scholarly journals SP1.2.4A Single Centre experience in Robot-assisted Colorectal Surgery: First 70 cases

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
William Rea ◽  
Sandeep Singh ◽  
Shaun Nai ◽  
Neil Kukreja ◽  
Hendrik Wegstapel
Keyword(s):  
Colorectal Surgery ◽  
Operating Time ◽  
Invasive Technique ◽  
Single Centre ◽  
Robot Assisted ◽  
Term Outcome ◽  
Female Ratio ◽  
Benign Pathology ◽  
The Mean ◽  
American Society

Abstract Aim To analyse the short-term outcome of robot-assisted colorectal surgery (RACS) in a single centre. Methods All the patients who underwent RACS using the DaVinci Xi platform between June 2018 and December 2020 were included in our study. RACS was performed by two consultant team. Data was collected from a prospectively maintained database. Results Over the 31-month study period, 70 RACS were performed with no 30-day mortality. Male to female ratio was 4:3, with mean age was 66 years (SD 12). The mean body mass index was 28.7 (SD 5.1). Pre-operative American society of anaethesiology (ASA) score was reported as 1-2 in 65% of patients and 35% as 3. Indication for surgery was malignancy in 89% (62/70) of patients and the remainder benign pathology. Type of surgery performed was high anterior resection (AR) in 39% (27/70) patients, low AR 33% (23/70), right hemicolectomies 21% (15/70), Hartmann’s procedure 3% (2/70), abdominoperineal resections 3% (2/70), and left hemicolectomy 1% (1/70). The mean operating time was 295 minutes (SD 92), with only 1 reported case of conversion to open. Complete resection (R0) was achieved in 95% (59/62) of malignant resections. The mean lymph nodes harvested were 19 (range 7-36). Post-operative complications occurred in 23% (16/70) of patients, including 6% (4/66) anastomotic leaks. The mean length of stay was 8 days (range 1-53), with readmission rate of 14% (10/70). Conclusion The robotic minimally invasive technique can be safely introduced for major colorectal resections without excessive morbidity.

SP1.2.5Robot-assisted Colorectal Surgery: Short-term Outcome of First 70 cases at Different Time-intervals along the Learning Curve

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sandeep Singh ◽  
William Rea ◽  
Shaun Nai ◽  
Tamas Sollei ◽  
Neil Kukreja ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Learning Curve ◽  
Operating Time ◽  
Total Duration ◽  
Time Intervals ◽  
Term Outcome ◽  
Female Ratio ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Aim To analyse the evolution of robot-assisted colorectal surgery (RACS). Methods All the patients who underwent RACS between June 2018 and December 2020 were selected. Study period was divided into 3 intervals along the learning curve; group A represents the 1st 10 months, group B 2nd 10 and group C last 11. Results Over the 31-month study period, 70 RACS were performed. Male to female ratio was 4:3, with mean age of 66 years and BMI 28.7. ASA score was reported as 1-2 in 65% patients and 35% as 3. Indication was malignancy for 89% patients and the remainder benign pathology. High or low anterior resection performed were 72%, right hemicolectomies 21%, Hartmann’s 3%, abdominoperineal resections 3%, and left hemicolectomy 1%. RACS performed in group A was 20 compared to 19 in B and 31 C. Type of RACS performed, BMI, ASA, complications, anastomotic leaks, R0 resections and harvested lymph nodes were unrelated to selected time-intervals along learning curve. Mean total duration of procedure dropped down to 247 minutes in group C from 375 in group A (p = <0.001). No significant difference in mean length of stay and readmission rate was observed in 3 groups (p = 0.7, p = 0.59). Conclusion The study demonstrates that introduction of this new surgical technique is safe even in the early phase of adoption with no significant difference in pre-and post-operative morbidities. Significant difference in time taken for surgery was observed with reduction of 88 minutes in average operating time between the start and end of the study.

