Pan-European survey on the implementation of robotic and laparoscopic minimally invasive liver surgery

BackgroundLaparoscopic and robotic minimally invasive liver surgery (MILS) is gaining popularity. Recent data and views on the implementation of laparoscopic and robotic MILS throughout Europe are lacking.MethodsAn anonymous survey consisting of 46 questions was sent to all members of the European-African Hepato-Pancreato-Biliary Association.ResultsThe survey was completed by 120 surgeons from 103 centers in 24 countries. Median annual center volume of liver resection was 100 [IQR 50–140]. The median annual volume of MILS per center was 30 [IQR 16–40]. For minor resections, laparoscopic MILS was used by 80 (67%) surgeons and robotic MILS by 35 (29%) surgeons. For major resections, laparoscopic MILS was used by 74 (62%) surgeons and robotic MILS by 33 (28%) surgeons. The majority of the surgeons stated that minimum annual volume of MILS per center should be around 21–30 procedures/year. Of the surgeons performing robotic surgery, 28 (70%) felt they missed specific equipment, such as a robotic-CUSA. Seventy (66%) surgeons provided a formal MILS training to residents and fellows. In 5 years’ time, 106 (88%) surgeons felt that MILS would have superior value as compared to open liver surgery.ConclusionIn the participating European liver centers, MILS comprised about one third of all liver resections and is expected to increase further. Laparoscopic MILS is still twice as common as robotic MILS. Development of specific instruments for robotic liver parenchymal transection might further increase its adoption.     

Designing the European registry on minimally invasive pancreatic surgery: a pan-European survey

BackgroundThe recent Miami international evidence-based guidelines on minimally invasive pancreatic surgery (MIPS) advise all centers that perform MIPS to participate in multicenter registries to safeguard optimal outcomes and patient safety. During the design phase of a pan-European registry on MIPS, the European consortium of Minimally Invasive Pancreatic Surgery (E-MIPS) sought input from European HPB surgeons.MethodsAn anonymous online questionnaire with 23 questions on MIPS practice was sent to all member centers of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) and E-MIPS.ResultsCompleted questionnaires were obtained from 98 centers in 23 countries, of which 75 (76.5%) were academic centers. Centers had a median annual pancreatoduodenectomy volume of 45. The most-performed MIPS procedure was laparoscopic distal pancreatectomy (93.9% of centers). Minimally invasive pancreatoduodenectomy was performed in 49% of all centers. Some 25 centers already participated in an ongoing national registry, and were willing to share their data with the European registry on MIPS. The most mentioned (45.4%) maximum time for processing one patient's data into the registry was 10–15 min.ConclusionThis European survey showed considerable support for the European registry on MIPS.     

Worldwide survey on opinions and use of minimally invasive pancreatic resection

Background

The introduction of minimally invasive pancreatic resection (MIPR) into surgical practice has been slow. The worldwide utilization of MIPR and attitude towards future perspectives of MIPR remains unknown.

微创外科在结直肠肿瘤手术的新进展

微创外科结直肠手术在我国的开展已超过20个年头。20余年来,以腹腔镜结直肠手术为代表的结直肠外科微创手术在我国蓬勃发展,尤其是进入21世纪以来发展势头迅猛,微创结直肠肿瘤手术的开展已经得到广泛认可,并得到循证医学证据的支持,由此更使其成为一种外科理念逐步深入结直肠外科领域。不断成熟的技术、不断更新的设备与器械,都为微创结直肠外科的进一步发展起到了重要推动作用。     

Role of minimally invasive surgery for rectal cancer

Rectal cancer is one of the most common malignancies worldwide.Surgical resection for rectal cancer usually requires a proctectomy with respective lymphadenectomy(total mesorectal excision).This has traditionally been performed transabdominally through an open incision.Over the last thirty years,minimally invasive surgery platforms have rapidly evolved with the goal to accomplish the same quality rectal resection through a less invasive approach.There are currently three resective modalities that complement the traditional open operation:(1) Laparoscopic surgery;(2) Robotic surgery;and(3) Transanal total mesorectal excision.In addition,there are several platforms to carry out transluminal local excisions(without lymphadenectomy).Evidence on the various modalities is of mixed to moderate quality.It is unreasonable to expect a randomized comparison of all options in a single trial.This review aims at reviewing in detail the various techniques in regard to intra-/perioperative benchmarks,recovery and complications,oncological and functional outcomes.     

