Cirugía robótica en el Centro Médico ABC: experiencia en los primeros 500 procedimientos realizados / Robotic surgery at ABC Medical Center: first 500 procedures experience

Resumen Antecedentes: La cirugía robótica se utiliza en múltiples especialidades quirúrgicas a nivel mundial. Objetivo: Documentar la experiencia inicial del programa de cirugía robótica en un hospital de práctica privada. Material y método: Se incluyen las primeras 500 cirugías robóticas realizadas en el Centro Médico ABC, abarcando un periodo de tres años. Se documentan especialidades involucradas así como datos transoperatorios principales. Resultados: De 500 pacientes, 367 (73.4%) fueron de sexo masculino y 133 (26.4%) de sexo femenino. Las tres cirugías más realizada fueron prostatectomía radical (269), seguido de histerectomía (64) y plastia inguinal (33). Un total de 40 médicos certificados de cinco especialidades realizaron la totalidad de los procedimientos. Conclusiones: El iniciar un programa en un centro médico privado tiene diversas implicaciones. La creación de un comité de cirugía robótica integrado por médicos especialistas certificados en cirugía robótica de cada especialidad y autoridades del hospital para la acreditación de lineamientos tanto para la certificación como la recertificación de sus médicos puede beneficiar a programas como el nuestro por crear un centro de excelencia de cirugía robótica, disminuyendo complicaciones y mejorando resultados.

Abstract Background: Robotic surgery is used in different surgical specialties worldwide. Objective: To documents the initial experience in a private hospital in the use robotic surgery in different surgical areas. Material and Methods: We included the first 500 robotic surgeries in our hospital in a 3 year period, documenting specialty and operative information. Results: Of the 500 patients, 367 (73.4%) were male and 133 (26.4%) female. The three most frequent surgeries performed were Radical Prostatectomy (269), Hysterectomy (64) an inguinal repair (33). A total of 40 certified surgeons ranging from 5 specialties performed the total number of surgeries. Conclusions: There are several implications in starting a robotic program in a private hospital setting. The creation of a robotic committee, formed by robotic certified physicians and hospital authorities, has helped in the certification process of its staff, lowering the complication rate and obtaining better surgical results.

Anatomical dissection: a positive experience for Venezuelan first year medical students / Disección anatómica: una positiva experiencia para alumnos venezolanos de primer Año de medicina

An anonymous survey was handed out to 616 first year medical students of the José María Vargas School of Medicine of the Central University of Venezuela during the six academic years from 2002 and 2008, so that they answer it voluntarily after a cadaver dissection session, after the first unit of the practice syllabus of Gross Anatomy I had completed. The results of these surveys delivered to first year medical students report a positive response to their initial experience with a cadaver in the anatomical dissection room. In fact, the students described this initial experience as positive in a 52.22 percent, while 34,25 percent referred to it as very positive, 7.14 percent as stressing and only a 1.13 percent rated it as traumatic. In the case of only 13.63 percent of these students the anatomical dissection room was the most stressing aspect of the anatomy syllabus.

Una encuesta anónima fue distribuida entre 616 estudiantes de primer año de Medicina, de la Escuela de Medicina J.M. Vargas, de la Universidad Central de Venezuela, durante los seis años académicos comprendidos entre 2002 y 2008. Esta encuesta debía ser respondida de manera voluntaria, posterior a una práctica de disección de cadáveres, una vez transcurrida la primera unidad del temario práctico de Anatomía Normal I. Los resultados de esta encuesta, entre estudiantes del primer año de Medicina, indicaron que es positiva la respuesta a su encuentro inicial con un cadáver en la sala de disección anatómica. El 55,22 por ciento de los estudiantescalificaron este encuentro inicial como positivo; 34,25 por ciento como muy positivo; 7,14 por ciento estresante y, tan solo el 1,13 por ciento de los estudiantes lo calificó como traumático. Para el 13,63 por ciento de estos estudiantes la sala de disección anatómica constituía lo más estresante en la Cátedra de Anatomía.

