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- •Disclaimer for Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Manual
- •Contents
- •Contributors
- •Commercialization
- •References
- •References
- •3: Asensus Surgical: Senhance Surgical System
- •Asensus Surgical: Senhance Surgical System
- •Senhance System Console
- •Straight Stick Instruments
- •Articulating Instruments
- •Energy
- •Intelligent Surgical Unit
- •Advanced Intelligent Surgical Unit Features
- •Senhance Connect
- •Surgeons Console Design
- •Arm Cart Design
- •The Hugo RAS™ System
- •Robotic Arms
- •The Surgeon’s Console
- •System Tower
- •Arm Cart
- •Hugo Instruments
- •Future Developments
- •References
- •5: Versius Surgical Robot
- •Introduction
- •System Design
- •Surgeon Console
- •Disclaimers
- •The Head-Up Display (HUD)
- •Some Important Icons
- •Alarm Icons
- •Arm Modes
- •Arm Clash
- •System Connections
- •Approved Procedures
- •Some Important Safety Features
- •Conclusion
- •6: Virtual Incision: MIRA Surgical System
- •Introduction
- •The MIRA Surgical System
- •Indication
- •Additional Technical Information
- •Clinical Data
- •Telesurgery
- •Purpose
- •Adopting
- •Operationalizing
- •Standardizing
- •Lessons
- •Conclusion
- •Bibliography
- •Introduction
- •Curricula Components
- •Web-Based Training
- •Virtual Simulation
- •Bedside Skills
- •Console Training
- •Training Programs
- •Intuitive Surgical Da Vinci Curriculum
- •Robotic Training Network (RTN)
- •Conclusion
- •References
- •9: Digital Surgery
- •Introduction
- •Advanced Visualization
- •3D Visualization
- •Fluorescence-Guided Surgery
- •Augmented Reality
- •Current Implementation
- •Enhanced Instrumentation
- •Data Capture
- •Video Data
- •Data Analytics
- •Artificial Intelligence
- •Surgical Decision-Making
- •Skills Assessment
- •Patient Care
- •Automated Surgery
- •Connectivity
- •Telementoring
- •Education
- •Clinical Practice
- •Telesurgery
- •Robotic Surgical Platforms
- •Conclusion
- •References
- •Introduction
- •Foundational Knowledge
- •Practical Skills
- •Continuing Education
- •Conclusion
- •References
- •Robotic Surgery Curriculum
- •Surgical Decision-Making
- •Surgical Technique
- •Operative Technique
- •Facebook™ Groups
- •Conclusions
- •References
- •12: Robotic Paraesophageal Hernia Repair
- •Postoperative Care
- •References
- •Introduction
- •Pathophysiology
- •Clinical Features
- •Diagnosis
- •Endoscopic Functional Luminal Imaging Probe (EndoFLIP)
- •Treatment
- •Pharmacotherapy
- •Endoscopic Treatment
- •Botulinum Toxin Injection
- •Pneumatic Dilation
- •Per-oral Endoscopic Myotomy (POEM)
- •Heller Myotomy
- •Operative Steps
- •Liver Retraction
- •Hiatal Dissection
- •Myotomy
- •Partial Fundoplication
- •Intraoperative Complications
- •Esophageal Perforation
- •Gastric Perforation
- •Vagal Nerve Injury
- •Postoperative Care
- •References
- •14: Robotic Esophagectomy
- •Introduction
- •Robotic-Assisted Ivor-Lewis Esophagectomy
- •Abdominal Phase
- •Thoracic Phase
- •Robotic-Assisted McKeown Esophagectomy
- •Thoracic Phase
- •References
- •Introduction
- •Indications
- •Local Resection: “Wedge Gastrectomy”
- •Lymphadenectomy
- •Proximal Gastrectomy
- •Distal Gastrectomy
- •Total Gastrectomy
- •Reconstruction
- •Billroth I
- •Roux-en-Y
- •Double-Tract Reconstruction
- •Conclusion
- •References
- •16: Robotic Sleeve Gastrectomy
- •Introduction
- •Operative Technique
- •Conclusion
- •References
- •17: Robotic Roux-en-Y Gastric Bypass
- •Introduction
- •Indications
- •Contraindications
- •Patient Preparation
- •Technique (Key Operative Steps)
- •Complications
- •Early Complications
- •Late Complications
- •References
- •18: DS/SADI
- •Introduction
- •Patient Preparation
- •Surgical Technique
- •Single Anastomosis DuodenoIleal Bypass
- •Sleeve Gastrectomy
- •Bowel Measurement
- •Duodenal Dissection
- •Duodenoileostomy
- •Bowel Measurement
- •Enteroenterostomy
- •Postoperative Care
- •References
- •Introduction
- •Part I: Revisional Foregut Surgery
- •Introduction
- •Operative Principles: Robotic Revisional Foregut Surgery
- •Presurgical Care: Optimization/Prehabilitation
- •Operating Room Setup
- •Patient Positioning
- •Access/Port Placement/Liver Retraction
- •Fundoplication Takedown
- •Crural Repair
- •Mesh Reinforcement
- •Antireflux Procedure
- •Outcomes
- •Part II: Revisional Bariatric Surgery
- •Introduction
- •Preoperative Assessment
