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Single anastomosis sleeve ileal (SASI) Bypass has recently emerged as a novel surgical technique. The purpose of this study is evaluating the efficacy and feasibility of our SASI technique. Between April 2018 and February 2020, 83 patients underwent SASI bypass at our center. A retrospective analysis was performed. Forty-three patients (51.8%) completed follow-up at 12 months. Average BMI at 12 months, change in BMI, and %EWL were 28.2 ± 4.5 kg/m2, 13.5 ± 5.7 kg/m2, and 85.6% respectively. From the 25 patients evaluated, diabetes remission occurred in 95.8% of them. There were 4 (4.8%) Clavien—Dindo (CD) I, 5 (6.0%) CD II, and 2 (2.4%) CD IIIb complications. SASI bypass offers excellent weight loss and comorbidities resolution. As expected, higher-quality studies are needed.

Background Opioids are commonly used after bariatric surgery for pain control because of their potent analgesic effects. Nevertheless, the morbidly obese patient has increased risk for developing adverse effects produced by opioids (such as sedation, apnea, hypoxemia, ileus, and vomiting). Intravenous acetaminophen (IVA) has been evaluated in some specialties showing a reduction in opioid consumption. The purpose of this study was to evaluate the effect on opioid consumption when IVA is administered in bariatric surgery patients. Material and methods A retrospective study was performed in patients who underwent bariatric surgery. Group A included those patients who received IVA perioperatively and group B those who did not. The amount of opioids administered was calculated and compared for each group. Results Group A included 38 cases (44.7%) and group B included 47 cases (55.3%). A comparison was performed in terms of age ( P = 0.349), body mass index ( P = 0.311), gender ( P = 0.890), American Society of Anesthesiologist score ( P = 0.438), total surgical time ( P = 0.497), perioperative complications ( P = 0.786), number of procedures per surgeon ( P = 0.08), and type of surgical procedure ( P ≤ 0.01). Group A had a mean 24-h total opioid dose of 99.5 mg, whereas group B of 164.6 mg ( P = 0.018). Group A received 39.5% less opioids than group B. A post hoc analysis determined a statistical power of 0.74. Conclusions IVA used perioperatively can decrease opioid consumption in patients after bariatric surgery. Randomized trials are needed to corroborate these results.

Background The introduction of the robotic platform to bariatric surgery has brought forth a novel approach, with modifications to the standard laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LGB). The purpose of this study was to match robotic gastric bypass (RGB) vs robotic sleeve gastrectomy (RSG) and compare them to those observed with the laparoscopic platform. Methods A retrospective data collection of RSGs and RGBs from a single institution was performed. Groups were compared. Results This study included 134 RSG and 165 RGB patients. RGB has a longer surgical time (p

Background Some authors recommend primary closure of the defect before placement of the mesh. The purpose of this study is to compare laparoscopic ventral hernia repair (LVHR) without primary closure of the defect (NPCD) versus LVHR with primary closure of the defect (PCD). Methods A retrospective review of 134 LVHR was performed. Each group included 67 cases. For the PCD group the robotic platform was used. Results Groups were similar in terms of demographics and comorbidities. For NPCD and PCD groups mean surgical time was 87.9±53.1 and 107.6±33.9 minutes (p = 0.012); conversion to open surgery was seen in 3(4.5%) and 1(1.5%) (p = 0.310); complications were 7(10.4%) and 2(3%) (p = 0.084); and finally, recurrences were seen in 5(7.5%) and 1(1.5%) (p = 0.095). Conclusions PCD has longer surgical time, however, a tendency in terms of complications and recurrences was found favoring the PCD group. The robotic assistance is a good alternative when primary closure of the defect is attempted. Copyright © 2014 John Wiley & Sons, Ltd.

