Standard surgical treatment of Zenker's diverticulum consists of open cricopharyngeal myotomy with diverticulectomy. A rigid or flexible endoscopic approach allowing a cricopharyngeal myotomy without diverticulectomy is currently considered as a less invasive alternative to open surgery with reportedly comparable symptom relief at short term follow-up. In recent years, high safety and efficacy of a transaxillary gasless robotic access to the thyroid gland has been shown. The present study describes the feasibility and preliminary results of robot-assisted transaxillary approach for cricopharyngeal myotomy and excision of Zenker's diverticulum. Patients with troublesome dysphagia and radiological evidence of Zenker's diverticulum underwent a robot-assisted cricopharyngeal myotomy and diverticulum excision using left transaxillary access with the support of endoscopic assistance. One month after intervention, symptoms were reevaluated and a barium swallow study was performed. Four patients with symptomatic Zenker's diverticulum were successfully operated. No adverse event was recorded. One month after intervention, total dysphagia remission was declared by all four patients and there was no evidence of diverticulum recurrence at radiology. According to our preliminary data, left transaxillary robot-assisted approach for the surgical management of Zenker's diverticulum is feasible, safe and effective. Whether our encouraging results will be confirmed in larger patient cohorts with prolonged follow-up, the robot-assisted transaxillary Zenker's diverticulectomy may represent an alternative to traditional open diverticulectomy when endoscopic interventions cannot be performed or have failed.
HighlightsDesmoid tumours are rare benign neoplasms with local invasion and recurrence.A margin-free excision may be challenging for the surgeon.If necessary, abdominal wall reconstruction can be required for rectus abdominis muscle tumours.A multidisciplinary approach is necessary approaching this rare disease.
Background: Laparoscopic right colectomy is regarded technically difficult especially with intracorporeal anastomosis, and in obese patients. Robotic surgery may offer a solution to these limitations. Our aim is to evaluate the results of robotic right hemicolectomy for cancer compared to traditional laparoscopy. Methods: Retrospective study including all patients who underwent elective laparoscopic or robotic right hemicolectomy for cancer from January 2009 till August 2011.We analyzed the preoperative, operative and pathological criteria, postoperative outcomes and follow up. Results: We had 48 patients (M: F of 1.3:1), 34 laparoscopic, 14 robotic comparable as regards ASA grade BMI and co-morbid conditions. The site of lesions were; cecum=18, ascending colon=24, hepatic flexure=7 (one patient had 2 synchronous tumors). There were no statistically significant differences in the total operative time or amount of blood loss or hospital stay between both groups. No open conversion in the robotic group compared to 2 in the laparoscopic group. There was a statistically significant difference in the number of lymph nodes retrieved; 21.1±10 in the robotic group compared to 16.4±4.8 in the laparoscopic group (P value=0.0320). In the laparoscopic group we performed extracorporeal mechanical anastomosis in 24 cases (70%) and in the robotic group intracorporeal manual anastomosis in 9(64%). In the laparoscopic group there were 3 anastomosis related complications: 2 bleedings and one major leak, none in the robotic group. We had a single mortality in the laparoscopic group from advanced disease. Short term follow up revealed no relapses in neither groups. Conclusion: Robotic hemicolectomy for right colon cancer appears as a safe and effective technique with less anastomosis related complications and better patient outcome with comparable oncological result
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