Volume 7, Issue 6 (Suppl)
J Gastrointest Dig Syst, an open access journal
ISSN: 2161-069X
Page 35
December 07-08, 2017 Madrid, Spain
&
13
th
International Conference on Clinical Gastroenterology & Hepatology
2
nd
International Conference on Digestive Diseases
CO-ORGANIZED EVENT
Minimally Invasive Approaches to Gastrointestinal Surgery
Background
: Traditionally, the majority of gastrointestinal surgery particularly for malignancies are performed via open
approaches. Longer length of hospitalizations, increased wound complications, and prolonged recovery are associated with
these techniques. Unfortunately, the level of complexity, increased length of operation, and prolonged learning curve of the
operating surgeon precludes wide spread adoption of minimally invasive techniques to gastrointestinal surgery. We sought to
examine the impact of minimally invasive techniques including robotics on GI surgery.
Methods
: Minimally invasive and robotic techniques are described and compared to conventional open techniques based upon
current available literature. Utilizing a prospectively maintained esophageal and pancreatic database we identified patients
that underwent robotic esophagectomy, pancreatic resection, colon resection and liver resection. Patient characteristics and
survival were compared with Mann-Whitney U, Pearson’s Chi-square, and the Kaplan-Meier method. Multivariable analysis
(MVA) was developed to identify predictors of survival.
Results
: There were 118 patients who underwent robotic pancreatic surgery; 42 distal pancreatectomies, 65 whipples, 4 total
pancreatectomies, 6 pancreatic enucleations, and 1 robotic cyst gastrostomy. Demographics were median age of 70 (24-94),
majority were males, 70 (59.3%), and the median BMI was 27.5 (16.8-40.2). 30 day mortality was 1 and 90 day mortality
was 0. Major complications (Clavien-Dindo Grade 3-5) were seen in 21 cases (17.8%). The incidence of major complications
significantly decreased between case 1 (20%) to case 60 (5.2%) and then steadily increased and stabilized between 5.2% and
7% from case 16 to 118. Similarly, operative time and overall complications decreased as case volume increased. We identified
203 patients (166 (81.8%) male: 37 (18.2%)female) with a median age of 67.2 (30-90) years who underwent robotic-assisted
esophagogastrectomy for malignant esophageal disease. One-hundred sixty six were adenocarcinoma, 26 were squamous cell
carcinoma and 11 were other. R0 resections was performed in 202 (99.5%) of patients. The median lymph node harvest was
18 (6-63). Neoadjuvant chemoradiation was administered to 157 (77.4 %) patients. A significant reduction in operative times
(p <0.005) following completion of 20 procedures was identified (514±106 min vs. 415± 91 min compared to subsequent 80
cases and further reduced with the subsequent 100 cases 397±71.9 min) p<0.001. Complications decreased after the initial
learning curve of 29 cases, p=0.04.
Conclusions
: Minimally Invasive and robotic techniques offer several advantages over conventional open approaches to
gastrointestinal surgery. However, longer learning curves mandate a strict regimented program with appropriate mentorship
and proctorship. Once learning curve has been surpassed, length of operation and post-operative morbidity will be substantially
decreased.
Biography
Meredith is a Professor of Surgery at Florida State University College of Medicine and serves as Medical Director of Gastrointestinal Oncology at the Sarasota Memorial
Institute for Cancer Care. He is a Surgical Oncologist with a focus on foregut malignancies. His clinical interests include minimally invasive approaches to resection of
gastrointestinal malignancies including robotics. He has lectured and taught surgeons across the world about his robotic approaches and has pioneered robotic approach-
es to esophageal and pancreatic resections. He has published extensively and given over 200 presentations at the local, regional, national and international meetings.
Dr.Kenneth-Meredith@smh.comMeredith Kenneth
Florida State University College of Medicine, USA
Meredith Kenneth, J Gastrointest Dig Syst 2017, 7:6(Suppl)
DOI: 10.4172/2161-069X-C1-057