Name: Robotics in Surgery: A Modular Robotic Platform Driven Gastric Wedge Resection (Video) | JoVE Journal
Uploaded: 2025-02-07T12:10:00.000+00:00
Duration: 7 min 27 s
Description: Learn robotic-assisted gastric wedge resection using a modular robotic platform for minimally invasive upper gastrointestinal surgery. This method demonstrates enhanced precision and improved patient recovery outcomes.

ai_agent_IP

ai_agent

maintenance

instantTrialDurationMinutes

isBiopharma

enableNewMyJoveSectionDesign

educationFeatures

seoMetaApi

ai_copilot_institution_blacklist

ai_chat_institution_blacklist

freeAccessWindow

ssoRoleCapture

scheduledMaintenanceBanner

joveLabsFeatures

disable_autoplay_for_bots

extended_trial_duration

5 minutes

The authors gratefully appreciate the ongoing support of our robotic team of nurses Daniela Salber, UIrike Butz, Claudia Hagemann and Beate Gatner-Pytlasinski. Prof. A. Tannapfel and the Institute of Pathology, Ruhr-University, Bochum, Germany provided the histological figures. Furthermore, we thank Mr. Kiril Belyaev for his skillful support on video editing.
The work was not funded.
The research was performed in compliance with institutional guidelines and in accordance to the Declaration of Helsinki.

All steps presented in the surgical method follow the guidelines of the ethics committee of the Ruhr-University Bochum, Germany. The study was approved by the local ethics committee (No.23-7872-BR). Informed consent was obtained from the patient for the presentation of the data and video material.
1. Patient positioning and surgical setting
<ol>
	<li>Patient positioning
	<ol>
		<li>Situate the patient in supine position, anti-Trendelenburg 30&#176; and slightly rolled to the right (10-15&#176;).</li>
		<li>Do not split the legs and position the abdomen at a height of &#62;70 cm above ground by adjusting the operating table.</li>
		<li>Arrange the robotic arms in a &#34;butterfly&#34;-setup with two arm carts on both sides of the patient (Figure 1).</li>
	</ol>
	</li>
	<li>Cutaneous incisions and mini-laparotomy
	<ol>
		<li>Disinfect the skin by using swabs and antiseptics and place self-adhesive sterile covers.</li>
		<li>Incise the skin (1-2 cm) and fascia supraumbilically by using a scalpel and scissors.</li>
		<li>Push the first robotic trocar (11 mm) through the incision. Connect it to a CO2 insufflator.</li>
		<li>Set the insufflator to a pressure of 12 mm Hg. Wait until the favored pressure is reached and control the display.</li>
		<li>Make additional incisions (1 cm) and pierce the abdominal wall with the other trocars by turning and applying constant pressure.</li>
	</ol>
	</li>
	<li>Positioning the trocars 
	NOTE: The optimal positions are shown in Figure 2.
	<ol>
		<li>Insert the surgeon&#39;s left hand-trocar in the right upper abdomen (width 8 mm).</li>
		<li>Position the third trocar (surgeon&#39;s right hand, width 11 mm) in the left upper abdomen and the last robotic trocar for the 4th arm (width 8 mm) laterally in the left upper abdomen.</li>
		<li>Ensure a distance of at least 9 cm between all robotic trocars.</li>
		<li>Place an additional laparoscopic trocar between the endoscope and right-hand port on a more caudal level. For the setup, see Figure 2.</li>
	</ol>
	</li>
	<li>Adjusting of robotic arms
	<ol>
		<li>After a short laparoscopic exploration and the insertion of a gauze swab with a grasping instrument, connect robotic arms to the trocars.</li>
