Proposal of set-up standardization for general surgery procedures with the CMR Versius system, a new robotic platform: our initial experience.

Background: The article describes our initial experience using CMR Versius platform for several procedures in general surgery.

Methods: Between September 2022 and April 2023, seventy patients underwent robotic surgery in a multi-robotic referral center (San Paolo University Hospital, Milan, Italy). Three surgeons with only laparoscopic experience performed 24 cholecystectomies, 13 inguinal hernia repairs, 9 ventral hernia repairs, 7 right hemicolectomies, 11 left hemicolectomies, 1 sigmoidectomy, 1 ileocecal resection, 1 ventral rectopexy, 1 Nissen fundoplication, 1 total splenectomy, and 1 exploration with multiple biopsies.

Development of an affordable, immersive model for robotic vaginal cuff closure: a randomized trial.

Safe and secure closure of the vaginal cuff is a critical component of a robotic assisted hysterectomy procedure. Our aim in this study is to develop and validate a novel vaginal cuff closure model (VC) created from porcine heart that allows trainees to obtain competency in a low-risk environment. Ten expert and 20 novice robotic surgeons performed a cuff closure exercise on the VC model and on the dV-Trainer, a virtual reality simulator (VR).

Indocyanine green fluorescence-guided intraoperative detection of peritoneal carcinomatosis: systematic review.

Background: To review the available clinical data about the value of Indocyanine Green (ICG) fluorescence imaging for intraoperative detection of peritoneal carcinomatosis.

Methods: We conducted a systematic review, according to the PRISMA guidelines, for clinical series investigating the possible role of ICG fluorescence imaging in detecting peritoneal carcinomatosis during surgical treatment of abdominal malignancies. With the aim to analyze actual application in the daily clinical practice, papers including trials with fluorophores other than ICG, in vitro and animals series were excluded.

Fluorescence-guided lymphadenectomy in gastric cancer: a prospective western series.

Background: Indocyanine green (ICG) has been recently introduced in clinical practice as a fluorescent tracer. Lymphadenectomy is particularly challenging in gastric cancer surgery, owing to the complex anatomical drainage.

Aim: The primary outcomes of this study were the feasibility and usefulness of ICG-guided lymphadenectomy in gastric cancer surgery, considering both the success rate and improved understanding of the surgical anatomy of nodal basins.

Factors Associated With Surgical Mortality and Complications Among Patients With and Without Coronavirus Disease 2019 (COVID-19) in Italy.

Importance: There are limited data on mortality and complications rates in patients with coronavirus disease 2019 (COVID-19) who undergo surgery.

Objective: To evaluate early surgical outcomes of patients with COVID-19 in different subspecialties.

Design, Setting, And Participants: This matched cohort study conducted in the general, vascular and thoracic surgery, orthopedic, and neurosurgery units of Spedali Civili Hospital (Brescia, Italy) included patients who underwent surgical treatment from February 23 to April 1, 2020, and had positive test results for COVID-19 either before or within 1 week after surgery.

Robotic-Assisted Roux-en-Y Gastric Bypass: Learning Curve Assessment Using Cumulative Sum and Literature Review.

Robotic-assisted Roux-en-Y gastric bypass (RARYGB) is a procedure that is used with increasing frequency in the United States. Among other bariatric procedures, RARYGB is a good model for the robotic platform because it allows hand-sewn suturing and energy devices application. The aim of this study was to conduct a literature review of robotic approach in RARYGB, its learning curve using the cumulative sum (CUSUM) method, and our experience as Center of Excellence recognized by the American Society for Metabolic and Bariatric Surgery (ASMBS).

Near-Infrared Indocyanine Green-Enhanced Fluorescence and Evaluation of the Bowel Microperfusion During Robotic Colorectal Surgery: a Retrospective Original Paper.

Background: Leakage of the anastomosis after colorectal surgery is a severe complication, and one of the most important causes is poor vascular supply. However, a microvascular deficit is often not detectable during surgery under white light. Near-infrared indocyanine green (ICG)-enhanced fluorescence may be useful for assessing microvascular deficits and conceivably preventing anastomotic leakage.

Reasons for open conversion in robotic liver surgery: A systematic review with pooled analysis of more than 1000 patients.

Background: Conversion to open during minimally invasive liver resection has a high rate. To identify the reasons to convert could help in defining a strategy to decrease the event "conversion."

Methods: A systematic review has been performed.

Is there a role for treatment-oriented surgery in stage IV gastric cancer? A systematic review.

