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Picciariello A, Annicchiarico A, Gallo G, Dezi A, Grossi U. Evaluation of the da Vinci single-port system in colorectal cancer surgery: a scoping review. Updates Surg 2024:10.1007/s13304-024-02014-y. [PMID: 39369142 DOI: 10.1007/s13304-024-02014-y] [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: 08/10/2024] [Accepted: 09/25/2024] [Indexed: 10/07/2024]
Abstract
Minimally invasive surgery for the treatment of colon and rectal cancer has gained popularity due to its association with reduced postoperative pain, shorter hospital stays, and quicker recovery. The Da Vinci Single-Port (SP) System combines single-port laparoscopy with robotic assistance. This scoping review aims to evaluate the safety and short-term postoperative outcomes of utilizing the Da Vinci SP platform in colorectal cancer surgery. A scoping review was conducted adhering to the PRISMA-ScR guidelines. Data were collected from PubMed, Embase, and the Web of Science Library as of December 22, 2023. Studies were screened and selected based on predefined criteria, focusing on the application of the SP robotic system in colorectal procedures. Data extraction included demographics, surgical details, intraoperative and postoperative outcomes. A narrative summary of the results was provided due to the heterogeneity in study designs. From an initial 2312 articles, 22 studies were selected for analysis, encompassing 465 patients undergoing robotic SP colorectal surgeries. Of these, 384 (82.6%) had a cancer diagnosis. The median age was 65 years, with approximately 60% being male. The median operative time was 225 min, with docking times averaging 12-20 min. Conversion to multi-port laparoscopy occurred in 4.2% of cases, with no conversions to open surgery. Mean intraoperative blood loss ranged from 50 to 150 ml. The mean number of lymph nodes retrieved ranged from 15 to 28. A diverting ileostomy was constructed in 20.3% of patients. Median times to flatus and soft diet were 2.5 and 3 days, respectively, with hospital stays ranging from 3 to 11 days. Perioperative complications occurred in 15.1% of patients, including wound infections (5.1%), anastomotic leakage (3.7%), and postoperative ileus (2.8%). Negative margin status (R0 resection) was achieved in 95% of cases. The Da Vinci SP robotic platform demonstrates promising safety and effectiveness in colorectal cancer surgery. It achieves high rates of successful oncological resection, adequate lymph node retrieval, and minimal intraoperative blood loss. Postoperative outcomes indicate quicker recovery times and manageable complication rates. However, longer follow-up studies are necessary to fully assess recurrence rates and long-term survival benefits associated with this innovative surgical approach.
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Affiliation(s)
| | - Alfredo Annicchiarico
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Gaetano Gallo
- Department of Surgery, La Sapienza" University of Rome, Rome, Italy
| | - Agnese Dezi
- Department of Precision and Regenerative Medicine and Ionian Area, University Aldo Moro of Bari, Piazza G. Cesare, 11, 70124, Bari, Italy.
| | - Ugo Grossi
- Department of Surgery, Oncology and Gastroenterology-DiSCOG, University of Padova, Padua, Italy
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Miyo M, Takemasa I, Okuya K, Ito T, Akizuki E, Ogawa T, Noda A, Ishii M, Miura R, Ichihara M, Toyota M, Kimura A, Sekimoto M. Questionnaire to Survey Cosmetic Outcomes in Laparoscopic Surgery for Colorectal Cancer. ANNALS OF SURGERY OPEN 2024; 5:e443. [PMID: 39310360 PMCID: PMC11415132 DOI: 10.1097/as9.0000000000000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/21/2024] [Indexed: 09/25/2024] Open
Abstract
Background and objectives There has been a steady increase in the use of minimally invasive surgery, including conventional multiport laparoscopic surgery (MLS) and single-site laparoscopic surgery (SLS) for colorectal cancer. We aimed to evaluate how important the cosmetic outcome, one of the advantages of SLS, is to patients and whether SLS reflects social needs. Methods We used a web-based questionnaire to survey nonmedical and medical workers for what factors were considered on the assumption that respondents undergo colorectal cancer surgery and that the most important person for them undergoes. Five items (curability, safety, pain, length of hospital stay, and cosmetic outcomes) were compared. After paired photographs before and after SLS and MLS were shown, perceptions of body image and cosmesis were assessed using a visual analog scale. Results This study included a total of 1352 respondents (990 nonmedical and 362 medical). Curability had the highest score (49.9-53.7 points), followed by safety (23.8-24.7 points). The scores for cosmetic outcomes (6.2-7.1 points) were almost equal to those of the length of hospital stay (6.2-7.1 points), which was associated with medical costs and pain (10.0-11.1 points), one of the main reasons for fear of surgery. Participants who were female, younger, and in the nonmedical group placed great importance on cosmetic outcomes. For all questions regarding body image and cosmesis, SLS had superior scores compared with MLS. Conclusions Understandably, curability, and safety were most important in colorectal cancer surgery. However, medical workers should consider cosmetic outcomes, even in malignant cases.
