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278
D. Laan and C. A. Galvani
Fig. 24.6 Adhesiolysis
Fig. 24.7 Hiatal hernia repair
of the phrenoesophageal membrane. Transhiatal dissection
of the esophagus is continued in cephalad. The articulated
vessel sealer device and the fenestrated bipolar grasper are
used for the circumferential dissection of the esophagus.
Mobilization of the esophagus can typically be accomplished using blunt dissection of relatively thin alveolar tissue with traction/countertraction and always dissecting
away from the esophagus. Esophageal mobilization is completed only after 3 cm of tension-free, intraabdominal
esophagus is observed. The esophagus is retracted anteriorly and to the left by Arm #4. Closure of the diaphragmatic
defect is started at the junction of the right and left crus to
decrease tension on every stitch and is carried out anteriorly.
The closure is performed using running non-absorbable
barbed suture. We utilize a “shoelacing technique” in order
to decrease tension.
• The incidence of hiatal hernias during reoperative surgery
is much higher than reported for primary bariatric surgery. Simultaneous repair of hiatal hernias during reoperative surgery is warranted.
24 Robotic Revisional Bariatric Surgery
279
Identication oftheSurgical Anatomy
(Upper Endoscopy/TilePro)
Upper endoscopy is utilized at any point during the procedure if anatomy is unclear (Fig.24.8). The TilePro TM feature is used to project intraoperative endoscopic images onto
Fig. 24.8 Identication of the surgical anatomy (upper endoscopy/
TilePro)
the console screen. The upper endoscopy can be performed
by the bedside assistant.
• TilePro is a multi-image video display mode of the da
Vinci Xi that allows the surgeon to simultaneously view
up to two additional images, such as intraoperative endoscopy, as a picture-on-picture on the three-dimensional
console screen and assistant monitors.
Anatomy Takedown/Reconstruction/Use
ofFirey
After the adhesiolysis is completed and anatomy of the previous surgery is outlined, the previous anatomy is taken down
according to the surgical plan (Fig.24.9). The risk of leak
after revisional surgery is higher than primary surgery likely
due to the less predictable tissue thickness. For that reason,
when using staplers for resection of previous anastomosis,
distal stomach, rst portion of the duodenum, devascularized
stomach, or thickened small bowel one should use a staple
load with proper height due to chronic inammation and
edema scarring. This point deserves special consideration
when using staple line reinforcement. It is also important to
Fig. 24.9 Anatomy takedown /reconstruction/use of Firey
280
be cognizant of previous staple lines, suture materials, clips,
and silastic/mesh banding which could cause the stapler to
jam and cause a misre and damage the tissue. Irrespective of
the index procedure, it is critical to identify and preserve in
the left gastric artery. The Firey feature of the robotic system
can facilitate the identication of the vascular supply.
We use robotic linear stapler (SureForm60 TM) with stapler line reinforcement to decrease bleeding and potentially
leaks. The stapler comes with white (2.5mm staple height),
blue (3.5mm staple height), green (4.3mm staple height),
and black (4.6mm staple height) reloads that can be selected
according to the tissue thickness. This stapler also offers a
120 degrees cone of articulation that allows for less tissue
pulling and improved tissue transection. In addition, the
increased articulation of the stapler could decrease the need
for two 12mm trocars in the eld.
NAGB
Extensive lysis of adhesions is usually required during this
case since these cases were routinely performed in an open
fashion (Fig.24.10). Finding and removing the band from
the perigastric position is an essential step of the procedure.
If the band cannot be removed due to adhesions, then excision of the stomach proximal and distal of the band should be
performed. Alternatively, if the band is eroded into the gastric lumen, transgastric removal of the band can be attempted.
D. Laan and C. A. Galvani
Fig. 24.11 LAGB
LAGB
Excision of the perigastric capsule created by the band is
essential to prevent staple misring. Common conversion
procedures post LAGB removal are sleeve gastrectomy and
gastric bypass (Fig.24.11). Usual stapler reloads for either
Fig. 24.10 NAGB
Fig. 24.12 Sleeve gastrectomy conversion to gastric bypass
gastric bypass or sleeve conversion are blue, green, or black
depending on tissue thickness.
