GERD has become one of the most frequent pathology of the upper GI tract. It is a spectrum disease and is a progressive disease as well. Serious and severe complications are possible. The mainstream therapy in most of the patients is the medical therapy with PPI's. The most severe cases with an impaired LES (Lower Esophageal Sphincter) function as well as important anatomical disruptions are of surgical indication, the gold standard being laparoscopic fundoplication, an elective therapy with long term follow up outcomes at the expense of de novo symptoms associated with fundoplications in general. 30% to 40% of the patients are PPI refractory with partial symptom control, but they are not willing to go for the laparoscopic fundoplication because of the invasive character and because of potential postfundoplications syndromes. There is a "treatment gap" for these patients with GERD. For a well selected patient population with GERD, with mild forms of the disease, without complications and without major anatomical disruptions (patients with small hiatal hernias), patients who are refractory on PPI medication, there are today new alternative therapies, minimally invasive. These therapies are less aggressive and basically with no side effects or new onset symptoms that Laparoscopic Fundoplications will give. These are endoscopic therapies which improve the LES function: Stretta utilizes radiofrequence therapy, a novel technique describes mucosal resection at the level of the cardia, while a partial fundoplication from within the stomach can be realized with EsophyX, Muse or Gerd-X. Form all these procedures, EsophyX is the most advanced with more than 20,000 patients treated worldwide, with good clinical outcomes and with no de novo symptoms. The laparoscopic techniques treat hiatal hernias larger than 2 cm. Linx utilizes a magnetic ring at the LES level. EndoStim utilizes electrodes in order to stimulate the LES muscle. These procedures are effective on short term and there are few patients treated with Linx or EndoStim. More research for Linx and EndoStim is necessary with randomized clinical trials, with improvement of the devices and with long term follow up.

Transoral Incisionless Fundoplication (TIF) with EsophyX device for a well selected GERD patient population has proven its efficiency, safety and durability. We present a case report of a male, 63 y old, with typical and atypical GERD symptoms started 15 years ago. The esophagogastroduo-denoscopy (EGD) showed a Hiatal Hernia (HH) of 3 cm and an erosive esophagitis Los Angeles Grade B. The first surgery was performed 7 years ago, in March 2009: a TIF with the EsophyX 2 (R) device (EndoGastric Solution, Inc., Redmond, WA, United States). Post-surgery the symptoms were controlled, completely eliminated, the EGD showing the healing of the esophagitis. Six years after the surgery the sore throat re-appears, while the EGD shows a 2 cm hiatal hernia and erosive esophagitis Los Angeles Grade A. The Impedance pH-metry confirms GERD with a DeMeester score of 44.5. In 2016 (7 years after first procedure) a second TIF 2.0 procedure, this time with EsophyX Z device is performed. The EsophyX Z device is an automatic stapler-like fastener delivery system, easier of use, faster, safer and more reproducible (standardized fastener delivery). The time of the procedure was significantly reduced, compared to first procedure. The patient is now symptom free, EGD is normal, the impendance ph metry at 13 months post-surgery showed a normal DeMeester score at 8. This is a World's first case report of a TIF 2.0 procedure with EsophyX Z device 7 years after a first TIF procedure with EsophyX 2 device, with excellent results and a significant reduction of the time for the procedure.

Background & Aims: The TIF procedure has emerged as an endoscopic treatment for patients with refractory gastro-esophageal reflux disease (GERD). Previous systematic reviews of the TIF procedure conflated findings from studies with modalities that do not reflect the current 2.0 procedure technique or refined data-backed patient selection criteria. A meta-analysis was conducted using data only from randomized studies that assessed the TIF 2.0 procedure compared to a control. The purpose of the meta-analysis was to determine the efficacy and long-term outcomes associated with performance of the TIF 2.0 procedure in patients with chronic long-term refractory GERD on optimized PPI therapy, including esophageal pH, PPI utilization and quality of life. Methods: Three prospective research questions were predicated on the outcomes of the TIF procedure compared to patients who received PPI therapy or sham, concomitant treatment for GERD, and the patient-reported quality of life. Event rates were calculated using the random effect model. Since the time of follow-up post-TIF procedure was variable, analysis was performed to incorporate the time of follow-up for each individual patient at the 3-year time point. Results: Results from this meta-analysis, including data from 233 patients, demonstrated that TIF subjects at 3 years had improved esophageal pH, a decrease in PPI utilization, and improved quality of life. Conclusions: In a meta-analysis of randomized, controlled trials (RCTs), the TIF procedure data for patients with GERD refractory to PPI's produces significant changes, compared with sham or PPI therapy, in esophageal pH, decreased PPI utilization, and improved quality of life.