		<li>Adjust arm cart 1 (left side, cranial, surgeon right hand) to a tilt angle of -30&#176; and a docking angle of 40&#176;.</li>
		<li>Set up arm cart 2 (left side, caudal, 4th arm) to a tilt angle of 0&#176; and a docking angle of 110&#176;.</li>
		<li>Align arm cart 3 (right side, caudal, surgeon left hand) to a tilt angle of 0&#176; and a docking angle of 290&#176;.</li>
		<li>Set up arm cart 4 (right side, cranial, endoscope arm) to a tilt angle of -30&#176; and a docking angle of 330&#176;. 
		NOTE: Always control the displays of the arm carts to ensure an optimal setup.</li>
	</ol>
	</li>
	<li>Insertion of the instruments
	<ol>
		<li>Insert the camera into arm cart 4 and use a straight-forward optic (0&#176;), which is indicated by the label.</li>
		<li>Equip the surgeon&#39;s left hand with a bipolar grasper, the surgeon&#39;s right hand with monopolar curved shears, and the 4th arm with a cadiere grasper.</li>
		<li>Insert all instruments strictly under visual control. Set up bipolar energy to 50 watts (standard setup).</li>
		<li>Furthermore, set monopolar energy to 30 watts (blend cut) for cutting and 30 watts (fulguration) for coagulation by adjusting the controls of the electrosurgical generator.</li>
	</ol>
	</li>
</ol>
2. Surgical procedure
<ol>
	<li>Incision of the gastrocolic ligament
	<ol>
		<li>At the beginning of the robotic part of the procedure, grasp and elevate the stomach with the 4th arm and incise the gastrocolic ligament using the bipolar grasper and the monopolar shears in combination with a vessel sealing device.</li>
	</ol>
	</li>
	<li>Dissection of the short gastric vessels
	<ol>
		<li>Insert the sealing device via the additional trocar, which is managed manually by the bedside assistant.</li>
		<li>Cut the gastroepiploic ligament from 3 cm below up to 3 cm above the tumor after coagulation by using the controls of the instrument.</li>
		<li>Use the sealing device to coagulate and dissect all short gastric vessels. For additional coagulation, use the bipolar grasper.</li>
	</ol>
	</li>
	<li>Stapling of the tumor
	<ol>
		<li>Identify the tumor by its shape and superficial appearance compared to normal gastric tissue. Resect the tumor using a laparoscopic stapler (30 mm and 45 mm cartridges).</li>
		<li>Take only small steps and pull the tissue tightly to save as much gastric tissue as possible. The result is a lateral wedge resection of the corpus and fundus of the stomach. After the extirpation, place the specimen on the liver temporarily.</li>
	</ol>
	</li>
	<li>Augmentation of the staple line
	<ol>
		<li>Ask the anesthesiologists to replace the gastric tube below the lesion manually. The tube can be localized visually in the stomach.</li>
		<li>Augment the staple line by single knots. Use absorbable sutures. Cut off surplus sutures laparoscopically and remove the needles fixed to the sutures.</li>
	</ol>
	</li>
	<li>Removal of the specimen and end of surgery.
	<ol>
		<li>Disconnect and remove the robotic arm carts.</li>
		<li>Insert a silicone drain laparoscopically, place it next to the lesion, and fix it to the skin with a suture.</li>
		<li>Remove the tumor using a retrieval bag via a mini laparotomy at the endoscope position.</li>
		<li>Finally, close the fascia with absorbable sutures and the wounds using non-absorbable sutures. Patch up the wounds using plasters.</li>
	</ol>
	</li>
</ol>

