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In the current landscape, several platforms are available, with numerous other systems in various stages of development (1). The use of the Hugo™ RAS system for gynecologic procedures has demonstrated effectiveness (2), and its application in the targeted treatment of endometriosis has yielded promising outcomes (3-4).
Bibliography:
1. Pavone M, Marescaux J, Seeliger B (2023). Current status of robotic abdominopelvic surgery. Show-Chwan Med J 22(3):467473. https://doi.org/10.30185/scmj.202307/pp.0003
2. Monterossi G, Pedone Anchora L, Gueli Alletti S, Fagotti A, Fanfani F, Scambia G (2022) The first European gynaecological procedure with the new surgical robot HugoTM RAS. A total hysterectomy and salpingo-oophorectomy in a woman affected by BRCA-1 mutation. Facts Views Vis ObGyn 14(1):91–4. https:// doi.org/10.52054/FVVO.14.1.014. PMID: 35373554 PMCID: PMC9612853 DOI: 10.52054/FVVO.14.1.014
3. Pavone M, Goglia M, Campolo F, Scambia G, Ianieri MM. En-block butterfly excision of posterior compartment deep endometriosis: The first experience with the new surgical robot Hugo™ RAS. Facts Views Vis Obgyn. 2023 Dec;15(4):359–62. PMID: 38128095 PMCID: PMC10832646 DOI: 10.52054/FVVO.14.5.104
4. Pavone M, Seeliger B, Alesi MV, Goglia M, Marescaux J, Scambia G, et al. Initial experience of robotically assisted endometriosis surgery with a novel robotic system: first case series in a tertiary care center. Updates Surg. 2024 Jan;76(1):271–7. PMID: 38133880 DOI: 10.1007/s13304-023-01724-z
Robot-assisted radical hysterectomy and bilateral salpingectomy with bilateral postero-lateral parametrectomy and cecum resection for deep endometriosis with the new Hugo™ RAS system
Bibliography:
1. Uccella S, Garzon S, Lanzo G, et al. Uterine artery closure at the origin vs at the uterus level in total laparoscopic hysterectomy: A randomized controlled trial. Acta Obstet Gynecol Scand. 2021; 100: 1840–1848. https://doi.org/10.1111/aogs.14238
2. Hyun Jin Choi, Myeong Seon Kim, Tae-Joong Kim,Uterine artery ligation at its origin following retroperitoneal space development decreases blood loss during single-port total laparoscopic hysterectomy,Taiwanese Journal of Obstetrics and Gynecology,Volume 59, Issue 2,2020, Pages 262-268, https://doi.org/10.1016/j.tjog.2020.01.015
3. Abo-Hashem, U., Rashed, R., El-Bassioune, W., & Abdou, H. (2021). Laparoscopic Hysterectomy with Prior Uterine Artery Ligation versus Conventional Laparoscopic Hysterectomy. International Journal of Medical Arts, 3(4), 1879-1883. doi: 10.21608/ijma.2021.91017.1352
4. Gueli Alletti S, Restaino S, Finelli A, et al. Step by Step Total Laparoscopic Hysterectomy with Uterine Arteries Ligation at the Origin. Journal of Minimally Invasive Gynecology. 2020 Jan;27(1):22-23. DOI: 10.1016/j.jmig.2019.06.001. PMID: 31201941.
Laparoscopic uterine artery clipping at its origin
The use of translaparoscopic liver ultrasound requires a solid knowledge of ultrasound liver anatomy. With proper training, it allows for the delineation of liver segments and for the exposure of reference hepatic veins during parenchymal dissection. It also helps to minimize the risk of injury to crucial structures (3)(4), and it is an invaluable tool to improve the accuracy and safety of the procedure. It also provides personalized and efficient liver management.
Bibliography:
1. Ferrero A, Lo Tesoriere R, Russolillo N. Ultrasound Liver Map Technique for Laparoscopic Liver Resections. World J Surg. 2019;43(10):2607-2611. doi:10.1007/s00268-019-05046-3 Link: https://pubmed.ncbi.nlm.nih.gov/31161357/
2. Kose E, Kahramangil B, Purysko AS, et al. The utility of laparoscopic ultrasound during minimally invasive liver procedures in patients with malignant liver tumors who have undergone preoperative magnetic resonance imaging. Surg Endosc. 2022;36(7):4939-4945. doi:10.1007/s00464-021-08849-5 Link: https://pubmed.ncbi.nlm.nih.gov/34734301/#similar
3. Ishizawa T, Gumbs AA, Kokudo N, Gayet B. Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg. 2012;256(6):959-964. doi:10.1097/SLA.0b013e31825ffed3 Link: https://pubmed.ncbi.nlm.nih.gov/22968066/
4. Cassese G, Han HS, Yoon YS, et al. Evolution of laparoscopic liver resection in the last two decades: lessons from 2000 cases at a referral Korean center. Surg Endosc. Published online December 12, 2023. doi:10.1007/s00464-023-10580-2 Link: https://pubmed.ncbi.nlm.nih.gov/38087108/
How to use a translaparoscopic ultrasound and how to interpret the anatomical landmarks of the liver: basic instructionals
Design: The procedure is performed in a stepwise fashion with narrated video footage.