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Affiliation(s)
- Masaaki Miyo
- From the Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Ichiro Takemasa
- From the Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Koichi Okuya
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Tatsuya Ito
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Emi Akizuki
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Tadashi Ogawa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Ai Noda
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Masayuki Ishii
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Ryo Miura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Momoko Ichihara
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Maho Toyota
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Akina Kimura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Mitsugu Sekimoto
- Department of Colorectal Surgery, NHO Osaka National Hospital, Osaka, Japan
- Department of Surgery, Kansai Medical University, Osaka, Japan
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Celotto F, Ramacciotti N, Mangano A, Danieli G, Pinto F, Lopez P, Ducas A, Cassiani J, Morelli L, Spolverato G, Bianco FM. Da Vinci single-port robotic system current application and future perspective in general surgery: A scoping review. Surg Endosc 2024; 38:4814-4830. [PMID: 39110221 PMCID: PMC11362253 DOI: 10.1007/s00464-024-11126-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/27/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND The da Vinci Single-Port Robot System (DVSP) allows three robotic instruments and an articulated scope to be inserted through a single small incision. It received FDA approval in 2014 and was first introduced in 2018. The aim of this new system was to overcome the limitations of single-incision laparoscopic and robotic surgery. Since then, it has been approved for use only for urologic and transoral surgeries in some countries. It has been used as part of experimental protocols in general surgery. OBJECTIVE By obtaining the CE mark at the end of January 2024, DVSP will soon enter the European market. This review aims to comprehensively describe the applications of DVSP in general surgery. DESIGN A search of PubMed, Embase, and Ebsco databases up to March 2024 was conducted, with registration in PROSPERO (CRD42024536430), following the preferred reporting items for Systematic reviews and Meta-analyses for scoping review (PRISMA-Scr) guidelines. All the studies about the use of DVSP in general surgery were included. RESULTS Fifty-six studies were included. The following surgical areas of use were identified: transabdominal and transanal colorectal, cholecystectomy, abdominal wall repair, upper gastroesophageal tract, liver, pancreas, breast, and thyroid surgery. The reported surgical and short-term outcomes are promising; a wide range of procedures have been performed safely. Some groups have found advantages, such as faster discharge, shorter operative time, and less postoperative pain compared to multiport robotic surgery. CONCLUSION Five years after its initial clinical applications, the use of the DVSP in general surgery procedures has demonstrated feasibility and safety. Hernia repair, cholecystectomy, and colorectal surgery emerge as the most frequently conducted interventions with this robotic system. Nevertheless, there is anticipation for further studies with larger sample sizes and extended follow-up periods to provide more comprehensive insights and data on the long-term outcomes, including the incidence of incisional hernia.
