Rodolfo Oviedo

By Rodolfo José Oviedo Barrera

The field of General Surgery with its multiple sub‐specialties has experienced the progression of minimally invasive procedures performed with the robotic technology since the last decade. The robotic applications are extensive and have contributed to the enrichment of the surgical sub‐specialties based on advantages such as increased surgeon control and autonomy, superior instrument dexterity and tissue handling, improved three‐dimensional visualization, wristed articulation, all of this despite the lack of haptic feedback. The sub‐specialties of Colorectal, Hepatobiliary and Pancreatic, Gastric Oncologic, Bariatric, Foregut, Pediatric, Endocrine, and Hernia Surgery, in addition to General Surgery as the principal specialty, have produced several high‐quality randomized controlled trials, meta‐analyses, prospective and retrospective series which have established, in many instances, superior results to those of laparoscopy, and at least non‐inferior outcomes over the years. From the first pioneer single‐surgeon experiences around the world to the most recent large trials, including the first Robotic General Surgery case series in an American community hospital not classified as a tertiary referral center, patients continue to benefit from this technology as surgeons engage in overcoming their learning curve and training their teams, involving their hospital administrators and working with the industry to perfect their techniques for the sake of their patients.

Part of the book: Surgical Robotics

By Rodolfo José Oviedo Barrera

Metabolic and bariatric surgery involves more than altering the stomach and small bowel anatomy to provoke structural changes in the gastrointestinal tract from a mechanical point of view to treat morbid obesity. Its profound impact on the body’s metabolism goes beyond anatomy and enters the realm of physiology. This is one of the most challenging and influential surgical subspecialties today due to its proven beneficial impact on the worldwide obesity epidemic and its millions of patients. A brief but comprehensive overview of the history of this fascinating yet challenging discipline and its advancement into the minimally invasive arena will be presented. Moreover, the body of this chapter will provide evidence-based data dealing with its indications, approaches, minimally invasive techniques including robotic surgery, the most common operations and the most recently introduced procedures, and management of complications. The impact of the laparoscopic revolution at the end of the twentieth century and the relevance of the robotic revolution from this century will be emphasized. An important point that will be made is the very specialized discipline of revisional bariatric surgery and its crucial role on the treatment of complications and failures that require extensive training and experience.

Part of the book: Gastrointestinal Surgery

By Rodolfo J. Oviedo, Jeffrey Hodges, Joseph Nguyen-Lee, David Detz, Mary Oh, João Bombardelli, Anuj Shah, Atteeba Manzar and Alessandro Martinino

From the first description of the component separation technique in the literature at the end of the twentieth century to the current state of complex abdominal wall reconstruction, this rapidly evolving field of General Surgery has advanced at an accelerated pace. With the advancement of technological breakthroughs that stem from the original open technique, endoscopic, laparoscopic, and more recently robotic approaches have been developed to facilitate complex abdominal wall reconstruction to restore the body’s anatomy and physiology to functional levels. This chapter will give an overview of the historic progression of these advanced techniques and will illustrate the key steps for their safe and effective performance including the endoscopic external oblique anterior release as well as posterior release techniques such as the robotic transversus abdominis release (TAR). Finally, other useful variations of complex repair such as the robotic extended totally extraperitoneal (eTEP) approach will be described.

Part of the book: Hernia Surgery