Monika Hagen

• MD, MBA
• Consultant at University of Geneva

Background Timely metabolic surgery improves glycemic control and reduces cardiovascular risk for patients with type 2 diabetes. Young age is a known predictor of metabolic success but RYGB is often delayed due to the reported vulnerability of young adults. Aims To compare diabetes remission, metabolic outcomes and surgical adverse events in young...

Background Bariatric surgery is performed mostly on obese women of reproductive age. Many studies have analyzed pregnancy outcomes after bariatric surgery, but only a small number have studied the impact of pregnancy on the postoperative outcomes.PurposeTo study the effect of pregnancy on outcomes after bariatric surgery in women of childbearing ag...

Background The objective of the present study is to compare the outcomes open PVHR and robotic PVHR. Methods /Design The present study will be a randomized single-blinded controlled trial with intention-to-treat analysis comparing robotic PVHR to open PVHR in adult patients undergoing elective PVHR with a defect ranging between 1-5cm. Patient refu...

The purpose of this chapter is to review the current trends and procedure volumes of robotic bariatric surgery and to assess its role in the future of bariatric surgery. Various bariatric operations, including revisional procedures, performed using the robot will be reviewed as well as the costs of incorporating the robot into surgical practice. Ad...

Introduction: Laparoscopic abdominoperineal resection (APR) for low rectal cancers is technically demanding. Robotic assistance may be of help and can be hybrid (HAPR) or totally robotic (RAPR). The present study describes outcomes of robotic APR and compares both approaches. Material and methods: A multicentric retrospective analysis of rectal...

Chronic pain is frequent after Roux-en-Y gastric bypass (RYGB). Recurrent internal hernias (IHs) may be responsible for chronic abdominal pain. Physical examination and computed tomography are often inconclusive. This observational retrospective study describes 11 patients who underwent elective laparoscopy for post-RYGB chronic abdominal pain of u...

Introduction Benefits of a pre-operative low-calorie high protein diet before bariatric surgery has been described. Liquid diet has been described as achieving better feeling of satiety than solid diet. The American Society of Metabolic and Bariatric Surgery (ASMBS) stated that pre-operative nutritional care should be more investigated, especially...

Single-Site® technology for da Vinci® Surgical Systems has been used since 2010 for cholecystectomy. Recent systematic reviews and meta-analyses emphase that this technique is safe, particularly regarding the risk of port-site hernia. However, several authors reported an increased risk of incisional hernia after Single-Site® technology cholecystect...

Purpose The da Vinci Surgical System family remains the most widely used surgical robotic system for laparoscopy. Data about gastric bypass surgery with the Xi Surgical System are not available yet. We compared Roux-en-Y gastric bypass surgery performed at our institution with the da Vinci Xi and the da Vinci Si Surgical System. Methods All roboti...

In 2017 there were about 875,000 robotic procedures performed worldwide with the da Vinci Surgical System, with gynecology being the specialty with the highest volume followed by general surgery and urology. Of these robotic general surgery procedures, only an estimated 10% were bariatric procedures. Given the complexity of bariatric procedures as...

The da Vinci Surgical System is intimately associated with the concept of robotic-assisted laparoscopic surgery. Its development, which started 25 years ago for military and astronautic purposes, has followed and answered the main challenges of laparoscopic telemanipulation. The innovative enhancement of surgeons’ dexterity, visual capacities, and...

Introduction Leak tests using air or methylene blue (MB) for gastrojejunal anastomoses are often performed during gastric bypass surgeries to avoid leaks due to technical errors. Still, early leaks have been reported in the literature. Indocyanine green (ICG) fluorescence with laser excitement makes this dye easily visible even in small amounts, an...

Background: Multiport laparoscopy is the gold-standard approach for cholecystectomy, and single-port laparoscopy has been developed to further reduce its invasiveness. A specific robotic single-port platform (da Vinci single-site, Intuitive Surgical Inc., Sunnyvale, CA, USA) has been released in 2011, which could technically facilitate single-site...

Background: The purpose of this analysis is to compare the robotic EndoWrist Stapling System (EWSS) 45 mm (Intuitive Surgical Inc. Sunnyvale, CA, USA) and the ECHELON FLEX(™) ENDOPATH(®) Staplers (EFES) 60 mm (Ethicon, Cincinnati, OH, USA) for gastric pouch formation during robotic gastric bypass surgery. Methods: Patients who underwent robotic...