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Affiliation(s)
- Francesco Celotto
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.
| | - Niccolò Ramacciotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alberto Mangano
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Giacomo Danieli
- Unit of Biostatistics, Epidemiology and Public Health (UBEP), Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Federico Pinto
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Paula Lopez
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Alvaro Ducas
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Jessica Cassiani
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Luca Morelli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gaya Spolverato
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Francesco Maria Bianco
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
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Erozkan K, Gorgun E. Robotic colorectal surgery and future directions. Am J Surg 2024; 230:91-98. [PMID: 37953126 DOI: 10.1016/j.amjsurg.2023.10.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/22/2023] [Indexed: 11/14/2023]
Abstract
As the adoption of robotic-assisted procedures expands across various surgical specialties, colorectal surgery stands out as a prominent beneficiary. This rise in usage can be traced back to the increased accessibility of robotic platforms and a growing institutional shift towards cutting-edge surgical methods. When compared with traditional laparoscopic methods, robotic techniques offer distinct advantages. Their true potential shines in surgeries involving complex anatomical regions, where the robot's enhanced dexterity and range of motion prove invaluable. The three-dimensional, magnified view provided by robotic systems further boosts surgical precision and clarity. These advantages render robotic assistance especially suitable for colorectal surgeries, notably in intricate areas such as the rectum and endoluminal spaces. As the medical world emphasizes minimally invasive surgical methods, there's a pressing need to evolve and optimize robotic techniques in colorectal surgery. This article traces the evolution of robotic interventions in colorectal surgeries, highlighting both its historical milestones and anticipated future trends. We'll also explore emerging robotic tools and systems set to reshape the colorectal surgical arena.
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Affiliation(s)
- Kamil Erozkan
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
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Keller DS, Reif de Paula T, Ikner TP, Saidi H, Schoonyoung H, H Marks J. Perioperative outcomes for single-port robotic versus single-incision laparoscopic surgery: a comparative analysis in colorectal cancer surgery. Surg Endosc 2024; 38:1568-1575. [PMID: 38177611 DOI: 10.1007/s00464-023-10629-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) may offer improved cosmesis, reduced postoperative pain and faster recovery than conventional platforms, but widespread implementation was limited by technical demands. A single-port robotic platform was recently introduced, with components that further enhance SILS benefits without the technical challenges. No study to date has compared the two platforms to validate benefits. Our goal was to compare outcomes of SP robotics and SILS in colorectal cancer (CRC). METHODS A prospective cancer registry was reviewed for CRC patients undergoing curative resection through a SILS or SP robotic approach from 2010 to 2022. Patient and cancer demographics, intraoperative, and postoperative outcomes were compared in a 1:1 propensity score-matched cohort, adjusting for baseline characteristics. The main outcome measures were complications, operative time, and oncologic quality measures. RESULTS Matching resulted 50 SP robotic and 50 SILS patients. Cohorts were well matched in all demographics, but SP robotic rectal cancer cases were significantly closer to the anorectal ring than SILS (1.8 cm vs. 3.4 cm, p = 0.018). SP robotic and SILS platforms had similar operative times. Intraoperative conversions was comparable, but more SILS cases required additional ports to be placed (p = 0.040). The intraoperative complications rate, complete total mesorectal excision rates, and lymph node yield were not statistically significantly different. There were no positive margins in either group. Postoperatively, groups had analogous day of return of bowel function, comparable morbidity, and discharge destination. There was no mortality in either group. The length of stay was significantly shorter with SP robotics than SILS (mean 4.135 vs. 5.282 days, median 4 (2-8) vs. 5 (2-14) days; p = 0.045). CONCLUSIONS Single-port robotics provided high quality oncologic surgery, adding the technical benefits of robotics to clinical and cosmetic benefits of single-port surgery. There were comparable operative time, complication rates, and oncologic outcomes in CRC cases, with shorter hospital stays with SP robotics. This early data is encouraging for expansion SP robotic technology.
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Affiliation(s)
- Deborah S Keller
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - Thais Reif de Paula
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - Taylor P Ikner
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - Hela Saidi
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - Henry Schoonyoung
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA
| | - John H Marks
- Lankenau Institute for Medical Research, Marks Colorectal Surgical Associates, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA.
- Department of Surgery, Lankenau Medical Center, Medical Science Building, Suite 375, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA.
