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Background: Single-incision laparoscopic cholecystectomy has emerged as an alternative to conventional multiport laparoscopic cholecystectomy (LC). Technical difficulty, prolonged surgical times and increased complication rates have been reported in single-incision laparoscopic surgery. One of the concerns is lack of triangulation of instruments. The SPIDER ® surgical system is a single-incision laparoscopic device that utilizes flexible instruments with the purpose of achieving adequate triangulation. The purpose of this study is to compare the outcomes of SPIDER versus LC., Methods: A retrospective chart review of patients who underwent LC and SPIDER cholecystectomy by a single surgeon during a concurrent 44-month period at Baptist Health South Florida hospitals was performed focusing on demographics, indication for surgery, complications and incisional hernia rates. Exclusion criteria were concomitant surgery and hernia repair at the time of surgery., Results: A total of 612 patients underwent minimally invasive cholecystectomy: 279 cases for SPIDER cholecystectomy and 333 for multiport LC. Baseline differences in patient characteristics between the SPIDER and LC groups were statistically significant. The SPIDER group had younger and healthier patients (lower ASA classification scores) with predominant diagnosis of cholelithiasis (69 %) compared to the LC group which had more complex cases. Total complications rate for both SPIDER and LC were 0.4 % (n = 1) and 3 % (n = 10), respectively. Conversion to open cholecystectomy occurred in one patient from the LC group (0.3 %). Conversion rate from SPIDER to additional ports or LC was performed in 5 cases (1.8 %) with no conversions to open surgery. Hemoperitoneum was reported in 2 cases, one for each approach, requiring reoperation., Conclusion: Single-incision laparoscopic cholecystectomy with SPIDER is a safe and feasible technique with similar outcomes to multiport LC. However, statistical significant difference was reported in baseline characteristics of both groups. No incisional hernias were reported in this case series for either technique.

New technologies have been developed to make laparoscopic cholecystectomy less invasive through single incision laparoscopic surgery (SILS), however this approach has its own limitations. Single incision robotic surgery (SIRC) is designed to overcome them. The concerns that limit adoption of this technology are attributed increases in costs, prolonged learning curves and surgical times. Here, we provide a literature review as well as our own experience with SIRC, with the intent to clarify these important concerns., (© 2015 Wiley Periodicals, Inc.)

Introduction: Gastropleural fistulas (GPF) were first described by Markowitz and Herter in 1960. These are uncommon entities and can occur as a consequence of pulmonary surgery, trauma, malignancy, hiatal hernia, infections, Nissen fundoplication and most recently, bariatric surgery. Many treatments have been used for GPF, such as conservative management with antibiotics, parenteral nutrition, percutaneous drainage of collections and endoscopic therapies, but these usually fail and may lead to complex surgical procedures., Case Description/operative Technique: Two patients diagnosed with GPF after bariatric surgeries were treated in our program. After failure of conservative management, both were subjected to laparoscopic-robotic assisted gastropleural fistula resection. Case 1 was a patient who had a sleeve gastrectomy 1 year prior, required partial esophagogastrectomy and esophagojejunal anastomosis. Case 2 had an open gastric bypass 13 years prior, and when medical resolution of fistula was not possible, he underwent a partial remnant gastrectomy and hiatal hernia repair., Discussion: Appearance of gastroplueral fistula after bariatric surgery is a rare occurrence. When surgical management is needed, we have noticed that the use of the robotic platform in these complex surgical cases is safe and feasible.