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Ureteral reimplantation, bladder diverticulectomy, prostatic utricular resection, bladder augmentation, continent catheterizable channel

Ureteral reimplantation (ureteroneocystostomy) Introduction Ureteral reimplantation remains the gold standard for correction of vesicoureteral reflux (VUR) refractory to nonoperative or endoscopic management. In the United States, traditional open reimplantation has progressively been supplanted by minimally invasive approaches. , Since the description of robot-assisted laparoscopic ureteral reimplantation (RALUR) in 2004, “minimally invasive” has increasingly become synonymous with robot-assisted laparoscopy, as the articulating wrists of the robotic surgical…

Robot-assisted laparoscopic urologic upper urinary tract reconstruction

Introduction Since the advent of the da Vinci robotic platform in 2000, robot-assisted procedures have become the standard of care in many adult urologic procedures. Adoption of the robotic platform in pediatric urology has been slower in comparison but has gained momentum in recent years. In 1995, the first laparoscopic pyeloplasty was performed on a 7-year-old boy, introducing the feasibility of minimally invasive approaches in children.…

Robotic surgery in pediatric otolaryngology—head and neck surgery

Introduction Robotic surgery provides enhanced visualization and maneuverability within the oropharynx and supraglottic larynx and enables a minimally invasive approach to lesions that would otherwise require conventional endoscopic or open transcervical resection. Advantages of transoral robotic surgery (TORS) include high-definition, magnified, three-dimensional (3D) visualization using 0 or 30-degree endoscopes and enhanced dexterity and surgical precision, potentiated by robotic EndoWrist instruments. Robotic instruments allow for maneuverability within…

Robotic abdominal and thoracic surgery in children

Introduction Pediatric general and thoracic surgical conditions cover a wide range of diagnoses that span the breadth of being congenital, infectious, malignant, or acquired. The combination of increasing surgeon experience and advances in surgical technology have resulted in the successful application of minimally invasive techniques in the treatment of almost all conditions. History Open approaches were the mainstay of surgical treatment until the 1980s when endoscopic…

Whipple’s operation and distal pancreatectomy

Introduction Over the past three decades, the evolution of minimally invasive surgery has paved the way for performing complex abdominal operations. Although the implementation of laparoscopic surgery was incorporated in all fields of abdominal surgery, its limitations are becoming clearer in the field of hepatopancreatobiliary (HPB) surgery where two-dimensional (2D) vision, uncomfortable maneuverability, increased operative duration, and surgeon fatigue impede performing complex procedures such as pancreaticoduodenectomy.…

Hepatectomy, cholecystectomy, and biliary reconstruction

Introduction Malignancies of the hepatobiliary system can only be cured by resectional treatment, despite the advent of modern chemotherapeutic agents. Ablation and liver transplantation can provide a cure for certain liver cancers, but they are limited by size of lesion, total number of lesions, and donor organ shortage, respectively. The latter is predicted to worsen with rising rates of obesity and nonalcoholic fatty liver disease (NAFLD)…

Inguinal, ventral, and parastomal hernias

Inguinal hernia Introduction Inguinal hernia remains a very common surgical problem with a lifetime risk of nearly 25% in men and 3% in women. Given the prevalence, nearly 20 million inguinal hernia repairs are performed each year worldwide. Traditionally, inguinal hernias have been repaired using an open technique with low morbidity. With the advent of laparoscopy, techniques such as transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP)…

Robot bariatric surgery

Introduction Bariatric surgery represents a field in which one operation can “cure” a patient of numerous medical comorbidities and is the only proven method that results in long-term weight loss for patients. Since its inception, the field has undergone continuous improvements in operative technique, with the most recent advancement being the adaptation of the procedures to facilitate robotic-assisted surgeries. It is estimated that there were approximately…

Robot foregut surgery

Introduction Foregut surgery is a broad term that encompasses a range of disease pathology and procedures. In this chapter, we will discuss the basic construct and robotic technique for four different foregut procedures—paraesophageal hernia repair, Nissen fundoplication, Toupet fundoplication, and Heller myotomy. The field of foregut surgery is a dynamic one, with continual changes in operative technique leading to improved patient outcomes. Surgeries that were once…

New platforms for low rectal cancer

Introduction Surgery for low rectal cancer is technically challenging. Traditionally, low rectal cancers were treated with either transanal excision, at the risk of compromising oncologic outcomes, or abdominoperineal resection (APR), which led to a significant impact on a patient’s functional status and quality of life. Several developments have increasingly allowed surgeons to treat low rectal cancers using sphincter-sparing, minimally invasive approaches while at the same time…