Background: Over the past decades, staging laparoscopy evolved as a useful tool in multimodality treatment of patients with abdominal malignancies, especially for detection of incurable peritoneal and liver metastasis. Natural orifice translumenal endoscopic surgery (NOTES) is a new, evolving technique which represents the next logical progression in minimally invasive surgery and has theoretical advantages in comparison with standard laparoscopic surgery. A review of the current literature revealed a continuous increasing number of fundamental and clinical studies addressing NOTES approach in multimodal management of oncologic patients. Technical possibility to use this new minimally invasive approach for oncological resection of abdominal malignancies was proved by some investigators.Hypothesis: NOTES can be used as an alternative method for staging patients with limited peritoneal carcinomatosis and may have better results compared to current imaging techniques for small diameter metastatic disease.Conclusions: With the continuous development of the NOTES techniques and technology, the second-look peritoneoscopy by NOTES may become an alternative method for staging in patients with peritoneal carcinomatosis. Nevertheless, NOTES is at a very early stage of its development, and its implementation in oncologic surgery should be made very caution, and only after careful evaluation. (C) 2013 Elsevier Ltd. All rights reserved.

GERD is a frequent, evolving, life quality-impairing disease. In addition to medication and laparoscopic fundoplication we have recently added endoluminal fundoplication (ELF). The EsophyX2 is currently the most efficient device for endoluminal fundoplication. This device produces a partial, anterior valve, redesigning the antireflux barrier and the Hiss angle geometry, thus improving the activity of the lower esophageal sphincter (LES). This paper presents the operative technique, the patient selection criteria and published results. It has been shown that this technique is both secure, reproductible and effective in patients followed for 12-24 months: life-quality improvement, decreased acid exposure, suppression of antiacids, reduced hospitalization and recovery. Compared to antiacid therapy, ELF is far more effective and less invasive than laparoscopic fundoplication. For the moment we have no long-term results. ELF with EsophyX2 is a minimally invasive and efficient therapy for GERD that requires further evaluation.

The da Vinci™ Surgical Robot (Intuitive Surgical Inc., Sunnyvale, CA, USA) is a computer-enhanced surgery device that helps to surpass some of traditional laparoscopic instruments limitations. Our work was performed to assess the safety and feasibility of robotically assisted aorto-femoral bypass grafting (AF) as well as to describe the technique. The aortic dissection is performed laparoscopically, with the patient in a modified right lateral position. The proximal anastomosis is completed with the da Vinci™ system by a remote surgeon, positioned at a distance from the patient. The role of the assistant at the patient’s side is especially to expose, to perform haemostasis and to maintain traction on the running sutures performed by the robot. No robot-related complications were noted. Robotically assisted anastomoses are possible by its unique ability to combine conventional laparoscopic surgery with stereoscopic 3D magnification and ultra-precise suturing techniques due to the flexibility of the robotic wristed instruments using different motion scaling of surgeon hand movements. In addition, prior training in laparoscopic aortic surgery is not necessary for surgeons to obtain the level required for suturing. Further clinical trials are needed to explore the clinical potential and value of robotically assisted AF.

The novel Endoluminal Fundoplication (ELF) technique using a Trans-Oral Incisionless and fastener-deploying device (EsophyX™, EndoGastric Solutions) was developed and evaluated for feasibility, safety and the treatment of Gastro-Esophageal Reflux Disease (GERD) in a series of animal and human (phase 1, phase 2) studies.

ROBOTIC SURGERY AND TELE-SURGERY: BASIC PRINCIPLES AND DESCRIPTION OF A NOVEL CONCEPT (Abstract): One of the most important advances in surgical technology in the last two decades of the twentieth century is represented by the introduction of the laparoscopic technique. Using the laparoscopic approach the patient is operated through keyhole incisions as opposed to long, traumatic incisions over the thoracic or abdominal cavity. Many open procedures, such as those for gallbladder disorders, groin hernia repair and anti-reflux surgery of the stomach have been replaced by minimally-invasive procedures, whose advantages include shorter postoperative hospitalization, less pain, and a faster return to normal activity. Although improvements continue to be made in laparoscopic surgery, surgeons are generally still faced with particular drawbacks of this technique. Robotic surgery and computer-enhanced surgery may revolutionize these techniques by restoring most of the advantages of open surgery but in the context of minimally-invasive procedures. For example, cardiac surgery has entered a new era since robotic surgery appeared a part of certain by-pass and valve surgery. This work describes the da Vinci Surgical RobotTM which represents the current stateof-the art of this technology. New developments in system accuracy, planning and simulation of the surgical act are highlighted.

