Rence. 2.6. Technical Notes 2.six.1. Laparoscopic Strategy Below basic anesthesia, the patient is placed in supine reverseTrendelenburg position (approximately 20 ). Surgeon stood involving the patient’s legs. Interventions are performed working with four/five trocars, as depicted within the Figure three. Pneumoperitoneum is induced employing Veress needle within the left upper quadrant (Palmer point), and maintained at 12 mm Hg abdominal stress. The abdominal cavity is initial inspected to assess the operability.Figure 3. Trocar localization in laparoscopic and robotic approaches.Wedge resections are routinely performed making use of a laparoscopic linear stapler, in particular for tumors located in favorable websites (anterior, posterior wall, and greater curvature), with or with no a reinforcing operating suture on the resection line. R0 marginfree resection plus the risk of tumor rupture are the key pitfalls to pay interest to through laparoscopic surgery. In all instances the tumor specimen extraction must be performed working with an endoCancers 2021, 13,7 ofscopic bag, so that you can stay away from spillage and abdominal wall contamination. We extract the specimen employing a trocar web site enlargement or Pfannenstiel incision for large tumors. The nasogastric tube placed throughout the operation was 12-Hydroxydodecanoic acid site generally removed the day after surgery. two.6.two. RoboticAssisted Surgery We utilized daVinci Robot Method Si (Intuitive Surgical Inc., Sunnyvale, CA) from 20102017, then the new Da Vinci Xi platform became out there. Only two in the 3 centers enrolled within the study performed robotic resections. The basic guidelines adopted in laparoscopy are also observed with the robotic method, including patient positioning. The principle variations involve the device docking, being the last da Vinci variety (Xi) more versatile and enabling a better ergonomics, having a consequent less difficult and faster docking. The robotic arms come from the patient’s head. We use 4 robotic ports, one placed just above the umbilicus for the 30 camera, and the other people positioned as depicted in Figure 3. A 5th accessory trocar for the assistant (slightly under the portline) is placed inside the left half of your abdomen. We usually use a monopolar curved scissors and fenestrated bipolar and prograsp forceps for retraction; sutures are performed applying a robotic articulated needledriver. The intracorporeal anastomosis consists of a manual two layers Quisqualic acid GPCR/G Protein running suture to close the gastric wall defect. In far more detail, we performed a longterm absorbable two suture or perhaps a single barbed suture having a backandforth approach (Figures four). Through robotic operations we usually do not use power devices for dissection nor an endoscopic stapler for wedge gastric resections. These devices are reserved for regular gastrectomies. The usage of Indocyanine green (ICG) method during gastric resection to superior recognize the tumor was performed in 12 cases more than 47 (Figures four and 6). Postoperative workup is the very same for each strategies. An intraoperative upper endoscopy was performed in 31 instances (38.three ) either to define the exact tumor location in absolutely endophytic GISTs or to check sutures just after gastric 23 of 25 wall reconstructions. In five (six.2 ) circumstances an endoscopic intraoperative ultrasound was performed for endophytic lesion identification.Cancers 2021, 13,Figure four. Use of Indocyanine green (ICG) strategy during surgical procedures and GIST resection. Figure four. Use of Indocyanine green (ICG) method through surgical procedures and GIST resection.Cancers 2021, 13,8 ofFigure 4. Use.