O100 WORLDWIDE TECHNIQUES AND OUTCOMES OF ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE): RESULTS FROM THE INTERNATIONAL UGIRA REGISTRY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
B F Kingma ◽  
P P Grimminger ◽  
M J van Det ◽  
Y K Chao ◽  
P Chiu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Operating Time ◽  
Case Series ◽  
Radical Resection ◽  
Pulmonary Complications ◽  
Cardiac Complications ◽  
Robot Assisted ◽  
Invasive Esophagectomy ◽  
The Mean

Abstract Aim The aim of this study was to gain insight in the techniques and outcomes of RAMIE worldwide. Background & Methods Although robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted. The current literature on RAMIE mainly consists of single-center case series with considerable variation in reported techniques and outcomes. To gain an overview of the worldwide practice in RAMIE, an online registry was established by the Upper GI International Robotic Association (UGIRA). The collected data involve patient- and treatment characteristics, as well as postoperative outcomes that include complications as defined by the Esophageal Complications Consensus Group, length of stay, re-admissions (i.e. <30 days after discharge), mortality (i.e. in-hospital or <30 days after surgery), and pathological results. The outcomes were descriptively analyzed for this interim report. Results A total of 434 patients who underwent RAMIE for esophageal cancer between 2016-2019 were included in this interim analysis. The mean age was 63 years (SD ±9.7), the majority was male (n=359, 83%), and nearly all patients had an ASA score ≥2 (n=398, 92%). Adenocarcinoma (n=253, 58%) and squamous cell carcinoma (n=162, 37%) were most prevalent. The usual surgical approach was transthoracic (n=428, 99%) with the patient in semiprone position (n=393, 91%). Gastric conduit reconstruction was performed in all except one patient, who received a colonic interposition. The anastomosis was created by hand-sewing (n=207, 48%), circular stapling (n=142, 32%), or linear stapling (n=85, 20%). The median intraoperative blood loss was 120 milliliters (IQR 70-280) and the median operating time was 392 minutes (IQR 353-455). Postoperative complications occurred in 251 patients (59%) and mainly involved pulmonary complications (n=138, 32%), anastomotic leakage (n=80, 18%), and cardiac complications (n=55, 13%). Mortality occurred in 9 patients (2%) and re-admission because of complications was required in 57 patients (14%). A median of 28 lymph nodes (IQR 21-35) were removed and a radical resection was achieved in 400 patients (92%). Conclusion The presented results are the first to provide an overview of the techniques that are commonly used in RAMIE. By demonstrating results that are in line with recent benchmarking literature, this study demonstrates the safety and feasibility of RAMIE.

scholarly journals Transurethral fragmentation of bladder stone in children: Our experience

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Ghulam Mujtaba Zafar ◽  
Naseem Javed ◽  
Fawad Humayun ◽  
Asif Iqbal
Keyword(s):  
Hospital Stay ◽  
Operating Time ◽  
Bladder Stone ◽  
Average Hospital ◽  
Female Ratio ◽  
Bladder Stones ◽  
Stone Recurrence ◽  
Febrile Uti ◽  
The Mean ◽  
One Year

Background: This study is performed to find the outcome of transurethral fragmentation and clearance of bladder stones in children as well as assessment of stone recurrence after the procedure. Methods: It was a retrospective analysis of the medical record of 365 patients with bladder stones, treated with transurethral fragmentation at the Department of Pediatric Urology, The Children’s Hospital and the Institute of Child Health, Lahore, over a period of 5 years. Bladder stones were fragmented by using ureterorenoscope (URS) and pneumatic Lithotripsy under general anesthesia. Patients were asked to void next day for spontaneous passage of stone fragments. Duration of procedure, hospital stay, peroperative, and postoperative complications were recorded on a self-structured proforma. The collected data was analyzed with SPSS, version 22. Results: The mean age of the patients was 4.7 ±2.31 years, and male to female ratio was 6:1. Clinical presentation was painful micturition with milking of penis (55%), followed by straining during micturition (17.5%), urinary retention (10%), increased frequency of urine (8%), febrile UTI (7.5%), and hematuria (2%). The mean stone size on ultrasound was 17.2 ±3.8 mm (Range 7-25 mm). The average operating time was 18 minutes (Range: 12-35 minutes). The transurethral fragmentation was successfully done in all (100%) patients. Average hospital stay was 24 hours. Most patients (98.5%) passed all stone fragments in urine & were stone free at one week, confirmed by ultrasound and X-Ray Kidney, Ureter, and Bladder (KUB). Postoperative minor complications were found in (6%) patients including hematuria (3%), dysuria (2%), febrile UTI (1%), failure to void (0.5%). Stone recurrence was 0.27% and no urethral stricture was noted up to one year follow up. Conclusion: Endoscopic treatment of bladder stone in children appears effective and safe by fragmenting the stone into multiple small pieces, which passed out spontaneously without any need for extraction of stone. The associated complications and recurrence rate are very negligible.

