Inventing the future of surgery.

Surgical innovation relies on patient safety and quality of life, which require a drastic iatrogenic impact reduction. A parallel development toward less invasive approaches has occurred in the field of surgery, interventional radiology, and endoscopy. Minimally invasive techniques provide unquestionable benefits to patients in terms of postoperative outcome.

Towards cybernetic surgery: robotic and augmented reality-assisted liver segmentectomy.

Background: Augmented reality (AR) in surgery consists in the fusion of synthetic computer-generated images (3D virtual model) obtained from medical imaging preoperative workup and real-time patient images in order to visualize unapparent anatomical details. The 3D model could be used for a preoperative planning of the procedure. The potential of AR navigation as a tool to improve safety of the surgical dissection is outlined for robotic hepatectomy.

Gastric supply manipulation to modulate ghrelin production and enhance vascularization to the cardia: proof of the concept in a porcine model.

Introduction: Selective embolization of the left-gastric artery (LGA) reduces levels of ghrelin and achieves significant short-term weight loss. However, embolization of the LGA would prevent the performance of bariatric procedures because the high-risk leakage area (gastroesophageal junction [GEJ]) would be devascularized.

Aim: To assess an alternative vascular approach to the modulation of ghrelin levels and generate a blood flow manipulation, consequently increasing the vascular supply to the GEJ.

Laparoscopic tension-free abdominal wall repair: impact of mesh size and of different fixation devices in a consecutive series of 120 patients.

Purpose: To assess the impact of mesh size and fixation devices on short-term outcomes in a consecutive series of tension-free laparoscopic abdominal wall repairs.

Methods: Data for 120 consecutive, unselected patients undergoing tension-free laparoscopic incisional (n=63) or umbilical (n=57) hernia repair were prospectively collected. A multivariate analysis was performed to evaluate variables influencing outcomes.

Updates on gastric electrical stimulation to treat obesity: Systematic review and future perspectives.

Aim: To evaluate the current state-of-the-art of gastric electrical stimulation to treat obesity.

Methods: Systematic reviews of all studies have been conducted to evaluate the effect of different types of gastric electrical stimulation (GES) on obesity.

Results: Thirty-one studies consisting of a total of 33 different trials were included in the systematic review for data analysis.

Design and development of a robotized system coupled to µCT imaging for intratumoral drug evaluation in a HCC mouse model.

Hepatocellular carcinoma (HCC) is one of the most common cancer related deaths worldwide. One of the main challenges in cancer treatment is drug delivery to target cancer cells specifically. Preclinical evaluation of intratumoral drugs in orthotopic liver cancer mouse models is difficult, as percutaneous injection hardly can be precisely performed manually.

Robotic spleen preserving distal pancreatectomy: how I do it (with video).

Laparoscopic hepatobiliary surgery, although technically demanding, gains popularity due to the patient benefits of a mini-invasive approach. Laparoscopic distal pancreatectomy is a technically feasible and reproducible operation that doesn't require complex digestive reconstruction. It requires advanced laparoscopic skill for vascular dissection and control.

Chronic pancreatitis: A surgical disease? Role of the Frey procedure.

Although medical treatment and endoscopic interventions are primarily offered to patients with chronic pancreatitis, approximately 40% to 75% will ultimately require surgery during the course of their disease. Although pancreaticoduodenectomy has been considered the standard surgical procedure because of its favorable results on pain control, its high postoperative complication and pancreatic exocrine or/and endocrine dysfunction rates have led to a growing enthusiasm for duodenal preserving pancreatic head resection. The aim of this review is to better understand the rationale underlying of the Frey procedure in chronic pancreatitis and to analyze its outcome.

The Business Engineering Surgical Technologies (BEST) teaching method: incubating talents for surgical innovation.

Introduction: Technological innovation in surgical science and healthcare is vital and calls for close collaboration between engineering and surgery. To meet this objective, BEST was designed as a free sustainable innovative teaching method for young professionals, combining surgery, engineering, and business in a multidisciplinary, high-quality, low-cost, and learning-by-doing philosophy.

Aims: This paper reviews the initial outcomes of the program and discusses lessons learned and future directions of this innovative educational method.

Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia.

