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AConferenceREGISTER BY FEBRUARY 10SAVE 100!Earn up to30 CME CreditsIncluding OptionalMOC Self-AssessmentCreditMARCH 16-19, 2020ARIA, LAS VEGASJoin us for the 20th anniversary of thispremier meeting of thought leaders inminimally invasive surgeryTOPICS··ColonEnhancedRecovery After TIVE DIRECTORPhilip R. Schauer, MDProfessor of Metabolic SurgeryDirector of Bariatric and Metabolic InstitutePennington Biomedical Research Center ofLouisiana State UniversityBaton Rouge, LouisianaConnect with the MISS ConferenceJointly Provided byFor complete information, including accreditation, and to register: MISS-CME.orgFlexible registration options available
FACULTYFaculty and agenda subject to change.EXECUTIVE DIRECTORPhilip R. Schauer, MDProfessor of Metabolic SurgeryDirector of Bariatric and Metabolic InstitutePennington Biomedical Research Center ofLouisiana State UniversityBaton Rouge, LouisianaDear Colleague,It is my pleasure to invite you to join us for the 20th Anniversary Minimally InvasiveSurgery Symposium (MISS), March 16-19, 2020 at the Aria in Las Vegas, Nevada.MISS is the premier meeting of thought leaders in minimally invasive colon,hernia, foregut, and metabolic/bariatric surgery as well as enhanced recoveryafter surgery. Attending MISS will provide you with practical tips and tricks youcan immediately apply to your practice.With flexible registration options, discount rates, and our collegial Chairman’sReception (included in your registration fee), MISS is an affordable, and enjoyableway to elevate your skills in the most advanced minimally invasive techniques whileyou earn essential CME credit (including optional MOC self-assessment credit).Our world-class host property, the Aria Las Vegas, is certain to add to yourenjoyment of the conference.I hope to see you and your colleaguesat the 2020 MISS.COLON PROGRAM CO-CHAIRBradley R. Davis, MDColon and Rectal SurgeryProfessor of SurgeryVice ChairSurgical EducationSurgery Care DivisionAtrium HealthCharlotte, North CarolinaENHANCED RECOVERY AFTER SURGERY CO-CHAIRJulie K. Marosky Thacker, MDMedical Director, Clinical Research UnitAssociate Professor of SurgeryDuke University Medical SchoolDurham, North CarolinaHERNIA PROGRAM CO-CHAIRGuy R. Voeller, MDProfessor of SurgeryUniversity of Tennessee Health Science CenterMemphis, TennesseeSincerely,FOREGUT PROGRAM CO-CHAIRAurora Pryor, MDPhilip R. Schauer, MDExecutive Director, MISSAbout our VenueAria Las Vegas3730 South Las Vegas BlvdLas Vegas, NV 89158P: (866) 359-7757Discounted Rate: 229* for single/doubleDeadline: February 13, 2020Phone Reservations: (866) 770 7555Identify yourself as Minimally InvasiveSurgery Symposium attendee andmention code SMIS0320AR to receivethe discounted rate.Just 229 a night at the Aria Las Vegas!The 2019 Minimally Invasive Surgery Symposium will take place at the Encore WynnLas Vegas where we have arranged for a discount room rate of just 229* a night(subject to availability) for MISS participants. To make your reservation, please call(866) 770-7555. You must identify yourself as Minimally Invasive Surgery Symposiumattendee and mention code SMIS0320AR to receive the discounted rate.Discount rate expires February 13, 2020, but we urge you to make yourarrangements before that date as our room block will sell out.*plus 37 amenity feePresident, SAGESProfessor of SurgeryProfessor & Vice Chair of Clinical AffairsChief, Division of BariatricForegut & Advanced GI SurgeryStony Brook MedicineStony Brook, New YorkMETABOLIC/BARIATRIC PROGRAM CO-CHAIRSJohn B. Dixon, MBBS, PhD, FRACGP,FRCP, EdinProfessorBaker Heart & Diabetes InstituteMelbourne, AustraliaPhilip R. Schauer, MDProfessor of Metabolic SurgeryDirector of Bariatric and Metabolic InstitutePennington Biomedical Research Center ofLouisiana State UniversityBaton Rouge, LouisianaKEYNOTE SPEAKERSLee M. Kaplan, MD, PhDHarvard Medical SchoolSteven E. Nissen, MD, MACCCleveland ClinicAurora D. Pryor, MDPresident, SAGES