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Kim HJ, Choi GS, Park JS, Park SY, Song SH, Lee SM, Jeong MH. Comparison of the efficacy and safety of single-port versus multi-port robotic total mesorectal excision for rectal cancer: A propensity score-matched analysis. Surgery 2024; 175:297-303. [PMID: 38036394 DOI: 10.1016/j.surg.2023.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/28/2023] [Accepted: 09/26/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND It is unknown whether the da Vinci single-port system performs similarly to the previous multi-port system during complicated procedures, such as rectal cancer surgery. Therefore, we compared the short-term clinical outcomes of single-port and multi-port robotic total mesorectal excision for the treatment of rectal cancer. METHODS This retrospective study reviewed 128 patients who underwent robotic total mesorectal excision between July 2020 and June 2022, of whom 84 (42 each: single-port versus multi-port) were included in the propensity score-matched cohort. Perioperative and pathologic outcomes were compared between groups. RESULTS Median tumor height was similar between groups (single-port versus multi-port, 5.9 ± 2.1 vs 5.6 ± 1.8 cm, P = .719). Preoperative chemoradiotherapy was performed equally. The total operative time was less (160.0 ± 42.2 minutes vs 199.6 ± 78.6 minutes, P = .005), the total length of incision was shorter (4.0 ±0.3 vs 5.4 ± 0.7 cm, P = .003), postoperative hospital stay was shorter (6.2 ±1.7 vs 7.2 ±2.8 days, P = .050), and C-reactive protein levels on postoperative day 3 trended to be lower (7.3 ± 4.7 vs 8.9 ± 5.6 mg/L, P = .096) in the single-port group, compared with the multi-port group. Postoperative complications did not differ between groups (single-port versus multi-port, 11.9% vs 16.6%, P = .864). Anastomotic leakage occurred in 1 and 2 patients in the single-port and multi-port groups, respectively. The circumferential resection margins were positive in 1 patient in the multi-port group. CONCLUSION The perioperative outcomes of single-port robotic total mesorectal excision were comparable to those of multi-port robotic TME. The single-port robot can be considered a surgical option for treating rectal cancer.
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Affiliation(s)
- Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Ho Song
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung Min Lee
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Min Hye Jeong
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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Jung JM, Kim YI, Yoon YS, Yang S, Kim MH, Lee JL, Kim CW, Park IJ, Lim SB, Yu CS. Short-term outcomes of da Vinci SP versus Xi for colon cancer surgery: a propensity-score matching analysis of multicenter cohorts. J Robot Surg 2023; 17:2911-2917. [PMID: 37821761 DOI: 10.1007/s11701-023-01727-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
Recent advancements in robotic systems have led to the introduction of the da Vinci SP system, which allows surgeons to perform colon cancer surgery through fewer ports. This study aimed to evaluate the perioperative outcomes of colon cancer surgeries conducted using the da Vinci SP and Xi systems. Patients who underwent robotic colon cancer surgeries between November 2020 and December 2022 at two tertiary referral centers were considered for inclusion. Following propensity-score matching, short-term outcomes between the two systems were retrospectively analyzed. Out of 189 patients included in the study, 106 from 53 propensity-score matched pairs were analyzed. Patients operated on with the SP system exhibited smaller incision lengths (5.0 cm vs. 9.4 cm, p < 0.001) experienced less pain at 8 h (3.0 vs. 3.5, p < 0.001) and at 24 h post-operation (2.9 vs. 3.3, p = 0.001) and had a shorter duration of hospital stay (5 days vs. 6 days, p = 0.002). The overall rate of postoperative complications was 10.4%, with no significant difference between the SP and Xi groups (7.5% vs. 13.2%). Robotic-assisted colon cancer surgery using the da Vinci SP system is feasible and demonstrates favorable short-term outcomes. Compared to the Xi system, the SP system offers advantages in terms of cosmesis, postoperative pain, and recovery duration for colon cancer patients.
