution. The types of resection included 2 left-sided splenopancreatectomy with celiac axis resection, 1 left-sided splenopancreatectomy with portal vein resection, and 2 pancreaticoduodenectomy with portal vein resection. Results: No conversions occurred. The overall mean operating time was 392 ± 66 minutes (range, 310-460 min). The overall mean blood loss was 200 ± 61 mL (range, 150-300 mL) with no transfusions. No mortalities occurred. At a median follow-up of 6 months (range, 3-20 months), 4 patients were alive and disease free. Conclusions: This early series by a single surgeon supports the feasibility and safety of robotic pancreatectomy with vascular resection for selected patients with locally advanced pancreatic tumor.

Outcomes of Robot-Assisted Pancreaticoduodenectomy in Patients Older Than 70 Years: A Comparative Study

BackgroundMinimally invasive pancreaticoduodenectomy (PD) remains one of the most challenging abdominal procedures and its application in the elderly population is poorly reported in the literature so far. The goal of this study was to demonstrate that robot-assisted PD can be safely performed in patients aged 70xa0years and older.MethodsForty-one consecutive robot-assisted PD performed between April 2007 and January 2010 were prospectively entered in a dedicated database. Patients were stratified into two groups: group 1, agedxa0≥70xa0years (nxa0=xa015, 36.6%); and group 2, agedxa0<70xa0years (nxa0=xa026, 63.4%). The data were reviewed retrospectively.ResultsIndications for surgery and patient characteristics were the same in both groups, with the exception of age. There was no statistical difference in terms of operative time (Pxa0=xa00.376), blood loss (Pxa0=xa00.989), conversion rate (Pxa0=xa00.52), mortality (Pxa0=xa00.36), or overall morbidity rate (Pxa0=xa00.74). The mean hospital stay was 14.3xa0days in group 1 and 11.2xa0days in group 2. This was not statistically significant (Pxa0=xa00.136).ConclusionsRobot-assisted pancreaticoduodenectomy can be performed safely in elderly patients with comparable mortality, morbidity, and outcomes compared with a younger population. Age alone should not be a contraindication for robotic pancreatic resection.

Robot-assisted lung resection: outcomes and technical details

Robotic surgery has gained acceptance for surgical use but few data exist regarding its value in thoracic procedures. The aim of this study is to report our experience with totally robotic thoracic resections. From June 2001 to June 2009, 38 consecutive totally robotic lung resections were performed in two different hospitals by a single surgeon. All data was prospectively collected in a dedicated database, and reviewed retrospectively. A total of 32 lobectomies, three bilobectomies, and three pneumonectomies were performed. The indication was a malignant tumor in 28 cases. There were nine cases with benign pathology. Mean operating time was 209xa0min (range: 105-380xa0min). Six conversions were required (15.8%) and there was one postoperative death (2.6%). Four postoperative complications occurred (10.5%). Median hospital stay was 10xa0days (range: 3-24xa0days). After a median follow-up of 42xa0months, 80% of patients with stage I disease are alive without recurrence. Advanced thoracic procedures can be performed safely using the robotic system. In this heterogeneous series of lung resections, we report low mortality and morbidity. The robotic approach can achieve a good dissection in difficult to reach areas, making it particularly useful for oncologic resections.

Robot-assisted versus Laparoscopic Roux-en-Y Gastric Bypass: Is There a Difference in Outcomes?

BackgroundApplication of the robot for Roux-en-Y gastric bypass has been slow to evolve, despite its rapid acceptance in other fields. This is largely due to associated costs of technology, reports of increased operative time, and inadequate data available to correlate the benefits of robotics to a clinical outcome. The authors present a comparative study between laparoscopic and robot-assisted Roux-en-Y gastric bypass performed at a specialized institution for robotic surgery.Materials and methodA total of 135 consecutive Roux-en-Y gastric bypass procedures were performed from January 2006 to December 2009 by a single surgeon. The first 45 were performed laparoscopically and the remaining 90 were robot-assisted. Patient demographics, operative time, complication rate, length of stay, long-term weight loss, and follow-up for the two groups were gathered from a prospectively maintained database and statistically analyzed.ResultsThe overall operative time was significantly shorter for the robot-assisted procedures than for the laparoscopic procedures (207xa0±xa031 vs. 227xa0±xa031xa0min) (Pxa0=xa00.0006). The robotic set-up time remained constant at 13xa0±xa04xa0min. 30 robotic cases were necessary in order to perform the procedure in less time than with the laparoscopic approach (Pxa0=xa00.047). Mortality was 0% in both groups, with no conversions to open surgery and no transfusions. Early morbidities and percentage of excess weight loss at 1xa0year were comparable for the two groups.ConclusionsThe use of the robot for performing the gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass does not increase the operative time or the rate of specific complications. The short-term outcomes of the robot-assisted procedure are comparable to those found with the conventional laparoscopic method.

Robot-assisted sleeve gastrectomy for super-morbidly obese patients.

BACKGROUNDnSleeve gastrectomy represents a valid option for morbidly obese patients, either as a primary or as a staged bariatric procedure. Several variations of the technique have been reported. Herein, we report our initial experience with robot-assisted sleeve gastrectomy (RASG).nnnMATERIALS AND METHODSnA prospectively held database for patients who underwent RASG was reviewed. Data included patient demographics, operative parameters, morbidity, and follow-up outcomes. The outcomes after RASG were compared to the laparoscopic approach.nnnRESULTSnFrom September 2007 to February 2010, 69 morbidly obese patients underwent sleeve gastrectomy. Of these, 30 (43.5%) were robot-assisted and 39 (56.5%) were laparoscopic. There was no statistically significant difference in demographics between the two groups. The RASG group underwent an oversewing of the staple line, and mean operative time was 135 minutes. In the laparoscopic group, where the staple line was not oversewn, mean operative time was 114 minutes (Pu2009=u2009.003). Morbidity after RASG was 3.3%, and there were no gastrointestinal leaks or staple line bleeding. Mean postoperative hospital stay after RASG was 2.6 days (range: 1.6-8.3 days). Mean body mass index decrease at 1 year was 16u2009 kg/m(2). There were no differences between the two groups in terms of morbidity, mortality, length of stay, and weight loss.nnnCONCLUSIONSnRASG can be performed safely, with good outcomes. However, the exact role and the advantages of RASG require further study in larger series.

Robot-assisted adrenalectomy: a technical option for the surgeon?

The robotic approach is an interesting option for overcoming the limitations of laparoscopic adrenalectomy. We aimed to report our technique and outcomes of robot‐assisted adrenalectomy (RAA).

Robotic palliation for unresectable pancreatic cancer and distal cholangiocarcinoma

Optimizing quality of life is a major goal for patients with unresectable pancreatic cancer and distal cholangiocarcinoma. The aim of this study was to assess the value of robotic surgery for palliation in these patients.