MISS FACULTYSubject to change. Please see Web site for complete, updated informationCOLON FACULTYBradley R. Davis, MD, FACS, FASCRSColon Program Co-DirectorAtrium HealthCharlotte, North CarolinaJamie A. Cannon, MD, FACS, FASCRSUniversity of Alabama at BirminghamBirmingham, AlabamaTodd D. Francone, MD MPH FACSFASCRSTufts Medical SchoolNewton, MassachusettsIan M. Paquette, MDUniversity of Cincinnati College of MedicineCincinnati, OhioRadhika Smith, MDWashington University School of MedicineSt. Louis, MissouriHERNIA FACULTYGuy R. Voeller, MDHernia Program Co-DirectorUniversity of Tennessee Health ScienceCenterMemphis, TennesseeJames G. Bittner IV, MD, FACSSaint Francis HospitalHartford, CTB. Todd Heniford, MDCarolinas Medical CenterCarolinas HealthCare SystemCharlotte, North CarolinaWilliam W. Hope, MDNew Hanover Regional Medical CenterWilmington, North CarolinaMichael Rosen, MDCleveland ClinicCleveland, OhioENHANCED RECOVERYAFTER SURGERY FACULTYJulie K. Marosky Thacker, MDEnhanced Recovery After SurgeryCo-DirectorDuke University Medical SchoolDurham, NCStephanie B. Jones, MDBeth Israel Deaconess Medical CenterBoston, MassachusettsMatthew McEvoy, MDVanderbilt University Medical CenterNashville, TennesseeTimothy E. Miller, MB, ChBDuke UniversityDurham, North CarolinaFOREGUT FACULTYAurora D. Pryor, MDForegut Co-DirectorPresident Elect, SAGESStony Brook, New YorkSteve Eubanks, MDAdventHealthOrlando, FloridaLeena Khaitan, MDUniversity Hospitals of ClevelandChagrin Falls, OhioWilliam O. Richards, MDUniversity of South Alabama College ofMedicineMobile, AlabamaJames Clarence Rosser, Jr., MD, FACSJacob School of MedicineOrlando, FloridaMETABOLIC/BARIATRICFACULTYJohn B Dixon, MBBS, PhDMetabolic Bariatric Program Co-DirectorBaker Heart & Diabetes InstituteMelbourne, AustraliaPhilip R. Schauer, MDMetabolic Bariatric Program Co-DirectorProfessor of Metabolic SurgeryDirector of Bariatric and MetabolicInstitutePennington Biomedical Research Centerof Louisiana State UniversityBaton Rouge, LouisianaCheguevara Afaneh, MDNew York-Presbyterian Hospital/Weill Cornell Medical CenterNew York, New YorkAli Aminian, MDCleveland ClinicCleveland, OhioRobin P. Blackstone, MDBanner Health University Medical CenterPhoenix, AZEric J. DeMaria, MDASMBS President-ElectEast Carolina UniversityGreenville, North CarolinaNeil Floch, MDNorwalk HospitalNorwalk, ConnecticutMatthew M. Hutter, MDMassachusetts General HospitalBoston, MassachusettsDaniel B. Jones, MD, MS, FACSBeth Israel Deaconess Medical CenterBoston, MassachusettsLee M. Kaplan, MD, PhDHarvard Medical SchoolBoston, MassachusettsTammy Lyn Kindel, MD, PhDMedical College of WisconsinMilwaukee, WisconsinKenneth G. MacDonald, Jr., MDPhysicians EastGreenville, North CarolinaCorrigan McBride, MDUniversity of Nebraska Medical CenterOmaha, NebraskaJohn Morton, MD, MPHStanford School of MedicineStanford, CaliforniaNinh T. Nguyen, MDUniversity of California, IrvineMedical CenterOrange, CaliforniaSteven E. Nissen MD, MACCUniversity of California, IrvineMedical CenterOrange, CaliforniaJaime Ponce, MD, FACS, FASMBSCHI Memorial HospitalChattanooga, TennesseeAurora