Sleeve Gastrectomy Conversion toGastric
Bypass
Adhesiolysis is performed from the antrum of the stomach
progressing in a cephalad direction until the angle of His
(Fig.24.12). If a neofundus is present, it should be complete
freed and excised during the creation of the gastric pouch.
Usual stapler reloads for pouch creation are either blue or
green. Care must be taken to identify clips on the staple line
from the index procedure. If the intention is to preserve the
sleeve and conversion to duodenal switch, dissection of the
inferior aspect of the sleeve is performed until the rst portion of the duodenum (2–3 cm distal to the pylorus). In
patients with chronic sleeve stulas, conversion to esophagojejunostomy must be considered.
24 Robotic Revisional Bariatric Surgery
281
VBG
Conversion to gastric bypass: the gastric pouch must be
created proximal to the ostoma and medial to the gastrogastric staple line of the VBG (Fig.24.13). It is our practice
to excise the fundus and most of the body of the stomach
that includes the previous staple line. For this purpose, the
short gastric vessels are taken down with vessel sealer.
Stapler reloads for the gastric resection are usually black or
green.
RYGB
It is crucial to delineate the anatomy of the gastric bypass at
the beginning of the procedure (Fig.24.14). The remnant
stomach is dissected off the gastric pouch with robotic
monopolar scissors. Then the posterior aspect of the GJA
Fig. 24.13 VBG conversion to gastric bypass
and the proximal alimentary limb are also dissected off. If
the gastric bypass reconstruction was done retrocolic/retrogastric, further dissection may be necessary to be able to
perform the reconstruction with no tension. Also, if a
banded bypass was performed, the previous nonadjustable
band must be removed. Once the anastomosis is freed, the
gastric pouch is transected proximal to the GJA with linear
stapler with either blue or green reload. The proximal jejunum is also transected with a white reload along with the
mesentery of the small bowel. There are multiple options
for revision of a gastric bypass including revision of the
GJA anastomosis, pouch trimming, distalization, lengthening procedure, conversion to duodenal switch, and
reversal.
Hand-Sewn Gastrojejunostomy Anastomosis
Hand-sewn gastrojejunostomy anastomosis, commonly the
gastrointestinal reconstruction, is carried out in the form of
gastric bypass (gastrojejunostomy) (Fig.24.15). However, a
hand sewn anastomosis (HSA) can be performed during
reversal/conversion procedures as a gastro-gastrostomy,
duodeno- ileostomy, or esophagojejunostomy.
For GJA, a gastrotomy and jejunotomy are created with
monopolar scissors. To create the gastrotomy, the anesthesia team will advance the bougie slowly to create tenting
of the anterior wall of the stomach; at this time the gastrotomy is carried out with cautery against the bougie.
Then a 1.5–2cm gastrojejunostomy was “hand-sewn” in
two layers using two needle drivers and absorbable 6-inch
barbed sutures (×3). Starting from lateral to medial, an
inner posterior layer of running 3–0 absorbable barbed
suture is created with full- thickness bites between the
stomach and jejunum.
Fig. 24.14 RYGB Fig. 24.15 Hand-sewn gastrojejunostomy anastomosis
282
D. Laan and C. A. Galvani
Fig. 24.16 Anterior layer of GJA
Anterior Layer ofGJA
Once the posterior layer is completed, the bougie is advanced
into the jejunum to stent the anastomosis (Fig.24.16). Finally,
two anterior layers of running seromuscular (Lembert sutures)
absorbable 6-inch 3–0 barbed sutures are used.
Leak Test
Once this is completed, the alimentary limb is clamped distally,
and the upper abdomen was lled with water to perform an air
leak test (Fig.24.17). The robotic image is switched to TilePro™
that enables the endoscopic view to be incorporated into the
surgical eld of view within the console. The gastroscope is
inserted into the patient’s esophagus insufating along the way.