<ol><li>Goh, E. Z., Ali, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robotic+surgery%3A+An+evolution+in+practice%5BTitle%5D)+AND+%22J+Surg+Protoc+Res+Methodol%22%5BJournal%5D)">Robotic surgery: An evolution in practice.</a> J Surg Protoc Res Methodol. 2022 (1), snac003(2022).</li>
<li>Prata, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((State+of+the+art+in+robotic+surgery+with+HUGO+RAS+system%3A+feasibility%2C+safety+and+clinical+applications%5BTitle%5D)+AND+%22J+Pers+Med%22%5BJournal%5D)">State of the art in robotic surgery with HUGO RAS system: feasibility, safety and clinical applications.</a> J Pers Med. 13 (8), 1233(2023).</li>
<li>Paciotti, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Nerve-sparing+robot-assisted+radical+prostatectomy+with+the+HUGO%E2%84%A2+robot-assisted+surgery+system+using+the+%27Aalst+technique%5BTitle%5D)+AND+%22BJU+Intl%22%5BJournal%5D)">Nerve-sparing robot-assisted radical prostatectomy with the HUGO™ robot-assisted surgery system using the 'Aalst technique.</a> BJU Intl. 132 (2), 227-230 (2023).</li>
<li>Bravi, C. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robot-assisted+radical+prostatectomy+with+the+novel+hugo+robotic+system%3A+initial+experience+and+optimal+surgical+set-up+at+a+tertiary+referral+robotic+center%5BTitle%5D)+AND+%22Eur+Urol%22%5BJournal%5D)">Robot-assisted radical prostatectomy with the novel hugo robotic system: initial experience and optimal surgical set-up at a tertiary referral robotic center.</a> Eur Urol. 82 (2), 233-237 (2022).</li>
<li>Bravi, C. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Outcomes+of+robot-assisted+radical+prostatectomy+with+the+hugo+ras+surgical+system%3A+Initial+experience+at+a+high-volume+robotic+center%5BTitle%5D)+AND+%22EU+Focus%22%5BJournal%5D)">Outcomes of robot-assisted radical prostatectomy with the hugo ras surgical system: Initial experience at a high-volume robotic center.</a> EU Focus. 9 (4), 642-644 (2023).</li>
<li>Bianchi, P. P., Salaj, A., Rocco, B., Formisano, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((First+worldwide+report+on+Hugo+RAS%E2%84%A2+surgical+platform+in+right+and+left+colectomy%5BTitle%5D)+AND+%22Updates+in+Surgery%22%5BJournal%5D)">First worldwide report on Hugo RAS™ surgical platform in right and left colectomy.</a> Updates in Surgery. 75 (3), 775-780 (2023).</li>
<li>Caputo, D., Farolfi, T., Molina, C., Coppola, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Full+robotic+cholecystectomy%3A+first+worldwide+experiences+with+HUGO+RAS+surgical+platform%5BTitle%5D)+AND+%22ANZ+J+surgery%22%5BJournal%5D)">Full robotic cholecystectomy: first worldwide experiences with HUGO RAS surgical platform.</a> ANZ J surgery. 94 (3), 387-390 (2023).</li>
<li>Caruso, R., Vicente, E., Quijano, Y., Ferri, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((New+era+of+robotic+surgery%3A+first+case+in+Spain+of+right+hemicolectomy+on+Hugo+RAS+surgical+platform%5BTitle%5D)+AND+%22BMJ+Case+Rep%22%5BJournal%5D)">New era of robotic surgery: first case in Spain of right hemicolectomy on Hugo RAS surgical platform.</a> BMJ Case Rep. 16 (12), e256035(2023).</li>
<li>Gangemi, A., Bernante, P., Rottoli, M., Pasquali, F., Poggioli, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Surgery+of+the+alimentary+tract+for+benign+and+malignant+disease+with+the+novel+robotic+platform+HUGOTM+RAS.+A+first+world+report+of+safety+and+feasibility%5BTitle%5D)+AND+%22Int+J+Med+Robot%22%5BJournal%5D)">Surgery of the alimentary tract for benign and malignant disease with the novel robotic platform HUGOTM RAS. A first world report of safety and feasibility.</a> Int J Med Robot. 19 (4), e2544(2023).</li>
<li>Mintz, Y., Pikarsky, A. J., Brodie, R., Elazary, R., Helou, B., Marom, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robotic+inguinal+hernia+repair+with+the+new+Hugo+RASTM+system%3A+first+worldwide+case+series+report%5BTitle%5D)+AND+%22MITAT%3A+Official+Journal+of+the+Society+for+Minimally+Invasive+Therapy%22%5BJournal%5D)">Robotic inguinal hernia repair with the new Hugo RASTM system: first worldwide case series report.</a> MITAT: Official Journal of the Society for Minimally Invasive Therapy. 32 (6), 300-306 (2023).</li>
