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Daykan Y, Rotem R, O'Reilly BA. Robot-assisted laparoscopic pelvic floor surgery: Review. Best Pract Res Clin Obstet Gynaecol 2023; 91:102418. [PMID: 37776580 DOI: 10.1016/j.bpobgyn.2023.102418] [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: 12/19/2022] [Revised: 07/22/2023] [Accepted: 08/26/2023] [Indexed: 10/02/2023]
Abstract
Minimally invasive surgical techniques have become more common in pelvic floor reconstructive urogynaecological surgery, specifically, robotic-assisted pelvic floor surgery. Female pelvic floor anatomy is complex, and some repairs require highly experienced surgical skills that can be gained more easily using robotic-assisted surgery. A common application of the robotic platform in urogynaecological surgeries includes sacrocolpopexy, which has become the gold standard approach in the last decade for the correction of apical prolapse. Additional procedures include sacrohysteropexy, sacrocervicopexy, fistula repair, and complex procedures involving the bladder and other pelvic organs. Despite its increasing use and clear benefit in our field, data in the literature and, in particular, randomised controlled trials are sparse. This review provides an update, incorporating recently published literature and our personal experience in that field.
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Affiliation(s)
- Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Reut Rotem
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland; Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Barry A O'Reilly
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland
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2
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Bravi CA, Dell'Oglio P, Piazza P, Scarcella S, Bianchi L, Falagario U, Turri F, Andras I, Di Maida F, De Groote R, Piramide F, Moschovas MC, Suardi N, Terrone C, Carrieri G, Patel V, Autorino R, Porpiglia F, Vickers A, Briganti A, Montorsi F, Mottrie A, Larcher A. Positive Surgical Margins After Anterior Robot-assisted Radical Prostatectomy: Assessing the Learning Curve in a Multi-institutional Collaboration. Eur Urol Oncol 2023:S2588-9311(23)00251-1. [PMID: 38036328 DOI: 10.1016/j.euo.2023.11.006] [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: 08/19/2023] [Revised: 10/08/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The learning curve for robot-assisted radical prostatectomy (RARP) remains controversial, with prior studies showing that, in contrast with evidence on open and laparoscopic radical prostatectomy, biochemical recurrence rates of experienced versus inexperienced surgeons did not differ. OBJECTIVE To characterize the learning curve for positive surgical margins (PSMs) after RARP. DESIGN, SETTING, AND PARTICIPANTS We analyzed the data of 13 090 patients with prostate cancer undergoing RARP by one of 74 surgeons from ten institutions in Europe and North America between 2003 and 2022. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable models were used to assess the association between surgeon experience at the time of each patient's operation and PSMs after surgery, with adjustment for preoperative prostate-specific antigen level, grade, stage, and year of surgery. Surgeon experience was coded as the number of robotic radical prostatectomies done by the surgeon before the index patient's operation. RESULTS AND LIMITATIONS Overall, 2838 (22%) men had PSMs on final pathology. After adjusting for case mix, we found a significant, nonlinear association between surgical experience and probability of PSMs after surgery, with a lower risk of PSMs for greater surgeon experience (p < 0.0001). The probabilities of PSMs for a patient treated by a surgeon with ten, 250, 500, and 2000 prior robotic procedures were 26%, 21%, 18%, and 14%, respectively (absolute risk difference between ten and 2000 procedures: 11%; 95% confidence interval: 9%, 14%). Similar results were found after stratifying patients according to extracapsular extension at final pathology. Results were also unaltered after excluding surgeons who had moved between institutions. CONCLUSIONS While we characterized the learning curve for PSMs after RARP, the relative contribution of surgical learning to the achievement of optimal outcomes remains controversial. Future investigations should focus on what experienced surgeons do to avoid positive margins and should explore the relationship between learning, margin rate, and biochemical recurrence. Understanding what margins affect recurrence and whether these margins are trainable or a result of other factors may shed light on where to focus future efforts in surgical education. PATIENT SUMMARY In patients receiving robotic radical prostatectomy for prostate cancer, we characterized the learning curve for positive margins. The risk of surgical margins decreased progressively with increasing experience, and plateaued around the 500th procedure. Understanding what margins affect recurrence and whether these margins are trainable or a result of other factors has implications for surgeons and patients, and it may shed light on where to focus future efforts in surgical education.
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Affiliation(s)
- Carlo A Bravi
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK; Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium.
