Robotic radical cholecystectomy for gallbladder cancer at a high-volume minimally invasive center

Background. For Tis and T1a gallbladder cancer (GbC), laparoscopic cholecystectomy can provide similar survival outcomes compared to open cholecystectomy. However, for patients affected by resectable T1b or more advanced GbC, open approach radical cholecystectomy (RC), consisting in gallbladder liver bed resection or segment 4b-5 bisegmentectomy, with locoregional lymphadenectomy, is considered the gold standard while minimally invasive RC (MiRC) is skeptically considered.Aim. To analyze current literature on perioperative and oncologic outcomes of MiRC for patients affected by GbC.Methods. A Medline review of published articles until June 2016 concerning MiRC for GbC was performed.Results. Data relevant for this review were presented in 13 articles, including 152 patients undergoing an attempt of MiRC for GbC. No randomized clinical trial was found. The approach was laparoscopic in 147 patients and robotic in five. Conversion was required in 15 (10%) patients. Postoperative complications rate was 10% with no mortality. Long-term survival outcomes were reported by 11 studies, two of them showing similar oncologic results when comparing MiRC with matched open RC.Conclusions. Although randomized clinical trials are still lacking and only descriptive studies reporting on limited number of patients are available, current literature seems suggesting that when performed at highly specialized centers, MiRC for GbC is safe and feasible and has oncologic outcomes comparable to open RC.

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Robotic completion radical cholecystectomy for incidental gallbladder cancer

HPB ◽

10.1016/j.hpb.2020.04.752 ◽

2020 ◽

Vol 22 ◽

pp. S186

Author(s):

J.M. Creasy ◽

M.E. Lidsky ◽

K.N. Shah ◽

G.S. Herbert ◽

P.J. Allen ◽

...

Keyword(s):

Gallbladder Cancer ◽

Radical Cholecystectomy ◽

Incidental Gallbladder Cancer

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Minimally invasive distal pancreatectomy: a case-matched cost-analysis between robot-assisted surgery and direct manual laparoscopy

Surgical Endoscopy ◽

10.1007/s00464-021-08332-1 ◽

2021 ◽

Author(s):

Gregorio Di Franco ◽

Andrea Peri ◽

Valentina Lorenzoni ◽

Matteo Palmeri ◽

Niccolò Furbetta ◽

...

Keyword(s):

Minimally Invasive ◽

Cost Analysis ◽

Distal Pancreatectomy ◽

Length Of Hospital Stay ◽

High Volume ◽

Fixed Costs ◽

Spleen Preservation ◽

Robotic Assisted Surgery ◽

The Mean ◽

Complications Rate

Abstract Background Few studies have reported a structured cost analysis of robotic distal pancreatectomy (RDP), and none have compared the relative costs between the robotic-assisted surgery (RAS) and the direct manual laparoscopy (DML) in this setting. The aim of the present study is to address this issue by comparing surgical outcomes and costs of RDP and laparoscopic distal pancreatectomies (LDP). Methods Eighty-eight RDP and 47 LDP performed between January 2008 and January 2020 were retrospectively analyzed. Three comparable groups of 35 patients each (Si-RDP-group, Xi-RDP group, LDP-group) were obtained matching 1:1 the RDP-groups with the LDP-group. Overall costs, including overall variable costs (OVC) and fixed costs were compared using generalized linear regression model adjusting for covariates. Results The conversion rate was significantly lower in the Si-RDP-group and Xi-RDP-group: 2.9% and 0%, respectively, versus 14.3% in the LDP-group (p = 0.045). Although not statistically significant, the mean operative time was lower in Xi-RDP-group: 226 min versus 262 min for Si-RDP-group and 247 min for LDP-group. The overall post-operative complications rate and the length of hospital stay (LOS) were not significantly different between the three groups. In LDP-group, the LOS of converted cases was significantly longer: 15.6 versus 9.8 days (p = 0.039). Overall costs of LDP-group were significantly lower than RDP-groups, (p < 0.001). At multivariate analysis OVC resulted no longer statistically significantly different between LDP-group and Xi-RDP-group (p = 0.099), and between LDP-group and the RDP-groups when the spleen preservation was indicated (p = 0.115 and p = 0.261 for Si-RDP-group and Xi-RDP-group, respectively). Conclusions RAS is more expensive than DML for DP because of higher acquisition and maintenance costs. The flattening of these differences considering only the variable costs, in a high-volume multidisciplinary center for RAS, suggests a possible optimization of the costs in this setting. RAS might be particularly indicated for minimally invasive DP when the spleen preservation is scheduled.