Adoption of single-incision laparoscopic cholecystectomy during fellowship training is safe and feasible; however, longer operative times are expected during the teaching process., Background and Objectives: Minimally invasive surgery fellowship programs have been created in response to advancements in technology and patient's demands. Single-incision laparoscopic cholecystectomy (SILC) is a technique that has been shown to be safe and feasible, but this appears to be the case only for experienced surgeons. The purpose of this study is to evaluate the impact of minimally invasive surgery fellow participation during SILC. Methods: We reviewed data from our experience with SILC during 3 years. The cases were divided in two groups: group 1 comprised procedures performed by the main attending without the presence of the fellow, and group 2 comprised procedures performed with the fellow present during the operation. Demographic characteristics, comorbidities, indication for surgery, total surgical time, hospital length of stay, and complications were evaluated. Results: The cohort included 229 patients: 142 (62%) were included in group 1 and 87 (38%) in group 2. No differences were found in demographic characteristics, comorbidities, and indication for surgery between groups. The total surgical time was 34.4 ± 11.4 minutes for group 1 and 46.8 ± 16.0 minutes for group 2 (P < .001). The hospital length of stay was 0.89 ± 0.32 days for group 1 and 1.01 ± 0.40 days for group 2 (P = .027). No intraoperative complications were seen in either group. There were 3 postoperative complications (2.1%) in group 1 and none in group 2 (P = .172). Conclusion: Adoption of SILC during an established fellowship program is safe and feasible. A longer surgical time is expected during the teaching process.

This report suggests that robotic repair of giant para-esophageal hernia has a lower recurrence rate than standard laparoscopic methods, but complications and mortality are similar to standard laparoscopic approaches., Background and Objectives: Giant paraesophageal hernia accounts for 5% of all hiatal hernias, and it is commonly seen in elderly patients with comorbidities. Some series report complication rates up to 28%, recurrence rates between 10% and 25%, and a mortality rate close to 2%. Recently, the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) has shown equivocal benefits when used for elective surgeries, whereas for complex procedures, the benefits appear to be clearer. The purpose of this study is to present our preliminary experience in robotic giant paraesophageal hernia repair. Methods: We retrospectively collected data from patients who had a diagnosis of giant paraesophageal hernia and underwent a paraesophageal hernia repair with the da Vinci Surgical System. Results: Nineteen patients (12 women [63.1%]) underwent surgery for giant paraesophageal hernia at our center. The mean age was 70.4 ± 13.9 years (range, 40–97 years). The mean American Society of Anesthesiologists score was 2.15. The mean surgical time and hospital length of stay were 184.5 ± 96.2 minutes (range, 96–395 minutes) and 4.3 days (range, 2–22 days), respectively. Nissen fundoplications were performed in 3 cases (15.7%), and 16 patients (84.2%) had mesh placed. Six patients (31.5%) presented with gastric volvulus, and 2 patients had other herniated viscera (colon and duodenum). There were 2 surgery-related complications (10.5%) (1 dysphagia that required dilatation and 1 pleural injury) and 1 conversion to open repair (partial gastric resection). No recurrences or deaths were observed in this series. Conclusion: In our experience robotic giant paraesophageal hernia repair is not different from the laparoscopic approach in terms of complications and mortality rate, but it may be associated with lower recurrence rates. However, larger series with longer follow-up are necessary to further substantiate our results.

The open approach continues to be widely performed for ventral hernia repair, while the minimally invasive laparoscopic approach has grown adoption over the last decade. Recently, robotic operation was described as a new modality due to the ease for performing intracorporeal closure of the hernia defect. This study is one of the first multi-institutional case series evaluating robotic-assisted laparoscopic ventral hernia repairs, with the goal of describing robotic-assisted surgical techniques for ventral and incisional hernia repair and the outcomes in teaching and community hospital settings. Medical records of consecutive patients (including surgeon’s learning curve cases) who underwent ventral or incisional hernia repair utilizing the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale CA) were retrospectively reviewed. Data collected included preoperative history and perioperative outcomes. Data for a total of 368 patients from four institutions involving five surgeons were analyzed. They were predominantly females (60.3 %), and the mean age was 51 years. The majority of the patients were obese or morbidly obese (47.8 and 20.9 %), and 83.2 % of the patients had a history of prior abdominal operation. Conversion rate was 0.8 %, and mean length of stay was 1 day. Total postoperative complications rate up to 30 days was 8.4 %, of which incidence of paralytic ileus was 2.4 %. This large case series of 368 patients demonstrates reproducibility of safety and performance associated with robotic-assisted ventral hernia repairs performed by five surgeons at four institutions. In addition, the results of short term perioperative outcomes for surgeons during their early experience for robotic-assisted cases are in the range of what is reported in the existing published data on laparoscopic and open ventral hernia repairs. Further comparative evidence initiatives are being pursued to determine the benefits of robotic-assisted technique and technology for long-term and patient-reported outcomes.