The gastric pouch is entered, and the anastomosis is transverses.
If no air leak is observed, the procedure is completed.
A. The HSA has the advantages of allowing for direct exam-
ination of the anastomosis, reducing the risk of bleeding,
and can be used in situations where the use of stapler
would be contraindicated like such us poor quality tissue
or thicker. In addition, it has decreased long-term complications such as strictures.
Fig. 24.17 Leak test
Fig. 24.18 Duodeno-ileostomy
B. The most notable advantages of the use of robotics for
the HSA are the surgeon’s autonomy, decreased variability, and reproducibility that lead to better quality
anastomosis.
C. Similar technique is applied to other GI anastomosis
(gastro-gastrostomy, duodeno-ileostomy [Fig. 24.18], or
esophagojejunostomy [Fig. 24.19]) during the
reconstruction.
24 Robotic Revisional Bariatric Surgery
Fig. 24.19 Esophagojejunostomy
283
References
1. English WJ, DeMaria EJ, Brethauer SA, Mattar SG, Rosenthal RJ,
Morton JM.American Society for Metabolic and Bariatric Surgery
estimation of metabolic and bariatric procedures performed in the
United States in 2016. Surg Obes Relat Dis. 2018;14(3):259–63.
https://doi.org/10.1016/j.soard.2017.12.013.
2. Park JY, Kim YJ. Revisional bariatric surgery. In: Bariatric and
metabolic surgery. Berlin Heidelberg: Springer; 2014. p.87–96.
3. Snyder B, Wilson T, Woodruff V, Wilson E.Robotically assisted
revision of bariatric surgeries is safe and effective to achieve further weight loss. World J Surg. 2013;37(11):2569–73. https://doi.
org/10.1007/s00268- 013- 1968- y.
4. Economopoulos KP, Theocharidis V, McKenzie TJ, Sergentanis
TN, Psaltopoulou T. Robotic vs. laparoscopic Roux-En-Y gastric bypass: a systematic review and meta-analysis. Obes Surg.
20`15;25(11):2180–9. Springer New York LLC,. https://doi.
org/10.1007/s11695- 015- 1870- 9.
5. El Chaar M, King K, Pastrana M, Galvez A, Stoltzfus J.Outcomes
of robotic surgery in revisional bariatric cases: a propensity scorematched analysis of the MBSAQIP registry. J Robot Surg. 2020;
https://doi.org/10.1007/s11701- 020- 01098- z.
6. Cheng YL, Elli EF.Role of robotic surgery in complex revisional
bariatric procedures. Obes Surg. 2021; https://doi.org/10.1007/
s11695- 021- 05272- 6.
Index
A
Achalasia, 27
Adhesiolysis, 11, 56, 277–280
Adjustable gastric band (AGB), 273
Adventitia, 22
Anterior esophagotomy, 195
Anterior layer of GJA, 282
Anterior partial fundoplication, 32
Anti-reux surgery, 71
Antrectomy, 91
Aortic injury and conversion, 1
Atraumatic robotic grasper, 79
B
Barrett’s esophagus, 274
Bedside assistant laparoscopic exible tip ultrasound probe placement,
Billroth II reconstruction, 91
Blunt dissection, 49
C
CEEA, 171
Celiac artery (CEL)
24-Charriere chest drain, 26
Cholecystectomy, 119
Circular oesophageal bres dissection, 31
Circumferential esophageal dissection, 13, 64
Circumferential hiatal dissection, 12
CO
Combined transhiatal and transcervical approach, 157
Continued distal dissection of the common hepatic artery, 7
D
da Vinci surgical robot, 61, 219
da Vinci Xi surgical system, 81, 157, 276
Delayed gastric emptying, 35
Diaphragmatic hernia following esophagectomy, 55
Dilatated esophagus, 28
Distal gastrectomy, 185, 213
4
dynamic elevated velocities, 2
with median arcuate ligament compression, 1
insufation, 21
2
Billroth I reconstruction with circular stapler, 218
camera trocar, infraumbilical position, 213
