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Robotic single-site cholecystectomy

Indications Laparoscopic cholecystectomy has been the standard for removal of the gallbladder since the 1990s. Attempts to introduce single-incision cholecystectomy in order to improve cosmetic outcomes were met with difficulty due to struggles during surgery, prolonged operative times, and inability to apply to all patients. In 2011, Intuitive Surgical, Inc. (Sunnyvale, CA, USA) released the single-site platform to overcome all these limitations. It was a novel…

Robotic multiport cholecystectomy

Indications In 1985, Prof. Dr. Erich Mühe of Germany performed the first laparoscopic cholecystectomy and began a new era of minimally invasive surgery in the field of general surgery. Laparoscopic cholecystectomy (LC) proved that minimally invasive surgery could reduce morbidity and speed recovery for patients. It has become the standard of care for all varieties of biliary procedures, including acute and chronic diseases of the gallbladder…

Robotic left hemicolectomy and low-anterior resection

Indications A left hemicolectomy is commonly indicated for colonic polyps, neoplasms, and diverticular disease. By employing robotic technology, we can offer a truly minimally invasive operation for varied pathologies. Robotic technology provides stable 3D visualization, more manual dexterity, and an additional arm for self-retraction or maintenance of exposure. These features are paramount when operating in tight spaces, such as the pelvis. Moreover, an intracorporeal anastomosis, which…

Robotic right colectomy

Indications Following its introduction in 1991, multiple reviews in the literature have shown numerous advantages of the minimally invasive laparoscopic approach to colectomy. Although the rates of utilization of minimally invasive techniques have continued to increase over time, more than half of all colon resections are still performed via an open approach decades after the introduction of laparoscopic colon resection. Limited visibility, poor exposure, the need…

Robotic transhiatal esophagectomy

Introduction Approximately 18,000 people in the US have developed esophageal cancer in 2019. Over the past 35 years, there has been tremendous increase in the incidence of adenocarcinoma of the esophagus. While squamous cell carcinoma has increased three-fold in incidence, adenocarcinoma of the esophagus has increased 56-fold over the past 35 years. Therefore, esophageal cancer as a whole has increased eight-fold. Whether a patient undergoes an…

Robotic heller myotomy

Indications Achalasia, although rare, is one of the most common motility disorders of the esophagus. It is characterized by aperistalsis of the esophagus and failure of receptive relaxation of the lower esophageal sphincter (LES). Both features are required for diagnosis. Patient symptoms can include dysphagia, heartburn, sensation of impacted food bolus after meals, and regurgitation. , Diagnosis is usually delayed due to these nonspecific symptoms, which…

Robotic paraesophageal hernia repair

Introduction Hiatal hernias are a common condition that can be classified into four anatomical types ( Fig. 21.1 ). Type I or sliding hernias comprise over 95% of all hiatal hernias. Paraesophageal hernias (PEH) include types II-IV, which are defined by herniation of either the fundus of the stomach (Types II and III) or herniation of another organ entirely (Type IV). Approximately 90% of PEHs are…

Robotic hiatal hernia repair and antireflux surgery

Introduction Gastroesophageal reflux disease (GERD) is one of the most common chronic diseases, affecting 18%–28% of the population in North America, and its prevalence has been increasing steadily with time. Nissen fundoplication is a safe and effective therapy for controlling patients’ reflux symptoms and has emerged as the gold standard surgical treatment for GERD. Robotic surgery has emerged as a useful alternative as it allows for…

Robotic gastric bypass

Indications Bariatric surgery continues to be the most effective treatment available for the treatment of obesity and its associated medical problems. In the USA, it is indicated for patients with body mass index (BMI) 40 and above or those with BMI 35–40 with medical comorbid conditions such as diabetes, hypertension, and sleep apnea. Multiple studies have demonstrated improved survival in morbidly obese patients who undergo bariatric…

Robotic sleeve gastrectomy

Indications In the last decade, sleeve gastrectomy has been accepted as a surgical treatment option for morbid obesity and currently accounts for almost 60% of bariatric procedures. It is considered safe and technically less demanding in comparison to the Roux-en-Y gastric bypass. Weight loss surgery is recommended for those with a body mass index (BMI) ≥35 kg/m and at least one related comorbidity (i.e., hypertension, hypercholesterolemia,…