Benefits of minimally invasive surgery in the treatment of gastric cancer

We read with great interest the article that retrospectively analyzed 814 patients with primary gastric cancer, who underwent minimally invasive R0 gastrectomy between 2009 and 2014 by grouping them in laparoscopic vs robotic procedures. The results of the study highlighted that age, American Society of Anesthesiologists status, gastrectomy type and pathological T and N status were the main prognostic factors of minimally invasive gastrectomy and showed how the robotic approach may improve long-term outcomes of advanced gastric cancer. According to most of the current literature, robotic surgery is associated with a statistically longer operating time when compared to open and laparoscopic surgery; however, looking at the adequacy of resection, defined by negative surgical margins and number of lymph nodes removed, it seems that robotic surgery gives better results in terms of the 5-year overall survival and recurrence-free survival. The robotic approach to gastric cancer surgery aims to overcome the difficulties and technical limitations of laparoscopy in major surgery. The three-dimensional vision, articulation of the instruments and good ergonomics for the surgeon allow for accurate and precise movements which facilitate the complex steps of surgery such as lymph node dissection, esophagus-jejunal anastomosis packaging and reproducing the technical accuracy of open surgery. If the literature, as well as the analyzed study, offers us countless data regarding the short-term oncological results of robotic surgery in the treatment of gastric cancer, satisfactory data on long-term follow-up are lacking, so future studies are necessary.     

Standardizing terminology for minimally invasive pancreatic resection

Background

There is a growing body of literature pertaining to minimally invasive pancreatic resection (MIPR). Heterogeneity in MIPR terminology, leads to confusion and inconsistency. The Organizing Committee of the State of the Art Conference on MIPR collaborated to standardize MIPR terminology.

Reduced morbidity with minimally invasive distal pancreatectomy for pancreatic adenocarcinoma

Background

Minimally invasive distal pancreatectomy (MISDP) has been shown to be safe relative to open distal pancreatectomy (ODP). However, MISDP has been slow to adopt for pancreatic adenocarcinoma (PDAC). This study sought to compare outcomes following MISDP vs. ODP for PDAC.

Anesthesia for minimally invasive cardiac surgery

Due to its potential benefits and increased patient satisfaction minimal invasive cardiac surgery (MICS) is rapidly gaining in popularity. These procedures are not without challenges and require careful planning, pre-operative patient assessment and excellent intraoperative communication. Assessment of patient suitability for MICS by a multi-disciplinary team during pre-operative workup is desirable. MICS requires additional skills that many might not consider to be part of the standard cardiac anesthetic toolkit. Anesthetists involved in MICS need not only be highly skilled in performing transesophageal echocardiography (TEE) but need to be proficient in multimodal analgesia, including locoregional or neuroaxial techniques. MICS procedures tend to cause more postoperative pain than standard median sternotomies do, and patients need analgesic management more in keeping with thoracic operations. Ultrasound guided peripheral regional anesthesia techniques like serratus anterior block can offer an advantage over neuroaxial techniques in patients on anti-platelet therapy or anticoagulation with low molecular weight or unfractionated heparin The article reviews the salient points pertaining to pre-operative assessment and suitability, intraoperative process and postoperative management of minimally invasive cardiac procedures in the operating theatre as well as the catheterization lab. Special emphasis is given to anesthetic management and analgesia techniques.     

Advances in minimally invasive esophageal surgery

Advances in minimally invasive techniques have substantially expanded the role of surgery in the treatment of esophageal disease. In many cases this expansion has made more effective treatment available to a larger number of patients. Gastroesophageal reflux disease, paraesophageal hernias, and achalasia are now routinely treated laparoscopically, and laparoscopy is beginning to be used for total esophagectomy as well. The introduction of this technology has created new controversies and revitalized existing ones in the surgical treatment of esophageal disease. The indications, techniques, and outcomes of videoendoscopic approaches to the esophagus, as well as the controversies surrounding them, are discussed in this review.     

发展中的肺癌微创主流技术——胸腔镜手术

电视辅助胸腔镜手术(VATS)作为肺部相关疾病微创手术的代表性技术,在其出现后的数十年间快速发展,凭借其相比传统的胸部开放手术体现出的"入路创伤小、术后预后佳、术后生活质量高"等优点,成为早期肺癌和其他肺部疾病外科治疗的主要方式.该文旨在通过介绍VATS的发展历程和治疗现状,阐明VATS在当下治疗中的强大生命力,以及探...     

Recent trends in minimally invasive cardiac surgery

Evolving technologies have resulted in an increase in minimally invasive cardiac surgery. Currently, robotic systems allow surgeons to perform a variety of procedures through small incisions. This changing paradigm is reviewed.     

仿真外科训练系统在微创外科的应用

目的 通过比较计算机模拟仿真训练和传统训练模型的训练效果，对模拟仿真训练的有效性和可行性进行评价。方法 17名低年外科医生和24名医学生被随机分成4组，分别受到计算机模拟仿真训练或传统训练模型的训练1h。在接受训练后，他们将在传统训练模型中接受连续缝合测试30min，根据完成缝合的数量和准确性来评价被测试者的能力。结果 无论接受何种训练，低年外科医生的测试结果都优于医学生，尤其在缝合速度方面，无论低年外科医生还是医学生，接受计算机模拟仿真训练的测试结果优于传统训练。结论 计算机模拟仿真训练将可能在腹腔镜外科训练中发挥重要作用。