Initial Experience Using Gasless Transaxillary Robotic Thyroidectomy by a Single Surgeon / 대한내분비외과학회지

PURPOSE: Various endoscopic thyroidectomy procedures have been designed to minimize visible cervical scarring. However, endoscopic thyroidectomy is a technically challenging procedure that is performed by a limited surgeon. Robotic systems aida surgeon in performing minimally invasive head and neck surgery by offering superior visualization and dexterity. This study reports the initial experience of one surgeon with robotic thyroidectomy to assess the technical feasibility and safety of the approach. METHODS: One hundred four thyroid cancer patients (97 females, 7 males; mean age of 39.8±8.1 years) underwent robotic thyroidectomy using gasless transaxillary approach between November 2008 and October 2009 in Ajou University Hospital. All the procedures were completed successfully using the da Vinci surgical system without open conversion. Patient characteristics, postoperative clinical results, complications, and pathologic details were assessed. RESULTS: Total thyroidectomy was performed in 25 (24.0%) patients, subtotal thyroidectomy in 13 (12.5%) patients, and unilateral lobectomy in 66 (63.5%) patients. All patients underwent ipsilateral central compartment neck dissection, and two patients underwent selective lymph node (LN) dissection. The mean operation time was 134.5±47.2 min (range 61~310 min), in which the actual time for the thyroidectomy with lymphadenectomy (console time) was 56.4 min. (range 31~270). The mean number of LN resected was 3.9 (range 0~28). There were no serious complications. The mean hospital stay was 2.9±0.9 days (range 2~7). CONCLUSION: Robotic thyroidectomy is a feasible, safe, and cosmetically excellent procedure. The application of robotic technology for thyroid surgeries could be an alternative to endoscopic or conventional open thyroidectomy.

Initial Experience with Laparoscopic Surgery for Treating Upper Gastrointestinal Disease / 대한내시경복강경외과학회지

PURPOSE: Performing laparoscopic surgery for upper gastrointestinal disease has gradually been increasing. The aim of this study is to review the initial experience with laparoscopic surgery for treating upper gastrointestinal diseases. METHODS: We retrospectively studied a total of 76 patients who underwent laparoscopic surgery for upper gastrointestinal disease from April 2003 to December 2008. The clinical features and surgical outcomes were analyzed. RESULTS: The types of upper gastrointestinal diseases that were treated by laparoscopic surgery were early gastric cancer (n=45), advanced gastric cancer (n=6), gastric submucosal tumor (n=14), duodenal ulcer stricture (n=5), duodenal ulcer perforation (n=2), superior mesenteric artery syndrome (n=2), gastroesophageal reflux (n=1) and dysphagia due to parkinsonism (n=1). There were 11 operative morbidities (14.5%), including 1 operative mortality (1.3%). CONCLUSION: Although this study shows the narrow range of indications for performing this laparoscopic procedure and the surgical experience is rather limited, laparoscopic surgery was applied for treating various upper gastrointestinal diseases. Based on this experience, surgeons should make efforts to improve the surgical outcomes.

The Initial Experience of Laparoscopy Assisted Distal Gastrectomy

PURPOSE: Recently, laparoscopy assisted gastrectomy has taken its place as one of the main strategies for managing early gastric cancer (EGC). We conducted this study to evaluate its value from the point of view of initial experience. METHODS: Between June 2007 and May 2008, 63 patients who underwent laparoscopy assisted distal gastrectomy (LADG, n=43) or open distal gastrectomy (ODG, n=20) for EGC by a single surgeon, enrolled in this retrospective, non-randomized study. The operative procedure was decided on through patients' preferences. We compared several clicopathological factors and short-term postoperative outcomes between the two groups. RESULTS: There were no significant differences in the patients' demography and pathologic results between the two groups. The operation time was more shorter (167+/-23.2 vs. 268+/-68.6 mins, P<0.0001) in the ODG group, but the time to first flatus (2.8+/-0.6 vs. 3.1+/-0.4 days, P=0.033), the time to first diet (3.0+/-0.3 vs. 3.6+/-0.6 days, P<0.0001), and the duration of hospital stay (9.1+/-1.2 vs. 11.6+/-3.1 days, P<0.0001) were significantly shorter in the LADG group. Although there were no significant differences in postoperative morbidity and mortality between the two groups, one patient died of postoperative myocardiac infarction in the LADG group (P=0.6854). Comparison between before and after learning curve; there were statistically significant differences in the number of retrieved lymph nodes (31.2+/-13.7 vs. 42.2+/-13.4, P=0.0185) and the time of operation (295+/-63.8 vs. 208+/-30.5 mins, P<0.0001). CONCLUSION: Although our results represent initial experiences, we could find some advantages in LADG compared with ODG. We suggest that application of more restrictive indication is required at an earlier time on the learning curve.