<li>Raffaelli, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+new+robotic+platform+Hugo%E2%84%A2+RAS+for+lateral+transabdominal+adrenalectomy%3A+a+first+world+report+of+a+series+of+five+cases%5BTitle%5D)+AND+%22Updates+Surg%22%5BJournal%5D)">The new robotic platform Hugo™ RAS for lateral transabdominal adrenalectomy: a first world report of a series of five cases.</a> Updates Surg. 75 (1), 217-225 (2023).</li>
<li>Raffaelli, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Feasibility+of+Roux-en-Y+Gastric+Bypass+with+the+novel+robotic+platform+HUGO+RAS%5BTitle%5D)+AND+%22Front+Surg%22%5BJournal%5D)">Feasibility of Roux-en-Y Gastric Bypass with the novel robotic platform HUGO RAS.</a> Front Surg. 10, e1181790(2023).</li>
<li>Vicente, E., Quijano, Y., Ferri, V., Caruso, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robot-assisted+cholecystectomy+with+the+new+HUGO%E2%84%A2+robotic-assisted+system%3A+first+worldwide+report+with+system+description%2C+docking+settings%2C+and+video%5BTitle%5D)+AND+%22Updates+in+Surg%22%5BJournal%5D)">Robot-assisted cholecystectomy with the new HUGO™ robotic-assisted system: first worldwide report with system description, docking settings, and video.</a> Updates in Surg. 75 (7), 2039-2042 (2023).</li>
<li>Belyaev, O., Fahlbusch, T., Slobodkin, I., Uhl, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Safety+and+feasibility+of+cholecystectomy+with+the+hugotm+ras%3A+proof+of+setup+guides+and+first-in-human+German+experience%5BTitle%5D)+AND+%22Visc+Med%22%5BJournal%5D)">Safety and feasibility of cholecystectomy with the hugotm ras: proof of setup guides and first-in-human German experience.</a> Visc Med. 39 (3-4), 76-86 (2023).</li>
<li>Raffaelli, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robotic-assisted+Roux-en-Y+gastric+bypass+with+the+novel+platform+HugoTM+RAS%3A+preliminary+experience+in+15+patients%5BTitle%5D)+AND+%22Updates+Surg%22%5BJournal%5D)">Robotic-assisted Roux-en-Y gastric bypass with the novel platform HugoTM RAS: preliminary experience in 15 patients.</a> Updates Surg. 76 (1), 179-185 (2024).</li>
<li>Salem, S. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robotic+Heller%27s+myotomy+using+the+new+Hugo%E2%84%A2+RAS+system%3A+first+worldwide+report%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Robotic Heller's myotomy using the new Hugo™ RAS system: first worldwide report.</a> Surg Endosc. 38 (3), 1180-1190 (2024).</li>
<li>Hoeppner, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robotisch+assistierte+totale+Gastrektomie+mit+D2-Lymphadenektomie+und+intrakorporaler+Rekonstruktion%5BTitle%5D)+AND+%22Zentralblatt+fur+Chirurgie%22%5BJournal%5D)">Robotisch assistierte totale Gastrektomie mit D2-Lymphadenektomie und intrakorporaler Rekonstruktion.</a> Zentralblatt fur Chirurgie. 147 (5), 427-429 (2022).</li>
<li>Vicente, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robot-assisted+resection+of+gastrointestinal+stromal+tumors+%28GIST%29%3A+a+single+center+case+series+and+literature+review%5BTitle%5D)+AND+%22Int+J+Med+Robot%22%5BJournal%5D)">Robot-assisted resection of gastrointestinal stromal tumors (GIST): a single center case series and literature review.</a> Int J Med Robot. 12 (4), 718-723 (2016).</li>
<li>Furbetta, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Gastrointestinal+stromal+tumours+of+stomach%3A+Robot-assisted+excision+with+the+da+Vinci+Surgical+System+regardless+of+size+and+location+site%5BTitle%5D)+AND+%22J+Minim+Access+Surg%22%5BJournal%5D)">Gastrointestinal stromal tumours of stomach: Robot-assisted excision with the da Vinci Surgical System regardless of size and location site.</a> J Minim Access Surg. 15 (2), 142-147 (2019).</li>
<li>Desiderio, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robotic+gastric+resection+of+large+gastrointestinal+stromal+tumors%5BTitle%5D)+AND+%22Int+J+Surg+%28London%2C+England%29%22%5BJournal%5D)">Robotic gastric resection of large gastrointestinal stromal tumors.</a> Int J Surg (London, England). 11 (2), 191-196 (2013).</li>
<li>Al-Thani, H., El-Menyar, A., Mekkodathil, A., Elgohary, H., Tabeb, A. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Robotic+management+of+gastric+stromal+tumors+%28GIST%29%3A+a+single+Middle+Eastern+center+experience%5BTitle%5D)+AND+%22Int+J+Med+Robot%22%5BJournal%5D)">Robotic management of gastric stromal tumors (GIST): a single Middle Eastern center experience.</a> Int J Med Robot. 13 (1), 1729(2017).</li>
</ol>

