K. Hashida, Goro Honda, Y. Ome, Toru Tanahashi, Chikai Ubukata, Yusuke Kawamoto, Yutaro Matsunaga, Shunichi Ariizumi
{"title":"Optimized approach for blood vessel excavation within liver parenchyma","authors":"K. Hashida, Goro Honda, Y. Ome, Toru Tanahashi, Chikai Ubukata, Yusuke Kawamoto, Yutaro Matsunaga, Shunichi Ariizumi","doi":"10.20517/2574-1225.2023.139","DOIUrl":"https://doi.org/10.20517/2574-1225.2023.139","url":null,"abstract":"The most practical approach for dissecting the liver parenchyma involves first visualizing and subsequently addressing the blood vessels within the parenchyma while maintaining a dry operative field. This process is similar to “excavation” of ancient artifacts from soil without causing any damage. To excavate the blood vessels in a dry operative field during liver parenchymal dissection, proficiency in both blood flow control and parenchymal dissection techniques is mandatory. For blood flow management, inflow control is achieved using an externally applied Pringle maneuver, whereas outflow control is achieved by decreasing the central venous pressure. Precision in parenchymal dissection lies in dissecting the liver parenchyma in areas devoid of the Glissonean branch, such as the intersegmental plane, using the back-scoring technique with a cavitron ultrasonic surgical aspirator (CUSA) to read the grain of the blood vessels.","PeriodicalId":388753,"journal":{"name":"Mini-invasive Surgery","volume":"32 27","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141813996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesco Corcione, Pasquale Ruberto, Giuseppe Magno
{"title":"Mininvasive surgery in abdominal wall repair: lights and shadows","authors":"Francesco Corcione, Pasquale Ruberto, Giuseppe Magno","doi":"10.20517/2574-1225.2024.56","DOIUrl":"https://doi.org/10.20517/2574-1225.2024.56","url":null,"abstract":"","PeriodicalId":388753,"journal":{"name":"Mini-invasive Surgery","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141830035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Strategies to build a robotic liver surgery program","authors":"Samantha M. Ruff, Allan Tsung","doi":"10.20517/2574-1225.2024.39","DOIUrl":"https://doi.org/10.20517/2574-1225.2024.39","url":null,"abstract":"Over the past few decades, an increasing proportion of abdominal surgeries are performed through minimally invasive platforms. In contrast, adaptation of minimally invasive techniques for liver surgery has garnered slower attraction due to the complexity and associated morbidity and mortality with these operations. Compared to laparoscopy, the robotic-assisted surgical system provides a three-dimensional operative view and instruments with articulation that mimic and extend wrist movement. These elements improve operative dexterity making dissection and suturing easier. Additionally, robotic surgery improves operative ergonomics and decreases physical and mental fatigue. Studies show that the robotic platform is safe and versatile with many technical advantages for complex operations, improved short-term outcomes compared to open surgery, and comparable oncologic outcomes. As such, hepatobiliary surgeons are increasingly adapting robotic techniques in their practice. It is crucial that as more hospitals adopt this technology, patient safety monitoring and quality initiatives are maintained. Establishing a robotic liver surgery program revolves around three pillars: designing a curriculum to overcome the learning curve, building a strong clinical and administrative team, and appropriate patient selection.","PeriodicalId":388753,"journal":{"name":"Mini-invasive Surgery","volume":"25 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141647693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Ciria, Manuel Durán, Rafael Calleja, José Manuel Pérez-de-Villar, Javier Briceño
{"title":"Laparoscopic liver ALPPS - How I do it","authors":"R. Ciria, Manuel Durán, Rafael Calleja, José Manuel Pérez-de-Villar, Javier Briceño","doi":"10.20517/2574-1225.2023.126","DOIUrl":"https://doi.org/10.20517/2574-1225.2023.126","url":null,"abstract":"In complex oncological liver resections, insufficient future liver remnant (FLR) volume may become the most challenging problem to deal with in the postoperative setting. The Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) is one of the techniques described for inducing hepatic hypertrophy and achieving an adequate FLR. The technique initially described is performed by a complete bipartition of the liver in the first operation and a portal vein ligation to achieve occlusion of the intrahepatic circulation followed by a major hepatectomy in the second operation once an adequate FLR has been reached. With the introduction of minimally invasive liver surgery, these procedures can be performed by laparoscopic or robotic approach. We aim to provide a comprehensive overview of ALPPS, highlighting key technical aspects. Furthermore, the main aspects of this technique based on current evidence, such as indications, outcomes, strengths, limitations and potential complications, will be analyzed.","PeriodicalId":388753,"journal":{"name":"Mini-invasive Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141660871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Carilli, R. Bertolo, M. Vittori, V. Iacovelli, Michele Antonucci, M. Signoretti, F. Maiorino, F. Petta, Pierluigi Bove