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Affiliation(s)
- Jin-Min Jung
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Young Il Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Yong Sik Yoon
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Songsoo Yang
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Min Hyun Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jong Lyul Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Chan Wook Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Seok-Byung Lim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Chang Sik Yu
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Marks JH, Yang J, Spitz EM, Salem J, Agarwal S, de Paula TR, Schoonyoung HP, Keller DS. A prospective phase II clinical trial/IDEAL Stage 2a series of single-port robotic colorectal surgery for abdominal and transanal cases. Colorectal Dis 2023; 25:2335-2345. [PMID: 37907449 DOI: 10.1111/codi.16788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/30/2023] [Accepted: 09/17/2023] [Indexed: 11/02/2023]
Abstract
AIM Slow laparoscopy adoption accelerated the uptake of robotic surgery. However, the current robotic platforms have limitations in transanal applications and multiple port sites. The da Vinci single-port (SP) robot is currently used on trial for colorectal surgery, and broad assessment of outcomes is needed. We aimed to report findings of a phase II clinical trial of SP robotic colorectal surgery. METHODS A sequentially reported prospective case series was performed on patients using SP robotics at a tertiary referral centre from 1 October 2018 to 31 August 2021. Cases were stratified into abdominal and transanal cohorts. Demographics, intra-operative variables and 30-day postoperative outcomes were evaluated. Univariate analysis was performed, with statistical process control for the docking process. Main outcomes were conversion rates, morbidity, mortality and point of standardization of docking. RESULTS In all, 133 patients were included: 93 (69.92%) abdominal and 40 (30.08%) transanal. The main diagnosis was rectal cancer (n = 59) and the procedure performed a robotic transanal abdominal transanal radical proctosigmoidectomy (n = 30). There were no conversions to open surgery. Two abdominal (2.15%) and three transanal cases (7.50%) were converted to laparoscopy. All colorectal adenocarcinomas had negative margins, proper lymph node harvest and complete mesorectal excision, as appropriate. Docking became a standardized process at cases 34 (abdominal) and 23 (anorectal). After surgery, bowel function returned on mean day 2 (abdominal) and 1 (transanal). The morbidity rate was 15.05% (abdominal) and 27.50% (transanal). There were two major morbidities in each cohort. Overall, there were three (2.65%) readmissions, one reoperation and no mortality. CONCLUSIONS Single-port robotics is feasible for all types of colorectal procedures, with good clinical and oncological outcomes. With this development in colorectal surgery, further studies can develop best practices with this novel technology.
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Affiliation(s)
- John H Marks
- Lankenau Institute for Medical Research and Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Jane Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Elizabeth M Spitz
- Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Jean Salem
- Department of Surgery, Saline Health System, Benton, Arkansas, USA
| | - Samir Agarwal
- Department of Surgery, Physician First Group, Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Thais Reif de Paula
- Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Henry P Schoonyoung
- Lankenau Institute for Medical Research and Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Deborah S Keller
- Lankenau Institute for Medical Research and Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
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Kim HS, Oh BY, Chung SS, Lee RA, Noh GT. Short-term outcomes of single-incision robotic colectomy versus conventional multiport laparoscopic colectomy for colon cancer. J Robot Surg 2023; 17:2351-2359. [PMID: 37402962 DOI: 10.1007/s11701-023-01666-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/02/2023] [Indexed: 07/06/2023]
Abstract
Since the da Vinci SP (dVSP) surgical system was introduced, single-incision robotic surgery (SIRS) for colorectal diseases has gained increasing acceptance. Comparison of the short-term outcomes between SIRS using dVSP and those of conventional multiport laparoscopic surgery (CMLS) was performed to verify its efficacy and safety in colon cancer. The medical records of 237 patients who underwent curative resection for colon cancer by a single surgeon were retrospectively reviewed. Patients were divided into two groups according to surgical modality: SIRS (RS group) and CMLS (LS group). Intra- and postoperative outcomes were analyzed. Of the 237 patients, 140 were included in the analysis. Patients in the RS group (n = 43) were predominantly female, younger, and had better general performance than those in the LS group (n = 97). The total operation time was longer in the RS group than in the LS group (232.8 ± 46.0 vs. 204.1 ± 41.7 min, P < 0.001). The RS group showed faster first flatus passing (2.5 ± 0.9 vs. 3.1 ± 1.2 days, P = 0.003) and less opioid analgesic requirement (analgesic withdrawal within 3 postoperative days: 37.2% vs. 18.6%, P = 0.018) than the LS group. The RS group showed a higher immediate postoperative albumin level (3.9 ± 0.3 vs. 3.6 ± 0.4 g/dL, P < 0.001) and lower C-reactive protein level (6.6 ± 5.2 vs. 9.3 ± 5.5 mg/dL, P = 0.007) than the LS group during the postoperative period. On multivariate analysis after adjusting for deviated patient characteristics, no significant difference was observed in short-term outcomes, except for operation time. SIRS with dVSP showed short-term outcomes comparable with those of CMLS for colon cancer.
