Carbon dioxide embolism during LH occurs frequently. Clinically, this finding appears to be nominal, but care must be taken when dissection around large veins is performed, and awareness by the surgical and anesthesiology teams of potential venous air embolism is essential. Further evaluation of this phenomenon is required.

The da Vinci surgical system released its new pure single-port platform, the da Vinci SP, offering improvements and refinements for established robotic single-site procedures. Herein, we present the first case of robotic single-site cholecystectomy using the da Vinci SP system (RSPC) demonstrating its safety and technical feasibility. A 59-year-old female with chronic calculus cholecystitis was admitted for elective RSPC. Docking time took 6 minutes. The patient underwent successful RSPC with a total operation time of 89 minutes. There was no significant intraoperative event. The patient had unremarkable postoperative course. Multijoint instruments, simple docking process, and third-arm functionality are among the RSPC's advantages. Absence of the port for an assistant surgeon can be a hindrance in performing more complicated surgeries. The present case suggests that RSPC is safe and feasible. The promising features and potential application of da Vinci SP in hepatobiliary and pancreas surgery need further study.

Backgrounds/Aims: Laparoscopic major liver resections are still considered innovative procedures despite the recent development of laparoscopic liver surgery. Robotic surgery has been introduced as an innovative system for laparoscopic surgery. In this study, we investigated surgical outcomes after major liver resections using robotic systems. Methods: From January 2009 to October 2018, 70 patients underwent robotic major liver resections, which included conventional major liver resections and right sectionectomy. The short-term and long-term outcomes were compared with 252 open major resections performed during the same period. Results: Operative time was longer in the robotic group (472 min vs. 349 min, p＜0.001). However, estimated blood loss was lower in the robotic group compared with the open resection group (269 ml vs. 548 ml, p=0.009). The overall postoperative complication rate of the robotic group was lower than that of the open resection group (31.4% vs. 58.3%, p＜0.001), but the major complication rate was similar between the two groups. Hospital stay was shorter in the robotic group (9.5 days vs. 15.1 days, p=0.006). Among patients with HCC, cholangiocarcinoma, and colorectal liver metastasis, there was no difference in overall and disease-free survival between the two groups. After propensity score matching in 37 patients with HCC for each group, the robotic group still showed a shorter hospital stay and comparable long-term outcomes. Conclusions: Robotic major liver resections provided improved perioperative outcomes and comparable long-term oncologic outcome compared with open resections. Therefore, robotic surgery should be considered one of the options for minimally invasive major liver resections.

Background Ultrasound (US) can be used for many perioperative procedures, but evidence is lacking as to its frequency of use and barrier of application. The objectives of this survey were to determine i) how often US guidance was used perioperatively for vascular access placement, nerve blocks, and heart and lung assessment, and ii) to identify the barriers and the limitations of using US amongst anesthesiologists in southwestern Ontario. Methods We conducted a web-based survey in over 40 academic or community hospitals at southwestern Ontario. Results Of 266 surveys sent, 66 complete surveys were obtained (response rate of 25%). Most respondents (> 80%) reported that US was commonly used for central venous catheter (CVC) insertion, followed by regional blocks; the uses were less frequent for neuraxial blockade and cardiopulmonary assessment. Most respondents wanted to use US more frequently as part of their practice and felt that they already had adequate US training. However, most respondents (59%) reported limited access to US machines in their working institutes as being the major barrier to incorporating US in their daily practice. Conclusion The most common uses of US in anesthesia practice in southwestern Ontario were for CVC insertion and regional blocks. Most anesthesiologists in southwestern Ontario are interested to incorporate US in their daily practice but most were limited by the lack of US resources. Apparently, only providing knowledge and skills teaching may not be sufficient to further improve the US utilization in our region; a matched administrative effort appears to be the next challenge.

Both robotic and laparoscopic right anterior sectionectomy and central hepatectomy can be performed safely in expert centres, with excellent outcomes. The robotic approach was associated with statistically significant less blood loss compared with laparoscopy, although the clinical relevance of this finding remains unclear.