Recently, the robotic single-site platform has been used to ameliorate the difficulties seen in single-incision laparoscopic surgery (SILC) while preserving the benefits of standard laparoscopic cholecystectomy. The purpose of this study is to describe the clinical outcomes of a large series of single-incision robotic cholecystectomy (SIRC). Medical records of consecutive patients who underwent SIRC were retrospectively reviewed. All procedures were performed by six surgeons at five different North American centers involved in the study. All patients included in the study underwent a cholecystectomy attempted through single site at the umbilicus, using the da Vinci® Surgical System (Intuitive Surgical Inc. Sunnyvale, CA). A total of 465 patients met study criteria. Median age was 48 years (range 18–89); 351 (75.5 %) were female and 304 (66.4 %) were overweight or obese. Except for gender, case characteristics differed significantly by surgeon/site. Previous abdominal surgery was reported for 226 (48.6 %) cases. SIRC was successfully completed in 455 (97.8 %) cases, and there were no conversions to open surgery. Median surgical time was 52 min with a decreasing trend after 55–85 cases. Male gender, obesity and diagnoses other than biliary dyskinesia were independent predictors of longer surgical times. The complication rate was 2.6 %. Our large, multicenter study demonstrates that robotic single-site cholecystectomy is safe and feasible in a wide range of patients.

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.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.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.

The introduction of the robotic platform to bariatric surgery has brought forth a novel approach, with modifications to the standard laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LGB). The purpose of this study was to match robotic gastric bypass (RGB) vs robotic sleeve gastrectomy (RSG) and compare them to those observed with the laparoscopic platform.A retrospective data collection of RSGs and RGBs from a single institution was performed. Groups were compared.This study included 134 RSG and 165 RGB patients. RGB has a longer surgical time (p 0.001) and a higher incidence of long-term complications (p = 0.005) but similar lengths of hospital stay (p = 0.093), rate of perioperative complications (p = 0.487) and EWL% at 1 year of follow-up compared to RSG.RSGs had shorter surgical times and a lower incidence of long-term complications when compared with RGBs. These results appear to be similar to those studies reporting the laparoscopic approach. Copyright © 2014 John WileySons, Ltd.

1 ABSTRACT Background and aim: Recurrent biliary pancreatitis is described as episodes of new abdominal pain after diagnosis of pancreatitis. Few studies have analyzed the abdominal pain before the diagnosis of acute pancreatitis. Our study aimed to analyze factors associated with previous abdominal pain episodes in patients with biliary pancreatitis, and elucidate its possible pancreatic origin. Methods: Data from direct interrogation and medical records was analyzed from 48 hospitalized female patients with diagnosis of acute biliary pancreatitis. Results: Mean age of our patients was 31.6 years (SD+13.9). Forty one (85.4%) patients gave history of at least one previous abdominal pain episode. During the episode 37 (90.2%) patients received H 2 receptor antagonist or proton pump inhibitors as treatment; 26 (63.4%) had epigastric pain; 23(56.1%) gave association with cholecystokinetic food; 21 (51.2%) complained of nausea and/or vomiting; 23 (56.1%) had jaundice, acholia and/or dark urine; and 20 (48.9%) patients had microlithiasis and/or biliary sludge. Conclusions: Previous abdominal pain episodes had similar characteristics to a pancreatic episode in a high percentage of our patients. These characteristics suggest that these episodes are often undiagnosed pancreatic attacks.