D. Pryor, MDPresident, SAGESStony Brook, New YorkJohn H. Rodriguez, MDCleveland ClinicCleveland, OhioScott A. Shikora, MD, FACS, FASMBSBrigham and Women’s HospitalBoston, MassachusettsAGENDA(subject to change. Please see website for updates.)MONDAY MARCH 16, 20206:30 AM7:10 - 7:55 AMBreakfastBreakfast SymposiumColon ProgramColon Session I8:00 - 8:15AM Welcome and Course Overview8:15 - 8:30AM Colon Surgery 20 Years Ago: Then, Now and Future8:30 - 8:45AM Robotic Surgery: Who Should Use It?8:45 - 9:00AMRobotic Right Colectomy: From Trocar Placement to Anastomosis9:00 - 9:15 AMTransanal Surgery Using Robotic Technology: Who and How?9:15 - 9:30 AM Q&A/Panel with Faculty9:30- 9:45AMI Want to Start a Robotics Program: What Does That Take?9:45 - 10:00AMBowel Preps: What Are the Current Evidence and Recommendations?10:00 - 10:15 AM Reducing Surgical Site Infection in CRS10:15 - 10:30 AM Break10:30 - 10:45 AM What Is New in the CRS ERAS Updates?10:45 - 11:00 AM Q&A/Panel with FacultyColon Program, continuedColon Session II11:00 - 11:20 AM 11:20 - 11:40 AM11:40 - 11:55 AM 11:55 - 12:15 PM12:15 - 12:30 PMParastomal Hernias: Avoidance and Best ManagementInflammatory Bowel Disease - What’s new?Diverticulitis: Are There Any Medical Therapies?Diverticulitis and Abscess ManagementQ&A/Panel with FacultyColon Program, continuedColon Session III12:30 - 12:45 PM Lunch12:45 - 1:30 PMLunch Symposium (Non-CME)1:30 - 1:45 PM Break1:45 - 2:30 PM Case Studies: Colovesical Fistula Management; Malignant BowelObstruction; Ostomies in the Morbidly Obese; Large BowelObstruction2:30 - 2:45 PM Q&A/Panel with Faculty2:45 - 3:00 PM Anastomotic Leak: Prevention and Management3:00 - 3:15PMCurrent Management of Colon Polyps: Surgery or Endoscopic?3:15 - 3:30 PM Malignant Colon Polyp: Should Everyone Have a Formal Resection?3:30 - 3:45 PM Q&A/Panel with Faculty3:45 PM Colon Program AdjournsHernia ProgramHernia Session I4:00 - 4:15 PM The “Tell” of the Preoperative CT Scan in AWR4:15 - 4:30 PMMeasuring Abdominal Wall Tension for AWR4:30 - 4:45 PM Abdominal Wall Anatomy for the AWR Surgeon4:45 - 5:00 PMRobotics for Ventral/Incisional Hernia Repair:What Does the Data Show?5:00 - 5:15 PM Q&A/Panel with Faculty5:15 - 5:30 PMComponents Separation: From Knowing Everything to Nothingand Partially Back Again5:30 - 5:45 PM Hernia Prevention Strategies Including Prophylactic Mesh5:45 - 6:00 PM Preoperative Optimization in AWR: Data from the AHSQC6:00 - 6:15 PM Q&A/Panel with FacultyTUESDAY, MARCH 17, 20206:30 - 7:30 AM7:10 - 7:55 AMBreakfast/Exhibits/PostersBreakfast SymposiumHernia Program, continuedHernia Session II8:00 - 8:15 AM My Experience with the Preperitoneal Space for AWR8:15 - 8:30 AMMy Experience with TAR: The Good, Bad and the Ugly8:30 - 8:45 AM My Experience with MIS Extraperitoneal AWR8:45 - 9:00 AMQ&A/Panel with Faculty9:00 - 9:15AM Hernia Surgery Past, Present and Future9:15 - 9:30 AMCoding and Billing for AWR: Maximizing ReimbursementAppropriately9:30 - 9:45 AM Q&A/Panel with Faculty9:45 - 10:15 AM Break/Exhibits/Posters
(Faculty and agenda subject to change. Please see web site for updated schedule.)Hernia Session III10:15 - 10:30 AM Robotic Inguinal Hernia: Yes or No?10:30 - 10:45 AM Non-permanent Prosthetics in AWR: When and How?10:45 - 11:00 AM Botulinum Toxin in AWR: Fad or Here to Stay?11:00 - 11:15AM Stump the Experts: Case Presentations11:15 - 12:00 AMQ&A/Panel with Faculty12:00 PMHernia Program adjourns12:00 - 12:15 PMLunch12:15 PM - 1:15 PM Lunch Symposium (Non-CME)1:00 - 1:30 PMDessert Break/Exhibits/PostersEnhanced Recovery after Surgery