Robotic Near-Total Pancreatectomy for Nesidioblastosis after Bariatric Surgery.

Postprandial symptoms of neuroglycopenia after bariatric surgery may result as a consequence of endogenous hyperinsulinemic hypoglycemia (nesidioblastosis) not dumping syndrome. Pancreatectomy is an acceptable treatment for this condition. We present the video of a case of near-total distal robotic pancreactectomy for the treatment of nesidioblastosis after Roux-en-Y gastric bypass. Robotic pancreatectomy is an alternative to the treatment of nesidioblastosis after Roux-en-Y gastric bypass.

Surgical treatment of hiatus hernia and gastroesophageal reflux disease in complex cases using robotic-assisted laparoscopic surgery: a prospective study/consistent experience in a single institution.

The aim of this study was to report our experience in robotic-assisted surgery of hiatus hernia and gastroesophageal reflux disease in a large series of complex cases. From March 2009 until July 2010, 21 patients were operated due to hiatus hernia or reflux disease using robotic-assisted surgery at Albert Einstein Hospital, São Paulo, Brazil. All patients were selected for the robotic approach because of the complexity of the cases (associated co-morbidity) such as: previous major upper abdominal surgery in 6 patients, hiatus hernia with paraesophageal involvement in 8 patients, obesity with a body mass index of over 29 kg/m(2) in 8 patients, and previous hiatus hernioplasty in 3 patients. Optimal trocar positioning, operating and setup times, conversion rate, intraoperative complications, and perioperative morbidity and mortality rate were analyzed. The mean operating time was reduced from 316 to 195 min after five procedures and the setup time from 20 to 10 min after five procedures. There were no conversions in this group of patients and also no complication or need of blood transfusion. Robotic-assisted fundoplication is feasible, safe and effective for treating hiatus hernias and gastroesophageal reflux disease, especially in complex cases because improved dissection in the esophageal hiatus region compensates for long operating times. Disadvantages are the high costs, the time to master the setup/system, and the necessity of exact trocar positioning.

Treatment of intraductal papillary mucinous neoplasms, neuroendocrine and periampullary pancreatic tumors using robotic surgery: a safe and feasible technique.

In the last few years, robotic surgery has started to take its place in pancreatic surgery. Robotic surgery provides advantages such as enhanced visualisation and freedom of dissection within a confined space and also allows economical surgery. The aim of this study was to evaluate the feasibility, safety and short-term outcome of the robotic approach using the da Vinci robotic system in pancreatic/peripancreatic tumors other than pancreatic carcinomas. Fifteen patients with eight intraductal papillary mucinous neoplasms, four pancreatic neuroendocrine and three periampulary tumors were included in this initial series. Seven left pancreatectomies, five pancreatoduodenectomies and two total pancreatectomies were performed at Albert Einstein Hospital, São Paulo, Brazil. The mean operating room time for all the procedures was 503 min (315-775 min). Blood transfusion was necessary in one patient (3 units). The mean length of stay for all patients was 16 days (5-52 days). Large series of robotic pancreatic surgery should be described and the decision as to its routine use will come from cumulative experience. This surgical system allows difficult procedures to be performed more easily, effectively and precisely.