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Scarcella
- Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy; Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ugo Falagario
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Filippo Turri
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Federico Piramide
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Nazareno Suardi
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Urology, Ospedali Civili of Brescia, Brescia, Italy
| | - Carlo Terrone
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | | | - Francesco Porpiglia
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Alessandro Larcher
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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3
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Baeten IGT, Hoogendam JP, Schreuder HWR, Jürgenliemk-Schulz IM, Gerestein CG, Zweemer RP. Introducing a novice surgeon to an experienced robotic gynaecological oncology team: An observational cohort study on the impact of a structured curriculum on outcomes of cervical cancer surgery. Gynecol Oncol 2023; 178:153-160. [PMID: 37865051 DOI: 10.1016/j.ygyno.2023.10.008] [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: 05/26/2023] [Revised: 09/26/2023] [Accepted: 10/14/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To evaluate the effect on patient outcomes when introducing a novice robotic surgeon, trained in accordance with a structured learning curriculum, to an experienced robotic surgery team treating cervical cancer patients. METHODS Patients with early-stage cervical cancer who were treated with primary robot-assisted surgery between 2007 and 2019 were retrospectively included. In addition to the 165 patients included in a former analysis, we included a further 61 consecutively treated patients and divided all 226 patients over three groups: early learning phase of 61 procedures without structured training (group 1), experienced phase of 104 procedures (group 2), and the 61 procedures during introduction of a novice with structured training (group 3). Risk-adjusted cumulative sum (RA-CUSUM) analysis was performed to assess the learning curve effect. Patient outcomes between the groups were compared. RESULTS Based on RA-CUSUM analysis, no learning curve effect was observed for group 3. Regarding surgical outcomes, mean operation time in group 3 was significantly shorter than group 1 (p < 0.001) and similar to group 2 (p = 0.96). Proportions of intraoperative and postoperative adverse events in group 3 were not significantly different from the experienced group (group 2). Regarding oncological outcomes, the 5-year disease-free survival, disease-specific survival, and overall survival in group 3 were not significantly different from the experienced group. CONCLUSIONS Introducing a novice robotic surgeon, who was trained in accordance with a structured learning curriculum, resulted in similar patient outcomes as by experienced surgeons suggesting novices can progress through a learning phase without compromising outcomes of cervical cancer patients.
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Affiliation(s)
- Ilse G T Baeten
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Jacob P Hoogendam
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Henk W R Schreuder
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ina M Jürgenliemk-Schulz
- Department of Radiology and Nuclear Medicine, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cornelis G Gerestein
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ronald P Zweemer
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Del Calvo H, Kim MP, Chihara R, Chan EY. A systematic review of general surgery robotic training curriculums. Heliyon 2023; 9:e19260. [PMID: 37681164 PMCID: PMC10481177 DOI: 10.1016/j.heliyon.2023.e19260] [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: 12/14/2022] [Revised: 07/19/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023] Open
Abstract
Background As of the most recent surveys of resident programs in 2018, only slightly more than half of programs have formal robotic training curriculums implemented. Fewer programs have further assessed their own curriculum and its benefit. Method We conducted a PubMed/MEDLINE literature search for robotic surgery curriculums and those that had assessment of their programs. Results A total of 11 studies were reviewed. When reviewed in chronological order, there has been a progression towards more robotic specific objective data analysis as opposed to subjective surveying. There is a wide variation in curriculums, but simulation use is pervasive. Conclusions Our review makes evident two important concepts-there is great variety in training curriculums and there is great benefit in implementation. The importance is in establishment of what makes resident training effective and supports the adaptable and successful surgeon. This may come from an adaptable curriculum but a structured test-out assessment.
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Affiliation(s)
- Haydee Del Calvo
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Min P. Kim
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
- Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Ray Chihara
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
- Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
| | - Edward Y. Chan
- Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
- Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA
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Fan S, Xu W, Diao Y, Yang K, Dong J, Qin M, Ji Z, Shen C, Zhou L, Li X. Feasibility and Safety of Dual-console Telesurgery with the KangDuo Surgical Robot-01 System Using Fifth-generation and Wired Networks: An Animal Experiment and Clinical Study. EUR UROL SUPPL 2023; 49:6-9. [PMID: 36691584 PMCID: PMC9860257 DOI: 10.1016/j.euros.2022.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
The coronavirus disease 2019 pandemic has drawn attention to telesurgery. Important advances in fifth-generation (5G) mobile telecommunication technology have facilitated the rapid evolution of telesurgery. Previously, only a single console was used in telesurgery; thus, there was the possibility of open or laparoscopic conversion. Furthermore, the 5G network has not been available for regional hospitals in China. From October 2021 to April 2022, dual-console telesurgeries with the KangDuo Surgical Robot-01 (KD-SR-01) system were performed using 5G and wired networks in an animal experiment and clinical study. A partial nephrectomy in a porcine model was performed successfully using a wired network. The console time, warm ischemia time, and control swap time were 69 min, 27 min, and 3 s, respectively. The mean latency time was 130 (range, 60-200) ms. A 32-yr-old male patient successfully underwent a remote pyeloplasty using a series connection of 5G wireless and wired networks. The console time and control swap time were 98 min and 3 s, respectively. The mean latency time was 271 (range, 206-307) ms. In the two studies, data pocket loss was <1%. The results demonstrated that dual-console telesurgery with the KD-SR-01 system is feasible and safe using 5G and wired networks. Patient summary Advances in fifth-generation (5G) mobile telecommunication technology helped in the rapid evolution of telesurgery. Dual-console telesurgery performed with the KD-SR-01 system using 5G and wired networks was shown to be feasible and safe in an animal experiment and clinical study.
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Affiliation(s)
- Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Weifeng Xu
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingzhi Diao
- Department of Urology, Beijing Miyun District Hospital (Miyun Hospital, Peking University First Hospital), Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Jie Dong
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingwei Qin
- Telemedicine Center, Peking Union Medical College Hospital, Beijing, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Cheng Shen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Beijing, China
- Corresponding author. Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, No. 8 Xishiku St., Xicheng District, Beijing 100034, China. Tel. +86 010 8357 5101; Fax: +86 010 6655 1726.
