Minimally invasive surgery and cancer: controversies part 1

Goldfarb, Melanie; Brower, Steven T.; Schwaitzberg, Steven D.

doi:10.1007/s00464-009-0583-3

Cited by 42 publications

(30 citation statements)

References 175 publications

(169 reference statements)

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“…EUS visualization can display five distinct layers of the esophageal wall (the echo/ superficial mucosa boundary, the mucosa, the submucosa, the muscularis propria, and the adventitia) and represents an important advance in esophageal cancer staging. The reported sensitivity of EUS in the assessment of T-stage is 85-90%, and the reported accuracy is 70-80% (16,17). EUS also is useful in detecting regional lymphadenopathy and sampling suspicious nodes with fine-needle aspiration (FNA) ( Table 2).…”

Section: Endoscopic Ultrasoundmentioning

confidence: 99%

Minimally invasive staging of esophageal cancer

Mehta

Bianco

Awais

et al. 2017

Ann. Cardiothorac. Surg.

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Esophageal cancer is one of the most common malignancies in the world today and the sixth-leading cause of cancer-related mortality. Accurate preoperative staging of esophageal cancer is imperative to the selection of appropriate treatments. Patients with esophageal carcinomas typically undergo a multimodality staging process including noninvasive imaging techniques, such as computed tomography (CT) and positron emission tomography (PET), as well as endoscopic ultrasound (EUS), which is slightly more invasive.Minimally invasive surgical staging, with laparoscopy, occasionally in combination with video-assisted thoracoscopy, is used in the staging process at select institutions and has been shown to be more accurate than noninvasive staging modalities. Two major advantages of minimally invasive surgical staging over conventional techniques are the improved assessment of locoregional disease and enhanced identification of distant metastases. These advantages decrease the likelihood that the patient will undergo a nontherapeutic laparotomy. Currently, no clear consensus exists regarding which patients with esophageal cancer would benefit most from the addition of minimally invasive surgical staging. We have, however, found that minimally invasive surgical staging with laparoscopy is particularly valuable in detection of occult distant metastases. In this article, we summarize the staging modalities for esophageal cancer including minimally invasive surgical staging.

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Section: Endoscopic Ultrasoundmentioning

confidence: 99%

Minimally invasive staging of esophageal cancer

Mehta

Bianco

Awais

et al. 2017

Ann. Cardiothorac. Surg.

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“…[28][29][30] However, MIE is very far from being accepted for routine clinical use worldwide due to the steep learning curve and the unproven cost-effectiveness. 31 Moreover, several technical variables (laparoscopy, thoracoscopy, combined steps, prone or supine position, stapled or hand-sewn anastomosis), together with the general poor quality of the published studies, has contributed to the confounded outcomes and oncologic results. 32 Robot-assisted, minimally invasive esophagectomy (RAMIE) facilitates esophageal dissection with enhanced visualization of the three-dimensional fields, allowing the execution of complex maneuvers through the articulated instruments, including lymphadenectomy and visceral anastomoses.…”

Section: Bencini Et Almentioning

confidence: 99%

“…31 Despite the advancements in recent years in laparoscopy (ie, colorectal surgery), the keyhole approach to gastric surgery is still debated and exclusive to a few skilled surgeons, many of them working in Eastern countries. 19,31,50 The limits for the widespread use of laparoscopic gastrectomy (LG) are represented mainly by the technical difficulties in both anastomosis, lymphadectomy and conflicting benefits. Nevertheless, two very comprehensive meta-analyses concluded that LG is better or comparable to open surgery with regards to early and long-term outcomes, although at the price of a longer duration of surgery.…”