Figure S1: Learning curve. (A) Operative time in minutes plotted against case number. (B) Cumulative sum for operative time plotted against case number. p‐value calculation is based on Pearson's correlation. Figure S2: Placement of the temperature probes into the kidney flushed with IGL‐1 (n = 3). Cortical probe was placed 0.6 cm under the capsule...

Purpose: Robotic LaparoEndoscopic Single-Site Surgery Cholecystectomy has been performed for 5 years using a dedicated platform (da Vinci(®) Single-Site(®)) with the da Vinci(®) Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA). While short-term feasibility has been described, long-term assessment of this method is currently outstandin...

The da Vinci Xi Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) has been released in 2014 to facilitate minimally invasive surgery. Novel features are targeted towards facilitating complex multi-quadrant procedures, but data is scarce so far. Perioperative data of patients who underwent robotic general surgery with the da Vinci Xi sys...

Background: Robotic technology shows some promising early outcomes indicating potentially improved outcomes particularly for challenging bariatric procedures. Still, health care providers face significant clinical and economic challenges when introducing innovations. Methods: Prospectively derived administrative cost data of patients who were co...

Robot-assisted kidney transplantation is feasible; however, concerns have been raised about possible increases in warm ischemia times. We describe a novel intra-abdominal cooling system to continuously cool the kidney during the procedure. Porcine kidneys were procured by standard open technique. Groups were as follow: Robotic renal transplantation...

Background: While conventional laparoscopy is the gold standard for almost all bariatric procedures, robotic assistance holds promise for facilitating complex surgeries and improving clinical outcomes. Since the report of the first robotic-assisted bariatric procedure in 1999, numerous publications, including those reporting comparative trials and...

Background: Most hepatic resections are currently performed using an open approach. Robotic surgery might enable the transition of these procedures to minimally invasive surgery. Methods: Pre-, peri- and post-operative data of all patients who underwent a liver resection from 2009/2012 to 2001/2015, were collected prospectively. All robotic rese...

Background Robotic technology shows some promising early outcomes indicating potentially improved outcomes particularly for challenging bariatric procedures. Still, health care providers face significant clinical and economic challenges when introducing innovations.

Robotic surgery has been developed to address the technical limitations of laparoscopic surgery and might result in similar outcomes for patients with low and high body mass index (BMI). Demographic, peri-operative data and surrogate oncologic markers for colorectal cancer of patients that underwent robotic colorectal procedures were collected in a...

Open surgery is currently the gold standard for most liver resection. Laparoscopic hepatic surgery is currently gaining significance, but technical challenges remain. Surgical robotics has been developed to overcome these technical limitations and to enable more difficult minimally invasive procedures. At our institution, 16 robotic hepatic resecti...

Partial splenectomy (PS) is a spleen-preserving technique that is applied as a result of trauma, focal lesions or hematological conditions. Despite the improvement of laparoscopic techniques within the past several decades, minimally invasive PS has remained a marginal technique that has not been well evaluated. Our objective was to provide an upda...

Robotic technology commenced to be adopted for the field of general surgery in the 1990s. Since then, the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, CA, USA) has remained by far the most commonly used system in this domain. The da Vinci surgical system is a master-slave machine that offers three-dimensional vision, articulated ins...

The use of robotics has been developing for several decades, but its adoption for General Surgery only started to emerge in the 1990s. While several robotic devices have been developed, the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA) remains today by far the most commonly used robotic device for General Surgery. This maste...

The da Vinci® Surgical System is currently the most frequently used computer-enhanced endoscopic instrument control system capable of laparoscopic surgery. The system contains a surgical console, a surgical cart, and a vision cart. Core characteristics include the physical separation of the surgeon from the patient, a three-dimensional stereoscopic...

Modern technology enables the remote guidance through surgical procedures via telementoring, which is particularly well suited to minimally invasive surgeries. Telementoring for robotic procedures might be carried over long distances as well as dual console mode using the da Vinci Surgical System with a proctor in the same room. This chapter discus...

Background: Laparoscopic Roux-en-Y gastric bypass (RYGB) has become the procedure of choice for the treatment of morbid obesity. Recently, several reports have shown the potential advantages of the robotic approach, notably by reducing complications. The aim of this study is to report our long-term experience with robotic Roux-en-Y gastric bypass...