Background And Aim: Surgeons currently rely on visual clues to estimate the presence of sufficient vascularity for safe anastomosis. We aimed to assess the accuracy of endoluminal confocal laser endomicroscopy (CLE) and laparoscopic fluorescence-based enhanced reality (FLER), using near-infrared imaging and fluorescence from injected Indocyanine Green, to identify the transition from ischemic to vascular areas in a porcine model of mesenteric ischemia.

Methods: Six pigs underwent 1-h sigmoid segmental ischemia.

Accuracy of preoperative automatic measurement of the liver volume by CT-scan combined to a 3D virtual surgical planning software (3DVSP).

Background: Liver volumetry is a critical component of safe hepatic surgery, in order to minimize the risk of postoperative liver failure. Liver volumes can be calculated routinely using the time-consuming gold standard method of manual volumetry. The current work sought to evaluate an alternative automatic technique based on a novel 3D virtual planning software, and to compare it to the manual technique.

Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery.

Background: Fluorescence-based enhanced reality (FLER) is a technique to evaluate intestinal perfusion based on the elaboration of the Indocyanine Green fluorescence signal. The aim of the study was to assess FLER's performances in evaluating perfusion in an animal model of long-lasting intestinal ischemia.

Materials And Methods: An ischemic segment was created in 18 small bowel loops in 6 pigs.

Real-time 3D image reconstruction guidance in liver resection surgery.

Background: Minimally invasive surgery represents one of the main evolutions of surgical techniques. However, minimally invasive surgery adds difficulty that can be reduced through computer technology.

Methods: From a patient's medical image [US, computed tomography (CT) or MRI], we have developed an Augmented Reality (AR) system that increases the surgeon's intraoperative vision by providing a virtual transparency of the patient.

Laparoscopic resection for hepatocellular carcinoma: comparison between Middle Eastern and Western experience.

Background: Laparoscopic liver resection (LLR) is growing in popularity, but the short- and long-term outcome of patients undergoing LLR for hepatocellular carcinoma (HCC) has not yet been established.

Methods: A literature search was performed using PubMed, Scopus, and Web of Science (WoS) from cited English and Chinese publications. Clinical and survival parameters were extracted.

Management of staple line leaks after sleeve gastrectomy in a consecutive series of 378 patients.

Introduction: Laparoscopic sleeve gastrectomy (LSG) is gaining acceptance as a stand-alone bariatric procedure with proven efficacy on weight loss and obesity-related comorbidities. A specific and potentially severe complication of LSG is the staple line leak (SLL). Our aim was to report the SLL rate and its management in a prospective cohort of 378 LSGs.

Robotic duodenopancreatectomy assisted with augmented reality and real-time fluorescence guidance.

Background: The minimally invasive surgeon cannot use 'sense of touch' to orientate surgical resection, identifying important structures (vessels, tumors, etc.) by manual palpation. Robotic research has provided technology to facilitate laparoscopic surgery; however, robotics has yet to solve the lack of tactile feedback inherent to keyhole surgery.

Age impact on weight loss and glycolipid profile after laparoscopic sleeve gastrectomy: experience with 308 consecutive patients.

Background: The aim of this study was to evaluate the impact of age on weight loss and on related glycolipid profile changes at 2-year follow-up after laparoscopic sleeve gastrectomy (LSG).

Methods: From 2005 to 2010, a total of 308 consecutive patients undergoing LSG were enrolled. Mean age was 39.

Inter-operative trajectory registration for endoluminal video synchronization: application to biopsy site re-localization.

The screening of oesophageal adenocarcinoma involves obtaining biopsies at different regions along the oesophagus. The localization and tracking of these biopsy sites inter-operatively poses a significant challenge for providing targeted treatments. This paper presents a novel framework for providing a guided navigation to the gastro-intestinal specialist for accurate re-positioning of the endoscope at previously targeted sites.

Using DNA barcoding to differentiate invasive Dreissena species (Mollusca, Bivalvia).

The zebra mussel (Dreissena polymorpha) and the quagga mussel (Dreissena rostriformis bugensis) are considered as the most competitive invaders in freshwaters of Europe and North America. Although shell characteristics exist to differentiate both species, phenotypic plasticity in the genus Dreissena does not always allow a clear identification. Therefore, the need to find an accurate identification method is essential.