SAGES is the largest surgical endoscopic association which has more than 7000 members worldwide. As reported by many surgical societies both nationally and internationally, COVID-19 Pandemic causes uncertainty and technical difficulty in holding an in-person meeting. Last year, the 2020 SAGES meeting in Cleveland had to be cancelled due to the pandemic, a very difficult decision made by the organizing committees. This year, SAGES made an extraordinary commitment to hold the annual meeting in Las Vegas utilizing in-person and virtual meeting platforms. The SAGES 2021 meeting was moved from its regular annual schedule in April to September with a hope of passing the peak of coronavirus spread. As a SAGES committee member, I had the privilege to contribute to the final program by designing sessions within the meeting. I worked with several colleagues to design and moderate the minimally invasive HepatoPancreatoBiliary session within the 2021 SAGES program. This year, the meeting has even a stronger component of the Hepatobiliary section by working together with International Laparoscopic Liver Society (ILLS) and Americas Hepatopancreatobiliary Association (AHPBA). The issues of bleeding control in laparoscopic and robotic liver resection, training/education of young surgeons in liver surgery, and how to manage intraoperative catastrophe are discussed in detail with experts and pioneers in the field. I had the opportunity to discuss management of bile duct injury, a known and dreaded complication after laparoscopic cholecystectomy. A pattern of vascular anatomy within the bile duct, combined biliovascular injury, timing of repair, and technical approach in minimally invasive bile duct reconstruction were discussed. With advances in technology, bile duct injury can be routinely repaired using minimally invasive techniques without the need for an open conversion. I am the director of the Hepatobiliary program in Tampa and our group has performed more than 16 successful repairs of bile duct injury of various types using robotic technology with excellent long-term outcomes.
In addition to the joint sessions with other societies, the 2021 SAGES itself also has strong scientific contents with high-level abstracts and video presentations were selected for podium/plenary presentations. Our hepatobiliary team presented the propensity score matching study comparing robotic versus open liver resection for the treatment of liver tumors. This is a novel and very important study since the robotic approach is gaining popularity based on its salutary benefits for patients. Robotic approaches offer solutions to the inherent limitations of straight instruments used in conventional laparoscopy. Performing liver resection via five small incisions is associated with decreased blood loss, shorter recovery, lower postoperative complications and earlier return to work as well as earlier resumption of systemic chemotherapy for those who need it. Our matched study confirmed this finding, favoring the robotic approach, whenever it is technically feasible.
Another research paper from our team, presented as a podium presentation at SAGES 2021 was analysis of surgical margins after robotic liver resection for colorectal liver metastasis. Since 2016, I performed a high number of robotic liver resection for stage 4 colorectal cancers which have spread to the liver. As we know, the liver is a fertile soil for colorectal cancer to grow. In about 50% of patients with colon or rectal cancer, metastasis to the liver will occur at some point. Liver resection to remove these metastatic tumors has become the standard of care in the last decade because it prolongs the patient’s overall survival significantly when compared to chemotherapy alone. Traditionally, these resections were done via open approach since many liver surgeons were concerned that resection margins compromise with laparoscopic or robotic approach. Our study confirmed that the oncological margins can be obtained adequately via robotic approach without any concerns, when compared with the open approach.
SAGES continues to be a very innovative surgical society, bringing together clinicians, researchers, and industry for healthy partnerships. Technology is being discussed and developed at SAGES with many younger members becoming actively involved in the development of science. Now is a very exciting time to practice medicine and SAGES serves as one of the vehicles to achieve our goals. SAGES has become an integral part of our daily lives as minimally invasive surgeons. It is where friendship is made and maintained among our colleagues.
Dr. Sucandy has no conflicts of interest to report.
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