\r\n\tManagement of these disorders requires good clinical evaluation, diagnostic tests, appropriate therapy and huge healthcare cost. Sometimes multiple specialties (gastroenterologists,
\r\n\tgastrointestinal motility specialists, otolaryngologists, surgeons, speech therapists, medical oncologists and radiation oncologists) are involved in the management of dysphonia and dysphagia. In the recent years, there have been many updates in the management of these disorders. This book will discuss systematically the different etiologies and management of dysphonia, maxillofacial, oropharyngeal and esophageal dysphagia. This book will be a good
\r\n\tguide to the practicing physicians for the management of voice and swallowing disorders.
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1. Introduction
\n
The field of surgery has experienced a revolution in the present era with a dramatic shift from the traditional open surgery to minimally invasive surgery (MIS). This has been associated to numerous advantages over open surgery, mainly for patients, such as a reduction of tissue trauma and smaller postoperative scars, which in turn involves shorter hospital stays, reduction of the postoperative pain, and faster recovery.
\n
Apart from all these meaningful benefits, this evolution in surgery also results in many technical challenges for surgeons. Relative to open surgery, surgeons lose direct vision, and only two-dimensional indirect vision through a display is available. This indirect vision sometimes takes the sense of orientation and depth perception away from surgeons. The precise manipulation of the laparoscopic instrument tip is restricted mainly because these instruments are generally slim and long and with limited dexterity. Most of the instruments are straight and do not have flexible tips. This surgical tools also lead to a reduction of sensory feedback during surgery due to surgeons cannot directly touch the organs in the body. Some of these limitations make the development of common surgical procedures in open surgery not as straightforward and simple through minimally invasive surgery.
\n
This book is just a step forward for the readers to learn further the recent surgical techniques and technologies that have emerged in order to deal with the aforementioned challenges in minimally invasive surgery.
\n
Laparoscopic surgeons are required long training time, experience, and practices in order to deal with the technical limitations introduced by laparoscopic surgery and become proficient. Due to the steep learning curve that laparoscopic surgery demands in certain surgical procedures, advanced and structured training programs and methods are constantly being introduced [1, 2]. Recently, there is a paradigm shift from traditional subjective assessment methods of trainees to more objective assessment tools that can accredit surgeons as competent in laparoscopic surgery [3, 4].
\n
Despite the many advantages laparoscopic surgery offers to patients, laparoscopy also entails a number of technical limitations for surgeons. The performance of this surgical technique implies important restrictions on freedom of movement, mainly due to the use of rigid and long surgical instruments with poor ergonomic design, the location of the screens, the use of pedals to control the diathermy system, and by the fixed surgical ports for the instruments. These limitations result in an increased incidence of static postures in surgeons and the adoption and maintenance of forced body postures for long periods of time, which potentially affect performance and accuracy during surgery and increase the incidence of physical fatigue and musculoskeletal disorders. In order to address some of these technical limitations, new surgical instruments and devices have been developed aiming to enhance the dexterity, accuracy, and ergonomics of laparoscopic instruments [5]. In addition, new methodological approaches and instrumental techniques for ergonomic analysis have been implemented to improve the working conditions of surgeons, as well as the design of the laparoscopic material [6].
\n
Since the introduction of laparoscopic surgery several decades ago, it has been constantly evolving to the emergence of more sophisticated approaches such as the laparoendoscopic single-site surgery (LESS), natural orifice transluminal endoscopic surgery (NOTES), or transanal surgery, which are intended to reduce the patient’s invasiveness and surgical outcomes.
\n
LESS surgery could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain [7, 8]. By reducing the number of transcutaneous points of access, the approach offers numerous advantages including, but not limited to, improving postoperative recovery time and pain, enhancing cosmetics, and minimizing port-related complications. Instrument collision, lack of triangulation, and in-line vision are among the main challenges of LESS surgery. Several techniques and advancements have been introduced to overcome constraints associated with this surgical approach such as novel access devices and curved, articulated, or pre-bent instruments [9, 10]. The feasibility of LESS for almost all types of upper gastrointestinal procedures has been proved [11, 12].
