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Vasdev N, Charlesworth P, Slack M, Adshead J. Preclinical evaluation of the Versius surgical system: A next-generation surgical robot for use in minimal access prostate surgery. BJUI COMPASS 2023; 4:482-490. [PMID: 37334028 PMCID: PMC10268579 DOI: 10.1002/bco2.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
Objectives To evaluate the Versius surgical system for robot-assisted prostatectomy in a preclinical cadaveric model using varying system setups and collect surgeon feedback on the performance of the system and instruments, in line with IDEAL-D recommendations. Materials and methods Procedures were performed in cadaveric specimens by consultant urological surgeons to evaluate system performance in completing the surgical steps required for a prostatectomy. Procedures were conducted using either a 3-arm or 4-arm bedside unit (BSU) setup. Optimal port placements and BSU layouts were determined and surgeon feedback collected. Procedure success was defined as the satisfactory completion of all steps of the procedure, according to the operating surgeon. Results All four prostatectomies were successfully completed; two were completed with a 3-arm BSU setup and two using a 4-arm BSU setup. Small adjustments were made to the port and BSU positioning, according to surgeon preference, in order to complete the surgical steps. The surgeons noted some instrument difficulties with the Monopolar Curved Scissor tip and the Needle Holders, which were subsequently refined between the first and second sessions of the study, in line with surgeon feedback. Three cystectomies were also successfully completed, demonstrating the capability of the system to perform additional urological procedures. Conclusions This study provides a preclinical assessment of a next-generation surgical robot for prostatectomies. All procedures were completed successfully, and port and BSU positions were validated, thus supporting the progression of the system to further clinical development according to the IDEAL-D framework.
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Affiliation(s)
- Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer CentreLister HospitalStevenageUK
- School of Life and Medical SciencesUniversity of HertfordshireHertfordshireUK
| | | | | | - Jim Adshead
- Hertfordshire and Bedfordshire Urological Cancer CentreLister HospitalStevenageUK
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Banapour P, Schumacher A, Lin JC, Finley DS. Radical Prostatectomy and Pelvic Lymph Node Dissection in Kaiser Permanente Southern California: 15-Year Experience. Perm J 2019; 23:17-233. [PMID: 30939263 DOI: 10.7812/tpp/17-233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Radical prostatectomy (RP) with pelvic lymph node dissection (PLND) is the standard treatment of high-risk prostate cancer. High-risk patients and those with lymph node metastasis (LNM) require further treatment. We review outcomes of RP+PLND in Kaiser Permanente Southern California (KPSC). METHODS Patients who underwent RP+PLND in KPSC from January 1, 2001, to July 1, 2015 were included. Patient charts were retrospectively reviewed for demographic information and clinicopathologic data which were used to calculate positive surgical margin rate, LNM, adjuvant treatment, 5-year biochemical recurrence, and overall survival. Univariate and multivariate logistic regression analyses were used to identify factors associated with margin positivity. RESULTS Patients (N = 1829) underwent RP+PLND (241 high-risk, 943 intermediate-risk, 645 low-risk). Positive margin rates were 17.8%, 14.8%, and 11.9% in the high, intermediate- and low-risk groups. Biochemical recurrence rates were 22% in high-risk and 12.1% in the low-risk category. Androgen deprivation use was 4.1% in the high-risk group and 0.9% in the low-risk group. Five-year overall survival was 92.5% in lymph node-positive patients and 94.9% in lymph node-negative patients (p = 0.8). On multivariate analysis, age (odds ratio [OR] = 1.02, p = 0.02), prebiopsy prostate-specific antigen (OR = 1.02, p < 0.001), and clinical T stage (OR = 1.49, p = 0.01) were associated with margin positivity. CONCLUSION In KPSC, RP+PLND was performed in patients with low-, intermediate-, and high-risk prostate cancer. Age, prebiopsy prostate-specific antigen, and clinical stage were associated with positive surgical margins in patients with LNM. Recipients of RP+PLND with LNM and positive surgical margins required adjuvant treatment.
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Affiliation(s)
- Pooya Banapour
- Department of Urology, Sunset Medical Center, Los Angeles, CA
| | | | - Jane C Lin
- Department of Research and Evaluation, Pasadena, CA
| | - David S Finley
- Department of Urology, Sunset Medical Center, Los Angeles, CA
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Bernstein DE, Bernstein BS. Urological technology: where will we be in 20 years' time? Ther Adv Urol 2018; 10:235-242. [PMID: 30034542 PMCID: PMC6048627 DOI: 10.1177/1756287218782666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/23/2018] [Indexed: 12/18/2022] Open
Abstract
Since prehistoric times, our understanding of urology has rapidly expanded. Whilst primitive urologists began by using urine as a therapeutic substance, modern urologists may find themselves removing a kidney remotely by driving a robotic arm, with seven degrees of movement, while using image overlay-augmented reality. This review provides an insight into the potential status of urological technology in 20 years' time, assessed through an analysis of developments in imaging, diagnostics, robotics and further technologies. A particular emphasis is given to the promising fields of minimally invasive techniques, nanotechnology and tissue engineering, which likely hold the key to a new era for urology.