Program1:30 - 1:45 PM What’s New in Enhanced Recovery? Update from ASER President1:45 - 2:00 PMPerioperative Hyperglycemia: Dexamethasone, Carb Loading,Stress, Diabetes2:00 - 2:15 PM Perioperative Fluid and Hemodynamic Management2:15 - 2:30 PM Regional Anesthesia for Enhanced Recovery2:30 - 2:45 PMEnhanced Recovery for High-Risk Surgery2:45 - 3:00 PM Q&A/Panel with Faculty3:00 - 3:15 PM Management of Patients on Chronic Opioid Therapy3:15 - 3:30 PM Tip for Implementation3:30 PM Break3:45 - 4:00 PM Opioid-free Anesthesia: How, Who, and Why?4:00 - 4:15 PM Postoperative Bowel Recovery and Management of PONV4:15 - 4:30 PM Preventable Complications and Readmissions4:30 - 4:45 PM Q&A/Panel with Faculty4:45 PM Enhanced Recovery Program AdjournsForegut ProgramForegut Session IModerators: Aurora D. Pryor, MD; James C. Rosser, MD4:45 - 5:00 PM Foregut Surgery 20 Years Ago: Then, Now and a Vision of20 Years from Now5:00 - 5:15 PM Endoscopic Options for GERD Management5:15 - 5:30 PM How to Select Surgical Alternatives for Reflux5:30 - 5:45 PM Falciform FlaP? What’s That?5:45 - 6:005 PM The Recurrent PEH: What To Do6:00 - 6:15 PM Q&A/Panel with Faculty6:15 - 8:00 PM Chairman’s Welcome Reception/Exhibits/PostersWEDNESDAY, MARCH 18, 20206:30 AM Breakfast/Exhibits/Posters7:10 - 7:55 AM Breakfast SymposiumForegut Program, ContinuedForegut Session IIModerators: Aurora D. Pryor, MD; William O. Richards, MD8:00 - 8:30 AM Stump the Experts: Case StudiesModerator: Leena Khaitan, MD8:30 - 8:45 AM Median Arcuate Ligament Syndrome: Fact or Fantasy?8:45 - 9:00 AM Watts 3D and CLE: What Are These New Tools andWhen Do I Use Them?9:00 - 9:15 AM How to Incorporate New Tricks into Practice and Get Paid for It9:15 - 9:30 AM Q&A/Panel with Faculty9:30 - 10:00 AM Break/Exhibits/Posters10:00 - 10:15 AM Working Up Motility Disorders10:15 - 10:30 AM Modern Management of Achalasia10:30 - 10:45 AM What to Do with Epiphrenic Diverticula and OtherEsophageal Oddities10:45 - 11:00 AM Q&A/Panel with Faculty11:00 Foregut Program AdjournsMetabolic/Bariatric Surgery ProgramSession 1: The Science11:00 - 11:30 AM KEYNOTE: Obesity and CVD11:30 - 11:50 AMObesity and CVD Drivers11:50 - 12:10 PM KEYNOTE: CVD Outcomes of New Diabetes Agents: GLP1, SGLT212:10 - 12:30PM CVD Outcomes of Metabolic Surgery12:30 - 12:50 PM How does Obesity Cause HF/Effects of BS on HF12:50 - 1:05 PM Q&A Panel with Faculty1:05 - 1:20 PM Lunch1:20 - 2:05 PMLunch Symposium (Non-CME)2:05 - 2:35 PM Dessert Break/Exhibits/PostersMetabolic/Bariatric Surgery Program, continuedMetabolic/Bariatric Session II: Hot Topics2:35 - 2:55 PM2:55 - 3:10 PM3:10 - 3:25 PM3:25 - 3:40 PM3:40 - 4:00 PM4:00 - 4:15 PM4:15 - 4:35 PM4:35 - 4:45 PMBariatric Surgery 20 Years Ago: Then, Now and a Vision of20 Years from NowSADI - Now Ready for Prime Time?Obesity Stigma is the Root of all Barriers to Obesity TreatmentUsing Social Media to Combat Obesity StigmaDEBATE: Does Gastric Sleeve Cause Barrett’s?How to Use Weight Loss Medications in your Surgical PracticeSurgeon BurnoutQ&A/Panel with FacultyMetabolic/Bariatric Session III: Access, Quality andOptimizing Outcomes4:45 - 5:00 PMNew MBSAQIP Standards- Medical Weight Loss5:00 - 5:15 PM Standards for Patient Safety and Efficacy in Metabolic andBariatric Surgery5:15 - 5:30 PM Round Table Discussion: Board Certification for MetabolicBariatric Surgery, Is it Coming?5:30 - 5:45 PM Recent Changes in Insurance Coverage for Bariatric Surgery5:45 - 6:00 PM What Happens to Patients Who are Denied for Bariatric Surgery?12-year Follow up6:00 - 6:20 PMKEYNOTE: Surgeon Volume