This work was supported by grants from the Project of Guangdong Clinical Medical Research Center of Digestive Diseases (2020B1111170004), National Key Clinical Discipline, and the program of Guangdong Provincial Clinical Research Center for Digestive Diseases.

The operation is routine and has received ethical approval. The research content and methods meet the medical ethics norms and requirements. The Ethics Committee of the Six Affiliated Hospitals of Sun Yat-sen University approved this study. The patient provided written informed consent.
1. Patient selection
<ol>
	<li>Use the following inclusion criteria: benign duodenal tumors, including adenoma, stromal cell tumor, lipoma, fibroma, and hemangioma.</li>
	<li>Use the following exclusion criteria: malignant tumors of the duodenum, including adenocarcinoma, leiomyosarcoma, malignant lymphoma, carcinoid, etc. Additionally, patients with severe comorbidities such as heart disease and diabetes, coagulation disorders or predispositions to bleeding, severe systemic infections, or a poor overall health status that renders them unsuitable for surgery are excluded. Furthermore, patients who have personally declined the surgical procedure will also be excluded.</li>
</ol>
2. Preoperative preparation, operative position, and anesthesia
<ol>
	<li>Ask the patient to adhere to a low-fat, low-salt, and low-sugar diet the day before the surgical operation and to refrain from consuming food or water for at least 8 h prior to the surgery.</li>
	<li>Place the patient in a supine position with the head elevated and slightly tilted to the left.</li>
	<li>Administer general anesthesia using 1%-4% sevoflurane, cyclopofol (10 mg/mL), cisatracurium (2 mg/mL), and sufentanil (5 &#181;g/mL). Perform endotracheal intubation. Evaluate the anesthetic effect based on the patient&#39;s post-anesthesia and intraoperative conditions, including the presence of a complete anesthesia block, the absence of additional drugs during the procedure, and the stability of vital signs.</li>
</ol>
3. Surgical procedure
<ol>
	<li>Make a vertical incision 1 cm below the navel and insufflate carbon dioxide using a Veress needle into the abdominal cavity to create a pneumoperitoneum. This causes the abdomen to inflate, providing a larger and clearer surgical field, which facilitates the procedure. Then, insert a 10 mm trocar and introduce the laparoscope (the third arm of the robot) after establishing the pneumoperitoneum.</li>
	<li>Explorate the intraperitoneal organs to observe that there were no ascites (identified as fluid visible inside the abdomen) and there were no signs of tumor implantation or metastasis. If there are signs of tumor implantation or metastasis, nodules or lesions will be visible in areas outside the primary tumor site on the camera.</li>
	<li>Place the other three trocars in the following positions: a 10 mm trocar in the right anterior axillary line level (the first arm of the robot), a 10 mm trocar in the medial to the intersection of the umbilical level and the midclavicular line (the second arm of the robot), a 10 mm trocar in the 5 cm above the umbilicus, at the left midclavicular line (the fourth arm of the robot). Additionally, prepare two 12 mm auxiliary ports located on the vertical line at the midpoint between trocars numbered 2 and 3 and medial to the left midclavicular line (see Figure 4).</li>
	<li>Connect to the robot operating lever and perform the laparoscopic operation with the robot&#39;s assistance (see Figure 5).</li>
	<li>Mobilize the descending and horizontal parts of the duodenum through a Kocher incision.</li>
	<li>Use an ultrasonic knife to dissect the descending part of the duodenum of about 8 cm (see Figure 6) and identify the duodenal papillary mass.</li>
	<li>Use an ultrasonic knife to incise the duodenal fold and muscle layer with a cut depth of 3-5 mm around the tumor. Fully excise the tumor and freeze the specimens immediately to examine. The results revealed no malignant evidence in the duodenal papillary adenoma.</li>
	<li>Use a 4-0 absorbable line to anastomose discontinuously the incised duodenal fold, muscle layer, and the stump of the confluent part of the biliary pancreatic duct.</li>
	<li>Place the stent tube to support them (see Figure 7). Use 4-0 priline to suture and place the stent into the distal part of the duodenum (see Figure 8). 
	NOTE: The diameter and length of the stent tube were 2.67 mm and 10 cm, respectively. (see Table of Materials).</li>
	<li>Suture intermittently the mucosal layer of the duodenal incision and the plasma muscle layer to bury the wound using 3-0 putis (see Figure 9).</li>
	<li>Rinse the abdominal cavity with saline to check for any bleeding points and place a drain at Winslow foramena and para duodenum, respectively. Finally, use 4-0 silk to suture the incision, and the operation is concluded.</li>
</ol>
4. Postoperative nursing and monitoring
<ol>
	<li>Perform ECG monitoring and administer low-flow oxygen post-operation.</li>
	<li>Encourage the patient to consume a semi-liquid diet and engage in bed exercises on the 1st day after surgery.</li>
	<li>Administer anti-inflammatory, hemostatic, analgesic, albumin, and acid suppression treatments.</li>
	<li>Monitor changes in amylase and bilirubin levels in the drainage tube on the 1st, 2nd, 3rd, 5th, 7th, and 9th day post-operation. 
	NOTE: It is crucial to maintain the patency of the drainage tube and to ensure the early recovery of gastrointestinal function.</li>
</ol>

