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"Robotic and laparoscopic total mesorectal excision for rectal cancer: a case-matched study." Baek, J. H., C. Pastor, et al. (2010). Surgical Endoscopy. BACKGROUND: Robotic total mesorectal excision (RTME), a novel approach for the treatment of rectal cancer, has been shown in previous studies to be safe and effective. However, the results of this approach compared with laparoscopic total mesorectal excision (LTME) have not been reported in terms of clinical outcome and oncologic data. This study compared early outcomes for rectal cancer between two groups. METHODS: Between April 2003 and March 2009, 82 patients from a prospectively maintained database were enrolled in a case-matched study. The patients were matched for gender, age, body mass index (BMI), and type of operative procedure. RESULTS: Neoadjuvant chemoradiotherapy was performed for 33 RTME patients (80.5%) and 18 LTME patients (43.9%) (p = 0.001). The mean operative time was 296 min for RTME and 315 min for LTME (p = 0.357). The number of conversions were 3 (7.3%) for RTME and 9 (22%) for LTME (p = 0.12). The anastomotic leak rate after surgery did not differ between RTME (n = 3, 8.6%) and LTME (n = 1, 2.9%) (p = 0.62). The mean number of harvested lymph nodes was 13.1 with RTME and 16.2 with LTME (p = 0.07), and negative distal resection margins (DRMs) were noted in all surgical specimens. Positive circumferential resections (CRMs) were identified in 2.4% of the RTME cases and 4.9% of the LTME cases. No difference was noted in lengths of the DRMs, times until a liquid diet, or postoperative hospital stays. The total hospitalization costs were higher in the RTME group, although the difference did not reach statistical significance. There was no operative mortality or port-site recurrence in either group. CONCLUSION: For rectal cancer, RTME may be as feasible and safe as LTME in terms of technical and oncologic issues. Further prospective randomized trials are necessary for conclusions to be drawn concerning definite oncologic outcomes of robotic procedures for rectal cancer. "Robotic thyroidectomy using a transaxillary approach can be performed by experienced surgeons in selected surgical clinics." Enoz, M., H. M. Inancli, et al. (2010). Surgical Endoscopy. "Minimally invasive sequential treatment of synchronous colorectal liver metastases by laparoscopic colectomy and robotic right hepatectomy." Giulianotti, P. C., A. Giacomoni, et al. (2010). International Journal of Colorectal Disease. PURPOSE: The ideal timing for patients with colorectal cancer to undergo surgery for resectable synchronous liver metastases remains under debate. We describe a new sequential approach using laparoscopic/robotic surgery for the treatment of synchronous liver metastases. METHODS: A 73-year-old man presented with sigmoid cancer and a single 8-cm right liver metastasis. A staged sequential minimally invasive approach was planned. A laparoscopic left colectomy was performed first, followed by a robotic right hepatectomy 10 days later. RESULTS: The left colectomy lasted 120 min with a negligible blood loss (<10 mL). The right hepatectomy was completed robotically with an operating time of 330 min and intraoperative blood loss of 300 mL. The postoperative course was uneventful and the patient was discharged at postoperative day 8 of the liver resection. Three weeks later, the patient received adjuvant chemotherapy. At 26-months follow up, the patient was alive without recurrence. CONCLUSIONS: This report suggests the technical feasibility and safety of a sequential totally minimally invasive approach for synchronous colorectal liver metastases. In selected patients, this approach can avoid the risk of a synchronous associate major liver/colonic resection using the advantages of minimally invasive surgery. "[Robotic surgery for gastric cancer with da Vinci SHD Surgical System]." Ishida, Y., S. Kanaya, et al. (2010). Nippon Rinsho (Japanese Journal of Clinical Medicine) 68(7): 1212-1214. "The management of colorectal cancer." Lee, P. J. and M. J. Solomon (2010). Medicine Today 11(6): 82-84. "Efficacy of the da vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis." Maeso, S., M. Reza, et al. (2010). Annals of Surgery 252(2): 254-262. AIM:: The main aim of this review was to compare the safety and efficacy of the Da Vinci Surgical System (DVSS) and conventional laparoscopic surgery (CLS) in different types of abdominal intervention. SUMMARY OF BACKGROUND DATA:: DVSS is an emerging laparoscopic technology. The surgeon directs the robotic arms of the system through a console by means of hand controls and pedals, making use of a stereoscopic viewing system. DVSS is currently being used in general, urological, gynecologic, and cardiothoracic surgery. METHODS:: This systematic review analyses the best scientific evidence available regarding the safety and efficacy of DVSS in abdominal surgery. The results found were subjected to meta-analysis whenever possible. RESULTS:: Thirty-one studies, 6 of them randomized control trials, involving 2166 patients that compared DVSS and CLS were examined. The procedures undertaken were fundoplication (9 studies, one also examining cholecystectomy), Heller myotomy (3 studies), gastric bypass (4), gastrectomy (2), bariatric surgery (1), cholecystectomy (4), splenectomy (1), colorectal resection (7), and rectopexy (1). DVSS was found to be associated with fewer Heller myotomy-related perforations, a