- •Setup
- •Access/Port Placement/Liver Retraction
- •Surgical Technique
- •Outcomes
- •References
- •20: Robotic Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair
- •Introduction
- •Preoperative Evaluation
- •Robotic TAPP
- •Instrumentation
- •Dissection
- •Mesh
- •Closure
- •Special Cases
- •Acute Presentation
- •Common Complications
- •Chronic Pain
- •Recurrence
- •Testicular Ischemia
- •Mesh Infection
- •Conclusion
- •References
- •Introduction
- •Preoperative Considerations
- •Intraoperative Considerations
- •R-TAPP
- •IPOM
- •Conclusion
- •References
- •22: Complex Robotic Abdominal Wall Reconstruction
- •Background
- •Preoperative Planning
- •Botox Injection
- •Patient Selection
- •Operative Procedure
- •Patient Positioning
- •Technique
- •Hybrid Robotic Ventral Hernia Repair
- •Conclusion
- •References
- •23: Robotic Cholecystectomy
- •Introduction
- •Indications
- •Robotic Dissection
- •Single-Port Robotic Cholecystectomy
- •References
- •Introduction
- •Robotic Liver Resection
- •Patient Selection
- •Positioning
- •Port Placement
- •Standard Robotic Instruments
- •Right Hepatectomy (see Video 1)
- •Falciform Dissection
- •Hilar Dissection
- •Intraoperative Ultrasound
- •Parenchymal Transection
- •Left Hepatectomy
- •Hilar Dissection
- •Pringle Maneuver
- •Left Lateral Sectionectomy
- •Right Posterior Sectionectomy
- •Segment 7 Resection
- •Segment 8 Resection
- •Robotic Biliary Reconstruction
- •Choledochal Cyst
- •Bile Duct Injury
- •Roux-en-Y Hepaticojejunostomy
- •Conclusion
- •References
- •25: Robotic-Assisted Pancreaticoduodenectomy (Whipple)
- •Robotic Whipple
- •Patient Selection
- •Operative Steps
- •Supra-pancreatic/Hilar Dissection
- •Uncinate Dissection
- •Reconstruction Phase
- •Final Steps
- •Vascular Resections
- •Postoperative Care
- •Conclusion
- •References
- •26: Right Hemicolectomy
- •Introduction
- •Indications
- •Preparation
- •Patient Positioning
- •Conclusion
- •References
- •Background
- •Indications
- •Operation Steps
- •Left Hemicolectomy
- •Total Colectomy
- •Learning Curve
- •Future Directions
- •Suprapubic Approach
- •Single-Site Robotic Surgery
- •da Vinci SP® Surgical System
- •Conclusion
- •References
- •28: Low Anterior Resection
- •Background
- •Learning Curve
- •Training Program
- •Genitourinary Function
- •Preoperative Planning
- •Operative Procedure
- •Room Setup
- •Patient Positioning
- •Technique
- •Conclusion
- •References
- •29: Robotic Lateral Transabdominal Adrenalectomy
- •Introduction
- •Pertinent Anatomy
- •Patient Positioning
- •Right Adrenalectomy
- •Port Placement
- •Technique
- •Left Adrenalectomy
- •Port Placement
- •Technique
- •Postoperative Care
- •Limitations
- •References
- •Introduction
- •Operative Room Setup
- •Patient Position
- •Surgical Procedure
- •Step 1: Working Space
- •Step 3: Console Time
- •Discussion
- •References
- •31: Robotic Pulmonary Lobectomy
- •Current Evidence
- •Surgical Technique
- •Right-Sided Resections
- •Right Upper Lobectomy
- •Right Lower Lobectomy
- •Right Middle Lobectomy
- •Left-Sided Resections
- •Left Lower Lobectomy
- •Conclusion
- •References
- •32: Robotic-Assisted Cardiac Surgery
- •Introduction
- •Robotic-Assisted Coronary Artery Bypass
- •Operative Technique
- •Outcomes
- •Robotic-Assisted TECAB
- •Hybrid Coronary Revascularization (HCR)
- •Robotic-Assisted Mitral Valve Surgery
- •Patient Selection
- •Outcomes
- •Robotic Aortic Valve Replacement
- •Conclusion
- •References
- •33: Mediastinal Procedures
- •Introduction
- •Anterior Mediastinal Mass Example Case Scenario
- •Anterior Mediastinal Mass Excision Operative Steps
- •Middle Mediastinal Mass Example Case Scenario
- •Middle Mediastinal Cyst Excision Operative Steps
- •Posterior Mediastinal Mass Case Scenario
- •Patient Positioning
- •Posterior Mediastinal Mass Excision Operative Steps
- •Summary
- •References
- •34: Liver Transplantation
- •Introduction
- •Robotic Donor Hepatectomy
- •Patient Selection
- •Positioning
- •Port Placement
- •Instruments
- •Adjunct Robotic Instruments
- •Right Donor Hepatectomy
- •Falciform Dissection
- •Hilar Dissection
- •Demarcation
- •Parenchymal Transection
- •“Rubber Band” Retraction Technique
- •Parenchymal Transection
- •Closure
- •Left Donor Hepatectomy
- •Hilar Dissection
- •Demarcation
- •Parenchymal Transection
- •“Rubber Band” Retraction Technique
- •Parenchymal Transection