Prof. Orlin Belyaev and Dr. Tim Fahlbusch are consultants for Medtronic.
Albert Tafelmeier works for Medtronic.
The other authors declare no conflict of interest.

The method is tailored for upper gastrointestinal purposes. Low regions of the abdominal cavity are not able to be reached and require different trocar and arm cart positions. A critical step is the placement of the trocars, which are supposed to be placed at a sufficient distance of at least 9 cm from each other. Otherwise, conflicting movements of the robotic arms may occur. Nevertheless, trocars must not be placed too close to osseous structures. Conflicts of the arms can sometimes be circumvented by slight alteration...

Robot-assisted surgery (RAS) is an advanced minimally invasive technique, which is associated with potential advantages such as fastened recovery times, shortened hospitalization and reduced risk of complications. According to Goh et al.1, surgeons benefit from better visualization, ergonomics, and dexterity.
Recently, a much-awaited modular robotic device was approved for in-human use in Europe in the field of visceral surgery2. Extensive experience has already been gathered by urologists earlier on3,4,5. Nevertheless, surgical experience with this new device is scarce but rapidly increasing6,7,8,9,10,11,12,13,14. The system comprises four arm carts for the endoscope and surgical instruments, a system tower, and a surgeon console2. Trocar positions and adjustments of the arm carts are highly important for the success of the surgical approach. False positions may lead to conflicts with robotic arms and technical inoperability. We developed this setup as a standard method for upper gastrointestinal surgery which includes numerous operations and organs such as the stomach, gallbladder, liver, pancreas or spleen. Therefore, the surgical approach needs to cover a wide range of requirements, especially in anatomical regions that are difficult to access. Due to the novelty of the platform, hardly any approaches for upper gastrointestinal surgery were described before. Other authors concentrated on bariatric procedures12. These setups are designed for a minority of obese patients with special anatomical demands12,15. Salem et. al. use alternate localizations of the arm carts for myotomies, which require an intricate positioning of the patient16. The presented method can be utilized for a wide range of purposes and patients and is easy to perform. Setups for other robotic platforms are not transferable17.
We now describe our surgical method and the case of a 69-year-old male patient who presented with an upper gastrointestinal bleeding. The diagnostic measures, including CT scans and endoscopy, revealed a gastric tumor localized at the greater curvature. It was sized 7 cm x 5 cm x 5 cm. Histological examination of a tissue sample suspected a leiomyoma and CT-scans showed no sign of metastatic spread. The patient did not undergo preceding major surgery, was presented with sufficient physical fitness, and, therefore, qualified for minimal-invasive surgery. The surgical resection of the lesion was indicated and performed at St. Josef-Hospital, University Hospital of the Ruhr-University Bochum, Germany, on January 12th, 2024.

<table><tbody><tr><td>Easy Flo&amp;nbsp;</td><td>P.J. Dahlhausen, K&amp;ouml;ln, Germany</td><td></td><td>12 mm</td></tr><tr><td>Endo GIA Ultra&amp;nbsp;</td><td>Medtronic, Dublin, Ireland</td><td></td><td></td></tr><tr><td>EndoRetrieval Pouch&amp;nbsp;</td><td>M&amp;ouml;lnlycke Health Care GmbH, D&amp;uuml;sseldorf, Germany</td><td></td><td></td></tr><tr><td>Ethilon</td><td>Ethicon, Bridgewater, New Jersey, USA</td><td></td><td>3-0</td></tr><tr><td>Hugo RAS</td><td>Medtronic, Dublin, Ireland</td><td></td><td></td></tr><tr><td>Ligasure&amp;nbsp;</td><td>Medtronic, Dublin, Ireland</td><td></td><td>44 cm, Blunt tip, laparoscopic version</td></tr><tr><td>Stomach Probe</td><td>Medicoplast, Illingen, Germany</td><td></td><td>Probe with plastic guidewire</td></tr><tr><td>UHI CO2 Insufflation Unit</td><td>Olympus, Hamburg Germany</td><td></td><td></td></tr><tr><td>Vicryl Sutures</td><td>Ethicon, Bridgewater, New Jersey, USA</td><td>1 and 3-0</td><td></td></tr></tbody></table>