mentioning

confidence: 99%

Gastrointestinal robotic surgery: challenges and developments

Becchini¹,

Annecchiarico²,

Marino³

et al. 2015

RSRR

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Abstract:The rapid diffusion of new technologies in surgery, together with high expectations of both patients and the mass media, has led to many gastrointestinal procedures being approached using robots. Robotic technology seems to resolve many of the drawbacks of laparoscopic advanced procedures, such as anastomotic reconstructions, accurate lymphadenectomy, and vascular sutures. In addition, a deeper tridimensional steady vision with excellent high definition, the EndoWrist technology offering seven degrees of freedom, tremor filtration, scaled motion, optimal working ergonomics, and avoidance of the 'fulcrum effect', are the main strengths of the da Vinci ® system. The use of near-infrared technology and the possibility of tutoring through a double-console will most likely add many more advantages of this technology over laparoscopy alone. However, none of the gastrointestinal robotic interventions has reached a level of evidence-based efficacy that enables it to be routinely applied. The main limitations of robotic gastrointestinal procedures are represented by the learning curve, the higher costs of robotic surgery compared to traditional and laparoscopic surgery, and the longer operation times, including setup and organizational troubles. Moreover, while the limits of robotics for benign diseases are mainly represented by technical issues, oncologic outcomes remain the foundation of any procedures to cure malignancies, and long-term follow-up is still lacking. On the other hand, a word of caution should be presented on the adoption of robotics in too many surgical units without the correct and formal technical background and third-party control to guarantee the best outcomes for patients at minimum risk. Therefore, the robotic treatment of gastrointestinal diseases requires a thorough analysis of the published evidence, in order to determine the correct indications and patient selection. This review aims to examine the evidence for the use of robotic surgery in both malignancies and benign disease arising from the gastrointestinal area. Future developments in robotics and ongoing areas of research are also analyzed.

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“…Einer tendenziell längeren Operationsdauer bei laparoskopischer Chirurgie stehen eine kleinere Inzisionslänge mit geringerer postoperativer Schmerzintensität, weniger Wundinfekten, kürzerer Krankenhausverweildauer, niedrigerem intraoperativen Blutverlust, einem besseren kosmetischen Ergebnis und weniger Narbenhernien sowie eine höhere Patientenzufriedenheit gegenüber [7]. …”

Section: Introductionunclassified

Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltrakts: Pankreas - Pro-Position

Bork¹,

Reißfelder²,

Weitz³

et al. 2013

Visc Med

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Hintergrund: Die laparoskopische Pankreaschirurgie hat in den letzten Jahren zunehmend Einzug in die Klinik gehalten. Bisher ist jedoch ungeklärt, ob die Laparoskopie auch bei malignen Pankreaserkrankungen einen Stellenwert besitzt. Methoden: Evidenzbasierter Übersichtsartikel zur minimalinvasiven Chirurgie bei malignen Pankreaserkrankungen. Mittels ausführlicher Literaturrecherche in medizinischen Datenbanken (PubMed, Medline) und manueller Recherche wurden relevante Publikationen bis Juni 2013 eingeschlossen. Ergebnisse: Die laparoskopische Pankreaschirurgie bei malignen Pankreaserkrankungen bietet in erfahrenen Händen die typischen Vorteile der minimalinvasiven Chirurgie (weniger postoperative Wundinfekte, kürzere Krankenhausverweildauer, geringerer intraoperativer Blutverlust) mit niedrigerer perioperativer Morbidität für die laparoskopische Pankreaslinksresektion und vergleichbarer Morbidität und Mortalität der anderen laparoskopischen Pankreasresektionen im Vergleich zur offenen Chirurgie. Bezüglich der onkologischen Gleichwertigkeit liegen bisher nur wenige Daten vor. Schlussfolgerungen: Die laparoskopische Pankreaschirurgie ist heute in spezialisierten High-Volume-Zentren mit mindestens vergleichbarer perioperativer Morbidität und Mortalität zur konventionellen Chirurgie gut durchführbar, weitere Studien bezüglich der Langzeitprognose sind jedoch notwendig.

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Minimally invasive surgery and cancer: controversies part 1

Cited by 42 publications

References 175 publications

Minimally invasive staging of esophageal cancer

Minimally invasive staging of esophageal cancer

Gastrointestinal robotic surgery: challenges and developments

Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltrakts: Pankreas - Pro-Position

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