TheSAGES Manual
ofRobotic Surgery
SarahSamreen
OmarYusefKudsi
DmitryOleynikov
Ankit D.Patel
Editors
SecondEdition
123

The SAGES Manual of Robotic Surgery

Sarah Samreen • Omar Yusef Kudsi
Dmitry Oleynikov • Ankit D. Patel
Editors
The SAGES Manual
of Robotic Surgery
Second Edition

Editors
Sarah Samreen
Surgery
The University of Texas Medical Branch
Galveston, TX, USA
Dmitry Oleynikov
Monmouth Medical Center
Rutgers Robert Wood Johnson
Medical School
Long Branch, NJ, USA
Omar Yusef Kudsi
Department of Surgery, Brigham and
Women’s Hospital
Harvard Medical School
Boston, MA, USA
Ankit D. Patel
Surgery
Emory University
Atlanta, GA, USA
ISBN 978-3-031-86926-6 ISBN 978-3-031-86927-3 (eBook)
https://doi.org/10.1007/978-3-031-86927-3
© SAGES 2018, 2025
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or
dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the
relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.

Disclaimer for Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Manual
The contents of this manual are intended exclusively for educational and informational purposes only, and nothing contained within constitutes medical advice.
Neither this manual nor its contents have been subject to formal peer review. The
information provided herein does not represent, nor should it be interpreted as, the
ofcial position, view, or endorsement of the Society of American Gastrointestinal
and Endoscopic Surgeons (SAGES) or its governing body. This manual is not
intended for use in diagnosing or treating any health problem, condition, or disease.
Individuals seeking personal medical advice should consult an appropriate licensed
professional.
Neither SAGES, nor its ofcers, directors, employees, members, nor any of the
contributors to this manual make any representation or warranty, express or implied,
regarding the accuracy, completeness, tness for any intended purpose, or suitability of the information contained herein for any specic use or function. Neither
access to, nor use of, this manual creates or implies any physician-patient relationship, and reliance on any information provided, contained, or implied herein is
solely at the user’s own risk.
v