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Quality of training in cervical cancer radical surgery: a survey from the European Network of Young Gynaecologic Oncologists (ENYGO)

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2021-002812 ◽

2022 ◽

pp. ijgc-2021-002812

Author(s):

Nicolò Bizzarri ◽

Andrei Pletnev ◽

Zoia Razumova ◽

Kamil Zalewski ◽

Charalampos Theofanakis ◽

...

Keyword(s):

Cervical Cancer ◽

Minimally Invasive ◽

Radical Surgery ◽

Gynecologic Oncology ◽

Laparoscopic Approach ◽

High Volume ◽

Lymph Node Biopsy ◽

European Network ◽

Before And After ◽

Level Of Training

BackgroundThe European Society of Gynaecological Oncology (ESGO) and partners are committed to improving the training for gynecologic oncology fellows. The aim of this survey was to assess the type and level of training in cervical cancer surgery and to investigate whether the Laparoscopic Approach to Cervical Cancer (LACC) trial results impacted training in radical surgery for gynecologic oncology fellows.MethodsIn June 2020, a 47-question electronic survey was shared with European Network of Young Gynaecologic Oncologists (ENYGO) members. Specialist fellows in obstetrics and gynecology, and gynecologic oncology, from high- and low-volume centers, who started training between January 1, 2017 and January 1, 2020 or started before January 1, 2017 but finished their training at least 6 months after the LACC trial publication (October 2018), were included.Results81 of 125 (64.8%) respondents were included. The median time from the start of the fellowship to completion of the survey was 28 months (range 6–48). 56 (69.1%) respondents were still fellows-in-training. 6 of 56 (10.7%) and 14 of 25 (56.0%) respondents who were still in training and completed the fellowship, respectively, performed ≥10 radical hysterectomies during their training. Fellows trained in an ESGO accredited center had a higher chance to perform sentinel lymph node biopsy (60.4% vs 30.3%; p=0.027). There was no difference in the mean number of radical hysterectomies performed by fellows during fellowship before and after the LACC trial publication (8±12.0 vs 7±8.4, respectively; p=0.46). A significant reduction in number of minimally invasive radical hysterectomies was noted when comparing the period before and after the LACC trial (38.5% vs 13.8%, respectively; p<0.001).ConclusionExposure to radical surgery for cervical cancer among gynecologic oncology fellows is low. Centralization of cervical cancer cases to high-volume centers may provide an increase in fellows’ exposure to radical procedures. The LACC trial publication was associated with a decrease in minimally invasive radical hysterectomies performed by fellows.

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Minimally invasive liver resection for gallbladder cancer

Laparoscopic Surgery ◽

10.21037/ls-20-51 ◽

2021 ◽

Vol 5 ◽

pp. 25-25

Author(s):

Mizelle D’Silva ◽

Ho-Seong Han ◽

Yoo-Seok Yoon ◽

Jai Young Cho

Keyword(s):

Liver Resection ◽

Minimally Invasive ◽

Gallbladder Cancer ◽

Minimally Invasive Liver Resection

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Abstract 14956: Improved Operative Efficiency for Minimally Invasive Mitral Valve Surgery at a Low-volume Center

Circulation ◽

10.1161/circ.142.suppl_3.14956 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Monica Fowler ◽

Jeffrey B MacLeod ◽

christie aguiar ◽

Alexandra M Yip ◽

zlatko pozeg ◽

...

Keyword(s):