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Zheng Y, Ershad M, Fey AM. Toward Correcting Anxious Movements Using Haptic Cues on the Da Vinci Surgical Robot. PROCEEDINGS OF THE ... IEEE/RAS-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL ROBOTICS AND BIOMECHATRONICS. IEEE/RAS-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL ROBOTICS AND BIOMECHATRONICS 2022; 2022:10.1109/biorob52689.2022.9925380. [PMID: 37408769 PMCID: PMC10321328 DOI: 10.1109/biorob52689.2022.9925380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Surgical movements have an important stylistic quality that individuals without formal surgical training can use to identify expertise. In our prior work, we sought to characterize quantitative metrics associated with surgical style and developed a near-real-time detection framework for stylistic deficiencies using a commercial haptic device. In this paper, we implement bimanual stylistic detection on the da Vinci Research Kit (dVRK) and focus on one stylistic deficiency, "Anxious", which may describe movements under stressful conditions. Our goal is to potentially correct these "Anxious" movements by exploring the effects of three different types of haptic cues (time-variant spring, damper, and spring-damper feedback) on performance during a basic surgical training task using the da Vinci Research Kit (dVRK). Eight subjects were recruited to complete peg transfer tasks using a randomized order of haptic cues and with baseline trials between each task. Overall, all cues lead to a significant improvement over baseline economy of volume and time-variant spring haptic cues lead to significant improvements in reducing the classified "Anxious" movements and also corresponded with significantly lower path length and economy of volume for the non-dominant hand. This work is the first step in evaluating our stylistic detection model on a surgical robot and could lay the groundwork for future methods to actively and adaptively reduce the negative effect of stress in the operating room.
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Affiliation(s)
- Yi Zheng
- Department of Mechanical Engineering, the University of Texas at Austin, 204 East Dean Keeton Street, Austin, TX 78712, USA
| | - Marzieh Ershad
- Intuitive Surgical, Inc., 1020 Kifer Road Sunnyvale, CA 94086
| | - Ann Majewicz Fey
- Department of Mechanical Engineering, the University of Texas at Austin, 204 East Dean Keeton Street, Austin, TX 78712, USA
- Department of Surgery, UT South-western Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
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Kato D, Namiki S, Ueda S, Takeuchi Y, Takeuchi S, Kawase M, Kawase K, Nakai C, Takai M, Iinuma K, Nakane K, Koie T. Validation of standardized training system for robot-assisted radical prostatectomy: comparison of perioperative and surgical outcomes between experienced surgeons and novice surgeons at a low-volume institute in Japan. MINIM INVASIV THER 2022; 31:1103-1111. [PMID: 35352619 DOI: 10.1080/13645706.2022.2056707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Although robot-assisted radical prostatectomy (RARP) has become a standard treatment modality in patients with prostate cancer (PCa), RARP is a complicated and difficult surgical procedure due to the risk of serious surgery-related complications. This study aimed to evaluate the validation of a standardized training system for RARP in patients with PCa at a single institute. MATERIAL AND METHODS We retrospectively reviewed the clinical and pathological records of 155 patients with PCa who underwent RARP at Gifu University between August 2018 and April 2021. We developed an institutional program for new surgeons based on the separation of the RARP procedure into six checkpoints. The primary endpoints were surgical outcomes and perioperative complications among three groups (expert, trainer, and novice surgeon groups). RESULTS The console time was significantly longer in the novice surgeon group than in the other groups. Regarding bladder neck dissection, ligation of lateral pedicles, and vesicourethral anastomosis, the operative time was significantly shorter in the expert group than in the other groups. Surgery-related complications occurred in 15 patients (9.7%). CONCLUSIONS Our training system for RARP might help reduce the influence of the learning curve on surgical outcomes and ensure that the surgeries performed at low-volume institutions are safe and effective.
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Affiliation(s)
- Daiki Kato
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Sanae Namiki
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Shota Ueda
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | | | - Shinichi Takeuchi
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Makoto Kawase
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Kota Kawase
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Chie Nakai
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Manabu Takai
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Koji Iinuma
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Keita Nakane
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Takuya Koie
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
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Leon MG, Carrubba AR, DeStephano CC, Heckman MG, Craver EC, Dinh TA. Impact of robotic single and dual console systems in the training of minimally invasive gynecology surgery (MIGS) fellows. J Robot Surg 2022; 16:1273-1280. [PMID: 35025036 DOI: 10.1007/s11701-022-01369-x] [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: 12/16/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
The advantages of dual console use in robotic surgical education have not been described. The aims of this study are to compare fellow console time, surgical steps performed, and surgical takeovers between attending and fellow surgeons using dual versus single console robotic systems. Participants included minimally invasive gynecologic surgery (MIGS) fellows (N = 3) and subspecialty trained gynecologic surgeons (N = 5). Prospective data were obtained on 126 patients (N = 77 single console, N = 49 dual console) undergoing robotic hysterectomy. Variables included demographics, surgical characteristics (fellow, month of fellowship, attending surgeon, concomitant oophorectomy, additional surgical procedures, estimated blood loss, specimen weight), and outcomes (console time, docking time, console time/docking time ratio, total case time, number of surgical steps performed by the fellow, number of surgical takeovers, complications). After controlling for potential confounders, fellows spent a mean of 25.8 min longer (P < 0.001) at the console in dual console operations compared to single. Dual console surgeries had a greater number of steps performed by the fellow (OR[> 5 steps]: 3.37, P = 0.009), a higher console time/docking time ratio (P < 0.001), and more surgical takeovers between fellow and attending (OR [> 1 takeover]: 3.53, P < 0.001). There were no significant differences between the two groups regarding docking time (P = 0.15), case time (P = 0.79), or complications (P = 0.30). Our findings suggest dual console robotic training provide fellows the opportunity for more "hands-on" experience with longer console time, higher number of surgical steps performed, and added interaction with the attending surgeon when compared with single console training. These surgical metrics provide objectivity in competency-based robotic training without increasing the complications or surgical time.