\n
To date, several NOTES procedures have been performed using mainly stomach, rectum, and vagina as the portal of entry into the peritoneal cavity. The main benefits of this surgical technique in comparison to conventional laparoscopic surgery include no scars, less external pain, and lower cost. However, there are also some barriers when using this technique, some of them include difficulty in the closure of enterectomy, anastomotic techniques, spatial orientation, long learning curve, lack of triangulation of instruments, control of hemorrhage, and prevention of the transluminal spread of infection [13]. In order to address some of these technical difficulties in NOTES surgery, novel devices and robotic platforms using a flexible endoscope are appearing as a new trend in the field of MIS [14, 15].
\n
Rectal cancer surgery has undergone a rapid change over the last few decades. We have come a long way from abdominoperineal resection to minimally invasive sphincter-preserving techniques. Minimally invasive surgical techniques have been applied to rectal surgery for several procedures such as transanal polyp excision, local excision of rectal cancer, or transanal total mesorectal excision (taTME), among others [16, 17]. Currently, the two most popular options for local excision are transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS) [18, 19]. TEM utilizes a rigid platform to access intraluminal lesions in the rectum, maintaining stable the pneumoperitoneum. TAMIS utilizes conventional laparoscopic devices and a single incision port rather than a specialized platform.
\n
One of the technological fields that has most recently affected laparoscopic surgery is robotics. Robotic surgery is a further advancement in the field of laparoscopic surgery, which has gained global acceptance, and a large number of centers are performing robotic surgery as a routine. Laparoscopic robotic surgery has made tremendous progress in a relatively short period of time, resulting in improvements for both the patient and surgeon. Generally speaking, the robot for laparoscopic surgery provides three-dimensional vision, dexterity, and intuitiveness. The majority of robotic surgery applications are in urology, gynecology, and colorectal application, providing comparable clinical results to conventional laparoscopic approaches for the most popular procedures in these fields [20, 21]. The da Vinci surgical system is the most extended robotic platform worldwide for laparoscopic surgery. However, recently many other robotic systems are under development, including additional features such as enhanced portability and force feedback [22, 23].
\n
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The cutting-edge training modalities and educational platforms for accredited surgical training: A systematic review. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences. 2017;22:51. DOI: 10.4103/jrms.JRMS_809_16\n]'},{id:"B2",body:'[Enciso S, Díaz-Güemes I, Pérez-Medina T, Zapardiel I, de Santiago J, Usón J, et al. Validation of a structured intensive laparoscopic course for basic and advanced gynecologic skills training. International Journal of Gynaecology and Obstetrics. 2016;133(2):241-244. DOI: 10.1016/j.ijgo.2015.09.011\n]'},{id:"B3",body:'[Sánchez-Margallo JA, Sánchez-Margallo FM, Oropesa I, Enciso S, Gómez EJ. Objective assessment based on motion-related metrics and technical performance in laparoscopic suturing. International Journal of Computer Assisted Radiology and Surgery. 2017;12:307-314. DOI: 10.1007/s11548-016-1459-3\n]'},{id:"B4",body:'[Pérez-Escamirosa F, Chousleb-Kalach A, Hernández-Baro M del C, Sánchez-Margallo JA, Lorias-Espinoza D, Minor-Martínez A. Construct validity of a video-tracking system based on orthogonal cameras approach for objective assessment of laparoscopic skills. International Journal of Computer Assisted Radiology and Surgery 2016;11:2283-2293. DOI: 10.1007/s11548-016-1388-1\n]'},{id:"B5",body:'[Sánchez-Margallo JA, Sánchez-Margallo FM. Initial experience using a robotic-driven laparoscopic needle holder with ergonomic handle: Assessment of surgeons’ task performance and ergonomics. International Journal of Computer Assisted Radiology and Surgery. 