Abstract : Robotic gastrectomy is a promising alternative to overcome the technical limitations of laparoscopic gastrectomy. Its indications have broadened in diverse surgical fields, demonstrating the advantages of using advanced instruments. Although evidence for the efficacy of robotic gastrectomy for gastric cancer has been consistently published, high-quality evidence from randomized controlled trials (RCTs) has only recently been published. This article reviewed the latest RCTs comparing robotic gastrectomy with laparoscopic gastrectomy. Robotic gastrectomy showed postoperative outcomes equivalent to those of laparoscopic gastrectomy. Some researchers have suggested that robotic gastrectomy can reduce intraoperative blood loss and improve the outcomes of lymphadenectomies. Although it is more expensive than laparoscopic gastrectomy, the cost is expected to decrease as robotic gastrectomy is increasingly applied in the surgical field. Therefore, large-scale multicenter RCTs are urgently needed to acquire strong evidence in the future.
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Abstract : The number of robot-assisted colorectal surgeries is increasing because these robotic devices afford surgeon-controlled, high-definition, and three-dimensional vision during surgery and have sophisticated, angulated arms with remarkable ergonomics and a great degree of range. Nevertheless, robotic colorectal surgery has been praised and criticized simultaneously because its superiority over laparoscopic surgery in terms of outcomes has not been clearly shown. Despite its numerous advantages, several studies have failed to reveal the supremacy of robotic surgery over laparoscopic surgery regarding oncologic and postoperative outcomes. Additionally, robotic surgery is more expensive and is associated with a longer operative time than laparoscopic surgery. Regardless of research findings, many surgeons perform robotic colorectal surgeries. Therefore, this review will evaluate the benefits and drawbacks of robotic surgery for colorectal cancer through recent studies and reviews. The indications for the robotic approach are increasing. Therefore, further research should be conducted to accurately assess the relevance of robotic surgery for colorectal cancer.
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Abstract : Successfully performing laparoscopic procedures in donor hepatectomy provides better quality of life and minimizes surgical complications for the donor. However, only a few experienced institutions can perform laparoscopic donor hepatectomy, which has a long learning curve and unergonomic surgical conditions. Meanwhile, robotic surgical systems have advanced to the point that they can compensate for the limitations of laparoscopic surgical systems. A robotic system provides a steady and magnified three-dimensional visualization with a wide range of motion and tremor-free instrumentation. Due to the benefits of robotic systems, robotic donor hepatectomy has been successfully performed in recent years. Therefore, the aim of this review is to present the current circumstances regarding the use of robotic systems in liver transplantation.
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Abstract : Robotic pancreatectomy, which has received attention in recent years, is subdivided into robotic distal pancreatectomy and robotic pancreatoduodenectomy. Benign and borderline malignant pancreatic tumors can be treated with robotic pancreatectomy, which has several advantages inherent to robotic surgery. The indications for robotic pancreatectomy are similar to those of laparoscopic pancreatectomy, and there are no absolute contraindications. The perioperative outcomes of robotic pancreatectomy are comparable to those of open or laparoscopic pancreatectomy. A high spleen preservation rate, low intraoperative blood loss, and a low open conversion rate are advantages of robotic pancreatectomy. Although robotic pancreatectomy is possible for the treatment of pancreatic cancer, appropriate case selection is required, and more research is needed.
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Abstract : The prevalence of obesity has increased steadily both in Korea and throughout the world, and bariatric surgery is the most powerful treatment modality for morbid obesity. Robotic digital platforms provide potential benefits such as three-dimensional visualization, wristed instruments that lead to enhanced dexterity, and blocked torque transmission to ports. These advantages are remarkable when robotic systems are employed for bariatric surgery. If robotic bariatric surgery can be demonstrated to be clinically safer than other approaches, it could become the standard procedure.