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Affiliation(s)
- Mateo G Leon
- McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin St # 1014, Houston, TX, 77030, USA.
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Emily C Craver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Tri A Dinh
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL, USA
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Neurovascular structure-adjacent frozen-section examination robotic-assisted radical prostatectomy: outcomes from 500 consecutive cases in the UK. J Robot Surg 2021; 16:951-956. [PMID: 34716876 DOI: 10.1007/s11701-021-01324-2] [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: 08/18/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022]
Abstract
The purpose is to report the United Kingdom's largest single-centre experience of robotically assisted laparoscopic radical prostatectomies (RALP), using the neurovascular structure-adjacent frozen-section (NeuroSAFE) technique. We describe the utilisation and outcomes of this technique. This is a retrospective study from 2012 to 2019 on 520 patients undergoing NeuroSAFE RALP at our Institution. Our Institution's database was analysed for false-positive frozen-section (FS) margins as confirmed on paraffin histopathological analysis: functional outcomes of potency, continence, and biochemical recurrence (BCR). The median (range) of console time was 145 (90-300) min. In our cohort, positive FS was seen in 30.7% (160/520) of patients, with a confirmatory paraffin analysis in 91.8% of our patients' cohort (147/160). The neurovascular bundles (NVBs) that underwent secondary resection contained tumour in 26.8% (43/160) of the cases. Biochemical recurrence (BCR) was 6.7% (35/520), of which FS was positive in 40% (14/35) of those cases. There were insufficient evidence of a statistical association of urinary incontinence and positive surgical margin rates according to NS or NVB resection. NeuroSAFE enables intraoperative confirmation of the oncologic safety of a NS procedure. Patients with a positive FS on NeuroSAFE can be converted to a negative surgical margin (NSM) by ipsilateral wide resection. This spared 1 in 4 men from positive margins posterolaterally in our series. Limitations are the absence of a matched contemporary cohort of NS RALP without NeuroSAFE in our centre.
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Yamamoto M, Ashida K, Hara K, Sugezawa K, Uejima C, Tanio A, Shishido Y, Miyatani K, Hanaki T, Kihara K, Matsunaga T, Tokuyasu N, Sakamoto T, Fujiwara Y. Initial Experience in Rectal Cancer Surgery for the Next Generation of Robotic Surgeons Trained in a Dual Console System. Yonago Acta Med 2021; 64:240-248. [PMID: 34429701 PMCID: PMC8380558 DOI: 10.33160/yam.2021.08.002] [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: 03/01/2021] [Accepted: 05/26/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Robotic surgery for rectal cancer is used worldwide, with an increasing incidence of robotic surgeons. Therefore, the most appropriate educational system for next-generation robotic surgeons should be urgently established. METHODS We analyzed 39 patients who underwent robotic rectal surgery performed by a next-generation surgeon with limited experienced in laparoscopic rectal cancer surgery. The dual console system was used in the initial 15 cases, and we assessed short-term outcomes and the learning curve on operative time using the cumulative sum method. RESULTS The patients were divided into two groups: 15 cases in the early phase, and 24 cases in the late phase. The operative time and surgeon console time were significantly shorter in the late phase than the early phase (P < 0.001). Postoperative complications were more frequently observed in the early phase (P = 0.049); however, the estimated blood loss and length of hospital stay were not significantly different. In the initial 15 cases that using the dual console, the average operative time changing to the expert surgeon was 82 minutes in the first 5 cases, 19 minutes on average in the next 5 cases, and no change occurred in the last 5 cases. The learning curve peaked after 14 cases, plateaued from case number 15 to 23, and decreased in a linear fashion until the final case. CONCLUSION Education of a next generation surgeon using a dual console system for robotic rectal cancer surgery was performed safely.
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Affiliation(s)
- Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Keigo Ashida
- Department of Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Kazushi Hara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Ken Sugezawa
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Chihiro Uejima
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Akimitsu Tanio
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Takehiko Hanaki
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Kyoichi Kihara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Naruo Tokuyasu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
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11
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De Pastena M, Salvia R, Paiella S, Deiro G, Bannone E, Balduzzi A, Giuliani T, Casetti L, Ramera M, Filippini C, Montagnini G, Landoni L, Esposito A. Robotic Dual-Console Distal Pancreatectomy: Could it be Considered a Safe Approach and Surgical Teaching even in Pancreatic Surgery? A Retrospective Observational Study Cohort. World J Surg 2021; 45:3191-3197. [PMID: 34304274 PMCID: PMC8408081 DOI: 10.1007/s00268-021-06216-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/21/2022]
Abstract
Background The study aims to assess the safety and feasibility of the robotic dual-console during a robotic distal pancreatectomy Methods The data of the consecutive patients submitted to RDP from 2012 to 2019 at the Verona University were retrieved from a prospectively maintained database. The patients submitted to RDP were divided into the dual-console platform group (DG) and compared to the standard robotic procedure group (SG). Results In the study period, 102 robotic distal pancreatectomies were performed, of whom 42 patients (41%) belonged to the DG and 60 patients (59%) to the SG. Higher operation time was recorded in the DG compared to the SG (410 vs. 265 min, p < 0.001). The overall conversion rate of the series was 7% (n 7 patients). All the conversions were observed in the SG (p = 0.021). No differences in morbidity or pancreatic fistula rate were recorded (p > 0.05). No mortality events in the 90th postoperative days were reported in this series. Conclusions The robotic dual-console approach for distal pancreatectomy is safe, feasible, and reproducible. The postoperative surgical outcomes are comparable to the standard RDP with the single-console da Vinci Surgical System®. This surgical technique can widely and safely improve the robotic surgical training program.