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Abstract
Twenty years after it was introduced, robotic surgery has become more commonplace in urology – we examine its current uses and controversies
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Wallis CJ, Peltz S, Byrne J, Kroft J, Karanicolas P, Coburn N, Nathens AB, Nam RK, Hallet J, Satkunasivam R. Peripheral Nerve Injury during Abdominal-Pelvic Surgery: Analysis of the National Surgical Quality Improvement Program Database. Am Surg 2017. [DOI: 10.1177/000313481708301122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Peripheral nerve injury (PNI) is a rare but preventable complication of surgery. We sought to assess whether the use of minimally invasive surgery (MIS) affects the occurrence of PNI. Using the American College of Surgeons National Surgical Quality Improvement Program database, we examined rates of PNI among patients undergoing appendectomy, hysterectomy, colectomy, or radical prostatectomy between 2005 and 2012. We assessed the effect of MIS, as compared with open surgery, on PNI occurrence using logistic regression. Among 297,532 patients, of whom 175,884 (59.1%) underwent MIS, the rate of PNI was 0.03 per cent. Forty-four patients treated using MIS had PNI (0.03%) as compared with 63 who underwent open surgery (0.05%; P = 0.0002). There was a significant decrease in the proportion of surgeries resulting in PNI (P < 0.0001) over time. In univariate analysis, MIS was associated with a decreased occurrence of PNI (odds ratio 0.48, 95% confidence interval 0.33–0.71), but this became nonsignificant on multivariable analysis (odds ratio 0.71, 95% confidence interval 0.47–1.09). Increased operative time and smoking status were the only factors independently associated with an increased risk of PNI on multivariable analysis. MIS techniques during common abdominal-pelvic surgeries do not appear to increase the risk of PNI. Prolonged operative time and smoking are independently associated with an increased risk of PNI. Quality improvement initiatives to increase awareness of PNI and identify patients at increased risk of this preventable complication should be considered.
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Affiliation(s)
| | - Sarah Peltz
- Division of Urology, Department of Surgery, University of Toronto, Ontario, Canada
| | - James Byrne
- Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Jamie Kroft
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Paul Karanicolas
- Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Natalie Coburn
- Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Avery B. Nathens
- Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Robert K. Nam
- Division of Urology, Department of Surgery, University of Toronto, Ontario, Canada
| | - Julie Hallet
- Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Raj Satkunasivam
- Division of Urology, Department of Surgery, University of Toronto, Ontario, Canada
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Ocular blood flow in steep Trendelenburg positioning during robotic-assisted radical prostatectomy. Eur J Ophthalmol 2017; 28:333-338. [DOI: 10.5301/ejo.5001061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Several ischemic optic neuropathies that occurred during robotic-assisted laparoscopic radical prostatectomy (RALRP) have been reported to be due to the Trendelenburg position, which lowers ocular perfusion pressure (OPP). We examined changes in pulsatile ocular blood flow (POBF) and its correlation with OPP during RALRP in the steep Trendelenburg position. Methods: Pulsatile ocular blood flow and intraocular pressure (IOP) were measured in 50 patients by the OBF Langham System 5 times during RALRP. The mean arterial blood pressure (MAP), heart rate, plateau airway pressure, and end-tidal CO2 (EtCO2) at each time point were recorded. Ocular perfusion pressure was calculated from simultaneous IOP and MAP measurements. Results: Pulsatile ocular blood flow was 15.53 ± 3.32 µL/s at T0, 18.99 ± 4.95 µL/s at T1, 10.04 ± 3.24 µL/s at T2, 11.45 ± 3.02 µL/s at T3, and 15.07 ± 3.81 µL/s at T4. Ocular perfusion pressure was 70.15 ± 5.98 mm Hg at T0, 64.21 ± 6.77 mm Hg at T1, 57.71 ± 7.07 mm Hg at T2, 51.73 ± 11.58 mm Hg at T3, and 64.21 ± 12.37 mm Hg at T4. Repeated-measures analysis of variance on POBF and OPP was significant (p>0.05). This difference disappeared when the correlation between MAP and POBF, EtCO2 and POBF, and EtCO2 and OPP were considered, while correlation between MAP and OPP confirmed the difference. The regression analysis between POBF and OPP showed a statistically significant difference at T0 and T3 (r = 0.047, p = 0.031 and r = 0.096, p = 0.002, respectively). Conclusions: Pulsatile ocular blood flow and OPP reached the lowest level at the end of surgery.