2017;12:2069-2077. DOI: 10.1007/s11548-017-1636-z\n]'},{id:"B6",body:'[Sánchez-Margallo FM, Sánchez-Margallo JA. Ergonomics in laparoscopic surgery. In: Malik AM, editor. Laparoscopic Surgery. London: InTech; 2017. pp. 105-123\n]'},{id:"B7",body:'[Evans L, Manley K. Is there a cosmetic advantage to single-incision laparoscopic surgical techniques over standard laparoscopic surgery? A systematic review and meta-analysis. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2016;26(3):177-182. DOI: 10.1097/SLE.0000000000000261\n]'},{id:"B8",body:'[Marks JH, Montenegro GA, Shields MV, Frenkel JL, Marks GJ. Single-port laparoscopic colorectal surgery shows equivalent or better outcomes to standard laparoscopic surgery: Results of a 190-patient, 7-criterion case-match study. Surgical Endoscopy. 2015;29(6):1492-1499. DOI: 10.1007/s00464-014-3830-1\n]'},{id:"B9",body:'[Sánchez-Margallo FM, Sánchez-Margallo JA. Assessment of postural ergonomics and surgical performance in laparoendoscopic single-site surgery using a handheld robotic device. Surgical Innovation. 2018;25:208-217. DOI: 10.1177/1553350618759768\n]'},{id:"B10",body:'[Matos-Azevedo AM, Díaz-Guëmes Martín-Portugués I, Pérez-Duarte FJ, Sánchez-Hurtado MÁ, Sánchez-Margallo FM. Comparison of single access devices during cut and suturing tasks on simulator. The Journal of Surgical Research. 2014;192:356-367. DOI: 10.1016/j.jss.2014.06.017\n]'},{id:"B11",body:'[Lee CM, Park DW, Jung DH, Jang YJ, Kim JH, Park S, et al. Single-port laparoscopic proximal gastrectomy with double tract reconstruction for early gastric cancer: Report of a case. Journal of Gastric Cancer. 2016;16:200-206. DOI: 10.5230/jgc.2016.16.3.200\n]'},{id:"B12",body:'[Machado MA, Surjan RC, Makdissi FF. Laparoscopic distal pancreatectomy using single-port platform: Technique, safety, and feasibility in a clinical case series. Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2015;25(7):581-585. DOI: 10.1089/lap.2015.0032\n]'},{id:"B13",body:'[Rattner D, Kalloo A, ASGE/SAGES Working Group. ASGE/SAGES Working Group on natural orifice translumenal endoscopic surgery, October 2005. Surgical Endoscopy. 2006;20(2):329-333\n]'},{id:"B14",body:'[Okamoto Y, Nakadate R, Nakamura S, Arata J, Oguri S, Moriyama T, et al. Colorectal endoscopic submucosal dissection using novel articulating devices: A comparative study in a live porcine model. Surgical Endoscopy. 2018. DOI: 10.1007/s00464-018-6408-5 [Epub ahead of print]\n]'},{id:"B15",body:'[Légner A, Diana M, Halvax P, Liu Y-Y, Zorn L, Zanne P, et al. Endoluminal surgical triangulation 2.0: A new flexible surgical robot. Preliminary pre-clinical results with colonic submucosal dissection. International Journal of Medical Robotics. 2017;13:e1819. DOI: 10.1002/rcs.1819\n]'},{id:"B16",body:'[Erkan A, Kelly JJ, Monson JRT. Current state of transanal minimally invasive surgery in the management of rectal cancer. Mini-invasive Surgery. 2018;2:30. DOI: 10.20517/2574-1225.2018.51\n]'},{id:"B17",body:'[Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, et al. Transanal total mesorectal excision: International registry results of the first 720 cases. Annals of Surgery. 2017;266(1):111-117. DOI: 10.1097/SLA.0000000000001948\n]'},{id:"B18",body:'[Keller DS, Tahilramani RN, Flores-Gonzalez JR, Mahmood A, Haas EM. Transanal minimally invasive surgery: Review of indications and outcomes from 75 consecutive patients. Journal of the American College of Surgeons. 2016;222(5):814-822. DOI: 10.1016/j.jamcollsurg.2016.02.003\n]'},{id:"B19",body:'[Saclarides TJ. Transanal endoscopic microsurgery. Clinics in Colon and Rectal Surgery. 2015;28(3):165-175. DOI: 10.1055/s-0035-1562889\n]'},{id:"B20",body:'[Peters BS, Armijo PR, Krause C, Choudhury SA, Oleynikov D. Review of emerging surgical robotic technology. Surgical Endoscopy. 2018;32:1636-1655. DOI: 10.1007/s00464-018-6079-2\n]'},{id:"B21",body:'[Szold A, Bergamaschi R, Broeders I, Dankelman J, Forgione A, Langø T, et al. European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery. Surgical Endoscopy. 2015;29(2):253-288. DOI: 10.1007/s00464-014-3916-9\n]'},{id:"B22",body:'[Gueli Alletti S, Perrone E, Cianci S, Rossitto C, Monterossi G, Bernardini F, et al. 3 mm Senhance robotic hysterectomy: A step towards future perspectives. Journal of Robotic Surgery. 2018;12:575-577. DOI: 10.1007/s11701-018-0778-5\n]'},{id:"B23",body:'[Hagn U, Konietschke R, Tobergte A, Nickl M, Jörg S, Kübler B, et al. DLR MiroSurge: A versatile system for research in endoscopic telesurgery. International Journal of Computer Assisted Radiology and Surgery. 2010;5:183-193. DOI: 10.1007/s11548-009-0372-4\n]'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Francisco M. Sánchez-Margallo",address:"msanchez@ccmijesususon.com",affiliation:'- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