Does Predict Outcomes6:20 - 6:30 PM Q&A/Panel with FacultyTHURSDAY, MARCH 19, 20206:30 AM Breakfast /Exhibits/Posters7:10 - 7:55 AM Breakfast SymposiumMetabolic/Bariatric Surgery Program, continuedMetabolic/Bariatric Surgery IV: Your Practice/ Videofest/Complications8:00 - 8:15 AM Laparoscopic Ligamentum Teres Fundoplication for GERD afterSleeve or DS (video and results)8:15 - 8:30 AM Technical Pearls for Revisional Bariatric Surgery8:30 - 8:45 AM RYGB for Failed Nissen - Tips and Tricks8:45 - 9:00 AM Sleeve Leaks - Still an Issue9:00 - 9:15 AM Bariatric Surgery in LVAD Patients - Tips and Tricks9:15 - 9:30 AM Robotic Techniques for Bariatric Surgery9:30 - 9:50 AM Stump the Experts9:50 - 10:00 AM Q&A/Panel with Faculty10:00 - 10:30 AM Break/Exhibits/PostersSession V: Controversies and New Frontiers10:30 - 10:45 AM10:45 - 11:05 AM11:05 - 11:20 AM11:20 - 11:35 AM11:35 - 11:50 AM11:50 - 12:05 PM12:05 - 12:20 PM12:20 - 12:35PM12:35 - 12:50 PM12:50 - 1:05 PM1:05 - 1:25 PM1:25 - 1:40 PM1:40PMMachine Learning - Our Future?Balloons without Endoscopy and the New Expanding Cellulose PillAspiration Therapy, Really?New Apps to Individualize Care in Metabolic SurgeryDistal Bypass after RYGBDuodenal Switch after RYGBEndoscopy Frontiers in Bariatric SurgeryOAGB for Failed Sleeve GastrectomyBanding the Sleeve - Better Results?Decision Regret after Procedure Selection:What are Patients Telling Us?DEBATE: Robotics for Metabolic SurgeryQ&A/Panel with FacultyMISS Adjourns
COURSE OBJECTIVESHOW TO REGISTER FOR MISSONLINE:QUESTIONS:6 AMA PRA Category 1 CreditsTMAfter completing this activity, the participant should be able to: Detail the different options for minimally invasive surgicalprocedures for colorectal concerns. Review the different techniques of intracorporeal anastomoticcreation and the potential ways to avoid and treat anastomoticleaks. Discuss the current approaches in the management ofdiverticulitis. Discuss the available strategies to improve peri- and postoperative outcomes and minimize e.comENHANCED RECOVERY AFTER SURGERYq PHYSICIANSq RESIDENTS/FELLOWSq ALLIED HEALTHCOLON PROGRAM3 AMA PRA Category 1 CreditsAfter completing this activity, the participant should be able to: Recognize the science and evidence supporting best practices inEnhanced Recovery to optimize patient outcomes Develop a functional knowledge of core ERAS elements,understanding how several targets vary from traditionalpractices. Summarize the challenges facing the adoption of ERAS programs.TMHERNIA PROGRAM6 AMA PRA Category 1 CreditsTMAfter completing this activity, the participant should be able to: Discuss abdominal wall anatomy with respect to reconstruction. Compare the benefits and risks of biological and biosyntheticmesh with synthetic mesh for hernia repair. Identify situations when robotic approaches are appropriate foringuinal hernia repair Review current evidence regarding hernia repair techniques forparastomal hernia, flank hernia, and loss of domain.FOREGUT PROGRAM4 AMA PRA Category 1 CreditsTMAfter completing this activity, the participant should be able to: Describe medical and surgical management of GERD. Describe preferred surgical management of Barrett’s esophagus. Develop strategies using mesh and minimally invasive surgicalapproaches to manage patients with PEH. Apply the 2014 update of the Chicago Classification (CC) ofesophageal motility disorders to help assess motility. Integrate the most current evidence into the diagnosis ofgastroparesis and management of EGJ outlet obstruction.METABOLIC/BARIATRIC PROGRAM11 AMA PRA Category 