<ol>
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The authors have no conflicts of interest or financial ties to disclose.

Duodenal benign tumors are infrequent in clinical practice, yet they can lead to severe complications1,15,16. The choice of treatment depends on factors such as the size, location, and tissue type of the lesion. Given the relatively fixed position of the duodenum, which is often situated posterior to the peritoneum and closely associated with the head of the pancreas and the ampulla of the bile pancreatic duct, intraoperative bl...

Duodenal tumors are relatively rare, exhibiting a low incidence, and can be classified as benign or malignant. Primary duodenal tumors (PTD) are the most common, while secondary tumors are less frequent1,2. Common benign tumors in the duodenum include adenoma, stromal cell tumor, lipoma, fibroma, and hemangioma, with adenoma being the most prevalent and possessing the potential for malignant transformation3,4,5. The disease typically presents insidiously, with early stages often being asymptomatic or displaying non-specific symptoms such as upper abdominal fullness, dull pain, and discomfort. As the disease progresses, symptoms may include anemia, jaundice, gastrointestinal bleeding, fever, abdominal mass, and intestinal obstruction, thus posing a significant threat to public health6. Surgical resection remains the preferred treatment for benign neoplasms in the duodenum7.
The generalized pancreaticobiliary junction encompasses the pancreatic head, the duodenal wall segment of the common bile duct, the pancreatic segment, the descending part of the duodenum, and the surrounding tissue of the pancreatic head. More specifically, it is defined as the point where the common bile duct terminates, the main pancreatic duct opens, and the area between the duodenal papilla anatomically referred to as the ampulla of Vater or the papilla8. Tumors at this junction can obstruct the outflow of fluids, leading to increased pressure within the ducts, dilation, stasis, and stone formation. Additionally, these tumors can disrupt fluid flow, leading to reflux, inflammation, and further tumor growth9,10. In recent years, laparoscopic biliary and pancreatic surgeries have gained popularity and success due to advancements in minimally invasive techniques. Traditional treatment methods for benign tumors of the duodenal papilla include endoscopic resection, local transduodenal resection, and pancreaticoduodenectomy11,12.
Although laparoscopy has been widely adopted in surgical practice, there have been few reports on the resection of benign duodenal tumors, particularly those involving the duodenal papilla11,13,14. In this study, an innovative treatment method was employed, involving robot-assisted pancreaticobiliary junction resection and duodenal anastomosis following biliary stent implantation. The overall goal of this approach is to restore bile duct patency while excising the tumor, preserving digestive system function, and minimizing the risk of complications. The rationale for this approach lies in its capacity to merge the precision of robotic surgery with the advantages of minimally invasive techniques. This method provides enhanced visualization, increased dexterity, and improved control during complex dissections, especially in delicate anatomical regions such as the pancreaticobiliary junction. By integrating an advanced robotic system, this approach not only facilitates lesion removal but also restores bile duct patency, preserves digestive system functionality, and minimizes complications such as bile leakage, pancreatic leakage, bleeding, and infection, ultimately demonstrating positive clinical outcomes.
CASE PRESENTATION: 
This study presents a 66-year-old female patient who was admitted to the hospital due to abdominal pain persisting for over a month. A CT scan revealed a 13 mm x 13 mm mass in the duodenal papillary area, characterized by a distinct boundary (see Figure 1). Preoperative gastroscopy indicated an enlarged duodenal papilla with surface congestion and erosion (see Figure 2A-B). Additionally, ultrasound gastroscopy demonstrated an occupied duodenal papilla measuring approximately 19.1 mm x 15.4 mm, extending to the end of the main pancreatic duct (see Figure 2C-D). Pathological analysis using Hematoxylin and Eosin (HE) staining confirmed the presence of a duodenal papillary villous tubular adenoma (see Figure 3). The patient had no significant medical history, and her physical examination findings and laboratory results were unremarkable.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Abdominal instrument button</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Abdominal instrument cap</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Abdominal instrument collar</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Abdominal instrument connector</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Barbs</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Blade</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Blood pad</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Cloth towel forceps</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Da Vinci robot (IV)</td>
			<td>Intuitive Surgical, USA</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Disposable drainage tube</td>
			<td>Johnson &#38; Johnson</td>
			<td>412280</td>
			<td>10 cm x 2.67 mm</td>
		</tr>
		<tr>
			<td>Electric knife head</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Forceps</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Hilt</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Holding flask</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Intestinal forceps</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Laparoscope</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Laparoscopic instruments</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Long curved forceps</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Medium curved forceps</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Needle holders</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Ovoid forceps</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Paraffin oil</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Purse string forceps</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Right angled forceps</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Right angled forceps</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Scissors</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Siphonhead</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Small cup</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Small curved forceps</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Sonotome keyhole</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Steel ruler</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Straight forceps</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Suction needle plate</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Suture needle</td>
			<td>Johnson &#38; Johnson</td>
			<td>Vcp397H</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Syringe</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Syringe needle</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Tissue forceps</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Trocar(XCEL)</td>
			<td>Ethicon Endo-Surgery</td>
			<td>695C71</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Ultrasonic knife spacers</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Ultrasound knife</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
		<tr>
			<td>Yarn ball</td>
			<td>Johnson &#38; Johnson</td>
			<td>/</td>
			<td>/</td>
		</tr>
	</tbody>
</table>