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Affiliation(s)
- M De Pastena
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - R Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - S Paiella
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - G Deiro
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - E Bannone
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - A Balduzzi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - T Giuliani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - L Casetti
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - M Ramera
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - C Filippini
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - G Montagnini
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - L Landoni
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - A Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. .,University of Verona, Verona, Italy.
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12
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Abstract
The use of robotic surgery in urology has grown exponentially in the past 2 decades, but robotic surgery training has lagged behind. Most graduating residents report a lack of comfort independently performing common robotic urologic surgeries, despite an abundance of available resources. There is a general consensus on the key components of a comprehensive robotics curriculum, and well-validated tools have been developed to assess trainee competency. However, no single curriculum has emerged as the gold standard on which individual programs can build their own robotics curricula.
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Affiliation(s)
- Robert S Wang
- Department of Urology, Michigan Medicine, 1500 East Medical Center Drive, TC 3875, Ann Arbor, MI 48109, USA
| | - Sapan N Ambani
- Department of Urology, Michigan Medicine, 1500 East Medical Center Drive, TC 3875, Ann Arbor, MI 48109, USA.
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13
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Matsuyama T, Kinugasa Y, Nakajima Y, Kojima K. Robotic-assisted surgery for rectal cancer: Current state and future perspective. Ann Gastroenterol Surg 2018; 2:406-412. [PMID: 30460343 PMCID: PMC6236106 DOI: 10.1002/ags3.12202] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/10/2018] [Accepted: 07/29/2018] [Indexed: 12/16/2022] Open
Abstract
Interest in minimally invasive surgery has increased in recent decades. Robotic-assisted laparoscopic surgery (RALS) was introduced as the latest advance in minimally invasive surgery. RALS has the potential to provide better clinical outcomes in rectal cancer surgery, allowing for precise dissection in the narrow pelvic space. In addition, RALS represents an important advancement in surgical education with respect to use of the dual-console robotic surgery system. Because the public health insurance systems in Japan have covered the cost of RALS for rectal cancer since April 2018, RALS has been attracting increasingly more attention. Although no overall robust evidence has yet shown that RALS is superior to laparoscopic or open surgery, the current evidence supports the notion that technically demanding subgroups (patients with obesity, male patients, and patients treated by extended procedures) may benefit from RALS. Technological innovation is a constantly evolving field. Several companies have been developing new robotic systems that incorporate new technology. This competition among companies in the development of such systems is anticipated to lead to further improvements in patient outcomes as well as drive down the cost of RALS, which is one main concern of this new technique.
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Affiliation(s)
- Takatoshi Matsuyama
- Department of Gastrointestinal SurgeryTokyo Medical and Dental University Graduate School of MedicineTokyoJapan
| | - Yusuke Kinugasa
- Department of Gastrointestinal SurgeryTokyo Medical and Dental University Graduate School of MedicineTokyoJapan
| | - Yasuaki Nakajima
- Department of Gastrointestinal SurgeryTokyo Medical and Dental University Graduate School of MedicineTokyoJapan
| | - Kazuyuki Kojima
- Division of Minimally Invasive TreatmentTokyo Medical and Dental University Graduate School of MedicineTokyoJapan
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14
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Tourinho-Barbosa RR, Tobias-Machado M, Castro-Alfaro A, Ogaya-Pinies G, Cathelineau X, Sanchez-Salas R. Complications in robotic urological surgeries and how to avoid them: A systematic review. Arab J Urol 2017; 16:285-292. [PMID: 30140463 PMCID: PMC6104661 DOI: 10.1016/j.aju.2017.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/26/2017] [Accepted: 11/08/2017] [Indexed: 01/16/2023] Open
Abstract
Objectives To review the main complications related to the robot-assisted laparoscopic (RAL) approach in urology and to suggest measures to avoid such issues. Methods A systematic search for articles of the contemporary literature was performed in PubMed database for complications in RAL urological procedures focused on positioning, access, and operative technique considerations. Each complication topic is followed by recommendations about how to avoid it. Results In all, 40 of 253 articles were included in this analysis. Several complications in RAL procedures can be avoided if the surgical team follows some key steps. Adequate patient positioning must avoid skin, peripheral nerve, and muscles injuries, and ocular and cognitive complications mainly related to steep Trendelenburg positioning in pelvic procedures. Port-site access and closure should not be neglected during minimally invasive procedures as these complications although rare can be troublesome. Technique-related complications depend on surgeon experience and the early learning curve should be monitored. Conclusions Adequate patient selection, surgical positioning, mentorship training, and avoiding long-lasting procedures are essential to prevent RAL-related complications. The robotic surgical team must be careful and work together to avoid possible complications. This review offers several steps in surgical planning to reach this goal.
