Copyright â Springer-2014
Overview of the Robotic System
1: History of Robotic Surgery
Robots in Ancient History
History of Robotic Technology in Surgery
Robotics in Visceral Surgery
2: Introduction to the Robotic System
The da Vinci đ Surgical System: The Surgical Console
The da Vinci đ Surgical System: The Patient Cart
The da Vinci đ Surgical System: The Vision Cart
3: Overview of General Advantages, Limitations, and Strategies
Technical Advantages of Robotics
Limitations in Robotics: Technical and Clinical
Surgical Techniques: Esophagus
4: Robotic Assisted Minimally Invasive Esophagectomy
5: Robotic Assisted Operations for Gastroesophageal Reflux
Pre-operative Diagnostic Evaluations
Esophagogastroduodenoscopy
Dor (Anterior) Fundoplication
Partial Fundoplication (The Toupet Procedure)
Re-operative Robotic Procedures for Recurrent Gastroesophageal Reflux, Recurrent Hiatus Hernia, Incarcerated Hiatus Hernia and Esophageal Dysmotility
Outcomes of Robotic Assisted Operations for Gerd at Abbott Northwestern Hospital
Perioperative Considerations
Dissection of the Lower Third of the Esophagus and the Division of the Short Gastric Vessels
Creation of the Partial Fundoplication (Dor)
Pearls and Pitfalls of the Operative Technique
Surgical Techniques: Thoracic
7: Complete Port-Access Robotic-Assisted Lobectomy Utilizing Three-Arm Technique Without a Transthoracic Utility Incision
Hilar and Mediastinal Lymph Node Dissection
Dissection and Division of Hilar Structures
Extraction of the Specimen
Haptics Feedback and Retraction
8: Robotic Pulmonary Resection Using a Completely Portal Four-ưArm Technique
Definitions and Nomenclature of Robotic Thoracic Surgery
Operative Technique and Trocar Placement of CPRL-4
Robotic Positioning and Docking
Step-by-Step Operative Technique of a Robotic Right Upper Lobectomy
Robotic-Assisted Compared to Completely Portal
Surgical Techniques: Stomach
9: Gastric Cancer: Partial, Subtotal, and Total Gastrectomies/Lymph Node Dissection for Gastric Malignancies
Operating Room Configuration
Patient Positioning, Port Placement, Robot Docking, and Preparation of the Operative Field
Intraoperative Determination of the Resection Extent
Procedure of Robotic Distal Subtotal Gastrectomy and D2 LN Dissection
Five Major Steps and Associated Vascular Landmarks
Right Side Dissection and Duodenal Transection
Hepatoduodenal Ligament and Suprapancreatic Dissection
Approach to the Left Gastric Artery and the Splenic Vessels
Lesser Curvature Dissection and Proximal Resection
Procedure of D2 Lymphadenectomy During Total Gastrectomy
Spleen-Preserving Total Gastrectomy (Fig. 9.7)
Dissection of Splenic Vessels
Isolation of Diaphragmatic Crura
Lymphadenectomy Include LN #14v, #8a, #9, #11p, #11d, and #12a
Surgical Techniques: Bariatric
10: Robotic Roux-en-Y Gastric Bypass
Step 1: Creation of the Gastric Pouch
Step 2: Creation of the Gastrojejunal Anastomosis
Step Three: Creation of the Jejunojejunostomy
Advantages to Robotic-Assisted Roux-en-Y Gastric Bypass (RARYGB)
Limitations to Robotic Roux-en-Y Gastric Bypass
11: Robotic Sleeve Gastrectomy
Step-by-Step Review of the Critical Elements of the Robotic Sleeve Gastrectomy
12: Robotic Biliopancreatic Diversion: Robot-Assisted (Hybrid) Biliopancreatic Diversion with Duodenal Switch
General Overview of Current Applications
Discussion of Advantages, Limitations, and Relative Contraindications
Surgical Techniques: Hepatobiliary / Pancreas
13: Robotic Pancreaticoduodenectomy (Whipple Procedure)
Position, Equipment, and Trocar Placement
Step 1: Mobilization of the Right Colon and Pancreatic Head
Step 2: Division of the Gastrocolic Omentum, Proximal Duodenum, and Jejunum
Step 3: Docking the Robot
Step 4: Portal Dissection and Division of the Bile Duct
Step 5: Mobilization of the Portal Vein and Division of the Pancreatic Neck
