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Robotically assisted approaches to thoracoabdominal diseases have gained increasing momentum over the last two decades. More than 100 companies offer robotic systems for all surgical disciplines worldwide, and technological progress is driving the adoption of procedures that are challenging with standard instrumentation. Of note, progress in endoluminal surgery will be accelerated with the use of flexible robots, and the treatment of small tumors in the liver and lungs using robotic systems for percutaneous image-guided surgery. Surgical robotic systems as digital interfaces with computer assistance and image guidance will provide connectivity between experts and decision-making support, and enhance training and teaching via the integration of machine learning-based diagnostic systems and advanced telecommunications infrastructures (5G today and 6G tomorrow). As a surgical community, we can continue to shape the future of minimally invasive surgery with clinical trials, research/development projects, and Industry collaborations on an internatinal scale.
New surgical robots on the horizon
Percutaneous surgery and e-mentoring: is it possible to train remotely?
The importance of cholangioscopy in cases of indeterminate biliary strictures lies in the adequate identification of the causes of biliary strictures, either benign or malignant for adequate therapeutic decision-making (1-4).
Bibliography:
1. Uribe Rivera AK, Seeliger B, Saldivar CA, et al. Percutaneous transhepatic cholangioscopy for benign and malignant biliary disease using a novel short single-operator cholangioscope. Surg Endosc. 2023;37(10):7774-7783. doi:10.1007/s00464-023-10337-x Link: https://pubmed.ncbi.nlm.nih.gov/37580582/
2. Ahmed S, Schlachter TR, Hong K. Percutaneous Transhepatic Cholangioscopy. Tech Vasc Interv Radiol. 2015;18(4):201-209. doi:10.1053/j.tvir.2015.07.003 Link: https://pubmed.ncbi.nlm.nih.gov/26615160/
3. Schubach A, Penmetsa A, Sharma A, Kothari S. A Unique Approach to Obtaining Tissue in a Difficult to Access Indeterminate Biliary Stricture: Percutaneous Cholangioscopy and Biopsy. ACG Case Rep J. 2023;10(7):e01095. Published 2023 Jul 8. doi:10.14309/crj.0000000000001095 Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332834/
4. Laleman W, Verraes K, Van Steenbergen W, et al. Usefulness of the single-operator cholangioscopy system SpyGlass in biliary disease: a single-center prospective cohort study and aggregated review. Surg Endosc. 2017;31(5):2223-2232. doi:10.1007/s00464-016-5221-2 Link: https://pubmed.ncbi.nlm.nih.gov/27604370/
Percutaneous transhepatic cholangioscopy and endocanalicular bile duct biopsy
Cholangioscopy-assisted lithotripsy techniques, including electrohydraulic lithotripsy (EHL) and laser lithotripsy, are investigated for their efficacy in breaking up stones. In EHL, the probe is directed to the stone and advanced at least 5mm from the tip of the cholangioscope, bringing it within 1 to 2mm of the stone (3).
As compared to other endoscopic techniques for the biliopancreatic system, cholangioscopy offers a major advantage, as it allows to directly visualize the biliary lumen and mucosa. As a result, cholangioscopy complements ERCP and endoscopic ultrasound (EUS) in the evaluation of complex clinical situations (3)(4).
Bibliography:
1. Gimenez ME, Uribe Rivera AK, Montanelli J, Swanström LL, Mutter D, Seeliger B. Cholangioscopy under direct visualization: skill progress during a dedicated Image-Guided Surgery Course. Surg Endosc. 2023;37(10):8116-8122. doi:10.1007/s00464-023-10357-7 Link: https://pubmed.ncbi.nlm.nih.gov/37658199/
2. Palermo M, Fendrich I, Ronchi A, Obeid J, Gimenez M. Laparoscopic Common Bile Duct Exploration Using a Single-Operator Cholangioscope. J Laparoendosc Adv Surg Tech A. 2020;30(9):989-992. doi:10.1089/lap.2020.0534 Link: https://pubmed.ncbi.nlm.nih.gov/32707008/
3. Uribe Rivera AK, Seeliger B, Saldivar CA, et al. Percutaneous transhepatic cholangioscopy for benign and malignant biliary disease using a novel short single-operator cholangioscope. Surg Endosc. 2023;37(10):7774-7783. doi:10.1007/s00464-023-10337-x Link: https://pubmed.ncbi.nlm.nih.gov/37580582/
4. Gerges C, Vázquez AG, Tringali A, et al. Percutaneous transhepatic cholangioscopy using a single-operator cholangioscope (pSOC), a retrospective, observational, multicenter study. Surg Endosc. 2021;35(12):6724-6730. doi:10.1007/s00464-020-08176-1 Link: https://pubmed.ncbi.nlm.nih.gov/33398561/
Percutaneous transhepatic cholangioscopy and lithotripsy in surgically modified anatomy after bariatric surgery
Refereeing for a surgical journal is arduous, and comes with specific privileges and responsibilities. However, if you wish others to spend their precious time reviewing your own work, the effort is worthwhile as Miss Grossman, BJS Associate Editor explains in this video.
How to referee a paper - What can you get out of being a referee? (part 1/4)
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Beyond IRCAD podcast with Dr. Manoel Galvao Neto
Delve into Dr. Galvao Neto’s journey as a modern surgeon, blending innovation with passion. Explore how he integrates music and dance into surgical preparation, highlighting the fusion of enjoyment and expertise. Discover the essential balance of surgical skills with empathy in the 21st century medical world, where active social media engagement is paramount. Listen to […]World virtual university
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