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Affiliation(s)
- Rafael Rocha Tourinho-Barbosa
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.,Division of Urology, ABC Medical School, Sao Paulo, Brazil
| | | | - Adalberto Castro-Alfaro
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Gabriel Ogaya-Pinies
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, FL, USA
| | - Xavier Cathelineau
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
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15
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Bolger JC, Broe MP, Zarog MA, Looney A, McKevitt K, Walsh D, Giri S, Peirce C, Coffey JC. Initial experience with a dual-console robotic-assisted platform for training in colorectal surgery. Tech Coloproctol 2017; 21:721-727. [PMID: 28929257 DOI: 10.1007/s10151-017-1687-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/18/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND Minimally invasive surgery is associated with several patient-related benefits, including reduced length of hospital stay and reduced blood loss. Robotic-assisted surgery offers many advantages when compared with standard laparoscopic procedures, including a stable three-dimensional binocular camera platform, motion smoothing and motion scaling, improved dexterity and ergonomics. There are limited data on the effectiveness of the dual-console DaVinci Xi platform for teaching resident surgeons. The goal of this study was to examine preliminary outcomes following the introduction of a dual-console robotic platform in our institution. METHODS A retrospective review of our prospectively maintained patient database was performed. The first ten dual-console resident-performed procedures in colorectal surgery were compared with matched cases performed on a single console by the trainer. Patient demographics, operative times and patient outcomes were compared. RESULTS Twenty patients were included in this study. There was no significant difference in console time (p = 0.46) or total operative time (p = 0.52) when residents and trainers were compared. Patient outcomes were equivalent, with no difference in length of stay, morbidity or mortality. CONCLUSIONS The DaVinci Xi dual-console platform is a safe and effective platform for training junior surgeons. The dual-console system has the potential to alter surgical training pathways.
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Affiliation(s)
- J C Bolger
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | - M P Broe
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - M A Zarog
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | - A Looney
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - K McKevitt
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | - D Walsh
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - S Giri
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - C Peirce
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | - J C Coffey
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland. .,Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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16
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Khene ZE, Peyronnet B, Bosquet E, Pradère B, Robert C, Fardoun T, Kammerer-Jacquet SF, Verhoest G, Rioux-Leclercq N, Mathieu R, Bensalah K. Does training of fellows affect peri-operative outcomes of robot-assisted partial nephrectomy? BJU Int 2017; 120:591-599. [DOI: 10.1111/bju.13901] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Benoit Peyronnet
- Department of Urology; Rennes University Hospital; Rennes France
| | - Elise Bosquet
- Department of Urology; Rennes University Hospital; Rennes France
| | - Benjamin Pradère
- Department of Urology; Rennes University Hospital; Rennes France
| | - Corentin Robert
- Department of Radiology; Rennes University Hospital; Rennes France
| | - Tarek Fardoun
- Department of Urology; Rennes University Hospital; Rennes France
| | | | - Grégory Verhoest
- Department of Urology; Rennes University Hospital; Rennes France
| | | | - Romain Mathieu
- Department of Urology; Rennes University Hospital; Rennes France
| | - Karim Bensalah
- Department of Urology; Rennes University Hospital; Rennes France
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17
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Does teaching of robotic partial nephrectomy affect renal function and perioperative outcomes? Urol Oncol 2017; 35:227-233. [PMID: 28089074 DOI: 10.1016/j.urolonc.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/03/2016] [Accepted: 12/01/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Partial nephrectomy (PN) represents the treatment of choice for localized renal tumor<7cm. Minimally invasive approaches are considered standard of care in many institutions. Maintaining acceptable warm ischemic time (WIT) while teaching robotic PN (RPN) remains challenging. The goal of the present study was to assess the effect of teaching RPN on WIT and renal function in patients undergoing RPN. METHODS Patients undergoing RPN for cT1-T2 renal tumors were included. RENAL nephrometry score was used to adjust for tumor complexity. Glomerular filtration rates (GFR) were determined preoperatively, at day 2 and at ≥3-month follow-up. Patients in whom the attending surgeon (staff) performed tumorectomy and renorraphy were compared with those in whom the fellow performed these steps. Primary outcomes were WIT and GFR decrease at follow-up visit. Morbidity and margin positivity represented secondary outcomes. RESULTS Overall, 69 patients (46 "staff" vs. 23 "fellow") were included. Patient׳s characteristics did not differ significantly between the 2 groups. In particular, RENAL score and preoperative GFR were similar between both groups. Mean WIT was 22±9 in the staff and 24±7 in the fellow group (P = 0.09). At follow-up, a GFR reduction of 9% was observed in the staff group vs. 13% in the fellow group (P = 0.38). Complication rates (13% vs. 17%, P = 0.63) and positive margins (9% vs. 4%, P = 0.47) did not differ significantly between staff and fellow. CONCLUSIONS In our experience, teaching RPN with a strict supervision and stepwise standardized procedure was oncologically and functionally safe after 3 to 6 months of follow-up.
