Tag Archives: robotic

General Surgery, Print Release

PUBLISHED: Robotic Hepatectomy for a Segment V/VI Suspected HCC Lesion with Cholecystectomy and Evaluation by Ultrasound and Excisional Biopsy of a Segment IVb Lesion

Robotic Hepatectomy for a Segment V/VI Suspected HCC Lesion with Cholecystectomy and Evaluation by Ultrasound and Excisional Biopsy of a Segment IVb Lesion
Ji Ho Park, MD; Corbin S. Morris, MD; Kelsey L. Fletcher, MD; Charles C. Vining, MD, FACS, FSSO; Lawrence M. Knab, MD, FACS, FSSO; Rushin D. Brahmbhatt, MD, FACS
Penn State Health Milton S. Hershey Medical Center

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is associated with high morbidity and mortality. In this case, the patient was incidentally found to have a segment V/VI lesion consistent with HCC and a IVb lesion indeterminate probability of malignancy. He underwent a robotic-assisted hepatectomy for a segment V/VI lesion with cholecystectomy and evaluation by ultrasound and excisional biopsy of a segment IVb lesion. His postoperative course was unremarkable, and he was discharged on postoperative day four. The pathology demonstrated well-differentiated HCC with resection margins negative for carcinoma. This video demonstrates an experienced surgeon’s technique for performing a robotic hepatectomy for a segment V/VI lesion with cholecystectomy and evaluation by ultrasound and excisional biopsy of a segment IVb lesion. It also highlights effective management of bleeding during hepatic parenchymal transection.

General Surgery, Print Release

PUBLISHED: Robotic Preperitoneal eTEP Repair for Umbilical Hernia and Diastasis

Robotic Preperitoneal eTEP Repair for Umbilical Hernia and Diastasis
Hector A. Valenzuela Alpuche, MD; Juan P. Saucedo Gonzalez, MD; Roland K. Cethorth Fonseca, MD
Hospital Angeles del Carmen, Guadalajara, Mexico

Robotic extraperitoneal approaches have expanded the possibilities of minimally invasive abdominal wall reconstruction. The suprapubic preperitoneal eTEP (PeTEP) technique offers an alternative for selected patients with small-to-medium midline hernias, with or without rectus diastasis, in whom preservation of the retrorectus plane is desirable. This article describes the application of PeTEP in a 58-year-old male with a 3-cm primary umbilical hernia and a 5-cm rectus diastasis, using a suprapubic robotic extraperitoneal approach to achieve functional midline reconstruction while maintaining the integrity of the retrorectus space. The procedure includes pretransversalis access, development of the preperitoneal and pretransversalis planes, midline restoration, and placement of a preperitoneal polypropylene mesh. This technique avoids posterior sheath division, neurovascular bundle manipulation, and retromuscular dissection, thereby reducing potential morbidity in selected patients. This case illustrates the feasibility of PeTEP in a carefully selected patient. The authors do not propose this approach as a replacement for open or transabdominal techniques, but rather as an additional option within a broader reconstructive spectrum.

General Surgery, Print Release

PUBLISHED: Robotic Retromuscular eTEP Repair of Ventral Incisional Hernias and Diastasis

Robotic Retromuscular eTEP Repair of Ventral Incisional Hernias and Diastasis
Benjamin S. C. Fung, MD, FRCSC1; Eric M. Pauli, MD, FACS, FASGE2
1North York General Hospital, University of Toronto
2Penn State Health Milton S. Hershey Medical Center

A 55-year-old female has a history of multiple abdominal surgeries including laparoscopic cholecystectomy, appendectomy, laparoscopic hysterectomy, tubal ligations, and multiple cesarean sections through a low transverse (Pfannensteil) incision. Cross-sectional imaging demonstrated multiple midline hernias ranging from 1–3 cm, a rectus diastasis measuring 4 cm wide, and intraparietal cesarean section (C-section) hernia (Zanellato Type II). She underwent a robotic retromuscular extended totally extraperitoneal (eTEP) repair wherein her ventral midline hernias, rectus diastasis, and intraparietal hernia were all repaired and reinforced with wide mesh overlap. This case highlights the strengths of an eTEP approach, the decision making behind considering all of a patient’s abdominal wall pathology, and the considerations with intraparietal hernias post C-section.

General Surgery, Print Release

PUBLISHED: Robotic Cholecystectomy for Recurrent Gallstone Pancreatitis in a Patient with Prior Distal Pancreatectomy and Splenectomy for Acinar Cell Carcinoma

Robotic Cholecystectomy for Recurrent Gallstone Pancreatitis in a Patient with Prior Distal Pancreatectomy and Splenectomy for Acinar Cell Carcinoma
Charles C. Vining, MD, FACS, FSSO; Lawrence M. Knab, MD, FACS, FSSO; Rushin D. Brahmbhatt, MD, FACS
Penn State Health Milton S. Hershey Medical Center

Recurrent gallstone pancreatitis is a common and potentially morbid condition for which definitive cholecystectomy is recommended to prevent recurrent biliary complications and reduce hospital readmissions. Surgical management may be technically challenging in patients with prior pancreatic resection because of altered anatomy, adhesions, and concern for malignancy recurrence. This video demonstrates a robotic-assisted cholecystectomy performed in a 78-year-old man with recurrent gallstone pancreatitis and a history of distal pancreatectomy for pancreatic acinar cell carcinoma. Preoperative imaging demonstrated cholelithiasis without evidence of recurrent malignancy. Diagnostic laparoscopy was performed to exclude occult intra-abdominal disease before proceeding with cholecystectomy. Operative findings included chronic cholecystitis and cholelithiasis. Robotic dissection facilitated meticulous clearance of fibrofatty tissue within the hepatocystic triangle and safe dissection around the cystic structures prior to cystic duct division, consistent with established principles for preventing bile duct injury. The procedure was completed without complication. This case highlights the role of robotic-assisted cholecystectomy in patients with recurrent gallstone pancreatitis and prior pancreatic surgery, where enhanced visualization and instrument dexterity may improve operative safety in complex inflammatory and reoperative settings.

General Surgery, Print Release

PUBLISHED: Robotic Transversus Abdominis Release (TAR)

Robotic Transversus Abdominis Release (TAR)
Katie A. Marrero, MD; Eric M. Pauli, MD, FACS, FASGE
Penn State Health Milton S. Hershey Medical Center

A 58-year-old patient underwent robotic bilateral transversus abdominis release (TAR) for repair of a recurrent incisional hernia following prior hernia repair complicated by mesh infection and subsequent explantation. This approach was selected based on the patient’s surgical history, the size of the hernia defect, and the extent of incarcerated small bowel. A double-docking technique was employed to facilitate bilateral TAR, and a large macroporous polypropylene mesh was placed. This case highlights the operative decision-making involved in complex hernia repair and demonstrates the technical considerations for performing a robotic bilateral TAR.

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.