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Affiliation(s)
- Ho Seung Kim
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Bo-Young Oh
- Department of Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Soon Sup Chung
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Ryung-Ah Lee
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Gyoung Tae Noh
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, South Korea.
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10
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Marchegiani F, Siragusa L, Zadoroznyj A, Laterza V, Mangana O, Schena CA, Ammendola M, Memeo R, Bianchi PP, Spinoglio G, Gavriilidis P, de'Angelis N. New Robotic Platforms in General Surgery: What's the Current Clinical Scenario? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1264. [PMID: 37512075 PMCID: PMC10386395 DOI: 10.3390/medicina59071264] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Robotic surgery has been widely adopted in general surgery worldwide but access to this technology is still limited to a few hospitals. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures. The aim of this systematic review is to highlight the current clinical practice with the new robotic platforms in general surgery. Materials and Methods: A grey literature search was performed on the Internet to identify the available robotic systems. A PRISMA compliant systematic review was conducted for all English articles up to 10 February 2023 searching the following databases: MEDLINE, EMBASE, and Cochrane Library. Clinical outcomes, training process, operating surgeon background, cost-analysis, and specific registries were evaluated. Results: A total of 103 studies were included for qualitative synthesis after the full-text screening. Of the fifteen robotic platforms identified, only seven were adopted in a clinical environment. Out of 4053 patients, 2819 were operated on with a new robotic device. Hepatopancreatobiliary surgery specialty performed the majority of procedures, and the most performed procedure was cholecystectomy. Globally, 109 emergency surgeries were reported. Concerning the training process, only 45 papers reported the background of the operating surgeon, and only 28 papers described the training process on the surgical platform. Only one cost-analysis compared a new robot to the existing reference. Two manufacturers promoted a specific registry to collect clinical outcomes. Conclusions: This systematic review highlights the feasibility of most surgical procedures in general surgery using the new robotic platforms. Adoption of these new devices in general surgery is constantly growing with the extension of regulatory approvals. Standardization of the training process and the assessment of skills' transferability is still lacking. Further studies are required to better understand the real clinical and economical benefit.