robotics in surgery: a modular robotic platform driven gastric wedge resection

Robotics in Surgery: A Modular Robotic Platform Driven Gastric Wedge Resection

Robotic-assisted surgery has become increasingly popular since the introduction of the first robotic platform. Recently, a modular robotic system was approved for in-human use in Europe. Possible applications for this new robotic system are being explored, and standardized approaches are evolving. In lieu of this, a gastric wedge resection and the standardized setup for upper gastrointestinal procedures using this new system are presented here. This safe and feasible robotic procedure is demonstrated in a 69-year-old patient with a gastric tumor. All steps of the surgery are described in a detailed and reproducible manner. The article also details trocar positioning, arm adjustments, and required surgical instruments. Docking time amounted to 13 min, whereas the console time took 115 min. The patient was discharged after 4 days after ensuring an uneventful course. The presented method is also suitable for other surgical purposes, such as fundoplications or hiatoplasties, and ensures both generalizability and reproducibility.

Docking time amounted to 13 min, whereas console time took 115 min. The tumor was removed, and the wounds were closed after another 15 min. There were no intraoperative complications or robotic malfunctions and hardly any blood loss. The patient was monitored in the recovery room for 3 hours postoperatively. The further course in the hospital was uneventful. There was no sign of postoperative bleeding or insufficiency of the stapling line. Therefore, the drain was removed after 2 days. There were 3 blood tests screening ...

Robotically assisted surgery has become highly popular in recent years. Presented here is the standard care for upper gastrointestinal procedures, including a demonstration of a robotic-assisted gastric wedge resection using a modular robotic device.

Robotic-assisted surgery has become increasingly popular since the introduction of the first robotic platform. Recently, a modular robotic system was ...

robotics-surgery-modular-robotic-platform-driven-gastric-wedge

Research

JoVE Journal

Medicine

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

Technical Detail for Robot Assisted Pancreaticoduodenectomy

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.

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

Robotic central pancreatectomy may be used in selected patients in experienced centers. This protocol presents all steps and the feasibility of a robotic central pancreatectomy with Roux-en-Y pancreaticojejunostomy in a 16-year-old adolescent patient.

Robotic Central Pancreatectomy with Roux-en-Y Pancreaticojejunostomy

Robotic pancreatoduodenctomy (RPD) has been highly standardized in recent years and may be used in selected patients with pancreatic head cancer, including those with a replaced right hepatic artery. This case report describes a standardized and reproducible technique for RPD, which includes the approach of the Dutch LAELAPS-3 training program to an aberrant vasculature.

Robotic Pancreatoduodenectomy for Pancreatic Head Cancer: a Case Report of a Standardized Technique

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.

Retzius-Sparing Robot-Assisted Radical Prostatectomy

Surgical myotomy with a partial fundoplication may be used in selected patients as a definitive treatment for achalasia. This article provides a step-by-step description of a robotic myotomy and partial fundoplication in a 32-year-old patient with megaesophagus.

Robotic Myotomy and Partial Fundoplication for Achalasia

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.

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

Robot-assisted natural orifice specimen extraction surgery is a minimally invasive technique that combines robotic precision with natural orifice specimen extraction. A 67-year-old patient successfully underwent the procedure in 290 min, with minimal bleeding and no residual cancer. This approach minimized abdominal trauma, reduced complications, and enabled a quick recovery.

Surgical Robot-Assisted Transanal Specimen Extraction Radical Sigmoidectomy Without an Auxiliary Abdominal Incision

This protocol demonstrates Single-port (SP) robotic transanal total mesorectal excision (taTME) in a porcine model, highlighting procedural feasibility, technical steps, and preclinical applicability for minimally invasive rectal surgery.

Single-port Robotic Transanal Total Mesorectal Excision in a Porcine Model (Sus scrofa domesticus)

Numerous studies using gastric bypass rat models have been recently conducted to uncover the underlying physiological mechanisms of Roux-en-Y gastric bypass operations. This article aims to demonstrate and discuss the technical and experimental details of our published gastric bypass rat model to understand advantages and limitations of this experimental tool.

Roux-en-Y Gastric Bypass Operation in Rats

Learn robotic-assisted gastric wedge resection using a modular robotic platform for minimally invasive upper gastrointestinal surgery. This method demonstrates enhanced precision and improved patient recovery outcomes.

Robotics in Surgery: A Modular Robotic Platform Driven Gastric Wedge Resection

Explore More Videos