'},{corresp:null,contributorFullName:"Juan A. Sánchez-Margallo",address:null,affiliation:'- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
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1. Introduction
\n
The field of surgery has experienced a revolution in the present era with a dramatic shift from the traditional open surgery to minimally invasive surgery (MIS). This has been associated to numerous advantages over open surgery, mainly for patients, such as a reduction of tissue trauma and smaller postoperative scars, which in turn involves shorter hospital stays, reduction of the postoperative pain, and faster recovery.
\n
Apart from all these meaningful benefits, this evolution in surgery also results in many technical challenges for surgeons. Relative to open surgery, surgeons lose direct vision, and only two-dimensional indirect vision through a display is available. This indirect vision sometimes takes the sense of orientation and depth perception away from surgeons. The precise manipulation of the laparoscopic instrument tip is restricted mainly because these instruments are generally slim and long and with limited dexterity. Most of the instruments are straight and do not have flexible tips. This surgical tools also lead to a reduction of sensory feedback during surgery due to surgeons cannot directly touch the organs in the body. Some of these limitations make the development of common surgical procedures in open surgery not as straightforward and simple through minimally invasive surgery.
\n
This book is just a step forward for the readers to learn further the recent surgical techniques and technologies that have emerged in order to deal with the aforementioned challenges in minimally invasive surgery.
\n
Laparoscopic surgeons are required long training time, experience, and practices in order to deal with the technical limitations introduced by laparoscopic surgery and become proficient. Due to the steep learning curve that laparoscopic surgery demands in certain surgical procedures, advanced and structured training programs and methods are constantly being introduced [1, 2]. Recently, there is a paradigm shift from traditional subjective assessment methods of trainees to more objective assessment tools that can accredit surgeons as competent in laparoscopic surgery [3, 4].
\n
Despite the many advantages laparoscopic surgery offers to patients, laparoscopy also entails a number of technical limitations for surgeons. The performance of this surgical technique implies important restrictions on freedom of movement, mainly due to the use of rigid and long surgical instruments with poor ergonomic design, the location of the screens, the use of pedals to control the diathermy system, and by the fixed surgical ports for the instruments. These limitations result in an increased incidence of static postures in surgeons and the adoption and maintenance of forced body postures for long periods of time, which potentially affect performance and accuracy during surgery and increase the incidence of physical fatigue and musculoskeletal disorders. In order to address some of these technical limitations, new surgical instruments and devices have been developed aiming to enhance the dexterity, accuracy, and ergonomics of laparoscopic instruments [5]. In addition, new methodological approaches and instrumental techniques for ergonomic analysis have been implemented to improve the working conditions of surgeons, as well as the design of the laparoscopic material [6].
\n
Since the introduction of laparoscopic surgery several decades ago, it has been constantly evolving to the emergence of more sophisticated approaches such as the laparoendoscopic single-site surgery (LESS), natural orifice transluminal endoscopic surgery (NOTES), or transanal surgery, which are intended to reduce the patient’s invasiveness and surgical outcomes.