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Bolzoni Villaret A, Doglietto F, Carobbio A, Schreiber A, Panni C, Piantoni E, Guida G, Fontanella MM, Nicolai P, Cassinis R. Robotic Transnasal Endoscopic Skull Base Surgery: Systematic Review of the Literature and Report of a Novel Prototype for a Hybrid System (Brescia Endoscope Assistant Robotic Holder). World Neurosurg 2017; 105:875-883. [PMID: 28645603 DOI: 10.1016/j.wneu.2017.06.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although robotics has already been applied to several surgical fields, available systems are not designed for endoscopic skull base surgery (ESBS). New conception prototypes have been recently described for ESBS. The aim of this study was to provide a systematic literature review of robotics for ESBS and describe a novel prototype developed at the University of Brescia. METHODS PubMed and Scopus databases were searched using a combination of terms, including Robotics OR Robot and Surgery OR Otolaryngology OR Skull Base OR Holder. The retrieved papers were analyzed, recording the following features: interface, tools under robotic control, force feedback, safety systems, setup time, and operative time. A novel hybrid robotic system has been developed and tested in a preclinical setting at the University of Brescia, using an industrial manipulator and readily available off-the-shelf components. RESULTS A total of 11 robotic prototypes for ESBS were identified. Almost all prototypes present a difficult emergency management as one of the main limits. The Brescia Endoscope Assistant Robotic holder has proven the feasibility of an intuitive robotic movement, using the surgeon's head position: a 6 degree of freedom sensor was used and 2 light sources were added to glasses that were therefore recognized by a commercially available sensor. CONCLUSIONS Robotic system prototypes designed for ESBS and reported in the literature still present significant technical limitations. Hybrid robot assistance has a huge potential and might soon be feasible in ESBS.
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Affiliation(s)
- Andrea Bolzoni Villaret
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
| | - Andrea Carobbio
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Camilla Panni
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Enrico Piantoni
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Giovanni Guida
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Marco Maria Fontanella
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo Cassinis
- Department of Information Engineering, University of Brescia, Brescia, Italy
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Shinder BM, Farber NJ, Weiss RE, Jang TL, Kim IY, Singer EA, Elsamra SE. Performing all major surgical procedures robotically will prolong wait times for surgery. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:87-91. [PMID: 28890901 PMCID: PMC5586216 DOI: 10.2147/rsrr.s135713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This article aimed to assess the burden of scheduling major urologic oncology procedures if all cases were performed robotically and to determine whether this would increase the time a patient would have to wait for surgery. We retrospectively determined the number of prostatectomies, radical nephrectomies, partial nephrectomies, and cystectomies at a single institution for one calendar year. A hypothetical situation was then constructed where all procedures were performed robotically. Using the allotted number of days that each surgeon was able to schedule robotic procedures, we analyzed the amount of time it would take to schedule and complete all cases. Five fellowship-trained surgeons were included in the study and accounted for 317 surgical cases. Three of the surgeons had dedicated robotic surgery (RS) time (block time), while two surgeons scheduled when there was non-dedicated RS time (open time) available. If all cases were performed robotically an additional 32 days would be needed, which could significantly increase the wait time to surgery. The limited number of robotic systems available in most hospitals creates a bottleneck effect; whereby increasing the number of cases would considerably lengthen the waiting time patients have for surgery. As RS becomes increasingly more commonplace in urology and other surgical fields, this could create a significant problem for health care systems.
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Affiliation(s)
- Brian M Shinder
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Nicholas J Farber
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Robert E Weiss
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Thomas L Jang
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Isaac Y Kim
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Eric A Singer
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Sammy E Elsamra
- Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Sivaraman A, Sanchez-Salas R, Prapotnich D, Yu K, Olivier F, Secin FP, Barret E, Galiano M, Rozet F, Cathelineau X. Learning curve of minimally invasive radical prostatectomy: Comprehensive evaluation and cumulative summation analysis of oncological outcomes. Urol Oncol 2017; 35:149.e1-149.e6. [DOI: 10.1016/j.urolonc.2016.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 08/08/2016] [Accepted: 10/23/2016] [Indexed: 12/30/2022]
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10
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Nason GJ, O’Kelly F, White S, Dunne E, Smyth GP, Power RE. Patient reported functional outcomes following robotic-assisted (RARP), laparoscopic (LRP), and open radical prostatectomies (ORP). Ir J Med Sci 2016; 186:835-840. [DOI: 10.1007/s11845-016-1522-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
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