Contents
Part I Robotic System Details
1 The Background of Robotic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Danyal Fer and Jamil Stetler
Part II Current and Upcoming Robotic Platforms
2 Current and Upcoming Robotic Platforms: Intuitive da Vinci . . . . . . . 15
Clark Gerhart
3 Asensus Surgical: Senhance Surgical System . . . . . . . . . . . . . . . . . . . . . 19
Amit Trivedi and Sarah Wong
4 The Hugo RASTM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Yoav Mintz and Ronit Brodie
5 Versius Surgical Robot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Subhash Khanna and Areendam Barua
6 Virtual Incision: MIRA Surgical System . . . . . . . . . . . . . . . . . . . . . . . . 63
Dmitry Oleynikov and Shane Farritor
7 Starting and Developing a Robotic Program . . . . . . . . . . . . . . . . . . . . . 69
C. Franco-Mesa and Sarah Samreen
8 Robotic Training and Pathway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Katherine Fay and Ankit D. Patel
9 Digital Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Jonathan Gootee and Nova Szoka
10 Navigating Resources for Aspiring and Experienced
Robotic Surgeons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Yasamin Taghikhan and Ankit Sarin
Part III Masters Program
11 Overview of SAGES Masters Program . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Daniel B. Jones, Brian P. Jacob, and Linda Schultz
vii

viii
Contents
12 Robotic Paraesophageal Hernia Repair . . . . . . . . . . . . . . . . . . . . . . . . . 129
Karan R. Chhabra and Charudutt N. Paranjape
13 Management of Achalasia: A Disease Hard to Swallow . . . . . . . . . . . . 139
Molly Belisle, Sana Khan, Nicholas Calvo, Alex Lynch,
and Abubaker A. Ali
14 Robotic Esophagectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Evangelos Tagkalos and Peter P. Grimminger
15 Robot-Assisted Partial and Total Gastrectomy . . . . . . . . . . . . . . . . . . . 175
Raj G. Vaghjiani
16 Robotic Sleeve Gastrectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Maria S. Altieri
17 Robotic Roux-en-Y Gastric Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Hany Takla
18 DS/SADI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Paul Anthony Karam, Sarah Samreen, Andrew Lin,
and Maher El Chaar
19 Revisional Foregut and Bariatric Surgery . . . . . . . . . . . . . . . . . . . . . . . 227
Michelle Nessen and Carlos A. Galvani
20 Robotic Transabdominal Preperitoneal (TAPP)
Inguinal Hernia Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Samuel Guba and Richard Lu
21 Robotic Transabdominal Preperitoneal (r-TAPP)
and Intraperitoneal Onlay Mesh (r-IPOM) Hernia
Repairs for Ventral Hernias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Rachel Reed, Savannah Smith, Eli Mlaver,
and S. Scott Davis Jr.
22 Complex Robotic Abdominal Wall Reconstruction . . . . . . . . . . . . . . . . 279
Cigdem Benlice, Bilgi Baca, and Omar Yusef Kudsi
23 Robotic Cholecystectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Samuel Cass, Jennifer Moffett, and Sarah Samreen
24 Liver Resection and Biliary Reconstruction . . . . . . . . . . . . . . . . . . . . . . 307
Yee Lee Cheah and Caroline J. Simon
25 Robotic-Assisted Pancreaticoduodenectomy (Whipple) . . . . . . . . . . . . 327
Ahmad Abou Abbass and Mohamad Othman El Helou
26 Right Hemicolectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Ibrahim H. Ozata and Emre Balık

Contents
27 Left Hemicolectomy and Total Colectomy . . . . . . . . . . . . . . . . . . . . . . . 365
Kamil Erozkan and Emre Gorgun
28 Low Anterior Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Cigdem Benlice and Bilgi Baca
Part IV Miscellaneous
29 Robotic Lateral Transabdominal Adrenalectomy . . . . . . . . . . . . . . . . . 407
Felipe B. Maegawa, Justin Malek, and Snehal G. Patel
30 Thyroid and Parathyroid Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
Micaela Piccoli, Alice Francescato, and Barbara Mullineris
31 Robotic Pulmonary Lobectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427
Andrei I. Gritsiuta, Abbas E. Abbas, and Roman V. Petrov
32 Robotic-Assisted Cardiac Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
Amalia A. Jonsson and Michael E. Halkos
33 Mediastinal Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471
Brittney Williams and Manu Sancheti
34 Liver Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493
Yee Lee Cheah, Gi Hong Choi, YoungRok Choi,
and Kwang Woong Lee
ix
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523