Robotic technology has recently emerged in different surgical specialties, but the experience with robotic sleeve gastrectomy (RSG) is scarce in the literature. The purpose of this study is to compare our preliminary experience with RSG versus the descriptive results of a systematic review of the laparoscopic approach.Data from our RSG experience were retrospectively collected. Two surgeons performed all the cases in one single surgery center. Such information was compared with a systematic review of 22 selected studies that included 3,148 laparoscopic sleeve gastrectomy (LSG) cases. RSG were performed using the daVinci Surgical System.This study included 134 RSG vs. 3,148 LSG. Mean age and mean BMI was 43 ± 12.6 vs. 40.7 ± 11.6 (p = 0.022), and 45 ± 7.1 vs. 43.6 ± 8.1 (p = 0.043), respectively. Leaks were found in 0 RSG vs. 1.97% LSG (p = 0.101); strictures in 0 vs. 0.43% (p = 0.447); bleeding in 0.7 vs. 1.21% (p = 0.594); and mortality in 0 vs. 0.1% (p = 0.714), respectively. Mean surgical time was calculated in 106.6 ± 48.8 vs. 94.5 ± 39.9 min (p = 0.006); and mean hospital length of stay was 2.2 ± 0.6 vs. 3.3 ± 1.7 days (p = 0.005), respectively. Four (2.9%) complications were found in our robotic series.Our series shows that RSG is a safe alternative when used in bariatric surgery, showing similar results as the laparoscopic approach. Surgical time is longer in the robotic approach, while hospital length of stay is lower. No leaks or strictures were found in the robotic cases. However, further studies with larger sample size and randomization are warranted.

Many series have shown the feasibility and safety of single-incision laparoscopic cholecystectomy (SILC), but this technique still has limitations such as instrument collisions and lack of triangulation. Recently, two single-incision platforms, robotic and SPIDER, have attempted to ameliorate such problems. This study aimed to compare three different techniques of single-incision cholecystectomy: standard laparoscopic, robotic, and SPIDER approaches. The authors retrospectively collected data from their first 166 single-incision robotic cholecystectomies (SIRCs) and compared the findings with the data from their first 166 SILCs and the first 166 s-generation SPIDER procedures. All the SILCs were performed with three trocars placed in one umbilical incision and with gallbladder retraction using a Prolene stitch on the right upper quadrant. All the robotic cases were managed using the da Vinci Single-Site Surgical System, and all the SPIDER procedures were performed using the SPIDER Surgical System. The SILC, SIRC, and SPIDER groups consisted respectively of 129 (76.3 %), 131 (78.9 %), and 136 (81.9 %) women with the respective mean ages of 44.5 ± 14.3, 51.6 ± 15.9, and 46.4 ± 15.2 years. The mean body mass indexes (BMIs) were respectively 29.1 ± 5.6, 29.4 ± 6.2, and 27.5 ± 4.8 kg/m2, and the mean surgical times were 37.1 ± 13.3, 63.0 ± 25.2, and 52.8 ± 18.7 min. The total hospital stays were respectively 1.3 ± 5.3, 1.2 ± 2.2, and 1.5 ± 2.6 days, and complications were seen respectively in three SILC cases (1.8 %), three SIRC cases (1.8 %), and two SPIDER cases (1.2 %). The results of this study demonstrate similar results among the three platforms for most of the parameters measured. The SILC procedure appears to be superior to SIRC and SPIDER in terms of surgical time, but selection bias could be the cause. The SILS, SIRC, and SPIDER procedures all are similar in terms of complication profile. It can be concluded that SILC, SIRC, and SPIDER all are feasible and safe alternatives when used for single-incision cholecystectomy.

Minimally invasive surgery has been used traditionally for removal of colorectal, gastric and gallbladder disease pathologies with great success. Many advantages have been demonstrated with the addition of robotic surgery, such as 3-D visualization, articulation of instruments and improved surgeon ergonomics while operating. These benefits have allowed the implementation of robotic surgery into new areas. We describe here a rare case of a robotic resection of an urachal carcinoma. A 53-year-old female patient presented to her primary care physician (PCP) with a chief complaint of recurrent urinary tract infections. An initial urinary bladder ultrasound showed a large mass anterior and superior to the bladder, thus prompting an abdominal/pelvic MRI, which confirmed a large complex cystic mass anterior to and abutting the urinary bladder (5.4 × 6.7 × 5.9 cm). A follow-up cystoscopy showed no abnormal findings within the bladder. Based on the patient’s symptoms and imaging, a careful evaluation by her PCP, oncology and surgical team prompted for the removal of the mass. Because of the uncertainty, complexity and location of the mass the patient was offered surgical treatment with the da Vinci robot. Histopathology revealed an urachal adenocarcinoma, well differentiated. We present that surgical resection of an urachal tumor can be performed with the da Vinci robot. Robotic surgery can add to the benefits seen with the conventional laparoscopic approach and thus can be an accepted method for treatment of abdominal wall masses.