Advanced surgical procedures have traditionally been a domain of open surgery. However, minimally invasive approaches are evolving with the development of robotic technology which appears capable to overcome technical limitations of conventional laparoscopy. While traditionally perceived as impossible indications for minimally invasive surgery, rep...

Descriptions of robots-portrayed as artificial helpers or companions-have been documented throughout human history. The ancient Greek god Hephaestus, for example, was said to have built automata of gold and silver to assist him in his forge. Other conceptions include automated toys such as a wooden, steam-propelled bird that was able to fly invente...

The da Vinci® Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) is at present the most commonly used robotic system for performing minimally invasive laparoscopic surgery in humans. Currently, the system is cleared by the Food and Drug Administration (FDA) for the use in urological surgical procedures, general laparoscopic surgical proc...

Minimally invasive approaches for cholecystectomy are evolving in a surge for the best possible clinical outcome for the patients. As one of the most recent developments, a robotic set of instrumentation to be used with the da Vinci Si Surgical System has been developed to overcome some of the technical challenges of manual single incision laparosc...

Transanal endoscopic microsurgery is a minimally invasive approach reserved for the resection of selected rectal tumors. However, this approach is technically demanding. Although robotic technology may overcome the limitations of this approach, the system can be difficult to dock, especially in the lithotomy position. The study aim is thus to repor...

Although reported in the literature, conventional laparoscopic approach for distal pancreatectomy is still lacking widespread acceptance. This might be due to two-dimensional vision and decreased range of motion to reach and safely dissect this highly vascularized retroperitoneal organ by laparoscopy. However, interest in minimally invasive access...

Background Computerized management of medical information and 3D imaging has become the norm in everyday medical practice. Surgeons exploit these emerging technologies and bring information previously confined to the radiology rooms into the operating theatre. The paper reports the authors' experience with integrated stereoscopic 3D-rendered images...

While the number of publications concerning robotic surgery is increasing, the level of evidence remains to be improved. The safety of robotic approach has been largely demonstrated, even for complex procedures. Yet, the objective advantages of this technology are still lacking in several fields, notably in comparison to laparoscopy. On the other h...

Background: With the introduction of a new platform, robotic single-site cholecystectomy (RSSC) has been reported as feasible and safe for selected cases. In parallel, the development of real-time near-infrared fluorescent cholangiography using indocyanine green (ICG) has been seen as a help during the dissection, even if the data are still prelim...

Background: Recent developments in minimal invasive surgery have led to laparoendoscopic single site surgery (LESS). This new approach has great potential but remains technically challenging. In order to relieve these difficulties many authors have adapted robotic technology to single site surgery. Numerous approaches have been developed and there...

Background: Strategies to spare operating room (OR) times are crucial to limiting the costs involved in robotic surgery. Among other factors, the pre-operative set-up and docking phases have been incriminated at first to be time consuming. The docking process on the standard multiport da Vinci Surgical System has not been shown to significantly pr...

Robotic surgery for laparoscopic procedures such as advanced gastrointestinal surgery and abdominal malignancies is currently on the rise. The first robotic systems have been used since the 1990s with increasing number of clinical cases and broader clinical applications each year. Although high-evidence-level data are scarce, studies suggest that t...

Background Strategies to spare operating room (OR) times are crucial to limiting the costs involved in robotic surgery. Among other factors, the pre-operative setup and docking phases have been incriminated at first to be time consuming. The docking process on the standard multiport da Vinci Surgical System has not been shown to significantly prolo...

Background: Courses, including lectures, live surgery, and hands-on session, are part of the recommended curriculum for robotic surgery. However, for general surgery, this approach is poorly reported. The study purpose was to evaluate the impact of robotic general surgery course on the practice of participants. Methods: Between 2007 and 2011, 10...

Background and study aims: Very recently, robotic single site cholecystectomy (RSSC) has been reported feasible and safe for selected cases. While an intra-operative cholangiography can be performed, data is scarce with respect to its use. Indocyanin green (ICG) has been shown to be a viable option to visualize biliary anatomy. Since the introduct...

Superobese patients (SO) (body mass index (BMI) ≥ 50 kg/m(2)) represent a real surgical challenge and the best management remains debatable. While the safety of a laparoscopic approach has been questioned for this population, robotics has been introduced in the armamentarium of the bariatric surgeon, yet its role remains poorly assessed, especially...