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18
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Mitsinikos E, Abdelsayed GA, Bider Z, Kilday PS, Elliott PA, Banapour P, Chien GW. Does the Level of Assistant Experience Impact Operative Outcomes for Robot-Assisted Partial Nephrectomy? J Endourol 2016; 31:38-42. [PMID: 27806631 DOI: 10.1089/end.2016.0508] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE A skilled assistant surgeon is presumed necessary during robot-assisted partial nephrectomy (RAPN) to minimize warm ischemia time (WIT) and to facilitate complex renorrhaphy. Studies observing impact of resident participation have focused on robotic prostatectomies, showing no impact on core surgical outcomes. Herein, we evaluated the level of experience of the bedside assistant and its impact on perioperative outcomes in RAPN. MATERIALS AND METHODS All RAPN cases in our healthcare system from January 2011 to December 2013 were retrospectively reviewed. The cases were divided into teaching and nonteaching hospitals. There were 18 fellowship-trained attending surgeons. At teaching hospitals, surgeries were performed by an attending physician and postgraduate year (PGY)-2 or PGY-3 resident at bedside; at nonteaching hospitals, surgeries were performed by two attending surgeons. We compared age, gender, body mass index, Charlson comorbidity index, operative difficulty by R.E.N.A.L. nephrometry score, and operative outcomes (WIT, estimated blood loss, operative time (OT), positive margin rate, length of stay (LOS), postoperative glomerular filtration rate, and readmission rate). RESULTS Of the 170 patients captured, 162 had R.E.N.A.L. nephrometry score and WIT: 112 from teaching hospitals and 50 from nonteaching hospitals. Patient characteristics were equivalent between both cohorts with the exception of the R.E.N.A.L. score, which was higher (6.3 vs 5.7, p = 0.046) in the teaching hospitals cohort. Regarding operative outcomes, we noted an overall increase in LOS by 1 day (p = 0.001) and OT by 16 minutes (p = 0.011) in the teaching hospitals. CONCLUSION We observed that increased LOS was the only clinically relevant measure negatively impacted by resident physician involvement during RAPN.
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Affiliation(s)
- Emmanuel Mitsinikos
- 1 Department of Urology, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California
| | - George A Abdelsayed
- 1 Department of Urology, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California
| | - Zoe Bider
- 2 Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, California
| | - Patrick S Kilday
- 1 Department of Urology, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California
| | - Peter A Elliott
- 1 Department of Urology, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California
| | - Pooya Banapour
- 1 Department of Urology, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California
| | - Gary W Chien
- 1 Department of Urology, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California
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19
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Schommer E, Tonkovich K, Li Z, Thiel DD. Impact of Resident Involvement on Robot-Assisted Radical Prostatectomy Outcomes. J Endourol 2016; 30:1126-1131. [PMID: 27445128 DOI: 10.1089/end.2016.0388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study examines perioperative outcomes of resident involvement during various steps of robot-assisted radical prostatectomy (RARP). METHODS The RARP procedure was divided into seven steps: bladder takedown (BTD), endopelvic fascia, bladder neck (BN), seminal vesicle/vas deferens, pedicle/nerve sparing, apex, and anastomosis. Three hundred seventy-two RARPs performed by a single surgeon were analyzed. Resident console time during each of the seven steps was recorded. Perioperative variables were compared to surgeon-only cases. RESULTS Residents performed on the console for 232 of 372 cases (62.4%). Estimated blood loss (p = 0.09), transfusion (p = 0.11), and complications (p = 0.33) were no different between surgeon-only and resident-involved cases. Mean operating room time (ORT) was less for the surgeon-only cases (190.4 vs 206.4 minutes, p = 0.003). There was no difference in positive margins (p = 0.79), length of stay (LOS) (p = 0.30), catheter days (p = 0.17), readmission (p = 0.33), or reoperation (p = 0.73) when comparing surgeon-only to resident-involved cases. Residents performing the BN step had no effect on BN margins (p = 0.73) or prolonged catheterization (p = 0.62). ORT was significantly prolonged if BTD was performed by a resident (233.0 vs 191.7 minutes, p < 0.0001). Residents performing anastomosis had no effect on prolonged catheter time (p = 0.62) or LOS (p = 0.20). Residents were more likely to be involved in at least one portion of RARP following the purchase of a Mimic simulator (Mimic Technologies, Inc., Seattle, WA) in January 2012. CONCLUSIONS Supervised resident console involvement in RARP does not affect perioperative outcomes, although, it prolongs ORT, with the BTD step having the most effect on ORT.
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Affiliation(s)
- Eric Schommer
- 1 Department of Urology, Mayo Clinic Florida , Jacksonville, Florida
| | - Kolbi Tonkovich
- 1 Department of Urology, Mayo Clinic Florida , Jacksonville, Florida
| | - Zhuo Li
- 2 Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic , Jacksonville, Florida
| | - David D Thiel
- 1 Department of Urology, Mayo Clinic Florida , Jacksonville, Florida
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20
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Pucheril D, Campbell L, Bauer RM, Montorsi F, Sammon JD, Schlomm T. A Clinician's Guide to Avoiding and Managing Common Complications During and After Robot-assisted Laparoscopic Radical Prostatectomy. Eur Urol Focus 2016; 2:30-48. [PMID: 28723448 DOI: 10.1016/j.euf.2016.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 01/21/2023]
Abstract
CONTEXT Robot-assisted radical prostatectomy (RARP) is on the advance globally, and it is essential for surgeons and patients to know the rates of perioperative complications. OBJECTIVE To provide evidence-based clinical guidance on avoiding and managing common complications during and after RARP in the context of a comprehensive literature review. EVIDENCE ACQUISITION In concordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis 2015 statement guidelines, a literature search of the PubMed database from August 1, 2011, to August 31, 2015, using the predefined search terms robot* AND radical prostatectomy, was conducted. The search resulted in 653 unique results that were subsequently uploaded to DistillerSR (Evidence Partners, Ottawa, Canada) for team-based screening and processing of references. EVIDENCE SYNTHESIS Overall, 37 studies met the inclusion criteria and were included. Median rate of overall complication was 12.6% (range: 3.1-42%). Most of the complications were minor (Clavien-Dindo grades 1 and 2). Grade 3 complications comprised the bulk of the major complications with a median rate of 2.7%; grade IV and V complications were exceedingly rare in all reports. CONCLUSIONS Despite continued adoption of the RARP technique globally, rates of overall complication remain low. Many of the complications experienced during and after RARP can be mitigated and prevented by experience and the implementation of safe techniques. PATIENT SUMMARY Despite continued adoption of the robot-assisted radical prostatectomy (RARP) technique globally, rates of overall and major complications remain low at 12.6% and 2.7%, respectively. Complications can be minimized and successfully managed using established techniques. RARP is a safe and reproducible technique.