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Affiliation(s)
- Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Leandro Siragusa
- Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Alizée Zadoroznyj
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Vito Laterza
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Orsalia Mangana
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Michele Ammendola
- Science of Health Department, Digestive Surgery Unit, University "Magna Graecia" Medical School, 88100 Catanzaro, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, General Regional Hospital "F. Miulli", 70021 Acquaviva delle Fonti, Italy
| | - Paolo Pietro Bianchi
- Division of General and Robotic Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, 20142 Milan, Italy
| | - Giuseppe Spinoglio
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Paschalis Gavriilidis
- Department of Surgery, Saint Helena General Hospital, Jamestown, Saint Helena STHL 1ZZ, South Atlantic Ocean, UK
| | - Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
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11
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Kim HS, Oh BY, Cheong C, Park MH, Chung SS, Lee RA, Kim KH, Noh GT. Single-incision robotic colorectal surgery with the da Vinci SP® surgical system: initial results of 50 cases. Tech Coloproctol 2023; 27:589-599. [PMID: 36971849 DOI: 10.1007/s10151-023-02791-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/14/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE The da Vinci SP® (dVSP) surgical system (Intuitive Surgical, Sunnyvale, CA, USA), a robotic platform designed for single-incision surgery, overcame the need for multiple ports in traditional robotic surgery and issues including triangulation and retraction in single-incision laparoscopic surgery. However, previous studies only included case reports or series with small sample sizes. The aim of this study was to assess the safety and performance of the dVSP surgical system and its instruments and accessories for colorectal procedures. METHODS The medical records of patients who had surgery with the dVSP from March 2019 to September 2021 at Ewha Womans University Seoul Hospital were investigated. The pathologic and follow-up data of patients who had malignant tumors were analyzed separately to evaluate oncological safety. RESULTS Fifty patients (26 male and 24 female) with a median age of 59 years (interquartile range 52.5-63.0 years) were enrolled. The procedures included low anterior resection with total mesorectal excision (n = 16), sigmoid colectomy with complete mesocolic excision and central vessel ligation (CME + CVL) (n = 14), right colectomy with CME + CVL (n = 9), left colectomy with CME + CVL (n = 4), right colectomy (n = 6), and sigmoid colectomy (n = 1). Operative time significantly decreased after 25 cases (early phase vs. late phase; operative time 295.0 min vs. 250.0 min, p = 0.015; docking time 16.0 min vs. 12.0 min, p = 0.001; console time 212.0 min vs. 190.0 min, p = 0.019). Planned procedures were successfully completed in all patients. Postoperative outcomes were acceptable with only six cases of mild adverse events through a 3-month follow-up. No local recurrence and only one case of systemic recurrence occurred within 1 year postoperatively. CONCLUSIONS This study demonstrated the surgical and oncological safety and feasibility of dVSP, which may be a novel surgical platform for colorectal surgery.
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Affiliation(s)
- H S Kim
- Department of Surgery, Ewha Womans University College of Medicine, 260, Gonghang-Daero, Gangseo-Gu, Seoul, 07804, South Korea
| | - B-Y Oh
- Department of Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - C Cheong
- Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - M H Park
- Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - S S Chung
- Department of Surgery, Ewha Womans University College of Medicine, 260, Gonghang-Daero, Gangseo-Gu, Seoul, 07804, South Korea
| | - R-A Lee
- Department of Surgery, Ewha Womans University College of Medicine, 260, Gonghang-Daero, Gangseo-Gu, Seoul, 07804, South Korea
| | - K H Kim
- Department of Surgery, Ewha Womans University College of Medicine, 260, Gonghang-Daero, Gangseo-Gu, Seoul, 07804, South Korea
| | - G T Noh
- Department of Surgery, Ewha Womans University College of Medicine, 260, Gonghang-Daero, Gangseo-Gu, Seoul, 07804, South Korea.
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12
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Lee CS, Chin JH, Han SR. How to do a single-port robotic totally extraperitoneal (TEP) inguinal hernia repair using the da Vinci SP platform. ANZ J Surg 2023; 93:1357-1359. [PMID: 36792554 DOI: 10.1111/ans.18328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
Although 8 years have passed since the introduction of the da Vinci SP robotic system, rTEP surgery using the SP robot has never been introduced due to technical barriers. Through this study, we would like to share the possibility of safe and feasible TEP by da Vinci SP robotic platform beyond the technical barriers. As far as we know, SP robotic TEP implemented in our institution is the first introduced case, and I think it will be good information for surgeons who are thinking about TEP using SP robot.
