Tag Archives: robotic

General Surgery, Print Release

PUBLISHED: Robotic Whipple Procedure for an Ampullary Intramucosal Carcinoma

Robotic Whipple Procedure for an Ampullary Intramucosal Carcinoma
Charles C. Vining, MD, FACS, FSSO; Rushin D. Brahmbhatt, MD, FACS; Lawrence M. Knab, MD, FACS, FSSO
Penn State Health Milton S. Hershey Medical Center

A 76-year-old man presented to the emergency department with fatigue and chest pain. Initial laboratory evaluation revealed significant anemia with a hemoglobin level of 7.4 g/dL. He was transfused one unit of packed red blood cells and discharged with plans for outpatient gastroenterology follow-up. Upper endoscopy performed shortly thereafter demonstrated a tubulovillous adenoma without high-grade dysplasia at the level of the ampulla. Subsequent cross-sectional imaging with CT of the abdomen and pelvis identified an area of mass-like thickening in the descending duodenum as well as two suspicious peripancreatic lymph nodes. Endoscopic ultrasound with biopsy confirmed the presence of a uT3N1 duodenal mass. Histopathologic analysis revealed at least intramucosal adenocarcinoma arising within an adenoma.

The case was reviewed at a multidisciplinary tumor board, where consensus recommendation was for surgical resection. The patient subsequently underwent diagnostic laparoscopy, laparoscopic liver biopsy, robotic pancreaticoduodenectomy (Whipple procedure), and falciform ligament flap. Pathologic examination of the resected specimen revealed an 8.2-cm, grade 2, moderately differentiated invasive adenocarcinoma of intestinal type, arising from a duodenal adenoma. The tumor demonstrated direct invasion into the pancreas, peripancreatic soft tissues, and periduodenal tissue. All surgical resection margins were negative for carcinoma. A total of 22 lymph nodes were examined, of which 6 were positive for metastatic adenocarcinoma, consistent with a final pathologic stage of pT3b pN2 duodenal adenocarcinoma.

This case highlights the diagnostic and therapeutic challenges associated with duodenal adenocarcinoma, a rare and often late-presenting malignancy. It further demonstrates the role of a multidisciplinary approach in guiding management, as well as the feasibility of a minimally invasive robotic pancreaticoduodenectomy in selected patients.

General Surgery, Print Release

PUBLISHED: Robotic Cholecystectomy for Chronic Cholecystitis for a Patient with Recurrent Gallstone Pancreatitis and a Percutaneous Cholecystostomy Tube

Robotic Cholecystectomy for Chronic Cholecystitis for a Patient with Recurrent Gallstone Pancreatitis and a Percutaneous Cholecystostomy Tube
Charles C. Vining, MD, FACS, FSSO; Mark Knab, MD, FACS, FSSO; Rushin D. Brahmbhatt, MD
Penn State Health Milton S. Hershey Medical Center

A 66-year-old man with chronic pancreatitis and prior exploratory laparotomy and appendectomy for perforated appendicitis presented with persistent right upper quadrant pain, nausea, and weight loss after placement of a percutaneous cholecystostomy (PC) tube for gallstone pancreatitis and chronic cholecystitis. Imaging confirmed gallbladder distension with equivocal wall thickening. He underwent robotic cholecystectomy with removal of the PC tube. The procedure was notable for extensive intra-abdominal adhesions requiring prolonged adhesiolysis. A critical view of safety was achieved, and the gallbladder was removed without complication. This case illustrates the technical considerations and challenges of delayed cholecystectomy following PC tube drainage.

General Surgery, Print Release

PUBLISHED: Robotic Cholecystectomy for Porcelain Gallbladder and a 6.8-cm Stone

Robotic Cholecystectomy for Porcelain Gallbladder and a 6.8-cm Stone
Rushin D. Brahmbhatt, MD
Penn State Health Milton S. Hershey Medical Center

The incidence of porcelain gallbladder is low but carries a potential risk of malignancy. Large gallstones pose technical obstacles for minimally invasive surgical procedures. In this case, a 72-year-old woman undergoes a robotic cholecystectomy because of her porcelain gallbladder and a 6.8-cm gallstone. The surgical procedure involved appropriately addressing two major concerns: obtaining sufficient gallbladder retraction because of the large size of the stone, and the presence of hepatic steatosis. Key modifications included strategic port placement, utilizing stone position for retraction, and early cystic artery division. The procedure finished without any issues. The frozen section analysis results showed benign pathology. The patient recovered from surgery without any complications. Key takeaways are that robotic cholecystectomy can be safely performed for a porcelain gallbladder with large gallstones using appropriate technical modifications, and that flexibility in the operating room is crucial in cases where standard methods become impractical.

Print Release, Thoracic Surgery

PUBLISHED: Robotic Right Middle Lobectomy and Mediastinal Lymph Node Dissection for Adenocarcinoma

Robotic Right Middle Lobectomy and Mediastinal Lymph Node Dissection for Adenocarcinoma
Hugh G. Auchincloss, MD, MPH
Massachusetts General Hospital

This surgical video provides a comprehensive demonstration of advanced robotic-assisted thoracic surgical techniques, focusing specifically on right middle lobectomy for adenocarcinoma. It documents the strategic decision-making processes involved in complex thoracic interventions. It highlights how technological advancements can enhance patient outcomes. As an educational resource, the video bridges theoretical knowledge with practical application, providing surgeons and medical professionals with a nuanced understanding of advanced surgical techniques. It exemplifies how robotic assistance can enhance surgical precision, reduce invasiveness, and enable more comprehensive tissue management, ultimately representing a significant advancement in the field of oncological surgery.