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Affiliation(s)
- Daniel Pucheril
- VUI Center for Outcomes Research, Analytics and Evaluation, Detroit, MI, USA.
| | - Logan Campbell
- VUI Center for Outcomes Research, Analytics and Evaluation, Detroit, MI, USA
| | - Ricarda M Bauer
- Department of Urology, Ludwig Maximilian University, Munich, Germany
| | - Francesco Montorsi
- Department of Urology, University Vita-Salute San Raffaele, Milan, Italy
| | - Jesse D Sammon
- VUI Center for Outcomes Research, Analytics and Evaluation, Detroit, MI, USA
| | - Thorsten Schlomm
- Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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21
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Lim SH, Lee HM, Son T, Hyung WJ, Kim HI. Robotic surgery for gastric tumor: current status and new approaches. Transl Gastroenterol Hepatol 2016; 1:28. [PMID: 28138595 DOI: 10.21037/tgh.2016.03.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/04/2016] [Indexed: 12/18/2022] Open
Abstract
Surgical techniques have evolved tremendously over this past century. To maximize the efficacy and minimize the invasiveness of laparoscopic surgery, researchers have sought to implement wider application of robotics. Nevertheless, both optimism without sound evidence and fear of new technology obscure the appropriate uses of robotic surgery. In the present review, we attempted to provide a balanced perspective on the current state of robotic gastrectomy, outlining evidence and opportunities for the use thereof. Although evidence is limited, the use of robotics is feasible for gastric cancer surgery, and less than 10 cases of robotic surgery are needed to become proficient therein. Compared to the clinical impact of laparoscopy on gastric cancer surgery, the additional benefits of robotic surgery to patients seem to be limited. Despite additional costs and longer surgeries, robotic surgery reportedly does not offer surgical outcomes superior to those for laparoscopic surgery, according to a recent multicenter study. Meanwhile, however, our in-depth review of retrospective and prospective reports revealed that robots could expand the indications of minimally invasive gastrectomy for patients requiring total gastrectomy and D2 lymph node dissection. Moreover, we found that robotic gastrectomy is associated with a higher number of retrieved lymph nodes, less bleeding, fewer complications, and shorter hospital stay, compared to laparoscopic gastrectomy. Accordingly, new surgical approaches using advanced technologies, such as near infrared detectors, the Tilepro® multi-input display, dual consoles, and the Single-Site® system, are under investigation. In conclusion, measuring the additional benefits of robotic over laparoscopic surgery would be difficult and clinically insignificant. Thus, developing new surgical procedures that extend the benefits of conventional laparoscopic surgery to patients in whom minimally invasive surgery would not be possible is necessary to justify the greater use of robotic surgery.
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Affiliation(s)
- Seung Hyun Lim
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Hae Min Lee
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Taeil Son
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea;; Robot and Minimally Invasive Surgery Center, Yonsei University Health System, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea;; Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei University Health System, Seoul, Korea
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22
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Goonewardene SS, Brown M, Challacombe B. Single- versus dual-console robotic surgery: dual improves the educational experience for trainees. World J Urol 2016; 34:1337-9. [PMID: 26767531 DOI: 10.1007/s00345-016-1762-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022] Open
Affiliation(s)
| | - M Brown
- Fiona Stanley Hospital, Perth, Australia
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Learning Experiences in Robotic-Assisted Laparoscopic Surgery. Best Pract Res Clin Obstet Gynaecol 2015; 35:20-9. [PMID: 26707192 DOI: 10.1016/j.bpobgyn.2015.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 11/12/2015] [Indexed: 11/21/2022]
Abstract
With the use and adoption of computer-assisted laparoscopic technology gaining more prominence, important issues pertaining to the learning process are raised. Several modalities can be incorporated into a training program for robotic surgical development. The role and utility of various methods, including didactic instruction, virtual reality simulators, dry and wet laboratories, bedside assistance, mentoring, as well as proctorship, are still in the process of being assessed and validated. Integration of robotic training in residency and fellowship programs as well as the formation of a structured didactic robotic curriculum continues to be a challenge. Finally, methods to assess competency of training and the process for credentialing robotic surgeons still require further structuring and codification.
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Mottrie A, Novara G, van der Poel H, Dasgupta P, Montorsi F, Gandaglia G. The European Association of Urology Robotic Training Curriculum: An Update. Eur Urol Focus 2015; 2:105-108. [PMID: 28723444 DOI: 10.1016/j.euf.2015.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/05/2015] [Accepted: 09/08/2015] [Indexed: 11/15/2022]
Abstract
The European Association of Urology robotic training curriculum is a validated structured program to provide standardized training and to certify surgeons for specific urologic procedures.
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Affiliation(s)
- Alexandre Mottrie
- OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
| | - Giacomo Novara
- OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Urology Clinic, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Henk van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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