Contributors
Abbas E.Abbas Department of Thoracic Oncology, Warren Alpert School of
Medicine at Brown University, Providence, RI, USA
Ahmad Abou Abbass Directory of Hepatobiliary Surgery, Mission Hospital,
Mission Viejo, CA, USA
AbubakerA.Ali Wayne State University, Detroit, MI, USA
MariaS.Altieri Department of Surgery, Hospital of the University of Pennsylvania,
Philadelphia, PA, USA
Bilgi Baca Department of General Surgery, Acibadem Mehmet Ali Aydinlar
University School of Medicine, Istanbul, Turkey
EmreBalık Maltepe Mahallesi, Zeytinburnu, Istanbul, Turkey
AreendamBarua Minimal Access and Robotic Surgical Oncology, Swagat Super
Speciality Surgical Institute and NH, Guwahati, Assam, India
MollyBelisle Wayne State University, Detroit, MI, USA
CigdemBenlice Department of General Surgery, Acibadem Mehmet Ali Aydinlar
University School of Medicine, Istanbul, Turkey
Ronit Brodie Department of General Surgery, Hadassah Hebrew University
Medical Center, Jerusalem, Israel
NicholasCalvo Wayne State University, Detroit, MI, USA
SamuelCass, MD Department of Surgery, University of Texas Medical Branch,
Galveston, TX, USA
YeeLeeCheah JC Walter Jr Transplant Center, Sherrie and Alan Conover Center
for Liver Disease and Transplantation, Houston Methodist Hospital,
Houston, TX, USA
Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
xi

xii
Contributors
Karan R. Chhabra Departments of Surgery and Population Health, NYU
Grossman School of Medicine, New York, NY, USA
Division of Bariatric and General Surgery, Bellevue Hospital Center, New
York, NY, USA
Gi Hong Choi Division of Hepato-biliary and Pancreatic Surgery, Yonsei
University College of Medicine, Seoul, South Korea
YoungRokChoi Division of HBP Surgery, Department of Surgery, Seoul National
University College of Medicine, Seoul, South Korea
Maher El Chaar Bariatric Surgery Department, St Luke’s University Health
Network, Bethlehem, PA, USA
MohamadOthmanEl Helou Department of Surgery, Yale New Haven Hospital,
Yale School of Medicine, New Haven, CT, USA
Department of Surgery, Henry Ford Providence Hospital, Southeld, MI, USA
KamilErozkan Department of Colorectal Surgery, Digestive Disease and Surgery
Institute, Cleveland Clinic, Cleveland, OH, USA
Shane Farritor David B. and Nancy K. Lederer Professor of Engineering,
Lincoln, NH, USA
Katherine Fay Department of General Surgery, Grady Memorial Hospital,
Atlanta, GA, USA
Department of General & Gastrointestinal Surgery, Emory University School of
Medicine, Atlanta, GA, USA
DanyalFer Department of General & Gastrointestinal Surgery, Emory University
School of Medicine, Atlanta, GA, USA
Department of General Surgery, David Grant Medical Center, United States Air
Force, Faireld, CA, USA
AliceFrancescato Department of General, Emergency Surgery and New technol-
ogies, Baggiovara General Hospital, AOU Modena, Modena, Italy
C.Franco-Mesa, MD Division of General Surgery, University of Texas Medical
Branch, Galveston, TX, USA
Carlos A. Galvani Department of Minimally Invasive and Bariatric Surgery,
Louisiana State University, Baton Rouge, LA, USA
Clark Gerhart General and Bariatric Surgeon, Associate Medical Ofcer,
Intuitive., Sunnyvale, CA, USA
Jonathan Gootee Department of Surgery, West Virginia University,
Morgantown, WV, USA
EmreGorgun Department of Colorectal Surgery, Digestive Disease and Surgery
Institute, Cleveland Clinic, Cleveland, OH, USA
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