1 CreditsTMAfter completing this activity, the participant should be able to: Identify factors that suggest safety and efficacy of weight-losssurgery in older adults. Identify factors that suggest safety and efficacy of weight-losssurgery in children and adolescents. Discuss the benefits and risks of the numerous approaches torevisional surgery. Discuss the role of medications and surgical interventions for theobese patient with diabetes Identify common causes of complications and approaches toaddress these complications. Identify both sides of common controversies in bariatric surgery. Discuss the EndoBarrier device and laparoscopic endoluminalsurgery.GENERAL SESSIONS REGISTRATION OPTIONS(All options include admission to the 2020 MISS Exhibit Hall 3/17-3/19) PLATINUM PASSPORTUntil 1/10Until 2/10After 2/10 (Includes admission to all Colon, Enhanced Recovery, Hernia, Foregut, and Bariatric General Sessions)q PHYSICIANq RESIDENTS/FELLOWSq ALLIED HEALTH 895 295 495 995 350 595 1095 395 695 COLON/HERNIA/FOREGUT/ERAS OPTION(Includes admission to all Colon, Enhanced Recovery, Hernia, and Foregut General Sessions) 795 245 395 895 295 495 995 345 595 795 245 395 895 295 495 995 345 595 175 195 245 BARIATRIC/HERNIA/FOREGUT OPTION(Includes admission to all Bariatric, Hernia, and Foregut General Sessions)q PHYSICIANSq RESIDENTS/FELLOWSq ALLIED HEALTH ENHANCED RECOVERY ONLY OPTIONCancellation Policy: A refund less a 50 administrative fee as follows: You may cancel your registration using our online registrationsystem prior to February 10, 2020. After February 10, 2020 no refunds will be granted. After the refund date, you have two options:you can transfer your registration to another party using our online registration system, or receive a credit in the amount you paidless a 50 administrative fee to be applied to your registration for next year’s conference. Refunds will not be issued to no-shows.CONTINUING MEDICAL EDUCATIONAccreditation InformationThis activity has been planned and implemented in accordance with the accreditationrequirements and policies of the Accreditation Council for Continuing Medical Education(ACCME) through the joint providership of the University of Cincinnati and Global Academyfor Medical Education, Inc. The University of Cincinnati is accredited by the ACCME to providecontinuing medical education for physicians.Physician Credit DesignationThe University of Cincinnati Continuing designates this live activity for a maximum of 30 AMA PRACME Category 1 credits . Physicians should claim only the credit commensurate with the extent oftheir participation in the activity.American Board of Surgery Maintenance of Certification (MOC)Self-Assessment CreditOptional American Board of Surgery Maintenance of Certification (MOC) Self-assessment will beoffered at 2020 MISS. Optional MOC self-assessment credit will be available for delegates whocomplete curriculum related questions. Self-assessment is a written or electronic question-andanswer exercise that assesses your understanding of the material presented in the CME program.Diplomats must achieve a score of 75% or higher for the self-assessment to count for MOC.
AGENDA MONDAY MARCH 16, 2020 30 6: AM Breakfast 7:10 - 7:55 AM Breakfast Symposium Colon Program Colon Session I 8:00 - 8:15AM Welcome and Course Overview 8:15 - 8:30 AM Colon Surgery 20 Years Ago: Then, Now and Future 8:30 - 8:45 AM Robotic Surgery: Who Should Use It? 8:45 - 9:00 AM Robotic Right Colectomy: From Trocar Placement to Anastomosis 9:00 - 9:15 AMTransanal Surgery Using Robotic .
