Rence. two.six. Technical Notes two.6.1. Laparoscopic Approach Below general anesthesia, the Hesperidin Technical Information patient is placed in supine reverseTrendelenburg position (roughly 20 ). Surgeon stood in between the patient’s legs. Interventions are performed utilizing four/five trocars, as depicted within the Figure three. Pneumoperitoneum is induced using Veress needle within the left upper quadrant (Palmer point), and maintained at 12 mm Hg abdominal pressure. The abdominal cavity is very first inspected to assess the operability.Figure three. Trocar localization in laparoscopic and robotic approaches.Wedge resections are routinely performed working with a laparoscopic linear stapler, particularly for tumors situated in favorable sites (anterior, posterior wall, and greater curvature), with or with no a reinforcing operating suture on the resection line. R0 marginfree resection and the risk of tumor rupture are the primary pitfalls to pay consideration to through laparoscopic surgery. In all cases the tumor specimen extraction must be performed applying an endoCancers 2021, 13,7 ofscopic bag, so that you can steer clear of spillage and abdominal wall contamination. We extract the specimen utilizing a trocar website enlargement or Pfannenstiel incision for large tumors. The nasogastric tube placed throughout the operation was frequently removed the day immediately after surgery. 2.6.2. RoboticAssisted Surgery We utilised daVinci Robot System Si (Intuitive Surgical Inc., Sunnyvale, CA) from 20102017, then the new Da Vinci Xi platform became accessible. Only two in the three centers enrolled in the study performed robotic resections. The common guidelines adopted in laparoscopy are also observed together with the robotic method, which includes patient positioning. The principle differences involve the device docking, getting the last da Vinci variety (Xi) more versatile and permitting a better ergonomics, with a consequent simpler and more quickly docking. The robotic arms come from the patient’s head. We use 4 robotic ports, 1 placed just above the umbilicus for the 30 camera, as well as the other individuals positioned as depicted in Figure three. A 5th accessory trocar for the assistant (slightly under the portline) is placed in the left half in the abdomen. We frequently use a monopolar curved scissors and fenestrated bipolar and prograsp forceps for retraction; sutures are performed employing a robotic articulated needledriver. The intracorporeal anastomosis consists of a manual two layers operating suture to close the gastric wall defect. In much more detail, we performed a longterm absorbable 2 suture or possibly a single barbed suture using a backandforth 12-OPDA References method (Figures 4). Through robotic operations we do not use power devices for dissection nor an endoscopic stapler for wedge gastric resections. These devices are reserved for normal gastrectomies. The use of Indocyanine green (ICG) method throughout gastric resection to far better identify the tumor was performed in 12 cases over 47 (Figures four and 6). Postoperative workup will be the identical for both strategies. An intraoperative upper endoscopy was performed in 31 cases (38.three ) either to define the exact tumor place in fully endophytic GISTs or to check sutures following gastric 23 of 25 wall reconstructions. In 5 (6.2 ) circumstances an endoscopic intraoperative ultrasound was performed for endophytic lesion identification.Cancers 2021, 13,Figure four. Use of Indocyanine green (ICG) method throughout surgical procedures and GIST resection. Figure 4. Use of Indocyanine green (ICG) technique for the duration of surgical procedures and GIST resection.Cancers 2021, 13,eight ofFigure 4. Use.