{"title":"Robot-assisted partial nephrectomy in patients with multiple ipsilateral renal tumors: single-centre experience","authors":"M. Carilli, R. Bertolo, M. Vittori, V. Iacovelli, Michele Antonucci, M. Signoretti, F. Maiorino, F. Petta, Pierluigi Bove","doi":"10.20517/2574-1225.2023.132","DOIUrl":"https://doi.org/10.20517/2574-1225.2023.132","url":null,"abstract":"Aim: This study aimed to report the perioperative outcomes of off-clamp robot-assisted partial nephrectomy (RAPN) for multiple ipsilateral renal tumours at our Institution.\u0000 Methods: Data of consecutive patients affected by multiple ipsilateral renal tumours managed by RAPN between September 2018 and June 2023 were retrospectively analysed. Perioperative and post-operative data were collected. Eventual intra- and post-operative complications with or without readmissions (occurred within 30 days) were recorded and classified according to Clavien-Dindo system. Final pathology examination of excised tumours was performed.\u0000 Results: Twelve patients were included in the analysis. Median tumour size was 34 mm and median R.E.N.A.L. [(R)adius (tumour size as maximal diameter), (E)xophytic/endophytic properties of the tumour, (N)earness of tumour deepest portion to the collecting system or sinus, (A)nterior (a)/posterior (p) descriptor and the (L)ocation relative to the polar line] score was 6. Median console time was 134 min. An off-clamp approach with pure enucleation was possible in 20 out of 28 lesions (71.4%). Median estimated blood loss was 200 mL. No differences were observed in renal function both at discharge and after 30 days, with respect to baseline. No intraoperative complications were recorded. Post-operative complications occurred in two patients, both classified as Clavien-Dindo grade 2. Positive surgical margins were reported in one case (4.5%). No local recurrence or metastasis were diagnosed within a median follow-up of six months.\u0000 Conclusion: Our case series showed the feasibility of off-clamp RAPN in patients with multiple ipsilateral renal tumours in experienced hands. Further studies with larger sample size and longer follow-up are warranted to better define the optimal management strategy in such an uncommon scenario.","PeriodicalId":388753,"journal":{"name":"Mini-invasive Surgery","volume":" 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141676075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew R. Harner, Francisco Jr Guerra, Shinil K. Shah, K. Bajwa, Peter A. Walker, Erik B. Wilson, M. Felinski
{"title":"Advanced endolumenal management of acute and chronic leaks after bariatric surgery","authors":"Andrew R. Harner, Francisco Jr Guerra, Shinil K. Shah, K. Bajwa, Peter A. Walker, Erik B. Wilson, M. Felinski","doi":"10.20517/2574-1225.2023.46","DOIUrl":"https://doi.org/10.20517/2574-1225.2023.46","url":null,"abstract":"Leaks remain an infrequent yet dreaded complication following bariatric surgery. Effective management includes appropriate classification of leaks and implementation of a multimodality treatment approach that focuses on adequate resuscitation, control of sepsis, and surgical or endoscopic intervention when necessary. Herein, we describe several endoscopic techniques that have demonstrated success in the management of acute and chronic leaks following bariatric surgery. In general, endoscopic interventions can be classified as exclusion techniques (self-expanding endoscopic stents), closure techniques (endoscopic clips, endoscopic suturing, or glues), or drainage techniques (transfistulary stents, endolumenal vacuum therapy, or septotomy). To guide the clinician in the appropriate patient selection for these interventions, we provide a suggested algorithm for the management of patients presenting with acute or chronic leaks following bariatric surgery.","PeriodicalId":388753,"journal":{"name":"Mini-invasive Surgery","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139606673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of type 2 diabetes after metabolic bariatric surgery","authors":"K. Tham, Phong Ching Lee","doi":"10.20517/2574-1225.2023.80","DOIUrl":"https://doi.org/10.20517/2574-1225.2023.80","url":null,"abstract":"Metabolic and bariatric surgery has been proven to be effective in the glycemic and metabolic control of type 2 diabetes (T2D) and obesity. While most patients experience