\n
LESS surgery could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain [7, 8]. By reducing the number of transcutaneous points of access, the approach offers numerous advantages including, but not limited to, improving postoperative recovery time and pain, enhancing cosmetics, and minimizing port-related complications. Instrument collision, lack of triangulation, and in-line vision are among the main challenges of LESS surgery. Several techniques and advancements have been introduced to overcome constraints associated with this surgical approach such as novel access devices and curved, articulated, or pre-bent instruments [9, 10]. The feasibility of LESS for almost all types of upper gastrointestinal procedures has been proved [11, 12].
\n
To date, several NOTES procedures have been performed using mainly stomach, rectum, and vagina as the portal of entry into the peritoneal cavity. The main benefits of this surgical technique in comparison to conventional laparoscopic surgery include no scars, less external pain, and lower cost. However, there are also some barriers when using this technique, some of them include difficulty in the closure of enterectomy, anastomotic techniques, spatial orientation, long learning curve, lack of triangulation of instruments, control of hemorrhage, and prevention of the transluminal spread of infection [13]. In order to address some of these technical difficulties in NOTES surgery, novel devices and robotic platforms using a flexible endoscope are appearing as a new trend in the field of MIS [14, 15].
\n
Rectal cancer surgery has undergone a rapid change over the last few decades. We have come a long way from abdominoperineal resection to minimally invasive sphincter-preserving techniques. Minimally invasive surgical techniques have been applied to rectal surgery for several procedures such as transanal polyp excision, local excision of rectal cancer, or transanal total mesorectal excision (taTME), among others [16, 17]. Currently, the two most popular options for local excision are transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS) [18, 19]. TEM utilizes a rigid platform to access intraluminal lesions in the rectum, maintaining stable the pneumoperitoneum. TAMIS utilizes conventional laparoscopic devices and a single incision port rather than a specialized platform.
\n
One of the technological fields that has most recently affected laparoscopic surgery is robotics. Robotic surgery is a further advancement in the field of laparoscopic surgery, which has gained global acceptance, and a large number of centers are performing robotic surgery as a routine. Laparoscopic robotic surgery has made tremendous progress in a relatively short period of time, resulting in improvements for both the patient and surgeon. Generally speaking, the robot for laparoscopic surgery provides three-dimensional vision, dexterity, and intuitiveness. The majority of robotic surgery applications are in urology, gynecology, and colorectal application, providing comparable clinical results to conventional laparoscopic approaches for the most popular procedures in these fields [20, 21]. The da Vinci surgical system is the most extended robotic platform worldwide for laparoscopic surgery. However, recently many other robotic systems are under development, including additional features such as enhanced portability and force feedback [22, 23].
\n
\n\n',keywords:null,chapterPDFUrl:"https://cdn.intechopen.com/pdfs/65969.pdf",chapterXML:"https://mts.intechopen.com/source/xml/65969.xml",downloadPdfUrl:"/chapter/pdf-download/65969",previewPdfUrl:"/chapter/pdf-preview/65969",totalDownloads:161,totalViews:0,totalCrossrefCites:0,dateSubmitted:"July 19th 2018",dateReviewed:"January 23rd 2019",datePrePublished:"March 5th 2019",datePublished:null,readingETA:"0",abstract:null,reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/65969",risUrl:"/chapter/ris/65969",signatures:"Francisco M. Sánchez-Margallo, Juan A. Sánchez-Margallo and Jesús Usón",book:{id:"8326",title:"Recent Advances in Laparoscopic Surgery",subtitle:null,fullTitle:"Recent Advances in Laparoscopic Surgery",slug:"recent-advances-in-laparoscopic-surgery",publishedDate:"November 27th 2019",bookSignature:"Francisco M. Sánchez Margallo and Juan A. Sánchez-Margallo",coverURL:"https://cdn.intechopen.com/books/images_new/8326.