A REVIEW OF THE STELLA-2 TRIAL OF EVALUATION OF THE EXTRAPERITONEAL APPROACH

This study consisted of a retrospective review of the STELLA-2 trial, which sought to assess whether an extraperitoneal approach or without violating the peritoneal cavity would be safer for patients undergoing staging procedures in ovarian and endometrial cancers in early stage. The results of this review have served to conclude that the extraperioteneal robot-assisted approach for lymphadenectomy or dissection of the lymph nodes arranged around the abdominal aorta, also known by its acronym PALND, was associated with fewer surgical complications. The results of this study have been published in The Journal of Minimally Invasive Gynecology.

The results of this recent study have served to conclude that the extraperioteneal robot-assisted approach to lymphadenectomy is associated with fewer surgical complications

A COMPARISON OF FOUR DIFFERENT SURGICAL APPROACHES

Data from 203 patients from the STELLA-2 trial were included in this outcome review and served to compare four different approaches. Thus, the results of two laparoscopic approaches were evaluated, one transperitoneal and the other extraperitoneal with another two robot-assisted, also transperitoneal and extraperitoneal. “In all cases it was observed that variables such as age, body mass index and waist-hip ratio independently increased the risk of complications in PALND, while the extraperitoneal robotic approach was an independent protective factor for the appearance of these complications”, explains Dr. Berta Díaz-Feijoo, gynecologist oncologist at the Instituto Clínic de Ginecología, Obstetricia y Neonatología (ICGON) of the Hospital Clínic de Barcelona and gynecologist oncologist of barnaclínic+.

Dra. Berta Diaz-Feijoo
“In all cases it was observed that variables such as age, body mass index and waist-hip ratio independently increased the risk of complications in PALND, while the extraperitoneal robotic approach was an independent protective factor for the appearance of these complications”

ADVANTAGES OF THE EXTRAPERITONEAL ROBOTIC APPROACH

The results of the published review also demonstrates that this extraperitoneal robotic approach does not compromise lymph node recovery or increase operative time or hospital stay. “Improved 3D robotic visualization, surgeon ergonomics, or hemostatic precision could explain these results”, adds Dr. Berta Díaz-Feijoo. In addition, it highlights how little data is available so far on the benefit of robot-assisted surgery in reducing intraoperative and postoperative complications and that, thanks to this publication, it has been possible to advance in defining a better approach to the many options that now exist.

Dra. Berta Diaz-Feijoo
“The improved robotic 3D visualization, the ergonomics of the surgeon or the hemostatic precision could explain these results”
Dr. Berta Díaz-Feijoo, gynecologic oncologist of the Hospital Clínic de Barcelona and barnaclínic+

Thus, and according to the data obtained, whenever lymphadenectomy is necessary for the surgical staging of high-risk ovarian or endometrial carcinoma, the extraperitoneal robotic approach could lead to better patient management, regardless of their baseline characteristics (that is, previous surgeries, age or obesity).

ROBOTIC CARDIOVASCULAR SURGERY FOR THE TREATMENT OF MITRAL INSUFFICIENCY

Robotic cardiovascular surgeries performed at Hospital Clínic for the treatment of mitral insufficiency take between 4 and 5 hours and allow better recovery and fewer postoperative complications than conventional surgeries. It is a minimally invasive technique in which the heart is accessed through small incisions between the ribs (about 8 millimeters) and without the need to open the sternum (as it does in conventional surgery). These types of benefits are also obtained with the conventional Port-Access surgery. However, the assistance of the Da Vinci robot provides greater precision, even less invasiveness, better aesthetic and better recovery results.

Mitral insufficiency is a pathology characterized by the poor closure of the mitral valve which, if not treated, can cause heart failure and arrhythmias. Mitral insufficiency can be treated by replacing or repairing the heart valve. Mitral valve repair surgeries avoid having to replace the valve with prosthesis. As Dr. Daniel Pereda affirms: “this surgery allows the patient’s valve to be preserved and its function restored, thus avoiding having to replace it with prosthesis, with all the possible complications that this may entail”. The Hospital Clínic Group is an Accredited National Reference Center (CSUR) for complex mitral valve surgical repairs. The Clínic Cardiovascular Institute performs over 100 surgeries of this type every year.

Dr. Daniel Pereda – Cardiovascular surgeon
«Mitral valve repair surgery allows the patient’s valve to be preserved and its function restored, thus avoiding having to replace it with prosthesis, with all the possible complications that this entails»

«Robotic cardiovascular surgery allows us to perform the intervention in a much less aggressive form. The Da Vinci robot allows us to have greater mobility with minimal invasiveness»
Dr. Daniel Pereda

WHICH HEART PATHOLOGIES CAN BE TREATED WITH ROBOTIC CARDIOVASCULAR SURGERY?

These first robot-assisted mitral valve repair surgeries open the gates to the treatment of other cardiac pathologies, some of them already available today. Currently, “not all cardiac interventions can be done using robotic technology,” Dr. Daniel Pereda affirms. However, this technology is available for various cardiac pathologies such as: septal defects of the tricuspid valve, congenital heart defects, some types of cardiac tumors (especially benign) and arrhythmias, specifically atrial fibrillation (the most common).

THE FUTURE OF ROBOTIC SURGERY IN CARDIOVASCULAR SURGERY

Hospital Clínic and barnaclínic+ consolidate their commitment to robotic surgery and add Cardiovascular Surgery to a list that already featured Urology, Digestive Surgery and Gynaecology.

As Dr. Pereda states, “with increasingly better technology and better diagnosis”, more and more patients will be able to benefit from robotic surgeries. These types of interventions offer greater benefits the sooner patients are diagnosed. With reference to the field of Cardiac Surgery in particular, Dr. Pereda states that the development of technology “will allow us to be able to offer robotic surgery treatments for pathologies that we cannot treat at the moment, such as pathologies of the aortic valve”.