Robotic gastrectomy

Introduction The application of laparoscopic techniques to gastric operations has become the preferred approach whenever feasible because of the known advantages of minimally invasive surgery. However, laparoscopy for advanced operations, such as gastric surgery, is beyond the technical abilities of many general surgeons. The application of the robotic approach to gastric surgery has been increasing steadily and may soon become preferred for the vast majority of…

Robotic parastomal hernia repair

Introduction Parastomal hernia is one of the most common complications following ostomy creation and may be unavoidable considering the mechanics of the abdominal wall and the need to keep a functioning loop of intestine coming through the dynamic abdominal wall. Parastomal hernias occur in almost half of ostomies created, depending on the type of ostomy. In 2003, the prevalence of ostomies was estimated to be 800,000,…

Robotic anterior component separation

Indications Ventral hernia (VH) repair with onlay mesh placement after anterior component separation is a safe alternative to sublay mesh placement after posterior component separation in low-risk patients. Onlay open VH repair is still one of the most common surgeries for the repair of hernias worldwide. , It is technically easy, with a relatively short surgical time, is very reproducible, and has a shorter learning curve…

Robotic transversus abdominis release (r-TAR) procedure

Introduction Few techniques in surgery have evolved more over the course of the last two decades than those related to hernia and abdominal wall reconstructions. Advances in technology, coupled with a better understanding of the abdominal wall anatomy, have resulted in the popularization of advanced reconstruction techniques that aim to restore the functional abdominal wall. Abdominal reconstruction with posterior component separation via transversus abdominis release (TAR)…

Robotic totally extraperitoneal retrorectus repair

Introduction The field of abdominal wall reconstruction has been rapidly evolving, particularly in recent years, with the popularization of several novel minimally invasive extraperitoneal approaches. Enhanced-view totally extraperitoneal (eTEP) access in combination with retromuscular repair has expanded what is feasible with minimally invasive surgical techniques. , The mainstay of traditional minimally invasive hernia repair has been intraperitoneal onlay mesh placement (IPOM) with penetrating fixation. , Although…

Robotic transabdominal retrorectus repair

Indications For ventral hernias of the midline between 2 and 5 cm in width, I prefer to perform a robotic retrorectus repair with a 15-cm wide mesh. I use a technique with a single dock lateral transabdominal approach. This technique has been described previously by Chowbey et al. in 2003 and by Schroeder et al. in 2013 using conventional laparoscopic instruments. They concluded that the technique…

Robotic transabdominal preperitoneal (rTAPP) ventral hernia repair

Preoperative considerations It is critical to have a thorough understanding of the layers of the abdominal wall. The preperitoneal space can be surgically dissected from the overlying layers of the abdominal wall from the diaphragm to the myopectineal orifice and posterolaterally encompassing the retroperitoneum. While the peritoneum is not considered a layer of “strength,” the preperitoneal space is being increasingly utilized as a form of autologous…

Robotic intraperitoneal hernia repair

Indications All patients with incisional hernias are candidates for hernia repair with mesh. The eligibility for a minimally invasive hernia repair depends largely on the hernia width. In our practice, a hernia width of up to 7 cm measured preoperatively on computed tomography is considered eligible for a robotic ventral hernia repair with intraperitoneal mesh (rIPOM). In addition, as with other operations, a patient should be…

Anatomy of the groin and robotic neurectomies

Background Inguinal hernia is a common pathology, occurring in approximately 27% of men and 3% of women throughout their lives. Worldwide, operative repair of inguinal hernia is performed an estimated 20 million times annually. With the widespread adoption of tension-free, mesh-based techniques, and an ever-increasing variety of approaches to repairing inguinal hernias, recurrence rates have been reduced dramatically. The most significant morbidity still plaguing inguinal hernia…

Robotic inguinal hernia repair without mesh

There has always been a need to perform an inguinal hernia repair without mesh, i.e., tissue repair. These repairs are typically performed in an open, anterior fashion and include techniques as described by Shouldice, Bassini, and McVay. The open preperitoneal posterior approach for inguinal hernia repair was first described by Cheatle in 1920 and later by others. This repair was refined and best described in detail…