General Surgery, Print Release

PUBLISHED: Robotic Paraesophageal Hernia Repair with Magnetic Sphincter Augmentation Using the LINX Device

Robotic Paraesophageal Hernia Repair with Magnetic Sphincter Augmentation Using the LINX Device
Jonathan A. Levy, MD
University of Michigan Health-Sparrow

Robotic paraesophageal hernia repair with concurrent LINX device placement represents an evolutionary step in the surgical management of complex hiatal pathology. When performed with appropriate patient selection and attention to technical detail, the procedure offers excellent outcomes with acceptable morbidity. This instructional video will be particularly beneficial for surgeons, surgical trainees, and advanced practice providers seeking to enhance their understanding of the technical aspects of robotic paraesophageal hernia repair with LINX placement, as well as for medical educators teaching complex, minimally-invasive upper gastrointestinal procedures.

General Surgery, Press Release

PUBLISHED: Robotic Abdominoperineal Resection (APR) with Bilateral Gracilis Muscle Flaps

Robotic Abdominoperineal Resection (APR) with Bilateral Gracilis Muscle Flaps
Eleanor Tomczyk, MD; Todd Francone, MD
Newton-Wellesley Hospital

Robotic APR with bilateral gracilis flap reconstruction is a vital procedure for managing advanced and metastatic rectal cancer. It offers a precise, minimally-invasive approach that addresses both tumor removal and functional reconstruction, providing significant benefits for patients requiring complex oncological and reconstructive surgery. This step-by-step video guideline is crucial for advancing surgical techniques in complex rectal cancer treatment. It serves as a vital educational resource for surgeons at all levels, demonstrating the combination of APR with gracilis flap reconstruction. The video’s importance lies in its ability to standardize the procedure, showcase innovative techniques, and highlight critical aspects that are difficult to convey through text alone. Providing detailed visual instruction on navigating challenges helps prevent complications and improve patient outcomes.

General Surgery, Print Release

PUBLISHED: Robotic End Colostomy Reversal

Robotic End Colostomy Reversal
George Velmahos, MD, PhD
Massachusetts General Hospital

The case presented in the video illustrates a complex clinical scenario involving a young male patient who sustained multiple traumatic injuries in a motorcycle collision. Following initial emergency management that included an exploratory laparotomy with sigmoid transection and subsequent end colostomy, the patient now undergoes robotic-assisted colostomy reversal. This approach represents an advanced surgical technique that uses minimally-invasive technology to address challenging postoperative reconstructive needs. Robotic-assisted surgery offers several advantages in colostomy reversal, such as better dissection precision and improved surgical field visualization. This video shows how cutting-edge technology improves surgical outcomes, reduces recovery time, and solves complex challenges. It is a valuable resource for medical professionals, especially surgeons and trainees, looking to deepen their understanding of advanced colorectal surgical interventions.

Bariatric Surgery, General Surgery, Print Release

PUBLISHED: Robotic Sleeve Gastrectomy for Treatment of Morbid Obesity

Robotic Sleeve Gastrectomy for Treatment of Morbid Obesity
Hany M. Takla, MD, FACS, FASMBS, DABS-FPMBS
Wentworth-Douglass Hospital, Mass General Brigham

Robotic surgery as an approach for bariatric surgery has been a subject of debate for at least two decades since the platform passed FDA approval. One could argue that the exponential growth of robotics in surgery could end such a debate. The robotic platform offers several advantages that are always advertised, but in the morbidly obese population it offers an added advantage. It is arguable that with the advanced ergonomics, superior visual tools, and wristed instruments the robotic platform is superior in its offerings to the surgeon and enables a wider variety of surgeons with variable skill set to adopt minimally-invasive surgery (MIS), especially in bariatrics.

The Sleeve gastrectomy is technically a straightforward procedure to perform and is easier to learn for trainees and novel surgeons. It could, however, pose some challenges especially in patients with increased BMI, which is a huge advantage for the robotic platform as it allows easier exposure and comfort during the operation.

General Surgery, Print Release

PUBLISHED: Robotic-Assisted Left Adrenalectomy

Robotic-Assisted Left Adrenalectomy
Hyunsuk Suh, MD
The Mount Sinai Hospital

Current evidence supports the use of robotic surgery as a method of minimally-invasive treatment for adrenal masses. This article presents the case of a robotic adrenalectomy (RA) for an adrenal tumor. Upon examination of the extracted 1.5-cm specimen, it exhibited typical characteristics of aldosterone-producing adenoma, including a golden tan color, well-circumscribed borders, and surrounding normal adrenal gland tissue and fat. The detailed demonstration of this surgical procedure in the accompanying video provides a thorough understanding of the latest advancements in robotic adrenal surgery, offering comprehensive insights into the nuanced techniques and emerging trends in the field.

General Surgery, Print Release

PUBLISHED: Robotic-Assisted Repair of a Left Lower Quadrant Spigelian-Type Hernia

Robotic-Assisted Repair of a Left Lower Quadrant Spigelian-Type Hernia
Samuel J. Zolin, MD; Eric M. Pauli, MD
Penn State Health Milton S. Hershey Medical Center

A left lower quadrant partial-thickness Spigelian-type incisional hernia resulting from wound complications after deep inferior epigastric perforator (DIEP) flap harvest is repaired in a minimally-invasive, robotic-assisted, transabdominal preperitoneal (TAPP) fashion. Utilizing robotic assistance, a large preperitoneal flap is created, fascial closure is achieved using barbed suture, and the hernia defect is reinforced widely with medium-weight polypropylene mesh. In this patient, this approach also allows for areas that had previously had mesh placed to be avoided, and for repair of a fat-containing indirect left inguinal hernia. Similar approaches can address primary or lateral incisional hernias. This patient had an uncomplicated postoperative course without early wound morbidity.