BACKGROUND:Telerobotic-assisted laparoscopic attempts to provide technological solutions to the inherent limitations of traditional laparoscopic surgery. The aim of this study is to report the first experience of two teams concerning telerobotic-assisted laparoscopic hysterectomy for benign and malignant pathologies.METHODS:This study included 14 patients at the University Hospital Saint Pierre of Brussels (Belgium) and 16 patients at the Cancer Center of Nancy (France) from September 1999 to July 2003.RESULTS:The indications for surgery were uterine malignant diseases in 12 cases (stade I) (41%), and benign pathologies of the uterus in 18 cases (59%). Five postoperative complications (17%) occurred, none related to the robotic system.CONCLUSION:Robotic surgery can be safely performed in gynecologic and gynecologic-oncologic surgery with no increase in complication rates. A significant advance is represented by the surgeon's ergonomic improvement.

You have accessJournal of UrologyVideo Session,Tuesday, May 11, 2004,1:00 - 3:00 pm1 Apr 2004Vl692: Robotic Minimally-Invasive Pyeloplasty Using the Da Vinci® Surgical System Jacques Hubert, Vandeuvre Les Nancy, András Hoznek, Benoit Feuillu, Vandeuvre Les Nancy, Adrian Lobontiu, Leticia Ruiz, and Clément-Claude Abbou Jacques HubertJacques Hubert More articles by this author , Vandeuvre Les NancyVandeuvre Les Nancy More articles by this author , András HoznekAndrás Hoznek More articles by this author , Benoit FeuilluBenoit Feuillu More articles by this author , Vandeuvre Les NancyVandeuvre Les Nancy More articles by this author , Adrian LobontiuAdrian Lobontiu More articles by this author , Leticia RuizLeticia Ruiz More articles by this author , and Clément-Claude AbbouClément-Claude Abbou More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)39204-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Vl692: Robotic Minimally-Invasive Pyeloplasty Using the Da Vinci® Surgical System." The Journal of Urology, 171(4S), p. 447 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 447 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Jacques Hubert More articles by this author Vandeuvre Les Nancy More articles by this author András Hoznek More articles by this author Benoit Feuillu More articles by this author Vandeuvre Les Nancy More articles by this author Adrian Lobontiu More articles by this author Leticia Ruiz More articles by this author Clément-Claude Abbou More articles by this author Expand All Advertisement PDF downloadLoading ...

Objective. The da Vinci(TM) Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) is a computer-enhanced telemanipulator that may help to overcome some limitations of traditional laparoscopic instruments. This prospective study was performed to assess the safety and feasibility of robotically assisted aorto-femoral bypass grafting W).Methods. Five patients undergoing elective AF were enrolled in this study. In three patients, a laparotomy of 6 cm was first performed, the aorta being exposed using an Omnitractdegrees retractor. In two patients, aortic dissection was performed with laparoscopy, with the patient in a modified right lateral decubitus position. In all patients, the proximal anastomosis was attempted with the da Vinci(TM) system by a remote surgeon. The role of the assistant at the patient's side was limited to exposure, haemostasis and maintaining traction on the running sutures performed by the robot. Six weeks after the operation, all patients underwent a duplex scan of the graft.Results. Mean operative time was 188 min. Robotically assisted aortic anastomoses were successfully completed in four out of five patients. In these four patients, adequate blood flow was observed within the graft with no need for conversion for haemostasis. In the fifth patient, despite an adequate laparoscopic aortic dissection, the anastomosis was impossible to perform due to external conflicts between the robotic arms. A conversion using conventional suture was successfully performed. No robot-related complications were noted. Six weeks after the operation, the duplex scans demonstrated a graft patency of 100%.Conclusion. Robotically assisted anastomoses are possible by their unique ability to combine conventional laparoscopic surgery with stereoscopic 3D magnification and ultra-precise suturing techniques due to the flexibility of the robotic-wristed instruments using different motion scaling of surgeon hand movements. In addition, prior training in laparoscopic aortic surgery is not necessary for surgeons to obtain the level required for suturing. Further clinical trials are needed to explore the clinical potential and value of robotically assisted AF.

OBJECTIVETo evaluate the experimental feasibility of laparoscopic computer-assisted pyeloplasty for pelvi-ureteric junction obstruction.MATERIALS AND METHODSFourteen pyeloplasties were undertaken in pigs using a laparoscopic transperitoneal approach and the robotic surgical system (da Vinci(TM), Intuitive Surgical Inc., Sunnyvale, CA, USA).RESULTSThe robotic surgical system provides real-time three-dimensional stereoscopic vision. Manipulating the intracorporeal endo-wristed instruments from a remote console allows laparoscopic manoeuvres that are as easy as those during open surgery. Surgeons with no particular experience in laparoscopic surgery could learn complex surgery easily and quickly.CONCLUSIONThis technique provides faster training and the possibility of undertaking complex laparoscopic procedures, especially reconstructive, with less fatigue for the surgeon.