Step 6: Division of the Retroperitoneal Margin
14: Robotic Distal Pancreatectomy
Procedure Overview (Fig. 14.1)
Pneumoperitoneum Technique
Step 1: Exposure of the Pancreatic Neck, Body, and Tail
Step 2: Mobilization of the Pancreas and Spleen and Identification of the Proximal Splenic Vessels
Step 3: Pancreatic and Vascular Transection
Step 4: Splenic-Preserving Distal Pancreatectomy
Medial to Lateral Approach
Lateral to Medial Approach
Step 5: Specimen Extraction
Published Outcome Studies to Date
15: Robotic Hepatic Resections: Segmentectomy, Lobectomy, Parenchymal Sparing
Indications for Robotic-Assisted Hepatectomy
Technique of Robotic-Assisted Hepatectomy
Patient Positioning, Room Setup
Left Lateral Sectionectomy
16: Robotic Right Colectomy: Four-ưArm Technique
Indications and Contraindications
Preoperative Assessment and Patient Preparation
Position, Port Placement, and Docking
Mobilization of Ascending Colon and Terminal Ileum
Vascular Control and Lymphadenectomy
Ileocolic Anastomosis and Specimen Extraction
Intracorporeal Anastomosis
Exploration and Wound Closure
17: Robotic Right Colectomy: Three-ưArm Technique
18: Robotic Left Colectomy
Port Placement and Robotic Position
Instrument Allocation to the Robotic Arms
19: Totally Robotic Low Anterior Resection
Patient Positioning for Totally Robotic LAR
Robot Positioning and Docking
Vascular Ligation and Sigmoid Colon to Splenic Flexure Mobilization
Rectal Division and Anastomosis
Potential Advantages of Totally Robotic LAR
Short-Term Outcomes of Safety and Feasibility
Preferable Indications and Relative Contraindications
20: Robotic Hybrid Low Anterior Resection
Laparoscopic-Assisted Abdominal Dissection
Robotic-Assisted Pelvic Dissection
21: Robotic-Assisted Extralevator Abdominoperineal Resection
Current Applications of Robotic Abdominoperineal Resection
Operative and Technical Steps (Hybrid Technique)
Laparoscopic Mobilization of Sigmoid Colon and Ligation of Vessels
Robotic Positioning and Docking
Robotic Setup and Instrument Selection
Total Mesorectal Excision
Extralevator Abdominoperineal Resection
Perineal Procedure and Stoma Creation
22: Robotic Single-Port Colorectal Surgery
Access Ports for Single-Port Surgery
Definitions and Terminologies
Laparoscopic Single-Port Colorectal Surgery Overview
Why Robotic Single-Port Surgery?
Robotic Single-Port Colorectal Surgery Overview
Robotic Single-Site Platform
Patient Position and Operating Theater Setting
Future Innovation for Robotic Single-Port Surgery
23: Robotic Transanal Surgery
Surgical Techniques: Endocrine
24: Robotic Thyroidectomy and Radical Neck Dissection Using a Gasless Transaxillary Approach
General Overview of Robotic Thyroidectomy
History and Development of Robotic Thyroidectomy
Indications and Contraindications for Robotic Thyroidectomy
Overview of the Procedure
Robotic Thyroidectomy Procedure
Robot Positioning and Docking
Step-by-Step Review of Critical Elements of the Robotic Thyroidectomy
Robotic Radical Neck Dissection Procedure
Robot Positioning and Docking
Step-by-Step Review of Critical Elements of the Robotic MRND
Review of Perioperative Outcomes
Oncologic Efficacy and Outcome
Operation Time and Surgical Learning Curve
Patient Perception and Satisfaction After Robotic Thyroidectomy
Robotic Modified Radical Neck Dissection Procedure
Limitations and Future Directions in Robotic Thyroidectomy
25: Robotic Adrenalectomy
Robotic Lateral Transabdominal Adrenalectomy
Robot Positioning and Docking
Hybrid Versus Totally Robotic Approach
Robotic Posterior Retroperitoneal Adrenalectomy
Hybrid Versus Totally Robotic Approach
Robot Positioning and Docking
Surgical Techniques: Solid Organ
26: Robot-Assisted Splenectomy
Indications to Minimally Invasive Splenectomy: When a ưRobot-ưAssisted Approach?
