# Minimally Invasive and Robotic Surgery — GCMD Library living collection

Updated: n/a · 3 episodes · 33 cited statements

## Episodes
### Robotic Surgery
- [Update Course Rewind 2025: Robotics in Pediatric Surgery: Which indications benefit the most?](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985) — podcast · 4:35 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985.md)

### Laparoscopic Techniques
- [Single incision laparoscopic appendectomy technique and instrumentation](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887) — video · 11:27 · [machine version](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887.md)
- [Laparoscopic inguinal hernia inversion and ligation in female children: a review of 173 consecutive cases at a single institution](https://library.globalcastmd.com/article/laparoscopic-inguinal-hernia-inversion-and-ligation-in-female-children-a-review-16883) — article · [machine version](https://library.globalcastmd.com/article/laparoscopic-inguinal-hernia-inversion-and-ligation-in-female-children-a-review-16883.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=0) Introduction and Advantages of Robotic Surgery (Ep 1)
- [1:08](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=68) Addressing Common Concerns: Learning Curve, Cost, and Tactile Feedback (Ep 1)
- [2:23](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=143) Comparative Data and Proficiency Requirements (Ep 1)
- [3:38](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=218) Summary and Clinical Indications (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=0) Equipment and Scope Assembly (Ep 2)
- [1:48](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=108) Instrument Set Overview (Ep 2)
- [2:15](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=135) Cecal Mobilization and Appendix Delivery (Ep 2)
- [4:33](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=273) Extracorporeal Appendectomy and Inspection (Ep 2)
- [6:49](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=409) Patient Selection and Conversion Criteria (Ep 2)
- [8:44](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=524) Technical Tips and Troubleshooting (Ep 2)
- [10:52](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=652) Credits and Closing (Ep 2)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- SILS appendectomy requires a specialized 10mm laparoscope with a 5mm working channel and extra long instruments to go down the working channel. — Rosen (clinical) [Ep 2 · 0:17](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=17)
- The 10mm scope will only fit through a 12mm trocar. — Rosen (clinical) [Ep 2 · 1:39](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=99)
- Cecal mobilization is performed by gently opening the peritoneum overlying the attachment between the cecum and body wall, taking care not to injure structures beneath. — Rosen (clinical) [Ep 2 · 2:39](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=159)
- The degree of cecal mobilization varies depending on how mobile the appendix is initially and how thick the abdominal wall is. — Rosen (clinical) [Ep 2 · 3:18](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=198)
- If the appendix can come up to the liver laparoscopically, then most likely it will be able to be delivered up through the abdominal wall. — Rosen (clinical) [Ep 2 · 3:47](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=227)
- Early in performing SILS appendectomy, it is beneficial to get a good intracorporeal view of the base ligature to ensure adequate ligation flush to the cecum without leaving a segment of appendix. — Rosen (clinical) [Ep 2 · 6:20](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=380)
- When deciding between one or three port approach, patient body habitus, duration of illness, and appendix size if imaging was obtained should be factored in. — Rosen (clinical) [Ep 2 · 7:05](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=425)
- Obese or extremely muscular patients can have thick abdominal walls that make it difficult to deliver even a mildly inflamed appendix. — Rosen (clinical) [Ep 2 · 7:14](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=434)
- The challenge of appendix delivery is compounded when the appendix is very thick and friable. — Rosen (clinical) [Ep 2 · 7:25](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=445)
- A five-minute timer approach is reasonable when attempting SILS, and if not making significant progress after 10 minutes, conversion to traditional three-port laparoscopy should be considered. — Rosen (opinion) [Ep 2 · 7:35](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=455)
- A 12mm trocar placed through the umbilicus by Veress needle technique will make an opening that in thin small patients will be large enough to work through for appendectomy. — Rosen (clinical) [Ep 2 · 8:12](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=492)
- When the abdominal wall is thick or the appendix is thick and friable, the fascial opening may need to be enlarged to safely deliver the appendix. — Rosen (clinical) [Ep 2 · 8:22](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=502)
- When placing a trocar by open technique, starting with the skin and fascial incision as large as possible while still concealing it within the umbilicus helps avoid failing to deliver the appendix initially. — Rosen (clinical) [Ep 2 · 8:31](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=511)
- A large fascial incision can make it hard for the trocar to stay in, which can be addressed by securing the trocar with a towel clip or suture. — Rosen (clinical) [Ep 2 · 8:49](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=529)
- If gas is leaking around the trocar, the insufflator flow should be set on high. — Rosen (clinical) [Ep 2 · 8:57](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=537)