The field of robotic surgery is rapidly advancing both in terms of the surgical procedures performed and the potential applications of this technology. This survey study attempts to evaluate the opinions of the public regarding a number of issues in robotic surgery. A web-based survey study was constructed using the web-based software “Kwiksurveys”...

Single-port platforms are increasingly being used for transanal surgery and may be associated with a shorter learning curve than transanal endoscopic microsurgery. However, these procedures remain technically challenging, and robotic technology could overcome some of the limitations and increase intraluminal manoeuvrability. An initial experimental...

Robotic surgery has been gaining increasing acceptance for several years now, establishing itself with success in all the surgical fields. Besides, since the introduction of single site surgery, the interest for the robotic technology is more than obvious, offering technical possibilities to overcome the natural limitations of laparoscopy. This art...

Within the next few years, the medical industry will launch increasingly affordable three-dimensional (3D) vision systems for the operating room (OR). This study aimed to evaluate the effect of two-dimensional (2D) and 3D visualization on surgical skills and task performance. In this study, 34 individuals with varying laparoscopic experience (18 in...

The increased distance between surgeon and surgical field is a significant problem in laparoscopic surgery. Robotic surgery, although providing advantages for the operator, increases this gap by completely removing force feedback. Enhancement with visual tools can therefore be beneficial. The goal of this preliminary work was to create a custom plu...

In most centers, Upper Gastrointestinal series (UGI) following Roux-en-Y Gastric Bypass (RYGB) is performed to rule out GJ anastomotic leak. According to the introduction of robotic technology associated with a hypothetical decrease of anastomotic complications, we aim to assess the validity and cost effectiveness of early routine UGI following rob...

Robot-assisted Roux-en-Y gastric bypass (RYGBP) is rapidly evolving as an important surgical approach in the bariatric field. However, the specific learning curve associated with this new approach remains poorly investigated. This study aimed to evaluate the learning curve for robot-assisted RYGBP. A series of 64 consecutive robot-assisted RYGBP pr...

The technique of single-port laparoscopy was developed over the past years in an attempt to reduce the invasiveness of surgery. A reduction of incisions and their overall size might result in enhanced postoperative cosmesis and potentially reduce pain when compared to conventional techniques. While manual single-port laparoscopy is technically chal...

Minimally invasive surgical approaches have revolutionized surgical care and considerably improved surgical outcomes. The instrumentation has changed significantly from open to laparoscopic and robotic surgery with various usability and ergonomics qualities. To establish guidelines for future designing of surgical instruments, this study assesses t...

Robotic surgery is a complex technology offering technical advantages over conventional methods. Still, clinical outcomes and financial issues have been subjects of debate. Several studies have demonstrated higher costs for robotic surgery when compared to laparoscopy or open surgery. However, other studies showed fewer costly anastomotic complicat...

Single-incision laparoscopy (SIL) is a rapidly growing procedure in the field of surgery. The most frequent site of abdominal access is the umbilicus. Its appearance can be altered during SIL procedures. The literature suggests that the umbilicus plays an important role in the overall physical appearance of patients. This study therefore investigat...

Despite improvements in minimally invasive techniques over recent decades, kidney implantation into the iliac fossa has remained a domain of open surgery. However, it was hypothesized that it would be feasible to perform robotic transplant kidney implantation as a means of reducing surgical trauma. Two robotic kidney transplantations into the iliac...

Single-incision laparoscopic and natural orifice translumenal endoscopic surgery (NOTES) are technically challenging methods. Robotics might have the potential to overcome such hurdles with computer technology. The da Vinci Standard and S System (Intuitive, Sunnyvale, USA) were used in human cadavers and pigs to perform single-incision transabdomin...

Robotic technology offers technical advantages that might offer new solutions for hip arthroscopy. Two hip arthroscopies were performed in human cadavers using the da Vinci surgical system. During both surgeries, a robotic camera and 5 or 8 mm da Vinci trocars with instruments were inserted into the hip joint for manipulation. Introduction of camer...

Laparoscopic resection of gastric gastrointestinal stromal tumor (GIST) has been shown as feasible and safe in terms of oncologic results. However, laparoscopic resection has been demonstrated to be mainly suitable for small, favorably localized GIST. The robotic approach may, by its characteristics, enable the surgeon to perform atypical gastrecto...

The aim of this meta-analysis was to compare clinical outcome following laparoscopic and robotic Nissen fundoplication. A systematic literature search of Medline, Embase and Cochrane Library databases was performed. Primary outcome measures were the requirement for re-operation, postoperative mortality and postoperative dysphagia. Secondary outcome...