Low anterior resection for rectal cancer

Introduction Following the results of multiple randomized controlled trials demonstrating improved short-term outcomes and equivalent oncologic outcomes compared to an open approach, laparoscopic colectomy has become the operation of choice for colon cancer. However, given the technical difficulty of operating in a narrow pelvis with fixed instruments and an inability to demonstrate noninferiority compared to an open approach with respect to oncologic safety in recent randomized…

Robotic sigmoid colectomy for diverticular disease

Introduction Indications for robotic sigmoid colectomy in diverticular disease Diverticular disease is common and increasing in incidence worldwide. The main site of disease in the Western world is the sigmoid, although diverticula can occur anywhere in the colon and right-sided diverticular disease is more common in Asian populations. Diverticular disease comprises a wide spectrum of disease ranging from mild inflammation that can be treated in an…

Splenic flexure mobilization

Introduction Splenic flexure mobilization is an integral part of total mesorectal excision (TME) for rectal cancer and for segmental resection of splenic flexure, distal transverse colon, and proximal descending colon neoplasms. Splenic flexure mobilization may also be part of operations for sigmoid diverticulitis, ischemic colitis, Crohn’s disease, or any procedure that includes left hemicolectomy, subtotal colectomy, and total abdominal colectomy or total proctocolectomy for ulcerative colitis,…

Right hemicolectomy and transverse colectomy

Introduction Robot-assisted right and transverse colectomy is rapidly gaining popularity among surgeons as the preferred approach for treatment of ascending and transverse colon cancers. This is partly due to the ease of performing intracorporeal anastomosis, limiting the need for larger extraction incisions, which was common in most laparoscopic approaches due to the utilization of an extracorporeal anastomosis. Studies have reported less estimated blood loss, shorter gastrointestinal…

Robot-assisted thyroidectomy

Introduction Thyroidectomy is commonly performed through a transcervical approach, a technique first described by Theodor Billroth in the late 19th century. , Since that early description, technological advancement and its application have seen a remarkable evolution in thyroidectomy techniques over the past 20 years. The endoscope was first utilized for parathyroidectomy by Gagner and then by Hüscher et al. for the thyroid lobectomy. , Several endoscopic…

Transoral robotic surgery for recurrent cancer and reconstruction

Introduction In a previously irradiated patient, salvage surgery remains the main, if not only, curative option for recurrent or residual squamous cell carcinoma (SCC) of the oropharynx. Traditionally, a large open resection was performed. The surgery may require mandibulectomy for tumor involvement or mandibulotomy with pharyngotomy for access. Soft tissue reconstruction is undertaken with free flap reconstruction or pedicled flap reconstruction techniques such as a pectoralis…

Transoral robotic surgery for parapharyngeal space tumors

Introduction Since its US Food and Drug Administration (FDA) approval in 2009, the utility of transoral robotic surgery (TORS) as a minimally invasive technique has continued to expand. Initially approved for resection of oropharyngeal tumors, its indications have now broadened to include tumors of the larynx, hypopharynx, nasopharynx, skull base, and, more recently, the parapharyngeal space (PPS). , The favored surgical approaches for PPS tumor resection…

Transoral robotic surgery for obstructive sleep apnea surgery

Introduction Obstructive sleep apnea (OSA) is a common medical condition characterized by repeated nocturnal episodes of complete or partial airflow reduction. This leads to nocturnal desaturations, sympathetic overdrive, and cortical arousals. In Australia it affects approximately 10% of middle-aged males and 5% of middle-aged females. OSA is an independent risk factor for hypertension, ischemic heart and cerebrovascular disease. OSA is associated with excessive sleepiness and a…

Transoral robotic surgery for hypopharyngeal and supraglottic tumor resection

Introduction The hypopharynx and supraglottic larynx are unique parts of the upper aerodigestive tract. These sites are critical to the functions of airway, speech, and swallowing. Therefore malignancy at these sites requires careful assessment and consideration of treatment options. Controversy reigns as to the optimal treatment option for early cancers of the hypopharynx and larynx. Although more than 90% of these malignancies are squamous cell carcinomas,…

Transoral robotic surgery for lateral oropharyngectomy, tongue base resection, and laryngeal tumor resection

Introduction Primary surgery with adjuvant radiotherapy has long been accepted as the standard treatment plan for cure for the majority of head and neck cancers, including oropharyngeal and supraglottic cancer. Although these open surgical approaches have yielded high rates of local and regional control, they carry the risk of significant and life changing morbidity. , This morbidity can have devastating effects upon the patient’s speech and…