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Affiliation(s)
- Chul Seung Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Je Hyun Chin
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Rim Han
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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13
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Li C, Zhang T, Wang H, Hou Z, Zhang Y, Chen W. Advanced surgical tool: Progress in clinical application of intelligent surgical robot. SMART MEDICINE 2022; 1:e20220021. [PMID: 39188736 PMCID: PMC11235784 DOI: 10.1002/smmd.20220021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/07/2022] [Indexed: 08/28/2024]
Abstract
Surgical robot is a revolutionary tool conceived in the progress of clinical medicine, computer science, microelectronics and biomechanics. It provides the surgeon with clearer views and more comfortable surgical postures. With the assistance of computer navigation during delicate operations, it can further shorten the patient recovery time via reducing intraoperative bleeding, the risk of infection and the amount of anesthesia needed. As a comprehensive surgical revolution, surgical robot technique has a wide range of applications in related fields. This paper reviews the development status and operation principles of these surgical robots. At the same time, we also describe their up-to-date applications in different specialties and discusses the prospects and challenges of surgical robots in the medical area.
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Affiliation(s)
- Chao Li
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Tongtong Zhang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Haoran Wang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Zhiyong Hou
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Yingze Zhang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Wei Chen
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
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14
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Piozzi GN, Kim JS, Choo JM, Shin SH, Kim JS, Lee TH, Baek SJ, Kwak JM, Kim J, Kim SH. Da Vinci SP robotic approach to colorectal surgery: two specific indications and short-term results. Tech Coloproctol 2022; 26:461-470. [PMID: 35182278 DOI: 10.1007/s10151-022-02597-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Da Vinci® Single Port (dvSP) was recently developed. Its application in colorectal surgery is under investigation. The aim of this study was to explore the safety and feasibility of dvSP for intersphincteric (dvSP-ISR), right colectomy (dvSP-RC), and transverse colectomy (dvSP-TC). Surgical indication and short-term results were analyzed. METHODS All consecutive patients from a prospective database of patients who underwent dvSP-ISR, dvSP-RC, and dvSP-TC at Korea University Anam Hospital from November 2020 to December 2021, were analyzed. Perioperative, pathological, and oncological short-term outcomes were analyzed. RESULTS A total of 7 dvSP-ISR, 5 dvSP-RC, and 1 dvSP-TC were performed. Median age was 56.0 (55.0-61.0) years for the dvSP-ISR and 54.0 (44.7-63.5) years for the dvSP-RC/TC. Median body mass index was 22.8 (17.1-24.8) kg/m2 for the dvSP-ISR and 23.6 (20.8-26.9) kg/m2 for the dvSP-RC/TC. All dvSP-ISR patients received neoadjuvant long-course chemoradiotherapy, including one patient with squamocellular carcinoma who was treated with 5-fluorouracil (5-FU)/mitomycin. All other patients, excluding one dvSP-RC patient with Crohn's disease, had an adenocarcinoma. Median operation time was 280 (240-370) minutes for the dvSP-ISR and 220 (201-270) minutes for the dvSP-RC/TC. Estimated blood loss was insignificant. No intraoperative complications or conversions to multiport/open surgery was reported. Median post-operative stay was 7.0 (6.0-10.0) days for the dvSP-ISR and 5.0 (4.0-6.7) days for the dvSP-RC/TC. Quality of mesorectum was complete for six patients, and nearly complete for one. Median number of retrieved lymph nodes were 21 (17-25) for the dvSP-ISR and 28 (24-49) for the dvSP-RC/TC. Proximal and distal resection margins were tumor free. Four patients experienced post-operative complications not related to the platform which were: ileus, voiding dysfunction, infected pelvic hematoma, and wound infection. Median follow-up was 9 (6-11) months and 11 (7-17) months for the dvSP-ISR and dvSP-RC/TC, respectively. Two patients had systemic recurrence; all others were tumor free. CONCLUSIONS The dvSP platform is safe and feasible for intersphincteric resection with right lower quadrant access, and right/transverse colectomy with suprapubic access. Further studies are needed to evaluate benefit differences compared to multiport robotic platform.
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Affiliation(s)
- G N Piozzi
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J-S Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J M Choo
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - S H Shin
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J S Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - T-H Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - S-J Baek
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J-M Kwak
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - S H Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
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15
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Robotic single-incision right hemicolectomy with extended lymphadenectomy using the da Vinci SP Surgical Platform. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:109-112. [PMID: 35600789 PMCID: PMC8965986 DOI: 10.7602/jmis.2021.24.2.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/08/2022]
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