infrapyloric pedicle, 215
omentectomy, 215
pylorus and proximal duodenum, 217
right gastroepiploic artery and vein, 216
Distal gastric cancer resection, 213
Divided phrenic artery, 7
D2 level lymphadenectomy, 125
Docking, 29
Dor fundoplication, 27, 32, 34
Double tract reconstruction, 171
Drop-in ultrasound probe, 4
Duodenal adenomas, 113
Duodenal-ileal anastomosis (DIA), 267
Duodenal switch (DS), 257, 274
components of, 257
modication of, 258
Duodenal switch and SADI-S
gastroesophageal reux/obstructive symptoms, 263
inner layer of the anastomosis, 268
leak test, 269
left gastric artery, 263
mobilization of greater curve, 266
penrose drain, 265
reverse Trendelenburg position, 261
superior dissection of the duodenum, 265
superior margin of dissection, 266
surgical cart placement, 259
trocar placement, 258
Duodenectomy, 113
Duodeno-ileostomy, 282
E
Early and advanced gastric cancer, 171
prospective randomized trials, 213
Endoscopy, 274
Endosonography, 21
Endo-wrist, 171
Energy devices and instrumentation, 81
Enterotomies, 99, 268
Epiphrenic and Zenker’s diverticula (pulsion type), 9
Esophageal diverticula, 9
Esophageal diverticulectomy, 9
Esophageal manometry, 274
Esophageal resections, 17
Esophagectomy/enucleation, 17, 125
Esophagectomy using a transhiatal approach, 157
Esophagogastric gastric anastomosis, 125
Esophagogastric junction outow obstruction (EGJOO), 9
Esophagogastric myotomy, 15
Esophagojejunal anastomosis, 171
Esophagojejunostomy, 283
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2022
O. Y. Kudsi, P. P. Grimminger (eds.), Atlas of Robotic Upper Gastrointestinal Surgery,
https://doi.org/10.1007/978-3-030-86578-8
285
286
Index
Esophagojejunostomy with Roux-Y-reconstruction, 207–212
Esophagus
direct suturing, 24
in mediastinum, 13
proximal mediastinal dissection, 14
Extensive lysis of adhesions, 280
F
Familial adenomatous polyposis (FAP), 113
Fenestrated bipolar forceps, 23
Fenestrated bipolar forceps on left arm and vessel sealer, 158
Finney pyloroplasty, 103
Foregut surgery, 81
Fundopexy, 80
G
Gastrectomy, 199
circular incision of peritoneum, 202
closure of enterotomy with modied double row technique, 211
dissection of left gastroepiploic vessels, 204
dissection of lesser omentum close to the liver, 201
dissection of pylorus and duodenum, 208
gastrocolic ligament, 203
gastrophrenic ligament, 202
hepatic artery using vessel sealer, 201
incision of esophageal staple line, 210
mesenteric defects with endohernia clips, 212
Pfannenstiel incision, 210
positioning of trocars and diagnostic laparoscopy, 200–201
retrieval of stomach, 207, 210
right gastric artery, 207
right gastroepiploic artery, 206
right gastroepiploic vein, 206
side-to-side esophagojejunal anastomosis, 211
side-to-side jejunojejunostomy, 212
transection of distal esophagus, 210
transection of duodenum, 208
transection of jejunum between the anastomoses, 212
trocar positioning, 200
Gastric bypass, 241
continuous seromuscular stitches, 251
dissection of small intestine, 252
dorsal adhesions of pouch, 246
enterostomy, 250, 251
gastric mucosa, 247
gastric pouch, 250
greater omentum above transverse colon, 243
hemostasis, 254
jejunojejunostomy, 253, 254
left hiatus crus, 243
ligament of Treitz, 248
omental bursa, 245
retrogastric tunnel, 244
Roux limp measuremenr, 253
tip-up fenestrated grasper, 246
trocar placement, 243
Gastric conduit, 56, 59, 125
and vascular supply, 55
Gastric electrical stimulation, 35
