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Safe and secure closure of the vaginal cuff is a critical component of a robotic assisted hysterectomy procedure. Our aim in this study is to develop and validate a novel vaginal cuff closure model (VC) created from porcine heart that allows trainees to obtain competency in a low-risk environment. Ten expert and 20 novice robotic surgeons performed a cuff closure exercise on the VC model and on the dV-Trainer ® , a virtual reality simulator (VR). Performances were timed, videotaped, and scored using the modified Global Evaluative Assessment of Robotic Skills (mGEARS) score. Expert robotic surgeons completed the task faster on both the VR (531 vs. 814 s, p = 0.03) and the VC platforms (311 vs. 631 s, p < 0.001) and achieved higher mGEAR scores (32.25 vs. 22.07, p < 0.0001). Knot quality and suturing accuracy were better in the VC than in the VR environment in both groups. In a post-completion survey, both expert and novice surgeons expressed strong preference towards the VC model. In this study, the novel VC model proved to be a reliable simulation tool with high face, content, and construct validity. Due to its simplicity and low cost, this high-yield simulation exercise can easily be incorporated into robotic training curricula of obstetrics and gynecology residents., (© 2022. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Purpose: Robotic-assisted Roux-en-Y gastric bypass (RARYGB) is a procedure that is used with increasing frequency in the United States. Among other bariatric procedures, RARYGB is a good model for the robotic platform because it allows hand-sewn suturing and energy devices application. The aim of this study was to conduct a literature review of robotic approach in RARYGB, its learning curve using the cumulative sum (CUSUM) method, and our experience as Center of Excellence recognized by the American Society for Metabolic and Bariatric Surgery (ASMBS). Methods: A total of 67 patients were included. Results revealed that the learning curve was achieved after case 11. Eighteen studies were included in the pooled analysis. Results: An increase in the operative time was noted at case 46, in which a second phase was identified. A significant difference between these two phases was found only related to previous bariatric surgery. The outcomes of this series were comparable with the ones available in the literature. Conclusions: The robotic platform is increasing its role in complex procedures such as RARYGB. The hand-sewn technique may offer important advantages in terms of shorter learning curve, reduced conversion rate, and lower leakage rate., Competing Interests: No competing financial interests exist., (Copyright 2019, Mary Ann Liebert, Inc., publishers.)

Laparoscopic gastric greater curvature plication (LGGCP) has been presented as an alternative to laparoscopic sleeve gastrectomy (LSG) for reversible reduction of stomach capacity without gastric reduction or stapling. We present a case of a 51-year-old Hispanic female with a BMI of 41.91 kg/m 2 , who underwent (LGGCP) 5 years previously at another institution. Despite multiple interventions, the patient was unable to successfully lose weight, and the decision was made to reverse the procedure with a robot-assisted Roux-en-Y gastric bypass. The plication was intact extending from the fundus to the antrum, with the sutures incorporated by scarring and fibrotic tissue. Sutures were delicately removed to form a 30-cc pouch, followed by jejuno-jejunal and gastrojejunal anastomosis. The patient tolerated the surgery well and control fluoroscopy was negative for anastomotic leaks, patient was discharged home on POD 2. At the 40-day follow-up, the patient had lost 22 lb., reducing her BMI to 37.64 kg/m 2 . The 3D vision of the robotic camera and the six degrees of freedom of the robotic instruments seemed to facilitate the challenging dissection of the embedded sutures used for the LGGCP and its overall undoing. However, further volume and data on the robotic approach for this specific revisional procedure are necessary before drawing any definitive conclusions.