Full robotic gastrectomy with extended (D2) lymphadenectomy for gastric cancer: surgical technique and preliminary results.

BACKGROUND: Widespread diffusion of minimally-invasive surgery for gastric cancer treatment is limited by the complexity of performing an extended D2-lymphadenectomy. This surgical step can be facilitated by using robot-assisted surgery. The aim of this study is to describe our technique and short-term results of a consecutive series of full robotic gastrectomies with D2-lymphadenectomy for gastric cancer, using the da Vinci Surgical System. MATERIALS AND METHODS: Between May 2004 and December 2009, we performed 24 consecutive full robot-assisted total and subtotal gastrectomies with extended D2-lymphadenectomy for histologically-proven gastric adenocarcinoma. Data referring to 11 robot-assisted total gastrectomies and 13 subtotal gastrectomies were collected in a database and analyzed. RESULTS: Median operative time was 267.50 min (255-305). Median intraoperative blood loss was 30 mL. Median number of harvested lymph nodes was 28 (23-34). Resection margins were negative in all cases. No conversions occurred. Surgery-related morbidity was 8%. Thirty-day mortality was 0%. Liquid diet started on postoperative d 5 (2-5). Median length of stay was 6 d (5-8). CONCLUSIONS: Robot-assisted gastrectomy with D2-lymphadenectomy is a safe technique and allows achieving an adequate lymph node harvest and optimal R0-resection rates with low postoperative morbidity and the learning curve appears to be shorter than in laparoscopic surgery. Longer follow-up and randomized clinical trials are needed to define the role of robot-assistance in gastric cancer surgery.

Robotic right colon resection: evaluation of first 50 consecutive cases for malignant disease.

BACKGROUND: Colorectal cancer is the fourth leading cause of death in the world. Minimally invasive surgery has been demonstrated to have the same oncological results as open surgery, with better clinical outcomes. Robotic assistance is an evolution of minimally invasive technique. This study aims to evaluate surgical and oncological short-term outcomes of robotic-assisted right colon resection in malignant disease. METHODS: Fifty consecutive patients affected by right-sided colon cancer were operated from May 2001 to May 2009 using the da Vinci(®) surgical system. Data regarding surgical and early oncological outcomes were systematically collected in a specific database for statistical analysis. RESULTS: Twenty-four male and 26 female patients underwent robotic right colectomy. Median age was 73.34 ± 11 years. Median operative time was 223.50 (180-270) min. No conversion occurred. Specimen length was 26.7 ± 8 cm (range 21-50 cm), number of harvested lymph nodes was 18.76 ± 7.2 (range 12-44), and mean number of positive lymph nodes was 1.65 ± 3 (range 0-17). Surgery-related morbidity was 1/50 (2%): one twisting of the mesentery in one case with extracorporeal anastomosis. All patients were included in a follow-up regimen. Disease-free survival was 90% (45/50), and overall survival was 92% (46/50). Cancer-related mortality was 8% (4/50). CONCLUSIONS: Robotic assistance allows performance of oncologically adequate dissection of the right colon with radical lymphadenectomy and to fashion a handsewn intracorporeal anastomosis as in open surgery, confirming the safety and oncological adequacy of this technique, with acceptable results and short-term outcomes.

[Robotic surgery: considerations after 250 procedures]. / La chirurgia robotica. Considerazioni dopo 250 interventi.

The aim of this study was to investigate the results of the first 250 procedures performed on 216 patients with the da Vinci Robotic Surgical System (34/216 patients were submitted to double procedure). The purpose of the da Vinci surgical system is to exactly translate the surgeon's hand movements to the robotic arms that manipulate the laparoscopic instruments, thus facilitating minimally invasive surgery. The da Vinci system has been available in our department since 2001. The first 50 procedures were simple cases (cholecystectomies and transperitoneal hernia repairs) and were performed during the learning curve of the surgical team. The last 200 procedures were more complex cases. Time of preparation of the robot gradually decreased with growing experience. The total conversion rate (to standard laparoscopy and to open surgery) was 4.8% (12/250); conversion to laparotomy was 2.8% (7/250). Morbidity was 8.8% (19/216), and reoperation was needed in 6 patients. Mortality was 1.8% (4/216). We conclude that robotic surgery has now moved beyond the learning phase with the device and may be routinely used in selected, more complex cases, such as colorectal surgery and surgery of the gastro-oesophageal junction. The device can also be used in pancreatic and gastric surgery.