Gastric emptying study, 274
Gastric fundus, 33, 34
Gastric mobilization and identication of tumor, 220–223
Gastric neurostimulator, 35
Prolene suture, 47, 51, 52
ski needle, 46
Gastric outlet obstruction, 105
Gastric transection, 97
Gastric wall tunneling, 39
Gastrocolic ligament, 203
Gastrocolic trunk, 93
Gastroduodenal/gastrojejunal anastomosis, 91
Gastroenterotomy, 99
Gastroesophageal reux disease (GERD), 71
Gastrohepatic ligament, 4, 12, 94
Gastrointestinal reconstruction, 281
Gastrointestinal stroma tumors (GIST), 113, 114, 116, 219
bursa omentalis, 221
CT scan, 220
instrument placement, 221
patient positioning and trocar set-up, 220
resection of lymph nodes along the right gastric artery, 221
situs and trocar position after robotic resection, 222
Gastrojejunal anastomosis, 171
Gastrojejunostomy, 250, 281
Gastro-oesophageal junction, 71
Gastroparesis, 35
Gastroparesis Cardinal Symptom Index (GCSI), 35
Gastrophrenic ligament, 202
Gastrotomy, 281
Giant paraesophageal hernia, 81, 82
anterior esophageal dissection, 87
anterior vagus nerve, 84
blunt dissection, 84
crural closure, 87
endoscopic evaluation, Hill grade 1 valve, 89
esophageal mobilization, 86
fundoplication, 89
peritoneal covering, 83
Phasix ST mesh, 88
posterior esophageal dissection, 86, 87
GJA, 281, 282
H
Handheld programming device, 35
Hand-sewn gastrojejunostomy anastomosis, 281
Hassan technique, 276
Heineke-Mikulicz pyloroplasty, 103
electrocautery, 104
hepatoduodenal ligament, 104
monopolar hook, 104
pyloric sphincter, 104
robotic port placement, 103
technical aspects, 103
Heller myotomy, 29
Hepatic exure of colon, 205
Hiatal hernia and oesophagitis, 72
Hiatal hernia during reoperative surgery, 278
Hiatal hernia repair, 55, 225, 234, 277–279
Hiatal hernia repair of large paraesophageal hernia, 61
anterior cruroplasty, 67
anterior 180˚ partial fundoplication, 67, 70
oppy anterior fundoplication valve, 70
intra-abdominal esophagus, 68
phrenoesophageal membrane, 63
Hiatal hernia type 1 and oesophagitis, 71
Hiatal hernia with abnormal transdiaphragmatic pressure gradient, 71
Hill grade I valve, 16
I
Indocyanine green with FireFly™ (Intuitive Surgical, Sunnyvale, CA)
uorescence angiography, 8
Intracorporeal hand-sewing during gastro-jejunal anastomosis, 171
Index
287
Intramural esophageal tumor, 17
Intraoperative endoscopy, 16
Intrathoracic bleeding, 19
Intrathoracic esophageal cancer, 157
Intra-thoracic stomach, 81
Ivor Lewis esophagectomy, 125
anterior and postero-medial aspect of the common hepatic artery,
131
Azygos, 133, 134
circular anastomosis, 139
esophageal stump, 138
fenestrated bipolar forceps, 126
gastric fundus, 127
gastric portion of conduit, 139
greater omentum, 127
inferior pulmonary ligament, 132
left gastroepiploic vessels, 127
parietal pleura, 132, 133
partial omentectomy, 127, 128
postpyloric duodenum, 129
residual gastro-pancreatic ligament or adhesions with the
transverse mesocolon, 128
sovra-pancreatic fat, 131
thoracic duct, 135
Trocar position, 126
Ivor Lewis procedure, 125
J
Jaboulay pyloroplasty, 103
Jaboulay technique, 103
Jejunojejunostomy, 197
Johnson classication of peptic ulcers, 91
inferior mediastinum, 143
liver retractor, 153
lymph node dissection, 152, 155
lymph node station 4R, 146
mesogastricum, 154
parietal pleura, 144, 145
peri-esophageal lymphatic tissue, 149
right vagus nerve, 147
subcarinal lymph nodes, 150
superior mediastinum, 145
thoracic phase, inferior mediastinum, 143