application of robot-assisted pancreaticobiliary junction resection in benign duodenal tumors

Robot-assisted pancreaticobiliary junction resection is a surgical technique employed to treat benign duodenal tumors. The procedure involves several key steps: making a longitudinal incision in the duodenum, excising the tumor at the pancreaticobiliary junction, inserting a biliary stent, connecting the biliary and duodenal mucosa, and suturing the duodenal incision during phase I. The robotic system enhances visibility, facilitates precise operations, minimizes duodenal traction injuries to the duodenum and surgical trauma, ensures accurate suture and fixation of bile duct stents, connects the bile duct and duodenal mucosa and reduces postoperative recovery time. Given the complexity of the operation and the associated risk of postoperative duodenal fistula, a thorough preoperative evaluation and meticulous perioperative preparation are crucial. Prior to the procedure, a comprehensive assessment was conducted, integrating the patient's medical history, family history, serological tests, and imaging studies. Special emphasis was placed on determining the benign or malignant nature of the tumor and evaluating the status of the duodenal artery blood supply network to ascertain the feasibility and efficacy of the surgery. During the operation, efforts were made to minimize duodenal trauma and avoid compromising the duodenal artery blood supply network. Additionally, the use of bile duct stents was considered essential to prevent biliary strictures, facilitate bile discharge, and mitigate biliary complications. Postoperatively, real-time monitoring of amylase and jaundice indicators in drainage fluid informed the timely removal of drainage tubes in accordance with the enhanced recovery after surgery (ERAS) protocol. Subsequent follow-up indicated a successful recovery, characterized by a notable reduction in preoperative abdominal pain, the absence of long-term complications, and no evidence of tumor recurrence. Consequently, robot-assisted pancreaticobiliary junction resection demonstrates a safe and effective surgical approach for the treatment of benign duodenal tumors.