Cardiac Surgery ◽

Mitral Valve ◽

Minimally Invasive ◽

High Volume ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Entire Study ◽

Invasive Approach ◽

Low Volume ◽

Skin To Skin

Introduction: When implementing a minimally invasive cardiac surgery program, increased surgical times may serve as a deterrent. Results demonstrating parity in operative times between minimally invasive (MIMVR) and conventional mitral valve replacement/repair (CMVR) have been limited to high-volume centers. The purpose of this study was to examine operative efficiency for MIMVR in a low-volume center. Methods: All patients having undergone non-emergent, isolated MIMVR or CMVR at the New Brunswick Heart Centre from 2011-2017 were considered. Detailed peri-operative data, including cross clamp (XC), cardiopulmonary bypass (CPB), skin-to-skin (SS) and total operative (TO) times, were collected. Patients were assigned to one of 3 eras: 2011-2013, 2014-2015, 2016-2017. Unadjusted comparisons were made between MIMVR and CMVR over the entire study period and within each era. Results: A total of 168 patients were included (MIMVR: 64; CMVR: 104). There was an increase in the number of MIMVR cases over time (2011-2013: 19; 2014-2015: 17; 2016-2017: 28). Patients undergoing MIMVR were less likely to be ≥70years (29.7% vs. 47.1%, p=0.04) and to have had NYHA-IV symptoms (17.2% vs. 41.3%, p=0.002), previous cardiac surgery (4.7% vs. 23.1%, p=0.003) or urgent presentation (12.5% vs. 35.6%, p=0.002). Intra-operatively, MIMVR patients were more likely to have undergone a mitral valve repair (65.1% vs. 29.1%, p<0.0001). No differences were noted in rates of in-hospital mortality (0.0% vs. 5.1%, p=0.29). Median operative times were uniformly longer among MIMVR patients between 2011-2013. However, in 2014-2015 and 2016-2017, these times improved to the point where no significant differences in operative efficiency were noted (Figure). Conclusions: Improved operative efficiency may be safely achieved for MIMVR in a low-volume center. The results of this study should encourage low-volume centers to adopt a minimally invasive approach to isolated mitral valve surgery.

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PS01.211: IMPLEMENTATION OF A TOTALLY MINIMALLY INVASIVE OESOPHAGECTOMY PROGRAMME IN A UK SPECIALIST CENTRE: INITIAL EXPERIENCE AND OUTCOMES

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.211 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 109-110

Author(s):

Temisanren Akitikori ◽

Bruno Lorenzi ◽

Kanatheepan Shanmuganathan ◽

Oluwasunmisola Soile ◽

Aadil Hussain ◽

...

Keyword(s):

Lymph Node ◽

Minimally Invasive ◽

Conflicts Of Interest ◽

High Volume ◽

Pulmonary Complications ◽

Cardiac Complications ◽

Initial Experience ◽

Chyle Leak ◽

Anastomotic Strictures ◽

Minimally Invasive Oesophagectomy

Abstract Background Totally minimally invasive oesophagectomy although challenging to perform has garnered popularity in the surgical treatment of oesophageal cancer. Advanced laparoscopic surgical skills are needed with the construction of the intra-thoracic anastomosis in the case of a 2-stage procedure being the rate-limiting step. We aim to report our initial experience and short-term outcomes of totally minimally invasive 3-stage and 2-stage oesophagectomies for cancer. Methods From January 2016 when the minimally invasive oesophagectomy programme was implemented in our Unit, to December 2017, 65 consecutive cases underwent either a 2-stage or a 3-stage oesophagectomy for cancer. In all cases a radical 2-field lymph node dissection was performed. All were performed in a prone position and in the 3-stage oesophagectomies, superior mediastinal lympadenectomy was additionally performed. In the 2-stage cases an end-to-side esophago-gastric anastomosis was constructed in two layers with barbed knotless suture (V-LocTM). Results Male: female was 4:1 with a mean age of 66.44 years (IQR, 43–82). n = 53 were 2-stage and 12 were 3-stage oesophagectomies. Thirty five (53.8%) had neoadjuvant chemotherapy and 30(46.2%) went straight to surgery. There were no open conversions. No feeding jejunostomies were placed routinely. Complete resection (R0) rate was 61.54% (40/65) with a mean lymph node harvest of 28 (IQR, 11–68). Five (7.6%) anastomotic leaks were diagnosed (4 in 2-stage and 1 in 3-stage oesophagectomies), with 1(1.5%) of them (in the 2-stage group) being subclinical requiring no intervention. Furthermore, 1(1.5%) chyle leak and 1(1.5%) gastric staple line leak were also observed. Pulmonary complications were reported in 13.8% of cases and cardiac complications arose in 1.5%. Seven (10.8%) anastomotic strictures were also noted that were treated with endoscopic balloon dilatation. Mean hospital stay was 13 days and 30-day mortality rate was 4.62%. Conclusion Implementation of a minimally invasive oesophagectomy program in our high-volume tertiary centre is yielding good initial results. Vast previous experience in the field is of paramount importance. Hand-sewn intrathoracic anastomosis during 2-stage procedures is feasible and with repetitively good outcomes. Disclosure All authors have declared no conflicts of interest.

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