Setting: The surgical management of deep endometriosis infiltrating the rectum necessitates either colorectal segmental resection or conservative techniques (i.e., shaving and discoid resection). When the intestinal nodule is extensive or involves two distant portions of the bowel, as in this case, decision is made to perform an intestinal resection with nerve sparing. For this surgery, the patient was placed in a dorsal modified lithotomy position. The surgeon stood on the patient’s left side, the first assistant on the right, and the second assistant between the patient’s legs.
Clinical case presentation: The authors present the case of a nulligravida 41-year-old patient with no relevant medical history. She was referred to our center due to dysmenorrhea, dyspareunia, dyschezia, and chronic pelvic pain. The patient was under hormone treatment with Dienogest 2mg for 24 months, without any response. On physical exam, she presented with a fixed uterus in the anterior vaginal fornix. A mild thickening of the anterior vaginal fornix was observed. In the posterior cul-de-sac, there was a palpable painful nodule. On MRI, a nodule involving the upper rectal wall, measuring 26mm in length and 11mm in thickness, located 12cm from the anal margin, was observed. It infiltrated the outer myometrium of the uterus. Lamellar fibrotic tissue was found at the level of the rectouterine pouch, blocking it. Another nodule was found in the sigmoid colon, measuring 14mm in length and 9mm in thickness, leaving an impression in the lumen. The vesicouterine space presented with endometriotic tissue, which did not involve the bladder. It had a cystic component with infiltration of the outer myometrium. A bilateral hematosalpinx was noted. There were endometriomas in both ovaries.
Interventions: A laparoscopic approach with intestinal resection and nerve sparing was decided upon to treat deep infiltrating endometriosis. In this video, the authors demonstrated a stepwise surgical demonstration with key steps through a narrated video.
Measurements and main results: Postoperative outcomes were uneventful. She was discharged on postoperative day 3. At the 3-month follow-up, the patient was symptom-free.
Conclusion: In cases where the intestinal disease is extensive and conservative treatment (shaving or discal) is not possible, it is necessary to perform intestinal resection with terminal anastomosis. Nerve sparing in such cases is crucial to prevent evacuatory disorders.
Bibliography:
1. Donnez O, Roman H. Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection? Fertil Steril. 2017 Dec;108(6):931-942. doi: 10.1016/j.fertnstert.2017.09.006. PMID: 29202966.
2. Nezhat C, Li A, Falik R, Copeland D, Razavi G, Shakib A, Mihailide C, Bamford H, DiFrancesco L, Tazuke S, Ghanouni P, Rivas H, Nezhat A, Nezhat C, Nezhat F. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol. 2018 Jun;218(6):549-562. doi: 10.1016/j.ajog.2017.09.023. Epub 2017 Oct 13. PMID: 29032051.
3. Roman H, Vassilieff M, Gourcerol G, Savoye G, Leroi AM, Marpeau L, Michot F, Tuech JJ. Surgical management of deep infiltrating endometriosis of the rectum: pleading for a symptom-guided approach. Hum Reprod. 2011 Feb;26(2):274-81. doi: 10.1093/humrep/deq332. Epub 2010 Dec 2. PMID: 21131296.
4. Alabiso G, Alio L, Arena S, di Prun AB, Bergamini V, Berlanda N, Busacca M, Candiani M, Centini G, Di Cello A, Exacoustos C, Fedele L, Gabbi L, Geraci E, Lavarini E, Incandela D, Lazzeri L, Luisi S, Maiorana A, Maneschi F, Mattei A, Muzii L, Pagliardini L, Perandini A, Perelli F, Pinzauti S, Remorgida V, Sanchez AM, Seracchioli R, Somigliana E, Tosti C, Venturella R, Vercellini P, Viganò P, Vignali M, Zullo F, Zupi E. How to Manage Bowel Endometriosis: The ETIC Approach. J Minim Invasive Gynecol. 2015 May-Jun;22(4):517-29. doi: 10.1016/j.jmig.2015.01.021. Epub 2015 Feb 10. PMID: 25678420.
Deep infiltrating endometriosis (DIE): laparoscopic treatment with intestinal resection and nerve sparing
Endometriosis is estimated to affect around 10% of women in their reproductive age. Bladder endometriosis is considered a relatively rare form of endometriosis, accounting for a small subset of all endometriosis cases. It is estimated that bladder involvement occurs in about 1 to 7% of women with endometriosis. The common symptoms of bladder endometriosis include chronic pelvic pain, urinary symptoms, and painful intercourse. The approach involves a combination of continued hormone therapy and surgical intervention, including nodule resection.