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"14715",title:"Prof.",name:"Francisco Miguel",middleName:null,surname:"Sánchez-Margallo",slug:"francisco-miguel-sanchez-margallo",fullName:"Francisco Miguel Sánchez-Margallo"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"14715",title:"Prof.",name:"Francisco Miguel",middleName:null,surname:"Sánchez-Margallo",fullName:"Francisco Miguel Sánchez-Margallo",slug:"francisco-miguel-sanchez-margallo",email:"msanchez@ccmijesususon.com",position:null,institution:{name:"Centro de Cirugía de Mínima Invasión Jesús Usón",institutionURL:null,country:{name:"Spain"}}},{id:"39774",title:"Prof.",name:"Jesus",middleName:null,surname:"Usón-Gargallo",fullName:"Jesus Usón-Gargallo",slug:"jesus-uson-gargallo",email:"juson@ccmijesususon.com",position:null,institution:null},{id:"264891",title:"Dr.",name:"Juan Alberto",middleName:null,surname:"Sánchez Margallo",fullName:"Juan Alberto Sánchez Margallo",slug:"juan-alberto-sanchez-margallo",email:"jasanchez@ccmijesususon.com",position:null,institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"}],chapterReferences:[{id:"B1",body:'[Forgione A, Guraya SY. The cutting-edge training modalities and educational platforms for accredited surgical training: A systematic review. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences. 2017;22:51. DOI: 10.4103/jrms.JRMS_809_16\n]'},{id:"B2",body:'[Enciso S, Díaz-Güemes I, Pérez-Medina T, Zapardiel I, de Santiago J, Usón J, et al. Validation of a structured intensive laparoscopic course for basic and advanced gynecologic skills training. International Journal of Gynaecology and Obstetrics. 2016;133(2):241-244. DOI: 10.1016/j.ijgo.2015.09.011\n]'},{id:"B3",body:'[Sánchez-Margallo JA, Sánchez-Margallo FM, Oropesa I, Enciso S, Gómez EJ. Objective assessment based on motion-related metrics and technical performance in laparoscopic suturing. International Journal of Computer Assisted Radiology and Surgery. 2017;12:307-314. DOI: 10.1007/s11548-016-1459-3\n]'},{id:"B4",body:'[Pérez-Escamirosa F, Chousleb-Kalach A, Hernández-Baro M del C, Sánchez-Margallo JA, Lorias-Espinoza D, Minor-Martínez A. Construct validity of a video-tracking system based on orthogonal cameras approach for objective assessment of laparoscopic skills. International Journal of Computer Assisted Radiology and Surgery 2016;11:2283-2293. DOI: 10.1007/s11548-016-1388-1\n]'},{id:"B5",body:'[Sánchez-Margallo JA, Sánchez-Margallo FM. Initial experience using a robotic-driven laparoscopic needle holder with ergonomic handle: Assessment of surgeons’ task performance and ergonomics. International Journal of Computer Assisted Radiology and Surgery. 2017;12:2069-2077. DOI: 10.1007/s11548-017-1636-z\n]'},{id:"B6",body:'[Sánchez-Margallo FM, Sánchez-Margallo JA. Ergonomics in laparoscopic surgery. In: Malik AM, editor. Laparoscopic Surgery. London: InTech; 2017. pp. 105-123\n]'},{id:"B7",body:'[Evans L, Manley K. Is there a cosmetic advantage to single-incision laparoscopic surgical techniques over standard laparoscopic surgery? A systematic review and meta-analysis. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2016;26(3):177-182. DOI: 10.1097/SLE.0000000000000261\n]'},{id:"B8",body:'[Marks JH, Montenegro GA, Shields MV, Frenkel JL, Marks GJ. Single-port laparoscopic colorectal surgery shows equivalent or better outcomes to standard laparoscopic surgery: Results of a 190-patient, 7-criterion case-match study. Surgical Endoscopy. 2015;29(6):1492-1499. DOI: 10.1007/s00464-014-3830-1\n]'},{id:"B9",body:'[Sánchez-Margallo FM, Sánchez-Margallo JA. Assessment of postural ergonomics and surgical performance in laparoendoscopic single-site surgery using a handheld robotic device. Surgical Innovation. 