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Introduction Laparoscopic cholecystectomy is a common procedure in general surgery, and in complex cases it is important for the surgeon to know all the alternatives with low associated morbidity. Laparoscopic subtotal cholecystectomy should be considered as an option when a critical view of safety cannot be obtained, because it has a low complication rate and gives the advantages of minimally invasive surgery. Methods Retrospective study of laparoscopic subtotal cholecystectomies in an eight years period. Results A total of 1059 laparoscopic cholecystectomies were performed; 22 were subtotal cholecystectomies, without conversion. Biliary fistula (9%) and intraabdominal collections (4.5%) were the most common complications described. No iatrogenic bile duct injuries or deaths were reported. Our follow-up period was 32 months, no recurrences were reported. Conclusions Laparoscopic subtotal cholecystectomy is a safe and effective procedure. It should be considered as an option in complex cases.

Resumen Introduccion La colecistectomia laparoscopica es uno de los procedimientos quirurgicos realizados con mas frecuencia a nivel mundial en el campo de la cirugia general, por lo que es fundamental que el cirujano conozca las diferentes alternativas al momento de enfrentarse con un caso complejo. Bajo esta premisa, es importante considerar la colecistectomia laparoscopica subtotal como una opcion, cuando despues de una adecuada diseccion, no se logra identificar las estructuras anatomicas y no se obtiene la vision critica de seguridad. Este procedimiento cursa con baja morbilidad y con las ventajas ampliamente conocidas de la cirugia minimamente invasiva. Metodos Estudio retrospectivo de pacientes a quienes se les realizo colecistectomia laparoscopica subtotal en un periodo de 8 anos. Resultados Se realizaron 1.059 colecistectomias laparoscopicas. De estas, 22 correspondieron a colecistectomias subtotales. No se registraron lesiones de via biliar ni conversiones. Las complicaciones mas frecuentes fueron la fistula biliar (9%) y la coleccion intraabdominal (4,5%). No hubo mortalidad asociada al procedimiento. Durante un periodo de seguimiento promedio de 32 meses, no se observo recurrencia de sintomatologia. Conclusiones La colecistectomia laparoscopica subtotal es un procedimiento efectivo, seguro y reproducible. Debe ser considerada como una opcion en casos complejos.

Inguinal lymphadenectomy is the indicated procedure in the regional lymph node management for patients with lower limb melanoma and positive nodes. This procedure is commonly associated with surgical site complications. Video endoscopic inguinal lymphadenectomy is a minimally invasive alternative with oncological principles and lower wound-related morbidity. Incorporation of robotic surgery with optimal vision and great maneuverability would offer great advantages. A 42-year-old male patient was diagnosed with acral lentiginous melanoma and palpable inguinal nodes T2 N1 M0. The patient was scheduled for robot-assisted left inguinal video endoscopic lymphadenectomy. The working space is created using blunt-finger dissection and then extended with the endoscope by sweeping with the lens. Two 8-mm robotic trocars and a 10-mm trocar for assistant are placed. The lymphadenectomy is carried out with Maryland and scissors. The operative time was 130 min, estimated blood loss 70 ml and hospital stay 2 days. The robot-assisted inguinal video endoscopic lymphadenectomy is a safe and feasible procedure for lower limb melanoma treatment. The incorporation of the robotic system to this approach where there is a limited working space would offer advantages to the technique.

Port placement represents the cornerstone of minimally invasive surgery procedures; an improper placement translates into difficulties leading to an extension of the operating time and sometimes requiring reposition of the trocars. As in laparoscopic surgery, there are complications in robotic surgery also when placing a port; carrying out a proper training and performing an adequate learning curve have shown a significant decrease in the rate of complications at this important phase. At the first step of surgery, pneumoperitoneum creation and primary trocar placement, is where the largest number of unwanted events occur. There are several techniques, which have proven to be equally effective, with similar rates of complications; therefore, the surgeon should use the method that s/he has more experience with and the one s/he feels more comfortable with. It is always important to individualize each case, to identify risk factors, and to choose the ideal techniques and instruments for prevention. In robotic surgery, there are special considerations regarding port placement, this allows a proper docking, avoiding a clash of the robot arms. Undoubtedly, no surgeon is free of complications, but an early diagnosis is crucial to resolve them timely and effectively, reducing this way the morbidity and mortality rate. Abdominal access and proper port placement without complications are key to the success of robotic surgery. When complications do occur, an excellent training will allow them to be managed appropriately.

Over the years, incisional hernia repair has evolved. Currently, primary closure of the defect before placing the mesh is a critical step in incisional hernia repair and minimally invasive surgery incorporation has an important role due to great advantages. Despite its benefits, laparoscopic closure with suture intracorporeal knotting is physically demanding and technically complex. Robotic technology provides an optimal three-dimensional view, maneuverability of the instruments but no study has assessed the impact of the DaVinci system in the ergonomics which is the objective in this study. Fourteen surgeons were able to achieve surgical repair of a defect in an incisional hernia inanimate model. The task was performed with conventional laparoscopy and robotic assistance. The mental effort was registered and physical disturbances were measured with the Local Experienced Discomfort scale. The subjects expressed discomfort mainly in the dominant side (p = 0.006). In the comparative analysis between the two approaches, upper limb less disturbance (p = 0.04) and lower mental effort (p = 0.001) were reported with robotic approach. Robotic assistance decreases mental and physical effort during the primary closure of a defect in an incisional hernia inanimate model.

The objective of this study is to determine the ability of the GEARS scale (Global Evaluative Assessment of Robotic Skills) to differentiate individuals with different levels of experience in robotic surgery, as a fundamental validation. This is a cross-sectional study that included three groups of individuals with different levels of experience in robotic surgery (expert, intermediate, novice) their performance were assessed by GEARS applied by two reviewers. The difference between groups was determined by Mann-Whitney test and the consistency between the reviewers was studied by Kendall W coefficient. The agreement between the reviewers of the scale GEARS was 0.96. The score was 29.8 ± 0.4 to experts, 24 ± 2.8 to intermediates and 16 ± 3 to novices, with a statistically significant difference between all of them (p