Initial experience with robotic sleeve gastrectomy for morbid obesity.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is used with increasing frequency for the treatment of morbid obesity. The application of robotic techniques has been reported for bariatric operations like laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding, but not for LSG. We report herein our initial experience with LSG performed with the use of the Da Vinci surgical system. METHODS: Nineteen consecutive patients underwent LSG with the use of the Da Vinci surgical system by the same surgical team. Surgical techniques followed the principles of standard LSG. Preparation of the stomach was performed by the console surgeon and its division with the staplers by the patient-side surgeon. RESULTS: Seventeen women and two men with a mean age of 39.4 years and a mean body mass index (BMI) of 48.2 kg/m(2) were operated. Mean operative time was 95.5 ± 11.5 min. Docking time was 16 ± 4.2 min. There were no conversions. Peri-operative morbidity and mortality was zero. Time to BMI ratio for robotic LSG was 2 ± 0.3 min/kg/m(2) and it was equal to the respective of our standard LSGs. When the docking time was excluded, the same ratio was 1.7 ± 0.2, significantly shorter than the respective 2.0 ± 0.5 of our conventional LSGs (p = 0.018). Mean excess body weight loss 1 year post-operatively was 65.5 ± 25.6%. CONCLUSIONS: Robotic laparoscopic sleeve gastrectomy is a feasible, safe, and efficient surgical technique for the treatment of morbid obesity and it does not add to the operating time of the procedure.

Retroperitoneal tumor invasion of the inferior vena cava. A single-centre experience in tumor thrombectomy.

BACKGROUND AND AIM: Radical surgical treatment improves survival in patients suffering from retroperitoneal tumors with co- existing inferior vena cava thrombus. The extraction excision can be performed through many techniques such as liver mobilization which is performed in liver transplantation procedures. METHODS: During 2000-2007, 11 patients with retroperitoneal tumors and inferior vena cava thrombus were surgically treated in our department. Classification of the thrombus was defined as suggested by Neves and Zinke. All patients were categorized as level I or level II. In all cases a transabdominal approach, liver mobilization and extraction of the thrombus by milking down or Fogarty catheter were used. RESULTS: No peri-operative mortality was observed. One case of pulmonary embolisation was conservatively treated. One patient presented recurrence 6 months after the procedure. CONCLUSIONS: The use of liver transplantation techniques in the surgical management of retroperitoneal tumors with inferior vena cava thrombus, is a safe procedure that improves the survival of these patients.

Pancreaticojejunostomy versus alternative treatment of the pancreatic stump after pancreaticoduodenectomy: a comparative analysis of early postoperative outcome.

The operative management of the pancreatic stump after pancreaticoduodenectomy has been shown to be an important factor influencing the postoperative development of pancreatic fistula. Thus far, there is no ideal technique for reconstruction, and end-to-end pancreaticojejunostomy (PJS) represents the preferable method. Comparative analysis of early postoperative outcome was done between two groups of patients who underwent either end-to-end PJS or pancreatic remnant ligation (PRL) after pancreaticoduodenectomy. Between January 1997 and December 2001, 39 consecutive patients underwent pancreaticoduodenectomy at the 1st Department of Surgery, University of Athens Medical School. All operations were performed or supervised by two senior surgeons, and all patients underwent a Whipple's procedure. After pancreaticoduodenectomy, 23 patients underwent end-to-end PJS (PJS group), whereas the remaining 16 patients underwent PRL without pancreatic reconstruction (PRL group). We compared the two groups in terms of patients' characteristics, clinical presentation, serum laboratory values on admission, operative details, and postoperative course. The morbidity and mortality rates were 15.4% and 5.1%, respectively, for the whole series. In the PJS group, the morbidity rate was 8.7%, the pancreatic fistula formation rate was 4.3%, and the mortality rate was 4.3%. In the PRL group, the morbidity rate was 25%, the pancreatic fistula formation rate was 12.5%, and the mortality rate was 6.25%. These differences were not statistically significant. There were two deaths in the whole series (one in each group); however, none of the deaths were related to pancreatic fistula formation. Hospital stay was similar in both groups. Both PJS and PRL are valid surgical options that correlate with acceptable postoperative incidence of pancreatic fistula formation, morbidity, and mortality rates. Although PRL avoids the construction of the most risky anastomosis, the results of this study show that early postoperative results after PRL are not superior to PJS; therefore, the method should not be considered as the treatment of choice for the pancreatic stump after a Whipple's procedure. Meticulous surgical technique, surgical experience, and close postoperative care are essential for a successful outcome after this major abdominal operation.