Robotic donor hepatectomy: a niche advancement or the way forward? A perspective from the world’s largest center

The application of minimally invasive liver surgery (MILS) in the field of living donor hepatectomy has been exceedingly slow, and its impact is limited to a handful of centers worldwide. Widespread adoption has been primarily hampered by the technical limitations of laparoscopy, namely rigid instrumentation, suboptimal optics, and a seemingly steep learning curve. These deficiencies are magnified in the donor hepatectomy operation wherein the parenchyma and vasculature must be handled atraumatically to produce a pristine allograft fit for implantation. Donor safety concerns and medicolegal ramifications are also cited as impediments to MILS in donor surgery. In 2013, our institution embraced a purely laparoscopic approach to living donor left lateral sectionectomy, and it quickly became our default technique. However, with donor hemi-hepatectomy, we gravitated to the robotic surgical system as our preferred modality. Herein, we describe our experience with minimally invasive donor hepatectomy, which we now universally offer to all living donors. Our extensive familiarity with robotic donor hepatectomy will provide the reader with an instructive perspective on the attributes and merits of the robotic approach. With appropriate collaboration and proctorship, we believe that the robotic platform will actualize a more rapid and widespread adoption than that experienced with the purely laparoscopic technique.

Endovideosurgical technology in the diagnosis and treatment of benign ovarian tumors

The article deals with the new possibilities of laparoscopic technique in diagnosis and treatment of ovarian tumors. The authors elaborate the criteria of differential diagnostics of benign and malignant ovarian tumors at early stages. The research is based on the analysis of 222 cases of different ovarian tumors. The authors state the necessity of rational preoperative preparation and obligatory screening in patients with ovarian tumors before and after the operation with the use of tumor marker CA-125.

Extra-peritoneal Laparoscopic Resection of Benign Prostate Adenoma >150 CC with preservation of posterior wall of prostatic urethra: Dundee Technique and early outcomes

Background There are limited options for men with large benign prostates (>150cc) and bladder outflow obstruction due to benign prostatic hyperplasia (BPH). Management options include surgery (open or minimal access) and endoscopic procedures. There is a paucity of literature on outcomes for prostates >150cc. Methods In this case series we describe a step-by-step, illustrated, modified extra-peritoneal technique of laparoscopic prostatectomy with preservation of the posterior prostatic urethra. This involves creation of extra-peritoneal space, transverse incision of prostate capsule, progressive adenoma dissection, resection, and closure of the capsule. Results Ten patients underwent this procedure between 2015 and 2019. The mean age was 72.4 years and mean prostate size was 215.5cc. Mean procedure duration was 200 min and there were no intraoperative complications. Most patients were discharged on postoperative day 1. Mean intraoperative blood loss was 120 ml with no patient requiring blood transfusion. At follow up (mean 37 months) no patients had residual symptoms of BPH. Conclusion We describe a novel extraperitoneal laparoscopic technique for benign prostates of >150cc with very good outcomes. The transferability of this technique to centres with laparoscopic expertise at minimal extra cost and future adaptability in the robotic setting are some of the advantages of this technique.

VP021 A WAY TO TREAT SPIGELIAN HERNIA

Aim “Spigelian hernia is uncommon and accounts for only 0.12–2% of all abdominal hernias. It is mandatory to perform surgical correction and in recent years the laparoscopic approach is gaining ground. The authors pretend to demonstrate a video of an outpatient laparoscopic repair of Spigelian hernia.” Material and Methods “53-year-old woman with a left Spigelian hernia referred to laparoscopic repair via intraperitoneal approach.” Results “The patient was submitted to laparoscopic correction with a Ventralex® mesh. The surgery went without any complication and under 30 minutes. A few hours after the surgery, the patient was discharged. In the follow-up appointment, the patient had no complaints or evidence of recurrence.” Conclusions “Spigelian hernias are rare and have a mandatory surgical indication. Traditionally, open surgical repair is most commonly used. However, laparoscopic approach is becoming increasingly popular since it allows faster recovery, shorter hospital stay, and less pain, with no commitment to recurrence. Currently, there are no studies that demonstrate the superiority of a laparoscopic technique (intraperitoneal, TAPP or TEP). The intraperitoneal route is a simple, faster, and easily reproducible approach.”

O52 LAP-T MINI LAPAROSCOPIC TECHNIQUE FOR THE REPAIR OF RECURRENT UMBILICAL HERNIA ON PRIMARILY UNTREATED DIASTASIS

Aim “This retrospective analysis on 1000 cases of Diatasis Recti (DR) complicated by single/multiple, primary/recurrent hernias, all treated with the Laparoscopic Abdominoplasty Technique (LAP-T), aims at evaluating the possible correlation of higher recurrence rate and complications when DR is left untreated” Material and Methods “This review on 1000 patients, <65yrs, BMI<30, 3>IRD>12, based on CT Scan/MRI study, showed 235 (23,5%) of them to be recurrent umbilical/midline hernias engaged on untreated RMD, independently from the surgical technique used for primary repair. Re-operation with LAP-T technique, consisted in removal of recurrent hernia and dislocated mesh when present, closure by self-locking running sutures of the hernia defect and the DR. Repair is consolidated placing an intra-peritoneal mesh” Results “In all patients, recurrence was repaired, DR reconstructed and abdominal wall anatomy and physiological functionality successfully restored. No intra operative bleeding, seroma formation, chronic pain, nor mesh infection have been recorded. 98% follow up at 12 months, 91% at 24, no recurrences observed” Conclusions “Higher incidence of recurrent umbilical/midline hernias observed in this analysis, compared to average recurrence rate reported in literature, suggest that regardless primary repair technique, the repair of the sole hernia engaged on a DR is likely to lead to a recurrent hernia, further midline hernia defects formation and worsening of the DR. A significant correlation between the recurrency after primary umbilical/midline repair when a concomitant RMD is left untreated is likely to lead to a more invasive and complicated re-intervention, higher complication rate and discomfort for the patient”

Laparoscopic repair of retro-caval ureter: report of two cases

Retrocaval ureter is a rare congenital disorder and surgery is necessary when the patient is symptomatic or having significant functional obstructions. The two cases referred to our center with severe hydronephrosis on their right sides. In both cases further evaluation with CT scan showed the diagnosis of retrocaval ureter. The retrocaval segment of the both ureters were isolated and after the excision of the narrow segments, end to end anastomosis have been done with transperitoneal laparoscopic technique. The laparoscopic ureteroureterostomy is a safe, effective and minimally invasive procedure and should be considered as a standard treatment for retrocaval ureter.