remission of T2D after surgery, some individuals remain with suboptimal glycemic control. In addition, a significant subset of patients experience relapse of diabetes in the long term after attaining diabetes remission. As a heterogenous disease, the underlying etiology of T2D and response to treatment can be variable in different individuals. The mechanism of diabetes relapse is not completely understood as is the optimal medical management of T2D after metabolic and bariatric surgery. Nonetheless, person-centred collaborative and supportive care beyond the monitoring of parameters forms the cornerstone in formulating care for people with diabetes. This paper reviews the clinical management of T2D after bariatric surgery, including persistent T2D or diabetes relapse after initial remission.","PeriodicalId":388753,"journal":{"name":"Mini-invasive Surgery","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139142199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Farinha, E. Mazzone, Marco Paciotti, Alberto Breda, James Porter, Kris Maes, Ben Van Cleynenbreugel, Jozef Vander Sloten, Alexandre Mottrie, Anthony G. Gallagher
{"title":"Systematic review on training models for partial nephrectomy","authors":"R. Farinha, E. Mazzone, Marco Paciotti, Alberto Breda, James Porter, Kris Maes, Ben Van Cleynenbreugel, Jozef Vander Sloten, Alexandre Mottrie, Anthony G. Gallagher","doi":"10.20517/2574-1225.2023.50","DOIUrl":"https://doi.org/10.20517/2574-1225.2023.50","url":null,"abstract":"Robot-assisted partial nephrectomy (PN) is a complex and index procedure with a difficult learning curve that urologists need to learn how to perform safely. We systematically evaluated the development and validation evidence underpinning PN training models (TMs) by extracting and reviewing data from PubMed, Cochrane Library Central, EMBASE, MEDLINE, and Scopus databases from inception to April 2023. The level of evidence was assessed using the Oxford Center for Evidence-Based Medicine. Of the 331 screened articles, 14 cohort studies were included in the analysis. No randomized controlled trials were found, and the heterogeneous nature of the models, study groups, task definitions, and subjectivity of the metrics used were transversal to all studies. All the models were rated good for realism and usefulness as training tools. Methodological discrepancies preclude definitive conclusions regarding the construct validation. No discriminative or predictive validation evidence was reported, nor were there comparisons between an experimental group trained with a TM and a control group. The previous findings stand for the low level of evidence supporting the efficacy of the described TMs in the acquisition of skills required to safely perform PN.","PeriodicalId":388753,"journal":{"name":"Mini-invasive Surgery","volume":"101 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139238951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Development of robotic surgical devices and its application in colorectal surgery","authors":"Kamil Erozkan, E. Gorgun","doi":"10.20517/2574-1225.2023.56","DOIUrl":"https://doi.org/10.20517/2574-1225.2023.56","url":null,"abstract":"Due to greater accessibility, robotic technology is becoming increasingly common in a wide range of general surgical procedures. In relation to traditional laparoscopic techniques, robotic surgery has four significant advantages: greater accessibility, visibility, accuracy, and comfortability. For example, robotic surgery is particularly beneficial for procedures in hard-to-reach areas (e.g., pelvis, rectum, and endoluminal areas) because it offers a greater range of motion and precision. In addition, surgical visibility and accuracy can be improved by providing 3D and magnified visualization of the surgical field. Robotic systems are also designed for surgeons’ comfort, allowing the operator to sit while working. For these reasons, robotic surgery is preferable for colorectal and other abdominal surgical procedures. As interest in minimally invasive surgery increases, so does the need to develop new approaches and procedures in colorectal surgery. While robotic surgery has great potential for improving outcomes, there may be disadvantages over traditional laparoscopic and open surgical procedures. For example, possible disadvantages include increased maintenance, training, and cost. This review discusses the evolution of robot-assisted surgery with respect to short-term and long-term outcomes. The development of robotic surgical devices, the new devices entering the market, and the possible future directions of robotic surgery will also be discussed.","PeriodicalId":388753,"journal":{"name":"Mini-invasive Surgery","volume":"161 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139267111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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