Real-time near-infrared fluorescent cholangiography could shorten operative time during robotic single-site cholecystectomy

Background: With the introduction of a new platform, robotic single-site cholecystectomy (RSSC) has been reported as feasible and safe for selected cases. In parallel, the development of real-time near-infrared fluorescent cholangiography using indocyanine green (ICG) has been seen as a help during the dissection, even if the data are still preliminary. The study purpose is to report our experience with ICG RSSC and compare the outcomes to standard RSSC. Methods: From February 2011 to December 2011, 44 selected patients underwent RSSC for symptomatic cholelithiasis. Among them, 23 (52.3%) were included in an experimental protocol using the ICG, and the remainder (47.7%) underwent standard RSSC. There was no randomization. The endpoints were the perioperative outcomes. This is a prospective study, approved by our local Ethics Committee. Results: There were no differences in terms of patients' characteristics, except that there were more male patients in the ICG group (47.8 vs. 9.5%; p=0.008). Regarding the surgical data, the overall operative time was shorter for the ICG group, especially for patients with a body mass index (BMI) ≤25 (−24min) but without reaching statistical significance (p=0.06). For BMI>25, no differences were observed. Otherwise, there were no differences in terms of conversion, complications, or length of stay between both groups. Conclusions: A RSSC with a real-time near-infrared fluorescent cholangiography can be performed safely. In addition, for selected patients with a low BMI, ICG could shorten the operative time during RSSC. Larger studies are still required before drawing definitive conclusion

Laparoscopic Versus Robotic Roux-En-Y Gastric Bypass: Lessons and Long-Term Follow-Up Learned From a Large Prospective Monocentric Study

Background: Laparoscopic Roux-en-Y gastric bypass (RYGB) has become the procedure of choice for the treatment of morbid obesity. Recently, several reports have shown the potential advantages of the robotic approach, notably by reducing complications. The aim of this study is to report our long-term experience with robotic Roux-en-Y gastric bypass (RYGB) and to compare outcomes with the laparoscopic approach. Methods: From January 2003 to September 2013, 777 consecutive minimally invasive RYGB have been performed in our institution: 389 laparoscopically (50.1%) and 388 robotically (49.9%). During the study period, all the data regarding these consecutive RYGB has been prospectively collected in a dedicated database. Results: While longer in duration compared to laparoscopy (+30min; p = 0.0001), the robotic approach had a lower conversion rate (0.8 vs. 4.9%; p = 0.0007), and less complications (11.6% vs. 16.7%; p = 0.05), in particular, less gastrointestinal leaks (0.3 vs. 3.6%; p = 0.0009). There were also less early reoperations (1 vs. 3.3%; p = 0.05) and a shorter hospital stay in the robotic group (6.2 vs. 10.4days; p = 0.0001). There were no statistical differences between the early and the current robotic experience, except in operative time and hospital stay, which were shorter for the last 100 cases. Finally, the BMI loss was significantly higher in the laparoscopic group starting at the first post-operative year. Conclusions: Robotic RYGB is not only safe and feasible, but also a valid option in comparison to laparoscopy. At the cost of a longer operative time, we observed better short-term outcomes with the robotic approach

Upcoming multi-visceral robotic surgery systems: a SAGES review.

BACKGROUND: Robotic surgical procedures continue to increase both in the United States (US) and worldwide. Several novel robotic surgical platforms are under development or undergoing regulatory approval. This review explores robotic platforms that are expected to reach US consumers within the next 2-3 years. METHODS: The SAGES Robotic Platforms Working Group identified robotic surgery platforms in various stages of development and selected multi-visceral systems nearing or completing the US Food and Drug Administration (FDA) approval process. We outline key system components including architecture, unique features, development status, regulatory approval, and expected markets. RESULTS: We identified twenty robotic platforms that met our selection criteria. Ten companies were based in North America, and ten were based in Europe or Asia. Each system is described in detail and key features are summarized in table form for easy comparison. CONCLUSION: The emergence of novel robotic surgical platforms represents an important evolution in the growth of minimally invasive surgery. Increased competition has the potential to bring value to surgical patients by stimulating innovation and driving down cost. The impact of these platforms remains to be determined, but the continued growth of robotic surgery seems to be all but assured

Bilan préopératoire avant bypass gastrique chez le patient asymptomatique : l'endoscopie haute est-elle obligatoire?

Une oeso-gastro-duodénoscopie (OGD) est actuellement pratiquée systématiquement avant bypass gastrique. Notre objectif consiste à déterminer la prévalence des lésions découvertes lors de cet examen chez les patients asymptomatiques, ainsi que le taux d'infection à Helicobacter Pylori (HP), puis d'en évaluer l'impact clinique et financier, afin de déterminer le meilleur mode de bilan digestif préopératoire. Le taux élevé de lésions découvertes chez nos 319 patients confirme que l'absence de symptômes ne peut être considérée comme absence de lésion, et un bilan préopératoire systématique est donc obligatoire avant bypass gastrique. Toutefois, l'absence d'impact clinique des lésions découvertes et les investigations inutiles engendrées posent la question du rapport coût-bénéfice de l'OGD systématique avant bypass gastrique. Nous proposons donc d'investiguer les patients asymptomatiques par un dépistage non invasif de l'HP associé à une prophylaxie par inhibiteurs de la pompe à protons, permettant ainsi la détection et le traitement des lésions significatives sans l'invasivité et le coût d'une OGD

EDITORIAL Patient safety and surgical innovation– complementary or mutually exclusive?

Safety vs. innovation Safety and innovation are not and need not be antagonists, but synonyms. If innovation is driven by safety, we can hopefully accelerate the rate of innovation desperately needed in medicine. In the surgical microcosm, it is not infrequent to hear the voices of surgical conservatism question innovation: why change the current device or method? It is proven to work, it is vetted by years of clinical research, and should therefore be chosen–because it’s safer. There’s nothing wrong with that thought process, is there? There is no doubt that safety is the cornerstone of our practice. However, caution and prudence should not be deterrents for innovation. On the contrary, if younger surgeons or trainees have the luxury of being attracted to innovation, it is only because their mentors use established methods and strategies. This creates a setting of safety and security in which younger surgeons are rooted. The established surgical practice needs to be one of absolute focus on safety; only then can the younger generation be comfortable enough with the current technologies to look into its shortcomings. Just like creating a safe household and offering children a rigid set of ground rules and education, anchoring residents in safety is a critical initial step. But at some point, your children will need to experience their own life. And if you hamper that, your kids will never surpass you … The role of mentors is therefore to teach and give trainees the tools to practice surgery safely. This will allow them to recreate the same environment of absolute attention to safety for their own patients. Surgical curriculums are aimed at training residents to reach this stage, not to surpass it. It is good, but not good enough. Once surgical training has been appropriately achieved, it is also the role of mentors to push trainees to venture out further and not fall asleep in the safe mode. They should be encouraged to keep searching. If we wan