25th International Congress of the European Association for Endoscopic Surgery (EAES) Frankfurt, Germany, 14-17 June 2017 : Oral Presentations

Introduction: Ouyang has recently proposed hiatal surface area (HSA) calculation by multiplanar multislice computer tomography (MDCT) scan as a useful tool for planning treatment of hiatus defects with hiatal hernia (HH), with or without gastroesophageal reflux (MRGE). Preoperative upper endoscopy or barium swallow cannot predict the HSA and pillars conditions. Aim to asses the efficacy of MDCT’s calculation of HSA for planning the best approach for the hiatal defects treatment. Methods: We retrospectively analyzed 25 patients, candidates to laparoscopic antireflux surgery as primary surgery or hiatus repair concomitant with or after bariatric surgery. Patients were analyzed preoperatively and after one-year follow-up by MDCT scan measurement of esophageal hiatus surface. Five normal patients were enrolled as control group. The HSA’s intraoperative calculation was performed after complete dissection of the area considered a triangle. Postoperative CT-scan was done after 12 months or any time reflux symptoms appeared. Results: (1) Mean HSA in control patients with no HH, no MRGE was cm2 and similar in non-complicated patients with previous LSG and cruroplasty. (2) Mean HSA in patients candidates to cruroplasty was 7.40 cm2. (3) Mean HSA in patients candidates to redo cruroplasty for recurrence was 10.11 cm2. Discussion. MDCT scan offer the possibility to obtain an objective measurement of the HSA and the correlation with endoscopic findings and symptoms. The preoperative information allow to discuss with patients the proper technique when a HSA[5 cm2 is detected. During the follow-up a correlation between symptoms and failure of cruroplasty can be assessed. Conclusions: MDCT scan seems to be an effective non-invasive method to plan hiatal defect treatment and to check during the follow-up the potential recurrence. Future research should correlate in larger series imaging data with intraoperative findings

A novel hybrid 3D endoscope zooming and repositioning system : design and feasibility study

Background: Manipulation of the endoscope during minimally invasive surgery is a major source of inconvenience and discomfort. This report elucidates the architecture of a novel one-hand controlled endoscope positioning device and presents a practicability evaluation. Methods and materials: Setup time and total surgery time, number and duration of the manipulations, side effects of three-dimensional (3D) imaging, and ergonomic complaints were assessed by three surgeons during cadaveric and in vivo porcine trials. Results: Setup was accomplished in an average (SD) of 230 (120) seconds. The manipulation time was 3.87 (1.77) seconds for angular movements and 0.83 (0.24) seconds for zooming, with an average (SD) of 30.5 (16.3) manipulations per procedure. No side effects of 3D imaging or ergonomic complaints were reported. Conclusions: The integration of an active zoom into a passive endoscope holder delivers a convenient synergy between a human and a machine-controlled holding device. It is shown to be safe, simple, and intuitive to use and allows unrestrained autonomic control of the endoscope by the surgeon

Implementation of robotic laparoscopic cholecystectomy in a university hospital.

BACKGROUND: Robot surgery is a further step towards new potential developments in minimally invasive surgery. Surgeons must keep abreast of these new technologies and learn their limits and possibilities. Robot-assisted laparoscopic cholecystectomy has not yet been performed in our institution. The purpose of this report is to present the pathway of implementation of robotic laparoscopic cholecystectomy in a university hospital. METHODS: The Zeus(R) robot system was used. Experimental training was performed on animals. The results of our experimental training allowed us to perform our first two clinical cases. RESULTS: Robot arm set-up and trocar placement required 53 and 35 minutes. Operative time were 59 and 45 minutes respectively. The overall operative time was 112 and 80 minutes, respectively. There were no intraoperative complications. Patients were discharged from the hospital after an overnight stay. CONCLUSION: Robotic laparoscopic cholecystectomy is safe and patient recovery similar to those of standard laparoscopy. At present, there are no advantages of robotic over conventional surgery. Nevertheless, robots have the potential to revolutionise the way surgery is performed. Robot surgery is not reserved for a happy few. This technology deserves more attention because it has the potential to change the way surgery is performed

Robotinė cholecistektomija: pirmosios operacijos Baltijos šalyse

[full article, abstract in English; abstract in Lithuanian] In this retrospective study we report the first series of robotic cholecystectomies in Baltic countries. From Nov 2018 to Feb 2019, 13 robotic cholecystectomies were performed in Klaipėda University Hospital using the Senhance (TransEnterix) robotic system. Patients were diagnosed with symptomatic gallstone disease and had no life-threatening co-morbidities. We retrospectively investigated patient demographics and pre-, peri- and postoperative data. Five male and eight female patients were included in this study (n = 13). Mean age was 46 years (range 26–72); mean BMI was 26.7 kg/m² (range 21.1–37.7). Mean docking time was 18 min (range 8–27), and mean operative time was 85 min (range, 70–150). There were no conversions to standard laparoscopy or open surgery. There were no intra-operative complications. There was one post-operative bleeding from the gallbladder bed and subhepatic hematoma, successfully treated by laparoscopy. This study demonstrates the feasibility of robotic surgery in performing minimally invasive cholecystectomies.[straipsnis ir santrauka anglų kalba, santrauka lietuvių kalba] Straipsnyje aptariami pirmieji Baltijos šalyse robotinės cholecistektomijos rezultatai. Operacijos atliktos Klaipėdos universitetinėje ligoninėje nuo 2018 m. lapkričio mėn. iki 2019 m. vasario mėn., naudojant Senhance (TransEnterix) robotinę sistemą. Tiriamieji sirgo simptomine tulžies pūslės akmenlige, sunkių gretutinių susirgimų neturėjo. Atliekant tyrimą, retrospektyviai įvertinti pacientų demografiniai duomenys, operaciniai ir pooperaciniai rezultatai. Tyrime dalyvavo 13 pacientų: penki vyrai ir aštuonios moterys. Pacientų amžiaus vidurkis – 46 metai (26–72 m.), KMI vidurkis – 26,7 kg/m² (21,1–37,7 kg/m²). Paruošti operacijai robotinę sistemą vidutiniškai užtruko 18 min. (8–27 min.). Robotinė cholecistektomija (kartu su pasiruošimu) vidutiniškai truko 85 min. (70–150 min.). Konversijų į laparoskopinę ar atvirą operaciją nebuvo. Operacinių komplikacijų nefiksuota. Vienam pacientui po operacijos pastebėta kraujavimo iš tulžies pūslės guolio požymių ir subhepatinė hematoma, tačiau pacientas sėkmingai pagydytas relaparoskopijos metu. Straipsnyje aptariami tyrimo duomenys atskleidžia robotinės chirurgijos galimybes tulžies pūslės akmenligei gydyti

Recent Advances in Laparoscopic Surgery

The implementation of laparoscopy has revolutionized surgery over the past few years, incorporating significant benefits for the patient. However, this evolution has also entailed many technical obstacles for surgeons. This book is for readers wanting to learn more about recent surgical techniques and technologies. Topics cover novel sophisticated approaches for single-site surgery, natural orifice transluminal endoscopic surgery, and transanal surgery, among others. Also included are reviews of new innovative surgical devices, robotic platforms, and methodological guidelines for improving surgical performance and surgeon ergonomics