The da Vinci robot in right adrenalectomy: considerations on technique.

The da Vinci Robotic System (Intuitive Surgical, Mountain View, CA) became available at the General Surgery Department of Camposampiero Hospital in May 2001. From May 2001 to October 2002, 139 robotic operations were performed, one of which was a right adrenalectomy for a right adrenal mass. The progressive growth of the mass was the indication for surgical excision. Surgical adrenalectomy was successfully completed with da Vinci Robotic System using 5 ports (3 for the robotic system, 2 as service trocars). The wrist-like movements of the instrument's tip easily enabled the detachment of the right hepatic lobe from the gland and vessel isolation, while the 3-dimensional vision facilitated dissection of the veins from the vena cava.

Robotic and laparoscopic surgery for treatment of colorectal diseases.

PURPOSE: In the last ten years, several robotic systems have been developed to overcome the loss of the three-dimensional view and dexterity characteristic of laparoscopic surgery. The aim of this study was to compare the traditional laparoscopic approach and robotic techniques in the treatment of colorectal diseases. METHODS: The study compares a consecutive series of patients treated surgically for colorectal disease from June 2001 to May 2003 with the da Vinci robotic system (Intuitive Surgical) and a matched number of patients who underwent conventional laparoscopy during the same time interval. The factors analyzed were the time required to prepare the patient and the room, total time of surgery, length of specimens, number of lymph nodes retrieved, blood loss, complications, and postoperative results. RESULTS: The study included 106 patients (53 in each group). No differences were observed in total time of surgery (laparoscopic group, 222 +/- 77 minutes vs. robotic group, 240 +/- 61 minutes), specimen length (laparoscopic group, 29 +/- 11 cm vs. robotic group, 27 +/- 13 cm), or number of lymph nodes retrieved (laparoscopic group, 16 +/- 9 vs. robotic group, 17 +/- 10). It took significantly longer to prepare the operating room and patient in the robotic group (24 +/- 12 minutes) than in the laparoscopic group (18 +/- 7 minutes). There were three conversions to laparotomy in the laparoscopic group; in the robotic group, two cases were converted to laparoscopy and three to hand-assisted laparoscopy. No significant differences were observed between the two groups in terms of recovery of bowel function and postoperative hospital stay. CONCLUSIONS: Robot-assisted surgery proved to be as safe and effective as laparoscopic techniques in the treatment of colorectal diseases. Because of its dexterity and three-dimensional view, the da Vinci system was particularly useful in specific stages of the procedure, e.g., takedown of the splenic flexure, dissection of a narrow pelvis, identification of nervous plexus, and handsewn anastomosis. The cost-effectiveness of the procedure still needs to be evaluated.

[Videolaparoscopic surgery in the treatment of colorectal disease: our experience with 200 patients]. / La chirurgia videolaparoscopica nel trattamento della patologia colo-rettale: nostra esperienza di 200 pazienti.

In this article we examine our experience over the last 4 years, from 1998 to 2001, in the surgical treatment of colorectal disease using the laparoscopic approach. We treated 200 patients, 54 of whom presented benign disease and 146 malignancies. The operations were performed by a team of surgeons and nurses experienced in advanced laparoscopy. Over this period, the duration of the surgical intervention was gradually reduced by 17%. The conversion rate from laparoscopy to open procedures was also reduced (mean rate 11%). Canalization and the resumption of walking and nutrition were reasonably fast. Postoperative complications occurred in 22% of cases The number of fistulas and anastomotic dehiscences was high (10/200 = 5%), due both to evaluation errors and the choice of surgical material. At present, on applying the criteria of traditional open surgery, this figure is also coming down. Bleeding complications (12/200 = 6%) can also be ascribed to the learning curve (2 bleeds in the trocar site and 2 haematomas in the Pfannenstiel laparotomy site) and are therefore likely to be reduced. Bleeding during the surgical procedures, however, was very low, with a mean value of 69.6 ml. Laparoscopic surgery for colorectal disease is well standardized and we believe there should be no doubts as to its use in benign disease. Its use in oncological surgery, though theoretically correct, needs to be confirmed by the trials currently in progress. The results we have obtained in our experience, after completion of the learning curve, agree with the figures reported in the literature.