scholarly journals Robotic hepatectomy and biliary reconstruction for perihilar cholangiocarcinoma: a pioneer western case series

2021 ◽  
Author(s):  
Umberto Cillo ◽  
Francesco Enrico D’Amico ◽  
Alessandro Furlanetto ◽  
Luca Perin ◽  
Enrico Gringeri
Keyword(s):  
Minimally Invasive ◽  
Open Surgery ◽  
Da Vinci ◽  
Video Clip ◽  
Operating Time ◽  
Perihilar Cholangiocarcinoma ◽  
Invasive Technique ◽  
Biliary Reconstruction ◽  
Robot Assisted ◽  
Liver Resections

AbstractOpen surgery is the standard of care for perihilar cholangiocarcinoma (pCCA). With the aim of oncologic radicality, it requires a complex major hepatectomy with biliary reconstruction. The postoperative course is consequently often complicated, with severe morbidity and mortality rates of up to 27.5–54% and 18%, respectively. Robotic liver surgery is emerging as a safe, minimally-invasive technique with huge potential for pCCA management. After the first case described by Giulianotti in 2010, here we present the first western series of robot-assisted liver resections with biliary reconstruction for pCCA with the aim to preliminarily assess the feasibility and repeatability of the procedure. At our high-volume teaching hospital center dedicated to HPB surgery, 128 pCCA patients have been surgically treated in the last 15 years whereas more than 800 laparoscopic liver resections have been performed. Since the Da Vinci Xi Robotic platform was introduced in late 2018, 6 major robotic liver resections with biliary reconstruction have been performed, 4 of which were for pCCA. All 4 cases involved a left hepatectomy with caudate lobectomy. The median operating time was 840 min, with a median blood loss of 700 ml. One case was converted to open surgery during the reconstruction due to a short mesentery preventing the hepatico-jejunostomy. None of the patients experienced major complications, while minor complications occurred in 3 out of 4 cases. One biliary leak was managed conservatively. The median postoperative stay was 9 days. Negative biliary margins were achieved in 3 of the 4 cases. An included video clip shows the most relevant technical details. This preliminary series demonstrates that robot-assisted liver resection for pCCA is feasible. We speculate that the da Vinci platform has a relevant potential in pCCA surgery with particular reference to the multi-duct biliary reconstruction. Further studies are needed to better clarify the role of this high-cost technology in the minimally-invasive treatment of pCCA.

scholarly journals LAP STAPLER GASTROJEJUNOSTOMY WITH TOTAL TRUNCAL VAGOTOMY FOR BENIGN GASTRIC OUTLET OBSTRUCTION.

2020 ◽  
Vol 4 (9) ◽  
Author(s):  
Sahun .
Keyword(s):  
Hospital Stay ◽  
Postoperative Complication ◽  
Operative Time ◽  
Outlet Obstruction ◽  
Length Of Hospital Stay ◽  
Truncal Vagotomy ◽  
Term Outcome ◽  
Female Ratio ◽  
Advantages And Disadvantages ◽  
The Mean

Aims: To study the advantages and disadvantages of laparoscopic truncal vagotomy and gastrojejunostomy, the outcome of surgery in terms of – mean operative time, Conversion rate, Postoperative pain measurement, intraoperative and postoperative complication and duration of hospital stay. Methods: A prospective analysis of operative, postoperative and short term outcome of 21 patients were carried out during time period of 2016 to 2019. Results: Out of 21 patient,.64% patients were males and 36 % patients were females. Male to female ratio was 1.7: 1. The mean operative time required was 130 minutes and the mean pain scale measured was 3 ± 0.81 on second day .The incidence of intraoperative and early postoperative complication was 5.26 % and 10.52 % respectively. The mean length of hospital stay was 8 days. Average follow up duration was 12 months. Conclusion: It is viable and safe option with shorter operative time and length of stay. It can be performed successfully with minimal morbidity and no mortality. However extreme care and skill is required to identify anatomy and handling of stapler. Keywords: Laparoscopy; Stapler Gastrojejunostomy; Vagotomy; Endoscopy.

scholarly journals Early Experience of Endoscopy-Assisted Anterior Spinal Surgery

2002 ◽  
Vol 10 (2) ◽  
pp. 152-159 ◽  
Author(s):  
W Adulkasem ◽  
W Surangsrirat
Keyword(s):  
Spinal Surgery ◽  
Operating Time ◽  
Early Experience ◽  
Skin Incision ◽  
Surgical Instruments ◽  
Invasive Technique ◽  
Laparoscopic Instrument ◽  
Estimated Blood Loss ◽  
The Mean ◽  
Anterior Spinal Surgery

