The role of telemedicine in the postoperative home monitoring after robotic colo-rectal cancer surgery: a preliminary single center experience.

The telemedicine studies, takes care and prevents diseases at distance basing on the interaction among physicians and patients remotely. Few data are available on its application to early postoperative after surgery. The endpoints of our preliminary experience were the detection, as primary, of feasibility and safety of home telemonitoring after robotic colo-rectal resection and, as secondary, perception and satisfaction of the patients. From December 2019 to March 2020, at the Division of Robotic Surgery of San Giovanni Hospital of Rome, 20 of 29 colorectal cancer patients, submitted to Robotic resection, were prospectively included in a program of postoperative home telemonitoring. Telemonitoring was considered feasible if at least 75% of data were available and safe if morbidity ≤ II by Clavien-Dindo classification. Perception and patients' satisfaction were evaluated through a dedicated questionnaire. Out of 20 patients, the median age was 68 years, overall postoperative morbidity was 30%, all events classified Clavien-Dindo Grade I or II. Only 2 patients were corresponded to surgical consult without readmission during home telemonitoring. Compliance of patients was > 80%, overall grade of satisfaction was very high: 4.2 as median (range 0-5). In this preliminary study, the procedures of postoperative home telemonitoring were feasible and safe and high rate of patients' satisfaction was observed. The telemedicine could enhance the role of robotic technique in decrease the hospital stay and improving postoperative recovery after surgery. Further structured prospective trial are needed to validate the routine application of telemedicine in healthcare.

ICG-NIR-guided lymph node dissection during robotic subtotal gastrectomy for gastric cancer. A single-centre experience.

BACKGROUND: Near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) allows intraoperative visualisation of the lymph nodes (LNs) draining the tumour. METHODS: We included in our study 20 patients who underwent robotic subtotal gastrectomy + D2 lymphadenectomy for gastric cancer. In 10 cases, intraoperative ICG-guided lymphography has been used (Group A). We compared the number of LNs retrieved with the use of NIR imaging and the number of LNs retrieved without the use of this technique (Group B, historical group). RESULTS: No complications related to ICG injection or near-infrared imaging were observed. The mean number of overall LNs retrieved was significantly greater in Group A than in group B (40 vs. 24). No statistically significant difference in operative time was observed. CONCLUSIONS: ICG-guided fluorescent lymphography can help in performing a more accurate locoregional lymphadenectomy during robotic subtotal gastrectomy for gastric cancer. This technique represents a precious contribution to gastric cancer surgery.

Safety profile and oncological outcomes of gastric gastrointestinal stromal tumors (GISTs) robotic resection: Single center experience.

BACKGROUND: Although usefulness of robot assisted surgery has been largely reported and accepted, robot assisted gastrointestinal stromal tumor (GIST) treatment is rare. Hence, the aim of this study is to report a single center evaluation on gastric GIST's robotic resection. METHODS: Six patients were analyzed focusing on safe (conversion/complications rate, hospital stay), oncological (margin resection, recurrence rate), and feasible (operative time, technical tip, and tricks) profile of robotic-assisted GIST surgery. RESULTS: The mean operative time and hospital stay was 173 ± 39 minutes and 3 ± 1 days, respectively. The conversion rate (to open or laparoscopy) was nil, and no intra and postoperative (mean follow-up 12 months) complications were registered. In all cases, the resections were classified as R0. CONCLUSIONS: This study supports the usefulness of robotic-assisted surgery, as the anatomical hand-sewn reconstruction might avoid the stomach distortion, and the oncological (100% R0) and safety profile outcomes encourage its use. However, further studies with larger sample size are recommended to confirm the outcomes of this study.

[Cholelithiasis and renal cysts: simultaneous laparoscopic treatment]. / Litiasi della colecisti e cisti renali: trattamento laparoscopico in un unico tempo.

Laparoscopic surgery has been increasingly used in different fields of surgery. This report concerns the authors' experience with combined laparoscopic cholecystectomy and symptomatic renal cyst decortication. The mean diameter of the cysts was 11.2 cm. and involved the left and right kidney in 3 and 1 patient, respectively. All cysts were peripheral. Surgery was performed using 4 trocars in 3 cases and 5 trocars in the other. The mean operative time was 110 minutes and mean blood loss 40 cc. Postoperative pain was minimal. The mean duration of postoperative ileus was 2.2 days. No significant complications were observed. The mean postoperative hospital stay was 3.5 days. At follow-up examinations all patients were pain-free. Recurrence of the cyst was observed in only one case. Combined laparoscopic cholecystectomy and renal cyst decortication is technically feasible in selected cases and does not seem to significantly affect the perioperative course of cholecystectomy.