Essential Operating Room Equipment
Necessary Laparoscopic and Robotic Instruments
The Laparoscopic Operating Room
Inspection of the Peritoneal Cavity
Patient Positioning and Robot Docking
27: Robotic Donor Nephrectomy and Robotic Kidney Transplant
Minimally Invasive Robotic-ưAssisted Kidney Transplantation
Donor Selection and Preoperative Evaluation
Incision and Port Placement (Fig. 27.1)
Patient Preparation and Positioning
Identification of the Ureter (Fig. 27.3)
Mobilization of the Left Colon (Fig. 27.2)
Dissection Around the Upper Pole and Adrenal Gland
Identification of the Renal Vein
Transection of the Ureter and Posterior Mobilization
Division of the Hilar Vessels and Kidney Graft Extraction (Figs. 27.5 and 27.6)
Field Inspection and Closure
Identification of the Renal Artery
Graft Backbench Preparation
Backbench Preparation of the Graft
Patient Positioning and Port Placement (Fig. 27.8)
Graft Implantation and Reperfusion
Surgical Techniques: Hernias
28: Robot-Assisted Ventral and Incisional Hernia Repair
Robot Positioning and Docking
Critical Elements of the Procedure
Hybrid Versus Totally Robotic Approach
Discussion of Advantages, Limitations, and Relative Contraindications
Surgical Techniques: Pediatric
29: Pediatric Robotic Surgery
Specific Pediatric Procedures
Congenital Diaphragmatic Hernia: Bochdalek Hernia
Congenital Diaphragmatic Hernia: Morgagni Hernia
Esophageal Atresia with Tracheoesophageal Fistula
Surgical Techniques: Microsurgery
30: Robotic-Assisted Microsurgery for Male Infertility and Chronic Orchialgia
General Overview of Current Applications
Operative Setup and Patient Positioning
Robotic-Assisted Microsurgical Vasovasostomy
Robotic-Assisted Microsurgical Vasoepididymostomy
RAVV/RAVE Outcomes Review
Robotic-Assisted Microsurgical Varicocelectomy
Robotic-Assisted Microsurgical Testicular Sperm Extraction
Robotic-Assisted Targeted Denervation of Spermatic Cord
31: Developing a Curriculum for Residents and Fellows
Didactic and Skills Educational Methods
Didactic Educational Methods
Skills Educational Methods
Virtual Reality Skills Training
32: Challenges and Critical Elements of Setting Up a Robotics Program
The Right Leadership Structure
Consistent Communication Pathways
Operating Room Efficiency: Parallel Task Model
Step 1: Setting Up the Back Table (Fig. 32.6)
Parallel Task: Go Get the Patient Before the Back Table Is Set Up
Step 2: Patient Enters the OR (Fig. 32.7)
Parallel Task: Drape the Robot While the Patient Is Being Intubated
Step 3: Patent Draped (Fig. 32.8)
Parallel Task: Team Members Need to Anticipate the Surgeons Needs not React to Them
Step 4: Ports Placed (Fig. 32.9)
Parallel Task: Docking Should Be a Team Effort That Includes the Surgeon
Step 5: Surgeon off the Console (Fig. 32.10)
Parallel Task: While the Surgeon Closes the Patient the Robot Should Be Undraped and the Back Table Cleared
Step 6: Patient Exits the OR (Fig. 32.11)
Parallel Task: While the Patient Heads to Recovery the Scrub and Assist Complete the Room Cleanup and Begin to Open for the Next Case
A Continuous Improvement Cycle
Standardize an Operation and the Activities That Support It
Measure the Standardized Operation
Gauge Measurements Against Requirements
Innovate to Meet Requirements and Increase Productivity
Standardize the New, Improved Operations
33: Professional Education: Telementoring and Teleproctoring
Applications of Telementoring in General Surgery
Systems and Technical Requirements
Value and Limitations of Telementoring
Robotic Surgery and Telementoring
Conclusion and Future Perspective
34: Single-Incision Platform
The Single-Site Platform
Instruments and Accessories
Robotic Flexible Instruments
Discussion of Advantages, Limitations and Relative Contraindications
Robotic Single-Site Right Colectomy
Discussion of Advantages, Limitations and Relative Contraindications
How to Use TilePro System
Current Applications of TilePro System During Robotic Surgery
General Surgery Application
Cholangiography Fluorescence of Indocyanine Green
Discussion of Advantages, Limitations, and Relative Contraindications
Fluorescence for Near-Infrared Imaging During Colorectal Surgery
The Evaluation of Perfusion of the Intestinal Stumps
Discussion of Advantages, Limitations, and Relative Contraindications
Discussion of Advantages, Limitations, and Relative Contraindications
37: Robotics and Remote Surgery: Next Step
Robotics and Remote Surgery: Expanding Boundaries
38: The Future of Robotic Platforms
Direct Image-Guided Robots
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