Application of fluorescence in robotic general surgery: review of the literature and state of the art.

The initial use of the indocyanine green fluorescence imaging system was for sentinel lymph node biopsy in patients with breast or colorectal cancer. Since then, application of this method has received wide acceptance in various fields of surgical oncology, and it has become a valid diagnostic tool for guiding cancer treatment. It has also been employed in numerous conventional surgical procedures with much success and benefit to the patient. The advent of minimally invasive surgery brought with it a new use for fluorescence in helping to improve the safety of these procedures, particularly for single-site procedures. In 2010, a near-infrared camera was integrated into the da Vinci Si System, creating a combination of technical and minimally invasive advantages that have been embraced by several experienced surgeons. The use of fluorescence, although useful, is considered challenging. Only a few studies are currently available on the use of fluorescence in robotic general surgery, whereas many articles have focused on its application in open and laparoscopic surgery. Many of these reports describe promising and satisfactory results, although with some shortcomings. The purpose of this article is to review the current status of the use of fluorescence in general surgery and particularly its role in robotic surgery. We also review potential uses in the future.

A Single Centre Retrospective Evaluation of Laparoscopic Rectal Resection with TME for Rectal Cancer: 5-Year Cancer-Specific Survival.

Laparoscopic colon resection has established its role as a minimally invasive approach to colorectal diseases. Better long-term survival rate is suggested to be achievable with this approach in colon cancer patients, whereas some doubts were raised about its safety in rectal cancer. Here we report on our single centre experience of rectal laparoscopic resections for cancer focusing on short- and long-term oncological outcomes. In the last 13 years, 248 patients underwent minimally invasive approach for rectal cancer at our centre. We focused on 99 stage I, II, and III patients with a minimum follow-up period of 5 years. Of them 43 had a middle and 56 lower rectal tumor. Laparoscopic anterior rectal resection was performed in 71 patients whereas laparoscopic abdomino-perineal resection in 28. The overall mortality rate was 1%; the overall morbidity rate was 29%. The 5-year disease-free survival rate was 69.7%, The 5-year overall survival rate was 78.8%.

Robotic laparoscopic surgery with the da Vinci® system: an early experience.

Theoretically, robotic surgery is likely to overcome the intrinsic limitations of laparoscopic surgery, such as a view not under the direct surgeon's control, two-dimensional imaging, and limited motion of instruments. In this chapter, the preliminary experience with a robotic laparoscopic surgery system in the Surgical Department of the Alessandria Hospital, Italy, is reported. From November 2005 to August 2007, a total of 162 laparoscopic robotic operations were performed, in which robotic surgery was found to be feasible and safe. It takes a longer time than standard laparoscopy but seems able to reduce the need of a steep learning curve.

Thoracoscopic and Laparoscopic Esophagectomy in a Case of Spontaneous Rupture of the Esophagus (Boerhaave's Syndrome).

Spontaneous barogenic rupture of the esophagus is a rare disease with high morbidity and mortality. Many therapeutic options are available. Esophagectomy is indicated when a large rupture is found with huge mediastinal contamination. Here, we describe a minimal invasive esophagectomy procedure for an esophageal barogenic rupture. A thoracoscopic esophagectomy was performed with the patient in a prone position. After a laparoscopic gastric tubulization, a cervical esopagho-gastro anastomosis was performed with a retro-sternal passage of the stomach in order to avoid the heavily contaminated posterior mediastinum. The postoperative outcome was almost uneventful. This minimal-invasive approach allowed direct optimal visualization of the esophageal laceration and a thorough mediastinal cleansing, thereby avoiding any septic complications, which are the major concern in this particular clinical procedure. In our case, the esophagectomywas mandatory because of the large laceration and massive mediastinal contamination. The minimal invasive thoracoscopic and laparoscopic esophagectomy approach is feasible even in an emergency setting. This is the first report of this procedure being used in a high-risk patient with Boerhaave's syndrome.

Robotic colorectal surgery: first 50 cases experience.

PURPOSE: Laparoscopic colorectal surgery is believed to be technically and oncologically feasible. However, some limitation of traditional laparoscopic surgery may cause difficulties. Robotic-assisted surgery may overcome these pitfalls. METHODS: From December 2005 to July 2007, 50 patients were selected for robotic-assisted colorectal resection mainly for cancer. RESULTS: Of the 50 patients enrolled, 32 (64 percent) were men and 18 (36 percent) were women. Their mean age was 66.7 (range, 37-92) years. The American Society of Anesthesiologists' (ASA) class distribution was 13 (26 percent) ASA I, 24 (48 percent) ASA II, 12 (24 percent) ASA III, and 1 (2 percent) ASA IV. Forty-four patients suffered from cancer and six patients from benign disease. Amongst the cancer patients, 3 percent were at UICC (International Union Against Cancer) Stage 0, 36 percent at UICC Stage I, 24 percent at Stage II, 28 percent at Stage III, and 9 percent at Stage IV. The global conversion rate was 4 percent. The mean operative time was 338.8 minutes. It decreased as the experience increased (419 minutes in the first 20 cases vs. 346 minutes in the last 30 cases; P = 0.036). As a gross comparison, the results of a coeval standard laparoscopy group of patients were shown. CONCLUSIONS: Robotic laparoscopic colon surgery is feasible and safe. A longer operating time is needed.