Hernia surgery and robotics: A comparative study of laparoscopic and robotic repairs [Meeting Abstract]
Surgical innovation has been at the forefront of surgery over the last decade, fine tuning many surgical procedures. This innovation occurs with the desire to increase efficiency while decreased morbidity and mortality. Laparoscopic surgery has, with this refinement, become the mainstay for many operations including hernia repairs. This study looks to analyze the upcoming field of robotic surgery to its laparoscopic counterpart. With this analysis, novel contributions to the field can be added in regard to robotic hernia repair and its ability to change the way minimally invasive surgery is done. Analysis was done of eighty-eight patients with hernia surgery who underwent either laparoscopic or robotic hernia repairs between 2016 and 2018. Several outcome parameters were noted, which include the duration of the operation postoperative complications, length of hospital day, and readmission rate. The average OR time for the robotic group was approximately 151 min compared to 139 min for the laparoscopic group. Overall, the robotic surgery time became more efficient showing the possible initial learning curve physician have when transitioning to robotic repair and the gain in effectiveness they achieve with continued practice. The average length of stay for the robotic group was approximately 9 h, 55 min compared to 11 h, 52 min in the laparoscopic group. The difference in postoperative complications between the two groups were noted. In regard to hematomas, one laparoscopic patient complained of this while none experience this in the robotic group. For seroma complications, eight patients from the laparoscopic group were seen with this post-op compared to three patients in the robotic group. Of note, one patient experienced a surgical site infection from the robotic group while no one in the laparoscopic had this complication. For the patient experiencing an SSI, CT confirmed an abscess that was subsequently treated with antibiotics and resolved. Lastly, recurrences of hernia since surgery occurred in one patient, who was in the laparoscopic group. This retrospective study was conducted to assess if the new robotic hernia surgery could be equal if not better than the previously accepted gold standard of laparoscopic repair. Interpreting this data shows that robotic hernia repairs are a suitable alternative to laparoscopic repairs. Robotic repairs were superior went assessing the length of hospital stay and post-operative complications. Thus, if these are major concerns for patients, robotic repair can be considered as a valuable alternative to the laparoscopic methods
Congenital abdominal adhesions in a bariatric patient [Meeting Abstract]
Adhesions are fibrotic bands that form between and among abdominal organs. The most common cause of abdominal adhesions is previous surgery in the area as well as radiation, infection and frequently occurring with unknown etiology. These bands occur among abdominal organs, commonly the small bowel, and can lead to obstruction or remain asymptomatic, akin to the patient discussed here. Congenital abdominal adhesions are rare and have received little attention in research and field of study. The patient described in this case is a 25-year-old female with a past medical history of morbid obesity, BMI of 45, hypertension and no past abdominal surgical procedures. The patient presented in August 2017 for bariatric surgical consultation and was ultimately taken for an attempted laparoscopic sleeve gastrectomy. Upon entering the abdomen, significant adhesions were encountered and an additional attending was called to assist in identifying the stomach. The splenic flexure was found to be plastered to the diaphragm and the descending and transverse colon were adhered to the anterior surface of the stomach. Additionally, small bowel adhesions encased the area between the right and left hepatic lobes as well as the caudate lobe. After extensive enterolysis, the pylorus remained the only identifiable portion of the stomach. The patient also demonstrated significant hepatomegaly and a wedge resection was performed. The amount of adhesion and matting of the small and large bowel obscured the view of the stomach and the procedure was deemed too dangerous and terminated. This case represents the uncommon scenario in which an abdomen with no prior surgical history presents with extensive, obscuring adhesions. One such recent study describes the influence of cytokines and proinflammatory states as contributors to obstruction and malrotation in children, but this patient demonstrated no significant history. Further investigation is needed to determine potential etiologies of symptomatic and non-symptomatic congenital adhesions among bariatric patients who fail conservative treatment. Today the patient is doing well and the surgical team will attempt to complete the procedure in the coming months
Robotic hernia repair-a comparative analysis with its laparoscopic counterpart. a single surgeon's experience [Meeting Abstract]