- The suction irrigator should not be opened in routine SILS appendectomy cases, nor is it necessary if only suction is needed. — Rosen (clinical) [Ep 2 · 9:05](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=545)
- For aspirating small amounts of fluid, the suction probe can be inserted through the port with the outside end covered with a lap pad, using thumb pressure to alternately press and relax on the gauze to allow positive pressure from insufflation to push fluid out. — Rosen (clinical) [Ep 2 · 9:19](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=559)
- In cases of advanced or perforated appendicitis, the suction irrigator should be opened. — Rosen (clinical) [Ep 2 · 9:45](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=585)
- With a thick abdominal wall, placing a small Weitlaner retractor in the wound with downward pressure can help expose the appendiceal base. — Rosen (clinical) [Ep 2 · 9:50](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=590)
- When ligating the mesoappendix, flashing and reclamping the mesentery as the tie is cinched down can prevent losing the divided end into the abdomen before the tie is set. — Rosen (clinical) [Ep 2 · 10:00](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=600)
- When the appendiceal base is deep in the wound and hard to ligate by usual means, endoloops can be used to get the tie down into position. — Rosen (clinical) [Ep 2 · 10:16](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=616)
- If uncertain about ligation at the true appendiceal base, the appendix can be ligated with a long suture held externally, returned to the abdomen for laparoscopic verification, and if inadequate, further dissection can be performed before completing appendectomy. — Rosen (clinical) [Ep 2 · 10:32](https://library.globalcastmd.com/watch/single-incision-laparoscopic-appendectomy-technique-and-instrumentation-16887?t=632)
- Robotic instruments have 7 degrees of freedom compared to 6 for the human hand. — Juan Gurria (clinical) [Ep 1 · 0:41](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=41)
- The learning curve for robotic surgery is better than laparoscopic surgery. — Juan Gurria (clinical) [Ep 1 · 1:21](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=81)
- Time to reduce operative times is way faster for robotic than laparoscopic after a few cases. — Juan Gurria (clinical) [Ep 1 · 1:27](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=87)
- There is currently no FDA approval for robotic surgery in pediatrics, but it should be coming soon. — Juan Gurria (guideline) [Ep 1 · 1:42](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=102)
- After a few cases, robotic surgery decreases operative time, which reduces costs in the long run. — Juan Gurria (clinical) [Ep 1 · 1:53](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=113)
- New robotic systems allow surgeons to detect when suture is about to rupture. — Juan Gurria (clinical) [Ep 1 · 2:05](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=125)
- With trained personnel, room turnover time for robotic surgery equals that of laparoscopic surgery. — Juan Gurria (clinical) [Ep 1 · 2:37](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=157)
- Basic proficiency in laparoscopy requires 20 to 30 cases. — Juan Gurria (clinical) [Ep 1 · 2:51](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=171)
- Basic proficiency in robotic surgery requires 10 to 15 cases. — Juan Gurria (clinical) [Ep 1 · 2:55](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=175)
- Robotic surgery does not impair outcomes in oncologic surgeries. — Juan Gurria (clinical) [Ep 1 · 3:07](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=187)
- Future pediatric surgeons entering the field will be doing robotic surgery rather than laparoscopy. (opinion) [Ep 1 · 3:28](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=208)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Robotic surgery reduces postoperative pain and infection risk, leading to faster recovery. — Jill Knepprath summarizing the discussion [Ep 1 · 1:02](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=62)
- Robotic surgery improves depth perception compared to laparoscopic surgery. — Jill Knepprath summarizing the discussion [Ep 1 · 2:09](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=129)
- Robotic surgery reduces surgeon fatigue compared to laparoscopic surgery. — Jill Knepprath summarizing the discussion [Ep 1 · 2:14](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=134)
- In colorectal surgery, robotic operative time is longer than laparoscopic, but laparoscopy has a higher conversion rate to open surgery. — Jill Knepprath summarizing the discussion [Ep 1 · 2:23](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=143)
- Both robotic and laparoscopic surgery have comparable oncological results. — Jill Knepprath summarizing the discussion [Ep 1 · 2:32](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=152)
- In smaller patients, ports should be measured 3 centimeters apart. — Jill Knepprath summarizing the discussion [Ep 1 · 3:24](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=204)
- Robotic surgery is ideal in select pediatric cases including adrenal masses, polycystic kidneys, and nephrectomies. — Jill Knepprath summarizing the discussion [Ep 1 · 3:38](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=218)
- Robotic surgery can be indicated for surgeries in the chest, pelvic reconstruction, abdominal tumors, and urology. — Jill Knepprath summarizing the discussion [Ep 1 · 3:14](https://library.globalcastmd.com/watch/update-course-rewind-2025-robotics-in-pediatric-surgery-which-indications-benefi-14985?t=194)

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