On January 14, 2024, a robot-assisted pancreaticobiliary junction resection was performed at the hospital, followed by biliary stent implantation and anastomosis of the bile duct and duodenum. Postoperative pathology results were consistent with the preoperative findings from other hospitals. Postoperative drainage amylase and bilirubin levels showed a significant decrease (see Table 1), and the patient experienced a smooth recovery following surgery. We have conducted follow-ups for over 6 months post-s...

The current protocol delineates the use of robot-assisted pancreaticobiliary junction resection for the surgical management of benign duodenal tumors. This approach provides an effective solution for treating these tumors while minimizing duodenal loss and reducing associated complications.

Application of Robot-assisted Pancreaticobiliary Junction Resection in Benign Duodenal Tumors

Robot-assisted pancreaticobiliary junction resection is a surgical technique employed to treat benign duodenal tumors. The procedure involves several key ...

application-robot-assisted-pancreaticobiliary-junction-resection

Research

JoVE Journal

Medicine

212 Views.  Sun Yat-sen University. The current protocol delineates the use of robot-assisted pancreaticobiliary junction resection for the surgical management of benign duodenal tumors. This approach provides an effective solution for treating these tumors while minimizing duodenal loss and reducing associated complications.

Video: Application of Robot-assisted Pancreaticobiliary Junction Resection in Benign Duodenal Tumors

A Protocol for Genetic Induction and Visualization of Benign and Invasive Tumors in Cephalic Complexes of Drosophila melanogaster

Drosophila has illuminated our understanding of the genetic basis of normal development and disease for the past several decades and today it continues to contribute immensely to our understanding of complex diseases 1-7. Progression of tumors from a benign to a metastatic state is a complex event 8 and has been modeled in Drosophila to help us better understand the genetic basis of this disease 9. Here I present a simple protocol to genetically induce, observe and then analyze the progression of tumors in Drosophila larvae. The tumor induction technique is based on the MARCM system 10 and exploits the cooperation between an activated oncogene, RasV12 and loss of cell polarity genes (scribbled, discs large and lethal giant larvae) to generate invasive tumors 9. I demonstrate how these tumors can be visualized in the intact larvae and then how these can be dissected out for further analysis. The simplified protocol presented here should make it possible for this technique to be utilized by investigators interested in understanding the role of a gene in tumor invasion.

A Protocol for Genetic Induction and Visualization of Benign and Invasive Tumors in Cephalic Complexes of Drosophila melanogaster

Cooperation between an activated oncogene like RASV12 and mutations in cell polarity genes like scribbled, result in tumor growth in Drosophila where tumor cells also display invasive behaviors. Here a simple protocol for the induction and observation of the benign and invasive tumors is presented.

Drosophila has illuminated our  understanding of the genetic basis of normal development and disease for the  past several decades and today it continues ...

Technical Detail for Robot Assisted Pancreaticoduodenectomy

Since its first report in 2003, robotic pancreaticoduodenectomy (RPD) has gained popularity among pancreatic surgeons. Inherent advantages of the robotic platform, including three-dimensional vision, wristed instruments, and improved ergonomics, allow the surgeon to recapitulate the principles of open pancreatoduodenectomy allowing safe oncologic dissection, hemostasis, and meticulous reconstruction. Over the course of the past decade, significant strides have been achieved in outlining the safety, feasibility, and learning curve of the robotic Whipple. When performed by high volume pancreatic surgeons experienced in RPD, recent comparative effectiveness studies show potential advantages compared to the open technique, including reductions in hospital stay and morbidity. National data also show reductions in conversion rates compared to its laparoscopic counterpart. Although long-term oncologic data are still needed, short-term oncologic surrogates of margin resection and lymph node harvest suggest no compromise in oncologic outcomes. As pancreatic surgeons increasingly integrate robotics into their practice, proficiency-based training and credentialing will be necessary for the safe application and dissemination of RPD. Here, we provide the detailed steps of a robotic pancreaticoduodenectomy performed at the University of Pittsburgh Medical Center.&#160;

The following manuscript details a stepwise approach to the robot-assisted pancreaticoduodenectomy performed at the University of Pittsburgh Medical Center.