Purpose. Endoscopy-assisted anterior spinal surgery is less invasive, resulting in less tissue trauma. It has a shorter recovery period, leads to less morbidity, and is more cost-efficient than conventional surgery. We report our early experience of endoscopic anterior spinal surgery in Thailand, which was performed with a basic laparoscopic instrument set and self-developed instruments for spinal surgery. Methods. All patients who underwent endoscopic anterior spinal surgery from July 2000 to May 2001 at the Orthopaedic Department, Nakhonpathom Hospital, Nakhonpathom were prospectively documented. The two-portal technique was applied on these patients: the first portal, a 4-cm skin incision, was made as the portal for the surgical instruments; the second portal, a one-cm skin incision, was made as the portal for the endoscope. Results. Nine patients underwent anterior spinal surgery with the minimally invasive technique. The mean patient age was 51.5 years (range, 17–72 years); 3 patients were females and 6 were males. The procedures included thoracoscopy, retroperitoneoscopy, diaphragmatic crus detachment, discectomy, corpectomy, fusion, and instrumentation. The mean operating time was one hour 58 minutes, and the mean estimated blood loss was 372ml; there were no serious complications. Conclusion. Endoscopy-assisted anterior spinal surgery can be performed without spending a high budget; the procedure is not difficult if the surgeon can develop some instruments and has experiences with arthroscopic surgery and anterior spinal surgery.

Early experience with ultrasound guided pneumatic reduction of intussusception using locally assembled equipment in Nepal

2019 ◽  
Vol 22 (2) ◽  
pp. 27-31
Author(s):  
Suman Bikram Adhikari
Keyword(s):  
Bowel Perforation ◽  
Pressure Gauge ◽  
Intraluminal Pressure ◽  
Invasive Technique ◽  
Duration Of Symptoms ◽  
Female Ratio ◽  
Hydrostatic Reduction ◽  
Pneumatic Reduction ◽  
Male Female Ratio ◽  
The Mean

Introduction: Intussusception is one of the commonest emergency conditions in children. Pneumatic reduction of intussusception, a minimally invasive technique, has a higher success rate and lower incidence of complications as compared to barium enema & hydrostatic reduction and also omits the need for unnecessary laparotomy. The aim of this study was to evaluate the results of the pneumatic reduction in our hospital as a treatment of idiopathic pediatric ileocolic intussusception and to identify the pretreatment factors associated with pneumatic reduction failure. Methods: This was a prospective analytical study. A total of 12 children were enrolled in the study between January to November 2018 at Nepal National Hospital, Kathmandu. Patients were given air enema under Ultrasound-guidance, using locally assembled equipment. All procedures were performed under intravenous anesthesia. The intraluminal pressure was monitored with a pressure gauge and was not permitted to go above 100 mmHg. A total of three attempts of 3 minutes each were allowed. Results: Average age of the patients was 2.7 years, with a male-female ratio of 3:1. Eleven (92%) of the cases were successfully reduced while 1 (8%) case failed to reduce. No bowel perforation occurred in this study. The mean duration of symptoms before presentation was 42 hours. The mean length of intussusceptum was 3.058 cm. the mean duration of pneumatic reduction was 1.97 minutes and total intervention time i.e. from induction of anesthesia to reversal from anesthesia was 18.55 minutes. Conclusion: The technique described is easy to assemble, safe and effective. I recommend it for regular use in pneumatic reduction of intussusception, especially in centers with limited resources.

Robot-Assisted Laparoscopic Fundoplications in Pediatric Surgery: Experience Review

2017 ◽  
Vol 29 (02) ◽  
pp. 173-178 ◽  
Author(s):  
Laurent Fourcade ◽  
Sarah Amar ◽  
Khalid Alzahrani ◽  
Ann-Rose Cook ◽  
Karim Braïk ◽  
...  
Keyword(s):  
Learning Curve ◽  
Pediatric Surgery ◽  
Operative Time ◽  
Operating Time ◽  
Laparoscopic Approach ◽  
Robot Assisted ◽  
Postoperative Rehabilitation ◽  
New Approach ◽  
Open Procedure ◽  
The Mean