Achalasia is a relatively rare medical condition that is classically not associated with obesity. The surgical treatment of a simultaneous occurrence of these two diseases requires careful consideration, and only a few reports can be found in the literature combining a Heller myotomy with gastric bypass, duodenal switch, or gastric banding. We repo...

Set-up and docking of the da Vinci surgical system are assumed to extend overall operating times. We hypothesized that these tasks could be achieved in adequate times. Therefore, a prospective analysis of set-up and docking times of the da Vinci Surgical System was conducted. We prospectively analysed set-up and docking times with the da Vinci surg...

Surgery is moving towards less invasive and cosmetically superior approaches such as single incision laparoscopy (SIL). While trans-umbilical SIL is gaining popularity, incisions may lead to post-operative deformations of the umbilicus and the possibility of an increased rate of incisional hernias. Access within the pubic hairline allows preservati...

Due to improved ergonomics and dexterity, robotic surgery is promoted as being easily performed by surgeons with no special skills necessary. We tested this hypothesis by measuring IQ elements, computer gaming skills, general dexterity with chopsticks, and evaluating laparoscopic experience in correlation to performance ability with the da Vinci ro...

Amyand's hernia is an atypical groin hernia which contains the vermiform appendix. The aim of this study was to review a single institution's experience in the clinical presentation, management and prognostic factors of this rare hernia. The authors reviewed records of all patients undergoing hernia surgery from 1996 to 2006 at their institution, a...

The advantages of a hybrid natural orifice transluminal endoscopic surgery approach to Roux-en-Y gastric bypass (hNOTES-RYGBP) might include: easier access to the peritoneal cavity, reduced number of ports and related complications, improved cosmesis, and others. However, currently available conventional endoscopic and laparoscopic instruments migh...

Natural orifice transluminal endoscopic surgery (NOTES) is a multidisciplinary surgical technique. If conventional endoscopic instrumentation can be easily mastered, surgeons with laparoscopic experience could head NOTES interventions. Thirty individuals were tested for endoscopic dexterity. Group 1 included seven gastroenterologists, group 2 inclu...

Decreased scarring is an advantage of minimally invasive surgery. The new experimental technique of natural orifice transluminal surgery (NOTES) aims at totally scarless surgery. We examined the general attitudes of patients and unaffected persons towards scarless surgery. We used a 7-item questionnaire in structured interviews with hospital visito...

Natural orifice translumenal endoscopic surgery (NOTES) is an exciting concept bringing scarless surgery a reality consisting in body cavity and organs approach through natural orifices (digestive, female genital, urinary tracts). While new instrumentation necessitated by NOTES is still developing, multiple surgical procedures have been performed w...

The lack of haptic feedback (HF) in robotic surgery is one of the major concerns of novice surgeons to that field. The superior visual appearances acquired during robotic surgery may give clues that make HF less important. We surveyed 52 individuals on their perception of HF during robotic surgery. The first group of 34 surgically inexperienced peo...

Pleural or peritoneal effusions (ascites) are frequent in terminal stage malignancies. Medical management may be hazardous. A 60-year-old man with metastatic malignant melanoma presented refractory ascites as well as bilateral pleural effusions. After failure of the medical treatment, bilateral pleural aspiration and paracentesis became necessary t...

Pyoderma gangrenosum is an aseptic skin disease. The ulcerative form of pyoderma gangrenosum is characterized by a rapidly progressing painful irregular and undermined bordered necrotic ulcer. The aetiology of pyoderma gangrenosum remains unclear. In about 70% of cases, it is associated with a systemic disorder, most often inflammatory bowel diseas...

Surgical repair of parastomal hernias is usually performed through a laparotomy (stoma translocation) or a peristomal incision (mesh repair). Laparoscopic approach may minimize the risks of mesh infection and, thus, represents an attractive alternative. Permacol (Tissue Science Laboratories plc, Aldershot, Hampshire, U.K.) is a new biomaterial impl...

Since 1990, laparoscopy and minimally invasive techniques in general, have been widely adopted in the field of digestive surgery. However, due to its technical limitations, the use of conventional laparoscopy remains limited to procedures of low (cholecystectomy, appendectomy) or intermediate (Nissen fundoplication, sigmoidectomy) complexity. This...