Since its first report in 2003, robotic pancreaticoduodenectomy (RPD) has gained popularity among pancreatic surgeons. Inherent advantages of the robotic ...

Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction

This article shows the technique of robot-assisted radical antegrade modular pancreatosplenectomy, including resection and reconstruction of the spleno-mesenteric junction, for cancer of the body-tail of the pancreas. The patient is placed supine with the legs parted and a pneumoperitoneum is established and maintained at 10 mmHg. To use the surgical system, four 8 mm ports and one 12 mm port are required. The optic port is placed at the umbilicus. The other ports are placed, on either side, along the pararectal line and the anterior axillary line at the level of the umbilical line. The assistant port (12 mm) is placed along the right pararectal line. Dissection begins by detaching the gastrocolic ligament, thus opening the lesser sac, and by a wide mobilization of the splenic flexure of the colon. The superior mesenteric vein is identified along the inferior border of the pancreas. Lymph node number 8a is removed to permit clear visualization of the common hepatic artery. A tunnel is then created behind the neck of the pancreas. To permit safe resection and reconstruction of the spleno-mesenteric junction, further preemptive dissection is required before dividing the pancreatic neck to bring in clear view all relevant vascular pedicles. Next, the splenic artery is ligated and divided, and the pancreatic neck is divided, with selective ligature of the pancreatic duct. After vein resection and reconstruction, dissection proceeds to complete the clearance of peripancreatic arteries that are peeled off from all lympho-neural tissues. Both celiac ganglia are removed en-bloc with the specimen. The Gerota fascia covering the upper pole of the left kidney is also removed en-bloc with the specimen. Division of short gastric vessels and splenectomy complete the procedure. A drain is left near the pancreatic stump. The round ligament of the liver is mobilized to protect the vessels.

The robotic technique shown herein aims at faithfully reproducing the open procedure for radical treatment of cancer of the body-tail of the pancreas. The protocol also demonstrates the ability to master involvement of major peripancreatic vessels without conversion to open surgery.

This article shows the technique of robot-assisted radical antegrade modular pancreatosplenectomy, including resection and reconstruction of the ...

On-Site Sampling and Extraction of Brain Tumors for Metabolomics and Lipidomics Analysis

Despite the variety of tools available for cancer diagnosis and classification, methods that enable fast and simple characterization of tumors are still in need. In recent years, mass spectrometry has become a method of choice for untargeted profiling of discriminatory compound as potential biomarkers of a disease. Biofluids are generally considered as preferable matrices given their accessibility and easier sample processing while direct tissue profiling provides more selective information about a given cancer. Preparation of tissues for the analysis via traditional methods is much more complex and time-consuming, and, therefore, not suitable for fast on-site analysis. The current work presents a protocol combining sample preparation and extraction of small molecules on-site, immediately after tumor resection. The sampling device, which is of the size of an acupuncture needle, can be inserted directly into the tissue and then transported to the nearby laboratory for instrumental analysis. The results of metabolomics and lipidomics analyses demonstrate the capability of the approach for the establishment of phenotypes of tumors related to the histological origin of the tumor, malignancy, and genetic mutations, as well as for the selection of discriminating compounds or potential biomarkers. The non-destructive nature of the technique permits subsequent performance of routinely used tests e.g., histological tests, on the same samples used for SPME analysis, thus enabling attainment of more comprehensive information to support personalized diagnostics.

The manuscript presents on-site sampling of human brain tumors with solid phase microextraction followed by their biochemical profiling towards the discovery of biomarkers.

Despite the variety of tools available for cancer diagnosis and classification, methods that enable fast and simple characterization of tumors are still ...