Spiegelian hernia is an uncommon entity and occurs as a result of a defect in the linea semilunaris located in the lateroventral abdominal wall.We report the case of a 44-year-old female with a history of progressive abdominal swelling. Clinical history included a previous blunt trauma to the abdomen. A Spiegelian hernia with a large aponeurotic defect (7 × 12 cm) and sac (15 × 15 cm) was diagnosed. A literature review of similar topics was performed.Weakness presented in the linea semilunaris in Spiegelian hernia may be caused either spontaneously or as a consequence of factors that increase intra-abdominal pressure. Otherwise, it is important to unify the terms related to the size of this entity in order to establish a correct classification.

Bladder and surrounding tissue resection followed by creation of a continent urinary reservoir is the gold standard treatment for invasive bladder cancer. In recent years, the da Vinci robot has played a major role in this procedure. Our objective was to describe our surgical technique, a robot-assisted laparoscopic radical cystoprostatectomy and totally intrabdominal ortothopic ileal neobladder construction (Studer).We present the case of a 79-year-old male patient with a diagnosis of transitional cell bladder carcinoma. The patient underwent radical cystoprostatectomy with urinary diversion. The procedure was performed with the use of the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA). Total operative time was 7 h, and the estimated blood loss was 500 ml. There were no intra- or postoperative complications, and the patient's hospitalization was 7 days. At early follow-up, oncological and functional results were favorable.Robot-assisted cystoprostatectomy and urinary diversion are feasible techniques, although their role in management of infiltrative bladder cancer is not well defined.

Introducción: la hernia de Spiegel es una entidad poco común. Dicha entidad ocurre debido a un defecto en la línea semilunar localizada en la pared abdominal lateroventral. Caso clínico: mujer de 44 años, se presentó con aumento progresivo del volumen abdominal asociado con un traumatismo abdominal contuso. Se le diagnosticó hernia de Spiegel con un gran defecto aponeurótico (7 × 12 cm) y saco herniario (15 × 15 cm). Se realizó una revisión de la literatura en búsqueda de reportes similares. Conclusiones: la debilidad en la línea semilunar en la hernia de Spiegel puede ocurrir de manera espontánea o como consecuencia de factores que incrementen la presión intraabdominal. Por otra parte, para una correcta clasificación se debe buscar la unificación de los términos en relación con el tamaño de la hernia.

Introducción, La resección de la vejiga y tejidos circundantes con la consecuente creación de un reservorio urinario es el procedimiento de elección para el cáncer de vejiga invasivo, en dicho procedimiento, el robot da Vinci ha tenido mayor participación en años recientes. Se describe la técnica quirúrgica para realizar cistoprostatectomía radical laparoscópica asistida con robot da Vinci y la creación de vejiga ortotópica con segmento ileal (tipo Studer) totalmente intraabdominal en un paciente con carcinoma de células transicionales de vejiga. Caso clínico, Hombre de 79 años con diagnóstico de carcinoma de células transicionales de vejiga a quien se le realizó una cistoprostatectomía radical con derivación urinaria. Para dicho procedimiento se utilizó el sistema da Vinci. El tiempo quirúrgico total fue de siete horas y la pérdida sanguínea estimada fue de 500 ml. No hubo complicaciones intraoperatorias o posoperatorias, y la estancia intrahospitalaria fue de siete días. En el seguimiento temprano los resultados funcionales y oncológicos fueron buenos. Conclusiones, La cistoprostatectomía radical y la derivación urinaria son factibles con la asistencia de un robot, aunque en el manejo de cáncer de vejiga infiltrativo todavía no está bien definida la utilidad de esta modalidad.