Robot Application for Hepatopancreatic Disorders, Gastroesophageal Reflux Disease, and Achalasia

Introduction We undertook this study to describe the number and variety of robotic operations undertaken for hepatopancreatic and esophageal disorders. Methods Data from 2015 through March of 2018 were analyzed for da Vinci™ robot application for hepatopancreatic disorders, gastroesophageal reflux disease (GERD), and achalasia. Results From 2015 through 2017, robotic hepatopancreatic operations increased 49%, robotic hepatic operations increased 107%, and robotic pancreatic operations increased 26%. Quarter after quarter, robotic application increased for hepatopancreatic operations, hepatic operations, and pancreatic operations ( P < .001 for each) with acceleration over the most recent months. The application of the Xi robot platform increased from 12% of robotic hepatopancreatic operations in 2015-71% in 2018 (1075% increase in numbers). From 2015 through 2017, robotic fundoplications and myotomies increased by 55%, robotic fundoplications increased by 59%, and robotic Heller myotomies increased by 211%. Quarter after quarter, robotic application increased for fundoplications and Heller myotomies ( P < .001 for each) with acceleration over the most recent months. The application of the Xi robot platform increased from 13% of these robotic operations in 2015-64% in 2018 (935% increase in numbers). Less than 10% of hepatopancreatic operations, fundoplications, and myotomies are undertaken robotically. Conclusions There has been an accelerating increase in the number of robotic operations for hepatopancreatic disorders, GERD, and achalasia over the past 3 ¼ years. Application of the Xi robot has dramatically increased, both absolutely and relatively. Still only a small proportion of operations for hepatopancreatic disorders, GERD, and achalasia use the robotic platform; this is changing fast.

Upper gastrointestinal and hepatopancreatobiliary surgery

This chapter reviews upper gastrointestinal surgery (UGI) for diseases of the oesophagus, stomach, gall bladder and biliary system, and the duodenum as well as an overlap with hepatopancreatobiliary (HPB) surgery. It highlights ‘places to be’ to see UGI conditions including the emergency department, radiology, ward, theatre, and intensive therapy unit, and radiology and endoscopy procedures to see. Common UGI conditions are discussed including oesophageal dysmotility and cancer, hiatus hernia, gastro-oesophageal reflux disease, and gastric cancer. There is a helpful section detailing bariatric surgery with appropriate information for a medical student. It also discusses HPB conditions such as gallstone disease, biliary colic, and acute pancreatitis. It also reviews pancreatic operations such as Whipple’s procedure. This chapter includes good pictorial guidance and is written for both those looking to apply for medicine, and those in medical school.

Clinical evaluation of the M-ANNHEIM classification: Development of the M-ANNHEIM-Surgery-Score as a new tool to monitor patients with chronic pancreatitis

Objectives The M-ANNHEIM classification of chronic pancreatitis (CP) stratifies degrees of disease severity according to the M-ANNHEIM-Severity-Score. We aimed to demonstrate the clinical usefulness of the M-ANNHEIM-Severity-Score in quantifying and predicting the frequency of pancreatic surgery, and to establish the M-ANNHEIM-Surgery-Score as a simplified system for patient surveillance regarding the demand of pancreatic surgery. Methods We performed a retrospective, cross-sectional study with 741 CP patients (Mannheim/Germany, n = 537; Gießen/Germany, n = 100; Donetsk/Ukraine, n = 104) categorized according to the M-ANNHEIM classification. Results We observed a significantly higher M-ANNHEIM-Severity-Score in patients that were classified within 7 days preceding pancreatic surgery than in individuals that did not require surgery (p < 0.001, Mann–Whitney-U-test). Using a logistic regression analysis with all variables of the M-ANNHEIM-Severity-Score, we established the M-ANNHEIM-Surgery-Score as a simplified new tool to identify patients that may require surgery. A receiver operating characteristic-analysis revealed a cut-off-value of 9 points within the M-ANNHEIM-Surgery-Score to identify these individuals (sensitivity 78.7 %, specificity 91 %). Based on the M-ANNHEIM-Surgery-Score, we defined three categories for demand of surgery with frequencies of pancreatic operations of 1.6 % (n = 7/440) in the “Baseline-Demand”-category, 7 % (n = 12/172) in the “Low-Demand”-category (p < 0.0001, Chi-square-test, OR 4.6, Confidence Interval (CI) 1.8 – 12), and 54 % (n = 70/129) in the “High-Demand”-category (p < 0.0001, OR 73, CI 32 – 167). Patients that were categorized for the “High-Demand”-category, but were not operated on, had a significantly increased ratio of clinical features that hamper performance of surgery (p < 0.001, Chi-square-test). Conclusions The M-ANNHEIM-Surgery-Score represents a useful tool to monitor patients with CP and to estimate the demand of surgery in CP.