more rapid intestinal recovery time after gastrectomy-and therefore a shorter hospital stay, a shorter hospital stay following cholecystectomy (although the duration of surgery was longer), longer colorectal resection surgery times, and a larger number of conversions to open surgery during gastric bypass. CONCLUSIONS:: The publications reviewed revealed DVSS to offer certain advantages with respect to Heller myotomy, gastrectomy, and cholecystectomy. However, these results should be interpreted with caution until randomized clinical trials are performed and, with respect to oncologic indications, studies include variables such as survival. "Robotic assisted laparoscopic colectomy." Pandalai, S., D. O. Kavanagh, et al. (2010). Irish Medical Journal 103(6). Robotic surgery has evolved over the last decade to compensate for limitations in human dexterity. It avoids the need for a trained assistant while decreasing error rates such as perforations. The nature of the robotic assistance varies from voice activated camera control to more elaborate telerobotic systems such as the Zeus and the Da Vinci where the surgeon controls the robotic arms using a console. Herein, we report the first series of robotic assisted colectomies in Ireland using a voice activated camera control system. "Editorial: Robotic colorectal surgery: For whom and for what?" Pigazzi, A. and J. Garcia-Aguilar (2010). Diseases of the Colon and Rectum 53(7): 969-970. "Robot-assisted gastrojejunal anastomosis does not improve the results of the laparoscopic Roux-en-Y gastric bypass." Scozzari, G., F. Rebecchi, et al. (2010). Surgical Endoscopy. BACKGROUND: Traditional laparoscopic surgery presents some difficulties for morbidly obese patients due to limited motion of instruments related to a thick abdominal wall, intraabdominal fat, and a large hepatic left lobe, with consequent loss of dexterity and greater musculoskeletal discomfort. Robotic technique could potentially overcome these limitations. This study aimed to evaluate robot-assisted laparoscopic Roux-en-Y gastric bypass in morbidly obese patients and to compare the results of robotic assistance with those of traditional laparoscopic technique. METHODS: Between September 2006 and June 2009, 110 morbidly obese patients underwent laparoscopic Roux- en-Y gastric bypass with robot-assisted hand-sewn gastrojejunal anastomosis using the da Vinci Surgical System. The data for these patients was compared with the data for 423 consecutive patients treated in a standard laparoscopic manner during the same period. RESULTS: The patients had a mean preoperative age of 42.6 years, a mean weight of 127.5 kg, and a mean body mass index (BMI) of 46.7 kg/m(2). The total mean operative time was 247.5 min. The robotic setup time was 10.1 min, and the robotic operative time was 54.5 min. The conversion rate was nil. The intraoperative complication rate was 4.5%. The early and late major postoperative complication rates were 3.6 and 6.4% respectively. The cost per patient was 5777.76 <euro>. For the standard laparoscopy, the operative time was significantly shorter (187 min; p < 0.001), and the costs per patient were significantly lower (4658.28 <euro>; p < 0.001), whereas no differences were found in terms of the intra- or postoperative complication rates, revisional surgery, or hospital length of stay. CONCLUSIONS: Although safe and intuitive, the robotic approach was burdened by a longer operative time and higher equipment costs. Moreover, it did not seem to provide a real advantage over standard laparoscopy in terms of hospital length of stay and complications rates. "Sleeve gastrectomy strictures: technique for robotic-assisted strictureplasty." Sudan, R., G. Kasotakis, et al. (2010). Surgery for Obesity and Related Diseases 6(4): 434-436. "Considerations for personalized surgery in patients with papillary thyroid cancer." Tufano, R. P. and E. Kandil (2010). Thyroid 20(7): 771-776. BACKGROUND: Personalizing treatment for papillary thyroid cancer (PTC) requires a multidisciplinary approach. The surgical management of PTC has long been based on retrospective studies focusing on endpoints that are of debatable significance. There is considerable debate in the literature regarding the optimal initial treatment for PTC. Many of these issues are discussed in this review. These debates have hindered the development of a tailored treatment strategy. SUMMARY: The ability to optimally personalize a surgical plan for the treatment of PTC is ultimately dependent on an understanding of the biological behavior of that individual patient's tumor. We are at the genesis of an age where molecular biology advances endeavor to profile a patient's tumor behavior. This review summarizes current strategies for managing PTC, where we are with personalizing surgery for these patients, and where we hope to go. Thyroid surgery is one of the newest fields for the application of minimally invasive techniques and can now be accomplished endoscopically or with robotic assistance in many patients who therefore may benefit from these alternative approaches. CONCLUSION: When treating a patient with PTC, it seems prudent to weigh the many factors discussed in this review to individualize the most optimal surgical plan. "Reply to Dr. Wawanitkit's Letter to the Editor: Robotic partial splenectomy for hydatid cyst of the spleen." Vasilescu, C., M. Popa, et al. (2010). Langenbeck's Archives of Surgery.
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