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Abstract : Background: The aim of this study was to determine whether esophageal stent placement in recurrent and refractory post-esophagectomy anastomotic strictures improves clinical outcomes and prolongs the intervals between re-interventions. Methods: This retrospective, observational, single-center study analyzed data from all patients who underwent esophageal stent placement for symptomatic benign post-esophagectomy anastomotic strictures from 2009 to 2019. The primary outcome was technical and clinical success. The secondary outcomes were stent-related complications and re-intervention duration and rates. Results: Twenty-eight patients underwent esophageal stent placement for post-esophagectomy benign anastomotic strictures. The technical success rate was 96.4%. The clinical success rates at 4 weeks, 12 weeks, and 1 year were 100%, 69.23%, and 72.72%, respectively. Serious stent-related complications occurred in two patients (7.1%), while minor adverse events were noted in 11 patients (39.28%). The rate of stricture recurrence with a mean dysphagia-free interval of 17 weeks after stent placement was 64.28%. The rate of luminal patency with a stent was 73.33% at 12 months. Conclusion: Stent insertion is an effective and safe treatment modality for anastomotic esophageal strictures. Long-term remission of the stricture, more luminal patency, and an improved dysphagia score were observed, but the findings need to be confirmed through multivariate analysis.
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Abstract : A 56-year-old male underwent a Whipple procedure for duodenal stricture secondary to a 32-mm duodenal adenocarcinoma. The patient presented again 66 months later with obstructive jaundice caused by an obstruction in the afferent loop. Biliary drainage was performed to relieve the obstruction. Two attempts to cross the occlusion were performed, but these were both unsuccessful. Percutaneous transhepatic stent deployment through the obstruction has previously been described in similar cases but was not feasible in this case. An attempt at retrograde cannulation was performed from a direct puncture of the bowel but this failed. Rather than abandoning the case, an extra-anatomic approach was taken by passing a needle across the point of malignant obstruction forming a new track between the Roux loop and small bowel, enabling a covered stent to be placed and relieving the biliary obstruction. This avoided the need for permanent external biliary drainage and its associated complications. Extra-anatomic percutaneous stenting is a viable alternative for the treatment of malignant afferent loop obstruction following pancreaticoduodenectomy.
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Abstract : A 2-year-old child presented with button battery (BB) ingestion that had taken place 5 months previously. The BB was impacted within the post-cricoid esophageal wall without an obvious perforation or communication with the trachea. In view of the high surgical risk, we attempted to remove the BB endoscopically. BB removal was not possible with conventional devices due to the post-cricoid location and the invagination of the BB into the esophageal wall. We dissected the BB from the surrounding esophageal wall using an insulated tip (IT) knife and successfully extracted the BB. The use of an IT knife prevented inadvertent injury or perforation while dissecting the BB, and surgery was avoided.
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Abstract : Liver venous deprivation (LVD) is considered to be a safe and effective method that induces more rapid and important liver hypertrophy before major hepatectomy in comparison with portal vein embolization (PVE) alone. Bleeding complications after LVD or PVE are rare, but can be a life-threatening event. Herein, we report a case of perihepatic and extended subcapsular hematoma of the liver after LVD. Transarterial embolization was performed using gelfoam to control the hemorrhage; however, the patient developed irreversible liver failure and passed away after 38 days of treatment. In patients with LVD or PVE, severe post-procedural bleeding poses a substantial challenge for treatment. Arterial embolization should be carefully considered to avoid liver failure and even death, regardless of whether temporary embolization is used.
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Abstract : Duodenal stenting is an established alternative for the palliation of malignant gastric outlet obstruction (MGOO). Despite being relatively rare, stent migration remains an issue of concern. We present a case of duodenal stent displacement in a 71-year-old female with biliary and duodenal strictures secondary to pancreatic cancer. She presented with acute abdominal pain 10 days following the insertion of a 24-mm partially covered double-layer knitted device, which migrated to the ileocaecal junction. Since the priority was to minimise hospitalisation, we performed a laparotomy with extraction through an enterotomy combined with gastrojejunostomy to bypass the duodenum. The patient resumed oral intake on postoperative day 9 and tolerated a semi-solid diet for 3 months, until death. Despite continuous advances in enteral stent design, patient surveillance remains paramount. This report illustrates the complex decision-making around MGOO, addresses the management of stent migration, and highlights the role of surgery in simultaneously treating stent complications and palliating duodenal obstruction.
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Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Susumu Hijioka, Takamichi Kuwahara, Masahiro Tajika, Tsutomu Tanaka, Makoto Ishihara, Yutaka Hirayama, Sachiyo Onishi, and Yasumasa Niwa
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