Robotic Inferior Mesenteric Artery, Common Iliac Artery, and Retroperitoneal Lymph Node Dissection

Temporal Artery Biopsy – gold standard for the diagnosis of temporal (giant cell) arteritis

Ultrasonic aspiration (UA) is commonly used for resecting intracranial tumors, as they allow for debulking of large tumors, while avoiding damage to adjacent brain tissue. There are multiple models on the market from several different manufactures, Integra’s CUSA, Söring’s LEVICS, and Stryker’s SONOPET, being the three most studied (A Borges1, 2019).

This technique is also highly effective when employed for excisions in anogenital cases (Henzi, 2019), and is growing in popularity. Some of the most common diseases treated with SONOPET include VIN 2 (41.79%) and VAIN 2 (40.62%) (Henzi, 2019). Patient’s can have complete excision of the lesion with the benefit of less disfiguration and scarring compared to traditional wide local excision (WLE), with the most commonly reported complication being post-operative pain. Because SONOPET allows for aspiration and collection of fragmented tissue, tissue diagnosis can be achieved and has found to be consistent with pre-operative biopsy diagnosis. However, since margins cannot be confirmed it is not recommended when malignant disease is suspected (Miller, 2002).

The purpose of this video is to briefly review assembly and use of the Striker SONOPET for excision of vulvar lesions.

As technique and technology have evolved in the modern age, surgical emphasis has shifted steadily towards minimally invasive alternatives. In colon surgery, laparoscopy has been shown to improve multiple outcome metrics, including reductions in post-operative morbidity, pain, and hospital length of stay, while maintaining surgical success rates. Unfortunately, despite the minimally invasive approach, elective laparoscopic sigmoidectomy typically requires an abdominal wall extraction site, leaving a large incision in addition to the laparoscopic port sites. It also utilizes three different types of intestinal staplers, leading to an anastomosis that may have multiple intersecting staple lines, thereby potentially influencing the anastomotic integrity, as well as increasing procedural costs substantially.
We present a case of a totally robotic sigmoidectomy utilizing a single stapler technique and natural orifice specimen extraction in a patient with multiple, severe, recurrent episodes of sigmoid diverticulitis over a 2-year period.