2018;25:208-217. DOI: 10.1177/1553350618759768\n]'},{id:"B10",body:'[Matos-Azevedo AM, Díaz-Guëmes Martín-Portugués I, Pérez-Duarte FJ, Sánchez-Hurtado MÁ, Sánchez-Margallo FM. Comparison of single access devices during cut and suturing tasks on simulator. The Journal of Surgical Research. 2014;192:356-367. DOI: 10.1016/j.jss.2014.06.017\n]'},{id:"B11",body:'[Lee CM, Park DW, Jung DH, Jang YJ, Kim JH, Park S, et al. Single-port laparoscopic proximal gastrectomy with double tract reconstruction for early gastric cancer: Report of a case. Journal of Gastric Cancer. 2016;16:200-206. DOI: 10.5230/jgc.2016.16.3.200\n]'},{id:"B12",body:'[Machado MA, Surjan RC, Makdissi FF. Laparoscopic distal pancreatectomy using single-port platform: Technique, safety, and feasibility in a clinical case series. Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2015;25(7):581-585. DOI: 10.1089/lap.2015.0032\n]'},{id:"B13",body:'[Rattner D, Kalloo A, ASGE/SAGES Working Group. ASGE/SAGES Working Group on natural orifice translumenal endoscopic surgery, October 2005. Surgical Endoscopy. 2006;20(2):329-333\n]'},{id:"B14",body:'[Okamoto Y, Nakadate R, Nakamura S, Arata J, Oguri S, Moriyama T, et al. Colorectal endoscopic submucosal dissection using novel articulating devices: A comparative study in a live porcine model. Surgical Endoscopy. 2018. DOI: 10.1007/s00464-018-6408-5 [Epub ahead of print]\n]'},{id:"B15",body:'[Légner A, Diana M, Halvax P, Liu Y-Y, Zorn L, Zanne P, et al. Endoluminal surgical triangulation 2.0: A new flexible surgical robot. Preliminary pre-clinical results with colonic submucosal dissection. International Journal of Medical Robotics. 2017;13:e1819. DOI: 10.1002/rcs.1819\n]'},{id:"B16",body:'[Erkan A, Kelly JJ, Monson JRT. Current state of transanal minimally invasive surgery in the management of rectal cancer. Mini-invasive Surgery. 2018;2:30. DOI: 10.20517/2574-1225.2018.51\n]'},{id:"B17",body:'[Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, et al. Transanal total mesorectal excision: International registry results of the first 720 cases. Annals of Surgery. 2017;266(1):111-117. DOI: 10.1097/SLA.0000000000001948\n]'},{id:"B18",body:'[Keller DS, Tahilramani RN, Flores-Gonzalez JR, Mahmood A, Haas EM. Transanal minimally invasive surgery: Review of indications and outcomes from 75 consecutive patients. Journal of the American College of Surgeons. 2016;222(5):814-822. DOI: 10.1016/j.jamcollsurg.2016.02.003\n]'},{id:"B19",body:'[Saclarides TJ. Transanal endoscopic microsurgery. Clinics in Colon and Rectal Surgery. 2015;28(3):165-175. DOI: 10.1055/s-0035-1562889\n]'},{id:"B20",body:'[Peters BS, Armijo PR, Krause C, Choudhury SA, Oleynikov D. Review of emerging surgical robotic technology. Surgical Endoscopy. 2018;32:1636-1655. DOI: 10.1007/s00464-018-6079-2\n]'},{id:"B21",body:'[Szold A, Bergamaschi R, Broeders I, Dankelman J, Forgione A, Langø T, et al. European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery. Surgical Endoscopy. 2015;29(2):253-288. DOI: 10.1007/s00464-014-3916-9\n]'},{id:"B22",body:'[Gueli Alletti S, Perrone E, Cianci S, Rossitto C, Monterossi G, Bernardini F, et al. 3 mm Senhance robotic hysterectomy: A step towards future perspectives. Journal of Robotic Surgery. 2018;12:575-577. DOI: 10.1007/s11701-018-0778-5\n]'},{id:"B23",body:'[Hagn U, Konietschke R, Tobergte A, Nickl M, Jörg S, Kübler B, et al. DLR MiroSurge: A versatile system for research in endoscopic telesurgery. International Journal of Computer Assisted Radiology and Surgery. 2010;5:183-193. DOI: 10.1007/s11548-009-0372-4\n]'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Francisco M. Sánchez-Margallo",address:"msanchez@ccmijesususon.com",affiliation:'- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
'},{corresp:null,contributorFullName:"Juan A. Sánchez-Margallo",address:null,affiliation:'- Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
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