Median arcuate ligament by ultrasound, 5
Median arcuate ligament syndrome (MALS), 1
Mediastinal dissection and exposure, 9
Mediastinal dissection on right side of esophagus, 65
Mediastinal lymphadenectomy, 157
Mediastinal retroesophageal mobilization, 65
Mesenchymal tumors of gastrointestinal tract, 219
Mesenteric defect closure in RYGB, 274
Mesenteric loop defect, 271
Methylene blue test of gastrojejunostomy, 255
Mini laparotomy, 181
Minimally invasive approach to repair, 55
Minimally invasive fundoplication, 71
Minimally-invasive gastrectomy, 185, 213
Minimally invasive placement of neurostimulator, 35
Minimally invasive resection of duodenum, 113
Minimally invasive surgery, 199
Monopolar electrosurgical energy, 48
Mucosal tube, 24
Multivisceral resection, 219
Myotomy, 31, 32
L
Laparoscopic adjustable gastric band (LAGB), 273, 280
Laparoscopic approach, 35
Laparoscopic sleeve gastrectomy (LSG), 225, 274
Laparoscopic surgery, 185
Large type III paraesophageal hiatal hernia, 62
Leak test, 282–283
Left gastric vein crossing the median arcuate ligament, 6
Left lobe liver suspension using a swab and the needle holder, 29
Leiomyomectomy, 17
endoscopic ultrasound, 18
Ligated phrenic artery, 6
Loop DS, 257
Lymphadenectomy, 130, 156, 171, 178, 180
along the common hepatic artery, 208
along the common hepatic artery and coeliac axis, 207
down to left side of portal vein, 208
in hepatoduodenal ligament Lymph node station, 207
of right gastroepiploic arcade, 203–207
along right gastroepiploic vessels, 206
along the splenic artery, 203
along the splenic vessels, 204, 205
with vessel preservation, 213
M
McKeown esophagectomy, 141
endoGIA stapler, 156
enveloping fascia, 151
greater curve of the stomach, 153, 154
hem-o-lock clips, azygos vein, 144
N
Nathanson liver retractor, 276
Neurostimulator, 44, 49, 50
Neurostimulator lead, 40, 46
NIR-ICG-induced FA, 32
Non-adjustable gastric band (NAGB), 273, 280
O
Obesity, 257
Oeso-gastro-duodenal transit and gastroscopy, 71
Oesophageal achalasia, 27
Oesophageal dilatation, 27
Oesophageal motility disorder of unknown cause, 27
Omentectomy, 186, 187
Oncological gastric cancer resection, 213
One-lung ventilation, 157
Open and minimally invasive transthoracic procedures, 157
Open esophagectomy, 141
P
Pancreas-sparing duodenectomy, 113
dissection of duodenum, 116
duodenal dissection from pancreatic head, 117
duodenal mobilization, 117
rst jejunal loop under the mesenteric root, 118
Kocher maneuver, 114, 115
mobilization of hepatic exure and exposure of duodenum, 114
proximal duodenum, 116, 117
resected tumor with distal duodenum, 117
trocar positioning, 114
288
Index
Paraconduit hernia, 55
crural closure, 57, 58
mediastinal dissection, 56, 57
mesh placement, 58, 59
port placement, 56
repair with mesh placement, 55
right crural dissection, 57
Paraconduit hiatal hernia of small intestine, 55, 56
Partial celiac ganglion resection, 7
Partial gastrectomy for GIST tumors, 219, 220, 222
Peptic ulcer disease, 91
Pleura parietalis, 21, 25
Pleura suture, 26
Posterior crura, 15
Posterior crural repair, 65
Posterior vagal trunk, 101
Postoperative esophagitis, 171
Post-release ultrasound, 8
Post-stenotic dilation, 2
Preoperative barium esophagram, 9
Pre-operative gastroscopy with hiatal hernia and oesophagitis, 72
Pre-operative oeso-gastro-duodenal transit, 72
Prepyloric gastric perforation, 94
Programming device, 42
Proximal aortic dissection, 7
