Dr. Matthew Albert

Optimizing Robotic Surgery in the LAR patient

Robotic surgery has revolutionized complex procedures, offering enhanced precision, dexterity, and visualization for surgeons. In the context of Low Anterior Resection (LAR), both a totally robotic technique and a laparoscopic hybrid approach can be performed. Although both techniques have demonstrated similar outcomes, robotics has shown immense potential in improving patient outcomes and quality of life. In this event, featuring experts in the field, we will explore the diverse aspects of optimizing robotic surgery in LAR patients. These experts will share their insights to keep you updated on the cutting-edge techniques and technologies driving the field forward.

With Medtronic

Antibiotic and antiseptics in colorectal surgery. What should we know?

Dr. Albert introduces the difficult topic of Surgical Site Infections (SSIs), explaining their classification and some factors that cause it. He then discusses SIP and SCIP (Surgical Care Intended Project), which are intended to reduce this complication. More specifically, he focuses on those measures to prevent SSI: Antibiotic prophylaxis  Skin preparation  Intravenous antibiotics  Intraabdominal irrigants  Oral +/- bowel preparation  Finally, he gives the key points to sum the topic up.

With Johnson & Johnson MedTech

Stapling Systems In Laparoscopic Approach

PROGRAM      1. Circular Stapling - Pelvis - Dr. Manish Chand Anastomotic leaks are one of the main problems in colorectal surgery. Surgeons should keep in mind the different factors that this complication entails, as well as its treatment. A standardized procedure is preferable in any type of surgery. To achieve a good operative outcome, recommendations are given on the mistakes to avoid. A video of the procedure is played, and Dr. Manish Chand discusses how to avoid problems in anastomotic leak surgery. Dr. Chand also discusses circular staplers and their characteristics that help reduce anastomotic leaks. He comments on a video of an important part of the procedure, as well as on some data and visual information to encourage the use of this device.     2. General Considerations about mechanical staplers - Dr. Ana Otero In this video, Dr. Ana María Otero provides an introduction to the use of staplers in anastomotic procedures, the different types of endostaplers, and their specific features. Two videos of the most common procedures in which anastomosis is performed are displayed: side-to-side anastomosis and end-to-end anastomosis. Videos of mechanical stapling anastomosis are also played to discuss the best approach and how to perform the procedure. Finally, Dr. Otero gives advice on the principles to follow for good endostapler performance.     3. Laparoscopic Right Hemicolectomy - Dr. Matt Albert Although laparoscopic right colectomy is regarded as the simplest colon operation, this does not mean that it cannot lead to severe complications. The basic steps of intracorporeal anastomosis are described. Dr. Matthew Albert comments on videos of specific steps of this procedure, giving advice based on his experience. Pancreas head anatomy is also explained by means of surgical videos. Dr. Albert describes the benefits of intracorporeal anastomosis and gives recommendations on what the surgeon should pay attention to in a laparoscopic right colectomy.

With Johnson & Johnson MedTech

Complete mesocolic excision with central vascular ligation (D3)

Case We present the case of a 58-year-old female, who was found to have cecal cancer on a screening colonoscopy. The patient described no associated symptoms, and had a BMI of 34. Treatment A medial mobilization was performed with central lymph node dissection, which included ligating the ileocolic, right colic, middle colic, and right gastroepiploic vessels successively at their origins. The ileocolic and superior mesenteric vessel pedicles are located. The small bowel and the omentum are displaced and the transverse colon and the ileocecal junction are towed cranially and laterally respectively. These tractions tent up the root of the mesentery and the right mesocolon, displaying the ileocolic and superior mesenteric vessels clearly, even in very obese patients. The superior mesenteric vein is first exposed and the origin of the ileocolic vessels are identified and then ligated from the superior mesenteric vessels. A medial-to-lateral approach creates a mesenteric window, just inferior to the ileocolic vascular pedicle. The right retrocolic space between the mesocolon and the right pre-renal fascia is the natural surgical plane, which is extended laterally and cranially. The inferior part of the duodenum is the first exposed structure, followed by the uncinate process of pancreas. The superior mesenteric vein is skeletonized cranially, seeking the inferior part of the pancreatic neck, where the middle colic vessels branch out from the superior mesenteric vessels. The gastrocolic venous trunk is then located and skeletonized when dissecting the ventral part of the superior mesenteric vein caudally to cranially. The gastrocolic venous trunk is composed of the confluence of the right colic vein and the right gastroepiploic vein draining into the superior mesenteric vein at an average distance of 2 cm from the inferior pancreatic border. The gastroepiploic artery was located at the anterior of the superior edge of the pancreatic neck, immediate to the right gastroepiploic vein. A hypopyloric lymphadenectomy could be performed along with the ligation of the gastroepiploic vessels. The transverse colon was mobilized up to the hepatic flexure along the prior plane of dissection as well as the ascending colon, joining the right retrocolic plane. Then, the gastrocolic ligament was divided near the greater gastric curvature. The right colon was completely mobilized once the distal ileum had also been dissected. Then, indocyanine green was injected to assess the vascularization of the transverse colon, at the level of the anastomosis. Vessels lit up under the camera, marking the site for the anastomosis, showing a correct vascularization. The same process was followed for the distal ileum. The transverse colon was sectioned using an endoGIA, as was the distal ileum. A functional side-to-side intracorporeal anastomosis between the ileum and the transverse colon was performed. A single stitch was placed to fixate the bowels and facilitate the anastomosis. Two enterotomies were made on each side and an endoscopic stapler was introduced to create the anastomosis. The enterotomies were closed with a V-lock suture. The anastomosis was checked once more with indocyanine green, revealing a perfectly irrigated anastomosis. Outcome For advanced tumors of the right colon, a right colectomy with D3 lymphadenectomy using a medial-to-lateral approach seems to be safe and feasible when the superior mesenteric vein serves as the main anatomical landmark and the right retrocolic space serves as the surgical plane.r advanced tumors of the right colon, a right colectomy with D3 lymphadenectomy using a medial-to-lateral approach seems to be safe and feasible when the superior mesenteric vein serves as the main anatomical landmark and the right retrocolic space serves as the surgical plane.

1st taTME course sponsored by Applied Medical

The AIS Channel represents a platform for interaction between surgeons that reaches globally. It is inspired in modern education and one of its cornerstones is represented by a serie of courses designed to reach the effective learning of new professionals. They are constituted of three parts, (Theoretical basis, Live Surgery and Hands-on-Lab) essential for the training of a surgeon. The most recent is dedicated to the new approach for rectal diseases. The Transanal Total Mesorectal Excision (taTME) course which is addressed to colorectal surgeons experienced in laparoscopic and/or robotic TME as well as transanal endoscopic surgery (TEM and/or TAMIS). Several surgeons from around the world have assisted to this course, giving very positive feedback that awakes the attention of the surgical community and the related industry. Applied Medical was the sponsor of the latest edition of this course, Matthew Albert, as an expert from the Center for Colon and Rectal Surgery at the Florida Hospital (Orlando, Florida) and Lee Cohen (Director of Clinical Education at Applied Medical Atlanta Georgia) were at the Hospital Clínic and had a deep immersion in this innovative model of teaching, their opinion after the experience was similar to previous trainees. Matthew Albert states that, "I think this course absolutely sets the standard, not just in Europe but worldwide, it sets the bar around the world.” Also Lee Cohen says that, “Bar none, this is now the best taTME course in the world”, and “I think watching this surgery is amazing and it is an incredible educational opportunity”.