To analyze the available evidence on the role of treatment-oriented surgery in stage IV gastric cancer (metastatic disease), a systematic literature search was undertaken using Medline, Embase, Cochrane, and Web-of-Science libraries. The search was not restricted to articles published within a given year range. Articles written in English language (or with abstracts written in English) were considered.

Snapshot in surgery: How do you approach this 12-year-old girl?

This case open questions about the dimensional limit for a laparoscopic treatment of a giant bezoar. A minimally invasive option should be considered every time a gastric obstruction is suspected, particularly for psychiatric patients, for whom a short hospital stay can be greatly beneficial.

Intraoperative ICG-based imaging of liver neoplasms: a simple yet powerful tool. Preliminary results.

Background: Detecting small nodules that are grossly unidentifiable remains a major challenge in liver resection for cancer. Novel developments in navigation surgery, especially indocyanine green (ICG)-based fluorescence imaging, are making a clear breakthrough in addressing this issue. ICG is almost routinely administered during the preoperative stage in hepatobiliary surgery.

Robotic right colonic resection. Is the robotic third arm a game-changer?

Background: Minimally invasive surgery (MIS) approaches have produces relevant advancements in the pre/intra/postoperative outcomes. The conventional laparoscopic approach presents similar oncological results in comparison to laparotomic approaches. Despite these evidences, a considerable part of the colorectal operations are still being performed in an open way.

Operative technique in robotic rectal resection.

A still too high percentage of the colorectal resections are currently performed by open technique. This in part because laparoscopy has some technical hurdles: not ideal ergonomics, poor control on the traction exerted by the Assistant, long/steep learning curve, confined dexterity, low tactile feedback, hand-tremor and 2D vision with a not completely stable camera. The robotic approach, given the increased surgical dexterity and the better surgical view, may be used to solve the laparoscopic downsides (in particular in the most complex cases).

Operative technique in robotic left colonic resection.

Minimally invasive techniques have changed the clinical practice in general surgery and provided an improvement of outcomes. Laparoscopic and open surgery have similar oncological outcomes in the colorectal field. Those findings have been proven by prospective randomized multicenter trials and systematic reviews.

Iatrogenic spleen injury risk during robotic left colonic and rectal resections by routine left flexure mobilization technique: a retrospective study.

Background: The routine mobilization of the left colonic flexure as a standard procedure during left colonic/rectal resection is a controversial topic in open and minimally invasive surgery. According to some authors, this maneuver may increase the risk of iatrogenic spleen damage; for others this does not change the odds. Ligaments over-traction is the most frequent injury mechanism.

Operative technique in robotic pancreaticoduodenectomy (RPD) at University of Illinois at Chicago (UIC): 17 steps standardized technique : Lessons learned since the first worldwide RPD performed in the year 2001.

Background: Minimally invasive pancreaticoduodenectomy (MIPD) was introduced in the attempt to improve the outcomes of the open approach. Laparoscopic pancreaticoduodenectomy (LPD) was first reported by Gagner and Pomp (Surg Endosc 8:408-410, 1994). Unfortunately, due to its complexity and technical demand, LPD never reached widespread popularity.

Affordable Laparoscopic Camera System (ALCS) Designed for Low- and Middle-Income Countries: A Feasibility Study.

Background: Minimally invasive surgical techniques (MISTs) could have tremendous benefits in resource-poor environment. There is growing interest in MISTs in most low- and middle-income countries (LMIC), but its adoption has remained limited; this is largely due to high cost of the initial setup, lack of technological backup and limited access to training among others. An affordable laparoscopic setup will go a long way in improving access to MISTs.

Virtual Reality Simulator Systems in Robotic Surgical Training.

The number of robotic surgical procedures has been increasing worldwide. It is important to maximize the cost-effectiveness of robotic surgical training and safely reduce the time needed for trainees to reach proficiency. The use of preliminary lab training in robotic skills is a good strategy for the rapid acquisition of further, standardized robotic skills.

Iatrogenic spleen injury during minimally invasive left colonic flexure mobilization: the quest for evidence-based results.

Introduction: To assess the frequency, risk factors and outcomes of iatrogenic spleen injury during minimally invasive colo-rectal surgery with a particular focus on the routine splenic flexure mobilization tehcnique.

Evidence Acquisition: Exclusion criteria: 1) topic not pertinent to the main topic of the review; 2) all case reports, editorials, conference highlights were excluded. After a title and abstract first selection and a final full-text analysis has been performed.