PURPOSE:We developed and assessed the feasibility of extraperitoneal laparoscopic radical prostatectomy performed using the da Vinci (Intuitive Surgical, Mountain View, California) robotic system.MATERIALS AND METHODS:In June 2002, 4 consecutive patients with clinically localized prostate cancer underwent extraperitoneal, robotic assisted laparoscopic radical prostatectomy. After development of the extraperitoneal space the surgeon performed laparoscopic prostatectomy from the remote control unit. The assistant aligned and exchanged robotic instruments and used conventional laparoscopic instruments to facilitate prostatectomy. Perioperative data and pathological results were recorded.RESULTS:No difficulties were noted when developing the extraperitoneal space. All additional steps were successfully performed with telerobotics. More distal placement of the robotic ports appeared to improve the feasibility of the extraperitoneal approach. The peritoneum acted as a natural bowel retractor and the distal port placement facilitated use of the assistant ports. Mean operative time was 274 minutes (range 124 to 360). Mean catheterization time and hospital stay were 2.7 and 5.3 days, respectively. A positive margin was observed in 1 patient and pathological stage was pT2 in 3 and pT3 in 1. No postoperative complications or open conversions were observed.CONCLUSIONS:The extraperitoneal approach was feasible with the da Vinci robotic system. Distal port placement for the robot appeared to create an ergonomic environment for the surgeon and assistant and more direct prostatic access. While additional clinical experience is required, the extraperitoneal approach may ultimately provide advantages for robotic and nonrobotic laparoscopic radical prostatectomy.

PURPOSE:The use of robotics is a recent innovation in surgery. In addition to dexterity enhancement and motion scaling, this new technology opens the horizon of remote surgery. This latter advancement has potential use during surgery involving a high risk of patient-to-professional or professional-to-patient virus transmission. We investigated the feasibility of robotic assisted kidney transplantation. MATERIALS AND METHODS:A right cadaveric kidney was transplanted into a 26-year-old male patient who has been on hemodialysis for 11 years. Surgery was done with the help of the da Vinci robot (Intuitive Surgical, Inc., Mountain View, California) by a remote surgeon, who completely performed vascular dissection and anastomosis as well as ureterovesical anastomosis. The role of the assistant by the side of the patient was limited to access creation, exposure, hemostasis and maintaining traction on the running sutures performed by the robot. RESULTS:Operative time was 178 minutes. Robotic assistance made anastomosis possible by its unique ability of stereoscopic magnification and ultra-precise suturing techniques due to the flexibility of the robotic wristed instruments. Renal perfusion was excellent with immediate diuresis. Postoperative acute tubular necrosis started to resolve after 1 week. CONCLUSIONS:This study demonstrates that robotic assisted kidney transplantation is feasible. Currently technical and cost hindrances limit the routine use of robots. However, with ongoing improvement and future availability of this technology the prevention of patient-to-professional and professional-to-patient viral transmission may become a potential field of application.

PURPOSE:Robotics in surgery is a recent innovation. This technology offers a number of attractive features in laparoscopy. It overcomes the difficulties with fixed port sites by restoring all 6 degrees of freedom at the instrument tips, provides new possibilities for miniaturization of surgical tasks and allows remote controlled surgery. We investigated the applicability of remote controlled robotic surgery to laparoscopic radical prostatectomy.MATERIALS AND METHODS:Our previous experience with laparoscopic prostatectomy served as a basis for adapting robotic surgery to this procedure. A surgeon at a different location who activated the tele-manipulators of the da Vinci* robotic system performed all steps of the intervention. A scrub nurse and second surgeon who stood at patient side had limited roles to port and instrument placement, exposure of the operative field, assistance in hemostasis and removal of the operative specimen. Our patient was a 63-year-old man presenting with a T1c tumor discovered on 1 positive sextant biopsy with a 3+3 Gleason score and 7 ng./ml. preoperative serum prostate specific antigen.RESULTS:The robot provided an ergonomic surgical environment and remarkable dexterity enhancement. Operating time was 420 minutes, and the hospital stay lasted 4 days. The bladder catheter was removed 3 days postoperatively, and 1 week later the patient was fully continent. Pathological examination showed a pT3a tumor with negative margins.CONCLUSIONS:Robotically assisted laparoscopic radical prostatectomy is feasible. This new technology enhances surgical dexterity. Further developments in this field may have new applications in laparoscopic tele-surgery.

This work presents the first experimental results of an ongoing cooperation between medical, robotics and computer science teams aimed at optimizing the use of robotic systems in minimally invasive surgical interventions. The targeted intervention is the totally endoscopic coronary artery bypass graft (TECAB), performed using the daVinci™ system (by Intuitive Surgical, Inc.). An integrated and formalized planning and simulation tool for medical robotics is proposed, and experimental validation results on an artificial skeleton and heart are presented.