Review of contemporary role of robotics in bariatric surgery.

With the rise in a number of bariatric procedures, surgeons are facing more complex and technically demanding surgical situations. Robotic digital platforms potentially provide a solution to better address these challenges. This review examines the published literature on the outcomes and complications of bariatric surgery using a robotic platform. Use of robotics to perform adjustable gastric banding, sleeve gastrectomy, roux-en-y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch and revisional bariatric procedures (RBP) is assessed. A search on PubMed was performed for the most relevant articles in robotic bariatric surgery. A total of 23 articles was selected and reviewed in this article. The review showed that the use of robotics led to similar or lower complication rate in bariatric surgery when compared with laparoscopy. Two studies found a significantly lower leak rate for robotic gastric bypass when compared to laparoscopic method. The learning curve for RYGB seems to be shorter for robotic technique. Three studies revealed a significantly shorter operative time, while four studies found a longer operative time for robotic technique of gastric bypass. As for the outcomes of RBP, one study found a lower complication rate in robotic arm versus laparoscopic and open arms. Most authors stated that the use of robotics provides superior visualisation, more degrees of freedom and better ergonomics. The application of robotics in bariatric surgery seems to be a safe and feasible option. Use of robotics may provide specific advantages in some situations, and overcome limitations of laparoscopic surgery. Large and well-designed randomised clinical trials with long follow-up are needed to further define the role of digital platforms in bariatric surgery.

Robot-assisted excision of a large retroperitoneal schwannoma.

INTRODUCTION: There are few case reports of retroperitoneal tumor excision using the robotic technique. We describe a case of a 13 × 9 × 7- cm retroperitoneal schwannoma that was excised using robot-assisted surgery to provide a minimally invasive benefit to the patient. CASE REPORT: A 45-year-old woman presented with a right paracaval retroperitoneal lump with well-defined margins displacing the inferior vena cava, the right kidney, the head of pancreas, and the duodenum. She underwent a robot-assisted excision of the tumor using the da Vinci Si HD surgical system using three robotic arms. The biopsy results revealed a well-encapsulated schwannoma diffusely positive for S100. The patient was discharged on the third postoperative day and was still doing well at 1-month follow-up. CONCLUSION: Use of robotic technology assists in providing minimally invasive benefits to the patient. It is a safe and effective technique for retroperitoneal surgery.

Laparoscopic management of Spigelian hernias.

Spigelian hernias, also known as spontaneous lateral ventral hernias, are rare primary ventral hernias arising in the Spigelian, or semilunar, line located at the lateral border of recti. Because of its varied presentation, clinical examination is often inconclusive. Traditional repair of such hernias use the open approach. Herein we report on three cases of Spigelian hernias. All were diagnosed and treated laparoscopically at our institution between March 2011 and June 2012. Multiple surgeons performed the repairs using the laparoscopic transabdominal preperitoneal technique of mesh reinforcement and reperitonization. There were no perioperative or postoperative complications. All three were discharged 1 day postoperatively. A complete resolution of preoperative symptoms was observed at follow-up at 1 week, 1 month and 6 months. Laparoscopic transabdominal preperitoneal repair of Spigelian hernia is safe, easy, and feasible for experienced laparoscopic surgeons.

Solo extracorporeal shock wave lithotripsy for management of upper ureteral calculi with hydronephrosis.

INTRODUCTION: The aim of this study was to evaluate extracorporeal shock wave lithotripsy (SWL) outcomes as a solo therapy in patients with upper ureteral calculi and varying degrees of hydronephrosis. MATERIALS AND METHODS: Eighty patients with upper ureteral calculi and a body mass index between 19.5 kg/m2 and 22.5 kg/m2 were included. They were categorized into 4 groups according to the severity of hydronephrosis as seen on ultrasonography and intravenous urography: group 1, no dilatation; group 2, mild dilatation; group 3, moderate dilatation; and group 4, severe dilatation of the pyelocaliceal system. The size of calculi, time to calculus clearance, success rate of solo SWL, and the need for additional therapeutic methods were recorded and compared between the four groups of patients. RESULTS: The median size of the calculi was 13.5 mm, and the mean time to calculus clearance was 56.0 +/- 24.2 days. In 71.3% of the patients, solo SWL was successful in the treatment of the calculi. Twenty-three patients required other therapies including double-J stenting, ureteroscopy, and nephrolithotomy. The patients without hydronephrosis and those with severe hydronephrosis (groups 1 and 4) showed a significant difference in the days to clearance of the calculus (mean, 31.7 days versus 85.6 days; P < .001). CONCLUSION: Patients with upper ureteral calculi and mild hydronephrosis can be effectively treated with solo SWL therapy. In those with moderate hydronephrosis, clearance takes longer or requires secondary interventions. In patients with severe hydronephrosis, we recommend alternative/adjunctive procedures.

A rare case of incidentally diagnosed primary papillary carcinoma of thyroglossal duct cyst.

Thyroglossal duct cysts are the most common congenital abnormality of thyroid development. Seventy percent of thyroglossal duct cysts are diagnosed during childhood and 7% are diagnosed in adulthood. Less than 1% of these cases are malignant with most being papillary in nature. It is often diagnosed incidentally after surgical excision. Incidentally discovered, well-differentiated thyroid carcinoma of the thyroglossal duct, in the presence of a clinically and radiologically normal thyroid gland, can be managed adequately by the Sistrunk operation. We present a rare case of primary papillary carcinoma of thyroglossal duct cyst, with normal thyroid gland, in a 28-year-old female that was diagnosed incidentally on histopathological examination. A Sistrunk procedure was performed on the patient to remove the thyroglossal duct cyst and patient is doing well at regular follow up.