Laparoscopic and robotic distal gastrectomy for gastrointestinal stromal tumour: case report.

BACKGROUND: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the digestive tract. The most frequent site of occurrence is the stomach. Due to the high potential for malignancy of GIST, resection should be the first-line treatment. Minimally invasive surgery may be used for surgical resection of GISTs. METHODS: We describe a case of laparoscopic and robotic distal gastrectomy in a patient with diagnosis of GIST in the gastric antrum. Laparoscopy was useful for dissection and a da Vinci robot was used for Roux-en-Y reconstruction. RESULTS: The postoperative course was uneventful. CONCLUSIONS: Minimally invasive surgery offers benefits compared to open surgery, and laparoscopic and robot-assisted gastrectomy for the treatment of GIST could be technically feasible and safe because of the advantageous movements provided by the robotic arms.

Robotic assistance may reduce conversion to open in rectal carcinoma laparoscopic surgery: systematic review and meta-analysis.

BACKGROUND: We hypothesized that robotic assistance (RARS) could provide better intraoperative and short-term outcomes than a traditional laparoscopic approach (LARS) to rectal cancer surgery. METHODS: Systematic review of the literature, including electronic searches and communications to international robotic meetings. INCLUSION CRITERIA: studies involving rectal cancer patients and comparing outcomes of robotic surgery vs laparoscopic surgery. Primary end-points: conversion and postoperative short-term complications. Meta-analysis performed using Review Manager 5.0 software. RESULTS: Five case-control studies involving 486 patients (203 RARS-283 LARS) were finally included. Conversion to open rate (RR = 0.31; 95% CI 0.12,0.78) was lower for RARS. No differences were found in oncological outcomes, hospital stay or anastomotic leakage. CONCLUSIONS: This meta-analysis of available non-randomized studies suggests that conversion to open rate may be reduced when using RARS instead of LARS for rectal cancer.

[Current state of digestive system robotic surgery in the light of evidence based medicine]. / Estado actual de la cirugía robótica digestiva a la luz de la medicina basada en la evidencia.

The incorporation of robotics in minimally invasive surgery has had mixed reception in the different fields of digestive surgery. Nowadays we are exposed to a continuous stream of publications on robotic approach techniques and outcomes, which do not always provide objective criteria and whose value, through scientific evidence analysis, is sometimes arguable. With the aim of shedding light on current knowledge on digestive robotic surgery and giving an update of its possibilities, the authors analyse the abundant literature available on the different digestive robotic surgery procedures, and sum up their own experience.

Lessons learned from long-term university training in minimally invasive surgery in Spain.

PURPOSE: Starting from our prolonged experience in university minimally invasive surgery training (1993 to 2005), we aim to analyze the most important differences in participants' requirements from these courses along this time span. METHODS: Surveys' answers from the 6 first course editions (from 1993 to 1999, group 1) are compared with the last 6 ones (from 1999 to 2005, group 2), for a number of items including reasons to choose these courses, opinion about duration of training minimally invasive surgery (MIS) courses, responsibility of training MIS, and opinion about experimental training with animals. RESULTS: Total number (N) of participants was 341, with 177 in group 1 and 164 in group 2. The most important feature was the number of hours of animal training (61% from group 1 vs. 75% from group 2, P<0.05). There was a trend to consider hospitals as more responsible (68.3% from group 1 vs. 83.5% from group 2, P=0.06) and the University as less responsible for MIS training (36.7% from group 1 and 18.2% from group 2, P=0.01). Laparoscopic training courses should last at least 1 year (76.7% from group 1 vs. 78.2% from group 2, not significant). CONCLUSIONS: The time dedicated to practical training is highly appreciated by participants in training courses. Furthermore, we have not found many changes in trainees' requirements from MIS training courses over the last 12 years.