Proximal gastrectomy with “double tract” reconstruction, 171
Proximal jejunal loop, 171
Pyloroplasty, 91, 103, 107
absorbable barbed monolament suture, 108
endoscopic leak test, 110
indocyanine green-enhanced uorescence, 110
interrupted apex suture, 109
interrupted suture, 107, 108
mobile omentum, 110
omental patch, 111
single interrupted stitch, 106
types, 103
R
Retrocolic anastomosis, 98
Retrocolic/antercolic roux limb in RYGB, 274
Retrocolic retrogastric Billroth II gastrojejunostomy, enteric
reconstruction, 91
Revisional bariatric surgery, 273
anesthesia equipment, 274
complication rate, 273
complications after primary bariatric surgery, 273
conversion, 273
corrective, 273
operating room, 274
patient education, 274
patient positioning, 276
port placement, 276
pre-operative assessment, 274
reversal, 273
Robot-assisted gastrectomy procedure, 185, 199
anvil and proximal transection, 195
celiac trunk and splenic artery, 192–193
distal transection, 191–192
duodenal transection, 191
en-bloc resection, 189
esophagus, 195
fundus, 194–195
infrapyloric area, 186
left gastric artery, 193
left gastroepiploic vessel, 186, 187
liver retraction, 186
midline minilaparotomy, 195
preparation, 185–186
proximal transection, 196
right gastric artery and hepatoduodenal ligament, 186–191
right gastric vessels, 190
right gastroepiploic vessels, 188
splenic vessels, 193–194
suprapancreatic lymph node dissection, 192, 194
upper pancreatic border, 189
Robot-assisted minimally invasive thoraco-laparoscopic
esophagectomy (RAMIE), 125, 132, 141, 166
Robotic-assisted combined transhiatal and transcervical approach for
esophagectomy, 157
Robotic-assisted gastric bypass, 241
Robotic-assisted proximal gastrectomy with double tract
reconstruction, 171
anastomotic spillage, 184
dual ring wound retractor, 181
esophageal resection, 180
fenestrated bipolar forceps, 172
gastric fundus, 174
gastric-remnant and transposed jejunal loop, 183
gastric suction drain, 183
gastrocolic ligament, 173
gastroepiploic-arcade vessels, 175, 176
greater omentum, 173
hand-sewn single-layer side-to-end anastomosis, 183
hepatic artery, 178
jejunal loop, 182
left gastric artery, 179
left gastroepiploic vessels, 174
mesenteric defect, 184
proximal jejunal loop, 181
reinforcement hand sewn purse string, 182
resected residual antrum, 177
right gastric artery arcade, 176
trocar position, 172
Robotic-assisted transabdominal hiatal hernia repair with the DaVinci
Xi, 62
Robotic and duodenal switch (rDS), 261
Robotic foregut surgery, 81
Robotic Heller myotomy with Dor fundoplication for oesophageal
achalasia using XI Da Vinci system, 27
Robotic linear stapler (SureForm60 TM) with stapler line
reinforcement, 280
Robotic median arcuate ligament release, celiac ganglionectomy, 8
Robotic partial duodenectomy, 113
Robotic partial gastrectomy for GIST tumors, 219, 222
gastric mobilization and identication of the tumor, 220–223
patient positioning and instruments, 219–220
surgical treatment, 219
Robotic revisional bariatric surgery
decisional owchart, 273
patient positioning, 276
pre-operative assessment, 275
Robotic roux-en-y gastric bypass, 241
Robotic single anastomosis duodenal-ileal bypass with sleeve
gastrectomy (rSADI-S) and duodenal switch (rDS), 261
Robotic sleeve gastrectomy, 225
Robotic transcervical and transhiatal esophagectomy (RACE
procedure), 157
azygos vein, 168
cervical esophagus, 167
circular stapler entry-site, 169