Robot-Assisted Kidney Transplantation

This paper describes robot-assisted kidney transplantation (RAKT) from a living donor. The robot is docked between the parted legs of the patient, placed in the supine Trendelenburg position. Kidney allografts are provided by a living donor. Before vascular anastomosis, the kidney allograft is prepared by inserting a double-J stent in the ureter, and the temperature for the anastomosis is lowered by wrapping it in an ice-packed gauze. A 12 mm or 8 mm port for the robotic camera and three 8 mm ports for robotic arms are placed. A peritoneal pouch is created for the kidney allograft by raising the peritoneal flaps on both sides over the psoas muscle before dissecting the iliac vessels and bladder. A 6 cm Pfannenstiel incision is made to insert the kidney into the peritoneal pouch, lateral to the right iliac vessels. 
After clamping the external iliac vein with Bulldogs clamps, a venotomy is performed, and the graft renal vein is anastomosed to the external iliac vein in an end-to-side continuous manner with a 6/0 polytetrafluoroethylene suture. After clamping the graft renal vein, the iliac vein is declamped. This is followed by clamping of the external iliac artery, arteriotomy, arterial anastomosis with a 6/0 polytetrafluoroethylene suture, clamping of the graft renal artery, and declamping of the external iliac artery. Reperfusion is then carried out, and ureteroneocystostomy is performed using the Lich-Gregoir technique. The peritoneum is closed at a few locations with polymer locking clips, and a closed-suction drain is placed through one of the working ports. After deflating the pneumoperitoneum, all incisions are closed.

This paper provides technical details for robot-assisted kidney transplantation from a living donor.

This paper describes robot-assisted kidney transplantation (RAKT) from a living donor. The robot is docked between the parted legs of the patient, placed ...

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex procedures. The high-quality 3-D visual, multijoint arm and natural tremor filtration allow the surgeon to expose and dissect more accurately with minimal invasion. Total mesorectal excision is the standard surgical technique for the treatment of resectable rectal cancer. To reduce the lateral recurrence rate, lateral pelvic lymph node dissection can be performed, as it is a safe and feasible procedure for locally advanced middle-low rectal cancer with a high possibility of metastasis to the lateral lymph nodes. However, the complexity of the anatomic structures and the high postoperative complication rate limit its application. Recently, several surgeons have increasingly used robotic techniques for total mesorectal excision and lateral pelvic lymph node dissection. Compared with open and laparoscopic surgery, the robotic technique has several advantages, such as less blood loss, fewer blood transfusions, minimal trauma, shorter postoperative hospitalization, and quicker recovery. A robotic approach is generally regarded as a reasonable alternative for complicated procedures such as lateral pelvic lymph node dissection, although there are a limited number of high-quality prospective randomized controlled studies reporting direct evidence. Here, we provide the detailed steps of robot-assisted total mesorectal excision and lateral pelvic lymph node dissection performed at the First Affiliated Hospital of Xi&#39;an Jiaotong University.

The robotic technique described herein aims to detail a stepwise approach to robot-assisted total mesorectal excision and lateral pelvic lymph node dissection for locally advanced (T3/T4) rectal cancer located below the peritoneal reflection.

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex ...

Retzius-Sparing Robot-Assisted Radical Prostatectomy

The technique of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and initial experience with it at a single center are provided. The technique is described step-by-step and further illustrated by a video to enhance reproducibility. Early oncological and functional results were evaluated. In total, 77 patients were included with a median follow-up of 11 months (range: 3-21 months). Fifty-one percent of patients had local high-risk or locally advanced prostate cancer. There were no intra-operative complications, and all high-grade complications (2.6%) were related to pelvic lymph node dissection performed concomitant with RS-RARP. Median operation time was 160 min (range: 122-265 min) and median hospital stay was 3 (range: 3-8) days. A positive surgical margin was reported in 42.9%. One-year biochemical recurrence-free survival was 90.1%. After 6 months, all patients were socially continent and after 1 year, 94.3% were fully continent. Of sexually active patients who underwent at least unilateral nerve-sparing, 43.3% were able to have sexual intercourse. This series underlines the surgical safety of performing RS-RARP by a standardized technique and confirms the beneficial effect on the early return of continence. The patient needs to be informed about the risk of a positive surgical margin.

Robot-assisted Retzius-sparing radical prostatectomy is a technique that enables to preserve urinary continence or facilitates recovery of urinary continence in the majority of patients. Patients must be informed about the risk of a positive surgical margin.

The technique of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and initial experience with it at a single center are provided. The ...

Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture

Cannulated screw fixation is the main therapy for femoral neck fractures, especially in young patients. The traditional surgical procedure uses C-arm fluoroscopy to place the screw freehand and requires several guide wire adjustments, which increases the operation time and radiation exposure. Repeated drilling can also cause damage to the blood supply and bone quality of the femoral neck, which can be followed by complications such as screw loosening, nonunion, and femoral head necrosis. In order to make fixation more precise and reduce the incidence of complications, our team applied robot-assisted orthopedic surgery for screw placement using the femoral neck system to modify the traditional procedure. This protocol introduces how to import a patient's X-ray information into the system, how to perform screw path planning in software, and how the robotic arm assists in screw placement. Using this method, the surgeons can place the screw successfully the first time, improve the accuracy of the procedure, and avoid radiation exposure. The whole protocol includes the diagnosis of femoral neck fracture; the collection of intraoperative X-ray images; screw path planning in the software; precise placement of the screw under the assistance of the robotic arm by the surgeon; and verification of the implant placement.

This article introduces a method of robot-assisted orthopedic surgery for screw placement during the treatment of femoral neck fracture using the femoral neck system, which allows for more accurate screw placement, improved surgical efficiency, and fewer complications.

Cannulated screw fixation is the main therapy for femoral neck fractures, especially in young patients. The traditional surgical procedure uses C-arm ...

Robotic D3 Partial Duodenal Resection with Primary Side-to-Side Anastomosis

Duodenal stenosis is a condition that can be related to several diseases, being either intrinsic, such as neoplasm and inflammatory stenosis, or extrinsic, such as pancreatic pseudocyst, superior mesenteric artery syndrome, and foreign bodies. Current treatments range from endoscopic approaches, such as endoscopic resection and stent placement, to surgical approaches, including duodenal resection, pancreaticoduodenectomy, and gastrointestinal bypass. Minimally invasive robot-assisted surgery is gaining importance due to its potential to decrease surgical stress, intraoperative blood loss, and postoperative pain, while its instruments and 3D-vision facilitate fine dissection and intra-abdominal suturing, all leading to a reduced time to functional recovery and shorter hospital stay. We present a case of a 75-year-old female who underwent robotic D3 partial duodenal resection with primary side-to-side duodeno-jejunal anastomosis for a 5 cm adenoma with focal high-grade dysplasia.

This protocol presents a case of a robotic partial duodenal resection with primary side-to-side duodeno-jejunal reconstruction in a patient with a 5 cm duodenal stenosis. This is done at the third duodenal segment (D3) after an endoscopic mucosal resection (EMR) for a duodenal polyp.

Duodenal stenosis is a condition that can be related to several diseases, being either intrinsic, such as neoplasm and inflammatory stenosis, or ...

Robot-Assisted Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma

Congenital cholesteatoma accounts for 25% of cholesteatoma cases in children. Transcanal Endoscopic Ear Surgery (TEES) is ideal for these patients because it offers a wide endoscopic view of the middle ear and a minimally invasive approach. The two main limitations are the loss of one operative hand and a narrow external auditory canal in younger children. Here, we present the case of a 3-year-old patient with a Potsic stage III congenital cholesteatoma adherent to the incus and branches of the stapes. A robotic-assisted TEES procedure was performed, during which a robotic arm with 6 degrees of freedom held a 0&#176;, 2.9 mm wide endoscope, enabling the surgeon to work in a narrow environment with both hands. The procedure's duration was 2 h and 9 min, including 16 min for the installation and draping of the robotic arm. After a trans-canal approach, the cholesteatoma was dissected from the ossicles using both a needle (or sickle knife) and suction to stabilize the ossicles and limit the risk of hearing trauma. The cholesteatoma was debulked to reduce its size, allowing it to be pushed under the malleus anteriorly and then separated from other adherences before removal. A tragal cartilage graft was used to reinforce the tympanic membrane.

This protocol describes the removal of congenital cholesteatoma using minimally invasive transcanal endoscopic ear surgery with a two-handed approach and a robotic endoscope holder.

Congenital cholesteatoma accounts for 25% of cholesteatoma cases in children. Transcanal Endoscopic Ear Surgery (TEES) is ideal for these patients because ...