Introduction Laparoscopic fundoplicature for gastroesophageal reflux disease has become the gold standard because of the improvement of postoperative rehabilitation compared with the open procedure. The robot-assisted surgery has brought new advantages for the patient and the surgeon compared with laparoscopy. We studied this new approach and the learning curve. Materials and Methods Sixty robot-assisted fundoplicatures were performed in two university pediatric surgery centers. Data of the patients were recorded, including peroperative data (operation length and complications), postoperative recoveries, and clinical evolution. The learning curve was evaluated retrospectively and each variable was compared along this learning curve. Results We observed a flattening of the learning curve after the 20th case for one surgeon. The mean operative time decreased significantly to 80 ± 10 minutes after 20 cases. There were no conversions to an open procedure. A revision surgery was indicated for 4.7% of the patients by a surgical robot-assisted laparoscopic approach. Conclusion The robotic system appears to add many advantages for surgical ergonomic procedures. There is a potential benefit in operating time with a short technical apprenticeship period. The setting up system is easy with a short docking time.

scholarly journals Delayed Primary Closure of Traumatic Tension Wounds Using Plastic Straps and Kirschner Wires

2018 ◽  
Vol 27 (1) ◽  
pp. 29-37
Author(s):  
Yalcin Yontar ◽  
Sedat Tatar ◽  
Ahmet Aydin ◽  
Atilla Coruh
Keyword(s):  
Primary Closure ◽  
Low Cost ◽  
Donor Site ◽  
Operating Time ◽  
Kirschner Wires ◽  
No Donor ◽  
Female Ratio ◽  
Delayed Primary Closure ◽  
Hospitalization Time ◽  
The Mean

Tension of the wound edges should be overcome with precise surgical planning, which is recognized as one of the major contributors to local complications by compromising circulation of the wound edges. In this article, it was aimed to present the clinical results of a surgical technique, in which the plastic straps and Kirschner wires are used for delayed primary closure of traumatic tension wounds. Depending on the assessment of the wound localization, wound dimension, and mobility of adjacent soft tissue, the technique was performed in 9 patients with a male to female ratio of 8:1. Gunshot injury was the leading cause (n = 5), and in most cases, the wounds were located at the lower extremities (n = 6). The mean time between performing the technique and closing the wound primarily and the mean hospitalization time were 4.8 ± 1.1 and 13.5 ± 3.9 days, respectively. In each case, wound closure and healing were achieved successfully without any serious complications. The presented technique provides advantages of using a low cost as well as a very simple equipment, improved and reliable stability during tightening process due to self-locking feature of the plastic straps, no donor site morbidity, short operating time with low rate of post-operative complications, and short hospitalization time. We recommend using this invaluable technique reliably for the treatment of traumatic tension wounds. However, further studies are needed for better evaluation of cosmetic and functional outcomes of the presented technique.

scholarly journals Short term outcome of total knee replacement in Kashmiri population without co-morbidities

2019 ◽  
Vol 6 (8) ◽  
pp. 2921
Author(s):  
M. Ahsan Wani ◽  
Mushtaq Ahmed Ganaiee ◽  
Bashir Ahmed Mir ◽  
Asif Sultan ◽  
Muneebul Islam
Keyword(s):  
Quality Of Life ◽  
Total Knee Replacement ◽  
Range Of Motion ◽  
Knee Replacement ◽  
Pain Perception ◽  
Operating Time ◽  
Term Outcome ◽  
Total Knee ◽  
The Mean

Background: The aim of the study was to evaluate the patients of osteoarthritis of knee prior to surgery and then 6 weeks after the total knee replacement surgery with regards pain, range of motion, stability, deformity, quadriceps power and support.Methods: This is a prospective follow up study. A minimum of 20 patients have been included in this study conducted in Department of Orthopedics, Bone and Joint Hospital Barzullah Srinagar, during the period of September 2014 to November 2016.Results: The average age of patients was 59.63 years, more than 35% of the patients belonged to the age group 66-70 years, majority of the patients were females (70%) in the whole study group. Most (88.89%) cases were bilateral, affecting both knees. The mean pre-operative range of motion in 94.38 degrees. The mean postoperative range of motion was 113.75 degrees. Patients were followed up at 2, 4, 6 weeks postoperatively. The average blood loss was 500 ml and the average operating time was one hour and 15 minutes and one hour. There was one deep vein thrombosis, one delayed wound healing, one common peroneal nerve palsy and one valgus deformity.Conclusions: The patients with  more severely deformed knees, are more elderly, have more pain perception, their functional quality of life was   impaired more, they were physically more dependent and their quality of life improves significantly after surgery.

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