Background: The foundation of innovation in surgery is driven by the inherent desire to yield an increasingly efficient surgical approached with decreased morbidity and mortality. The advancements of laparoscopy have made a tremendous impact in hernia surgery, and it has largely replaced open surgical repair. In this regard, a novel technical approach is being explored through the robotic platform. This study compares a single physician's experience with inguinal and ventral hernias, being repaired laparoscopically and robotically, with respect to duration of surgery, intraoperative costs, length of stay (LOS), and postoperative complications. Methods: A single center, single surgeon retrospective review was conducted sampling data from January 2017 to August 2017 examining ventral and inguinal hernia repairs. Results: Data was extrapolated from 13 inguinal hernia repairs, 6 were robotic (RIH) and 7 were laparoscopic (LIH). Average OR time for RIH was 127 minutes compared to LIH which was 85 minutes. Average intraoperative cost for RIH was $1,110 compared to LIH which was $890. Of note, one LIH was converted to open, whereas none of the RIH required conversion. Average LOS was 9.16 hours for RIH compared to 11.6 hours for LIH. Postoperative pain at one week follow up was the same between both groups. Two postoperative surgical site occurrences (SSO) occurred in the LIH group (2 groin seromas), whereas no SSOs occurred in the RIH group. Eleven ventral hernia repairs were examined, 7 were robotic (RVH) and 4 were laparoscopic (LVH). Average OR time for RVH was 132 minutes compared to 65 minutes for LVH. Average intraoperative cost for RVH was $1,492 compared to LVH which was $1,264. No procedure from either group required conversion to open. Average LOS was 9.86 hours for RVH, and 13.5 hours for LVH. Again, postoperative pain was the same at one week follow up for both groups. There were no postoperative complications noted in either cohort. Conclusion: Operative time and procedural costs for RVH and RIH repairs were shown to be longer and more expensive when compared to their laparoscopic counterparts. However, with increased operative experience using the robotic platform, surgical time did show a decreasing trend. Length of stay was similar between robotic and laparoscopic cohorts. Postoperative pain and complications were comparable between robotic and laparoscopic groups. In conclusion, we found that the robotic platform offers an acceptable approach to inguinal and ventral hernia repairs
Duplicate appendix with acute ruptured appendicitis: a case report
Duplication of the appendix is a rare congenital anomaly that, in adults, is most often found incidentally during surgery for other reasons. Appendicitis in the duplicated appendix is very rare and has been reported less than 10 times in the medical literature. We describe a 33-year-old woman with worsening periumbilical pain, nausea, vomiting, and fever. Physical examination showed localized peritonitis in the right lower quadrant. She had an elevated white blood cell count with neutrophilia. Computed tomography showed acute ruptured appendicitis. Diagnostic laparoscopy showed 2 appendices attached via separate bases to a single cecum with no other concurrent anomalies. Both appendices were removed laparoscopically. Histopathology confirmed normal appendiceal tissue in one and severe acute transmural appendicitis in the other. Awareness of appendiceal duplication and a thorough intraoperative inspection are critical to assess the presence of significant associated anomalies and avoid life-threatening complications.
Importance of the node of Calot in gallbladder neck dissection: an important landmark in the standardized approach to the laparoscopic cholecystectomy
The current rate of bile duct injury (BDI) after laparoscopic cholecystectomy is 0.4%, which is an unacceptable outcome. Several surgical approaches have been suggested to mitigate the occurrence of this dreaded complication. We propose a standardized approach, using Calot's node as a critical anatomical landmark to guide gallbladder dissection and avoid BDI. We retrospectively analyzed a prospectively gathered database of 907 laparoscopic cholecystectomies using this standardized approach in our practice over a 5-year period. To date we have had no BDI and no cystic duct leak. Therefore, we suggest identification of Calot's node as an additional method to avoid BDI during laparoscopic cholecystectomy.
Duodenal web associated with malrotation and review of literature
Intestinal obstruction due to midgut malrotation in neonates is well known. The incidence of malrotation in newborns is around 1:500 and the symptomatic incidence is 1:6000 births. Duodenal web as a cause of intestinal obstruction is less common and is reported to be 1:10 000-1:40 000. Malrotation is known to be associated with other congenital obstructive anomalies including duodenal atresia, stenosis and duodenal web. But, intestinal obstruction due to malrotation associated with duodenal web has been reported only rarely with a few published cases in our literature review. We present a case of intestinal obstruction diagnosed in the prenatal period via sonogram. A plain X-ray of the abdomen after birth showed a distended duodenum with paucity of air distally suggesting duodenal obstruction. An exploratory laparotomy showed a duodenal web proximal to the sphincter of oddi. The patient also had an associated malrotation and underwent Ladd's procedure and appendectomy. The post-operative period was uneventful.
Secondary Prophylaxis of Hepatic Encephalopathy in Cirrhosis: An Open Label, Randomized Controlled Trial of Lactulose, Probiotics and No-therapy [Meeting Abstract]
Microwave Ablation (MWA) of Colorectal Liver Metastases: A Single Institution Experience [Meeting Abstract]
Peptic Ulceration in the Puerperium: A Case Report [Meeting Abstract]
Primary Pure Squamous Cell Carcinoma of the Gallbladder with Local Invasion and Lymph Node Metastasis [Meeting Abstract]