Safety and Performance Evaluation of Su2ura Approximation, a New Suturing Device, in Pigs

One of the challenging aspects of minimal invasive surgery (MIS) is intracorporal suturing, which can be significantly time-consuming. Therefore, there is a rising need for devices that can facilitate the suturing procedure in MIS. Su2ura Approximation Device (Su2ura Approximation) is a novel device developed to utilize the insertion of anchors threaded with stitches to allow a single action placement of a suture. The objective of this study was to evaluate the long-term safety and tissue approximation of Su2ura Approximation in comparison to Endo Stitch + Surgidac sutures in female domestic pigs. All incision sites were successfully closed by both methods. Firm consolidation within and around the incision site was noted in several animals in both treatment groups, which corresponded histopathologically to islands of ectopic cartilage or bone spicules within the fibrotic scar. These changes reflect heterotopic ossification that is commonly seen in the healing of abdominal operation sites in pigs. No other abnormal findings were observed throughout the study period. In conclusion, the use of Su2ura Approximation under the present experimental conditions revealed no safety concerns.

VP020 ENDOSCOPIC PREPERITONEAL APPROACH IN STRANGULATED INGUINAL HERNIA

Aim According to the clinical sympthoms and radiological findings minimal invasive surgery can be an option to repair an strangulated inguinal hernia. Material and Methods We present the different ways we have used in our Hospital to treat incarcerated inguinal hernia combining endoscopic preperitoneal and laparoscopic approach Results Multiple treatment schemes are possible for inguinal incarcerated hernia. The choice must be made according to the surgeońs experience, patient´s characteristic and the risk of intestinal ischemia. Laparoscopy combined with preperitoneal endoscopic inguinal repair allows us to explore and to treat possible complications of intestinal ischemia with no need of laparotomy. Conclusions Laparoendoscopic techniques are an option to consider when treating an incarcerated inguinal hernia, even if bowel resection is needed. Thanks to laparoscopic approach, laparotomy can be avoided in many cases.

Robotic Versus Laparoscopic Adrenalectomy: Systemic Review

Background: Minimal invasive surgery has become the standard for most surgical procedures now. Many studies have tried to compare robotic versus laparoscopic to adrenalectomy. Objectives: The aim of this study is to review most of the available studies comparing robotic to laparoscopic adrenalectomy to evaluate which procedure provides the superior clinical outcomes. Methods: A systematic literature search of ScienceDirect and PubMed databases. The perioperative clinical outcomes were collected by two independent reviewers. We used Random-effects (DerSimonian-Laird) models to get the pooled effect estimates. Results: 18 studies were eligible in our study. 10 of them were prospective and 8 were retrospective. A total of 1376 patients underwent adrenalectomy, 592 (43.02%) were treated with RA and 784 (56.9%) with the LA technique. There were no significant differences between both groups regarding the conversion rate (Odds ratio: 0.70, 95% CI 0.31-1.57, P= 0.65), intraoperative complications (OR: 2.18, 95% CI 0.49- 9.71, P= 0.28), post-operative complications (OR: 0.83, 95% CI: 0.55-1.24, P= 0.49), and mortality (OR: 0.42, 95% CI: 0.07-2.72, P= 0.98). However, robotic adrenalectomy was associated with longer operative times (MD: 9.89 min, 95% CI: -2.79 to 22.58), shorter hospital stay (MD: -0.33, 95% CI: -0.46 to -0.21) with less blood loss (MD: -25.34, 95% CI: -36.77 to -13.91). Conclusions: We proved that robotic adrenalectomy has equal safety and feasibility with similar clinical outcomes when compared with laparoscopic approach. However, better well-designed studies are required to determine the role and cost-effectiveness of robotic adrenal surgery.

Robotic resection for hydatid disease of the liver

Robotic-assisted surgery for the management of hepatic echinococcosis was introduced in 2016. The advantage it offers over laparoscopy is less rigidity with the use of the 360° rotation of the Endo-Wrist technology, thus allowing the preservation of the integrity of the liver tissue. Herein, we report the first successful robotic resection of the left lobe of the liver for hydatid disease in the Middle East. Our patient is a 71-year-old man found to have a large left hepatic lobe hydatid disease on CT scan. The hydatid liver disease was resected completely with an operation time of 130 min and minimal intraoperative blood loss. Patient did well postoperatively and was discharged home on day 2. Our experience shows that robotic surgery for hydatid disease of the liver can be safely performed, with an excellent outcome to the patient. It also provides unique technical advantages in the field of minimal-invasive surgery.