Bibliography:
1. Tomasi MC, Ribeiro PAA, Farah D, Vidoto Cervantes G, Nicola AL, Abdalla-Ribeiro HS. Symptoms and Surgical Technique of Bladder Endometriosis: A Systematic Review. J Minim Invasive Gynecol. 2022 Dec;29(12):1294-1302. doi: 10.1016/j.jmig.2022.10.003. Epub 2022 Oct 15. PMID: 36252916. https://pubmed.ncbi.nlm.nih.gov/36252916/
2. Allaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of endometriosis. CMAJ. 2023 Mar 14;195(10):E363-E371. doi: 10.1503/cmaj.220637. PMID: 36918177; PMCID: PMC10120420. https://pubmed.ncbi.nlm.nih.gov/36918177/
3. Piriyev E, Schiermeier S, Römer T. Laparoscopic Approach in Bladder Endometriosis, Intraoperative and Postoperative Outcomes. In Vivo. 2023 Jan-Feb;37(1):357-365. doi: 10.21873/invivo.13086. PMID: 36593051; PMCID: PMC9843782. https://pubmed.ncbi.nlm.nih.gov/36593051/
4. Diniz ALL, Resende JAD Jr, de Andrade CM Jr, Brandão AC, Gasparoni MP Jr, Favorito LA. Urological knowledge and tools applied to diagnosis and surgery in deep infiltrating endometriosis - a narrative review. Int Braz J Urol. 2023 Sep-Oct;49(5):564-579. doi: 10.1590/S1677-5538.IBJU.2023.9907. PMID: 37450770; PMCID: PMC10482465. https://pubmed.ncbi.nlm.nih.gov/37450770/
Bladder endometriosis: laparoscopic treatment
Here, BJS Editor, Paul Sutton, explains what to look for in a scientific article that will help judge whether or not it has scientific credibility sufficient for publication, and in which journal.
How to review a paper - How to undertake a peer-review? (part 2/4)
Guideline 1: What are the risk factors for developing an incisional hernia after previous abdominal surgery?
Guideline 2: Do all patients with an incisional hernia require imaging? and what is the best modality?
Guideline 3: Is it possible to predict from imaging whether fascial closure will be possible?
Guideline 4: Do all incisional hernias need surgical treatment? and what are the key outcome measures in the treatment of incisional hernias?
Guideline 5: What are the important modifiable risk factors that should be optimized before surgery? and what is the effect of pre-optimization?
Guideline 6: What is the difference in outcome for mesh versus suture repair in incisional hernia repair?
Guideline 7: What is the difference in outcome considering different positions of mesh in incisional hernia repair?
Guideline 8: What is the difference in outcome between techniques (open, laparoscopic, and robotic) for incisional hernia repair?
Guideline 9: Is there a benefit of primary fascial closure in midline incisional hernia mesh repair?
Guideline 10: What is the difference in the outcome using different techniques for mesh fixation in intraperitoneal and extraperitoneal mesh placement for incisional hernia repair?
Guideline 11: What is the benefit of enhanced recovery after surgery (ERAS) in incisional hernia repair?
Guideline 12: Should prophylactic antibiotics be used in the elective repair of incisional hernia in adult patients?
Guideline 13: What information is essential for patients after incisional hernia repair? and what activities influence outcome?
Dr. B East, MD, PhD has the following potential conflicts of interest to disclose, receiving research grants from AZV and EHS, as well as speakers' fees from Medtronic. However, industrial companies were never committed to the elaboration and running organization of this webinar. There is neither commercial publicity nor commercial promotion in this webinar. Dr. B East is Secretary for (e)Quality at the EHS and Secretary of the AWS section at the UEMS; she will be the EHS 2024 Conference President, and she is co-producer of the Hernia Basecamp.
Dr. B East declares that she is fully committed to maintaining professional autonomy and independence in relation with the medical device Industry.
This webinar is aimed to promote education among its learners, and Dr. B East, MD, PhD declares that this webinar is fair, balanced, and free of commercial bias.
Dr. B. East has no financial affiliations that would affect the content of her talks.
Dr. A De Beaux, MD, FRCS, MBChB has the following potential conflict of interest to disclose, receiving honoraria BBraun, BD Bard, Medtronic, CMR Surgical Proctor, and Tissium. He is the director of de Beaux Medical Services Ltd, Edinburgh Bariatric Surgeons LLC, British Journal of Surgery Society, the past president of British Hernia Society, the general secretary of the European Hernia Society, a council member of Scottish Intercollegiate Guidelines Network, an executive committee member of the UEMS AWS, and co-producer of Hernia Basecamp. However, these industrial companies were never committed to the elaboration and running organization of Dr. De Beaux's lectures and videos. There is neither commercial publicity nor commercial promotion in Dr. De Beaux's lectures and videos.
Dr. A De Beaux, MD, FRCS, MBChB declares that he is fully committed to maintaining professional autonomy and independence in relation with the medical device Industry.
Dr. Andrew Charles de Beaux has no financial affiliations that would affect the content of his presentations.
Prof. Dr. René Fortelny, MD, FEBS has no financial affiliations that would affect the content of his presentations.
EHS midline incisional hernia guidelines
IRCAD News
Visit from CMR Surgical: exploring IRCAD facilities
We were happy to host a delegation from CMR Surgical yesterday. It included their new General Manager for Europe, who joined the company six months ago and had the chance to discover IRCAD’s top-notch facilities. Many thanks to Mr. Marco Zambonini, General Manager, Europe, and Ms. Fiona Morrison, Global Head of Professional Education, for their […]World virtual university
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