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Peñafiel JAR, Valladares G, Cyntia Lima Fonseca Rodrigues A, Avelino P, Amorim L, Teixeira L, Brandao G, Rosa F. Robotic-assisted versus laparoscopic incisional hernia repair: a systematic review and meta-analysis. Hernia 2024; 28:321-332. [PMID: 37725188 DOI: 10.1007/s10029-023-02881-1] [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: 02/21/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE This study aimed to perform a systematic review and meta-analysis comparing the efficacy and safety outcomes of robotic-assisted and laparoscopic techniques for incisional hernia repair. METHODS PubMed, Embase, Scopus, Cochrane databases, and conference abstracts were systematically searched for studies that directly compared robot-assisted versus laparoscopy for incisional hernia repair and reported safety or efficacy outcomes in a follow-up of ≥ 1 month. The primary endpoints of interest were postoperative complications and the length of hospital stay. RESULTS The search strategy yielded 2104 results, of which four studies met the inclusion criteria. The studies included 1293 patients with incisional hernia repairs, 440 (34%) of whom underwent robot-assisted repair. Study follow-up ranged from 1 to 24 months. There was no significant difference between groups in the incidence of postoperative complications (OR 0.65; 95% CI 0.35-1.21; p = 0.17). The recurrence rate of incisional hernias (OR 0.34; 95% CI 0.05-2.29; p = 0.27) was also similar between robotic and laparoscopic surgeries. Hospital length of stay (MD - 1.05 days; 95% CI - 2.06, - 0.04; p = 0.04) was significantly reduced in the robotic-assisted repair. However, the robot-assisted repair had a significantly longer operative time (MD 69.6 min; 95% CI 59.0-80.1; p < 0.001). CONCLUSION The robotic approach for incisional hernia repair was associated with a significant difference between the two groups in complications and recurrence rates, a longer operative time than laparoscopic repair, but with a shorter length of stay.
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Affiliation(s)
- J A R Peñafiel
- Department of Surgery, University of Cuenca, Cuenca, Ecuador
- Health Sciences Faculty, Universidad Internacional, Quito, Ecuador
| | - G Valladares
- Department of Mathematics, University Central of Ecuador, Quito, Ecuador.
- Francisco Viteri and Gato Sobral, Universidad Central of Ecuador, Campus Universitario, Pichincha, Ecuador.
| | - Amanda Cyntia Lima Fonseca Rodrigues
- Department of Medicine, Positivo University, Curitiba, Brazil
- Department of Statistics and Biostatistics, Anhembi Morumbi University, Curitiba, Brazil
| | - P Avelino
- Department of Surgery, Federal University of Rio Grande do Norte, Natal, Brazil
| | - L Amorim
- Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - L Teixeira
- Department of Surgery, University of UniEvangelica, Anapolis, Brazil
| | - G Brandao
- Department of Surgery, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - F Rosa
- Department of Surgery, Instituto Tocantinense Presidente Antônio Carlos, Palmas, Tocantins, Brazil
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Kumar K, Kumar P, Deb D, Unguresan ML, Muresan V. Artificial Intelligence and Machine Learning Based Intervention in Medical Infrastructure: A Review and Future Trends. Healthcare (Basel) 2023; 11:healthcare11020207. [PMID: 36673575 PMCID: PMC9859198 DOI: 10.3390/healthcare11020207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/01/2023] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
People in the life sciences who work with Artificial Intelligence (AI) and Machine Learning (ML) are under increased pressure to develop algorithms faster than ever. The possibility of revealing innovative insights and speeding breakthroughs lies in using large datasets integrated on several levels. However, even if there is more data at our disposal than ever, only a meager portion is being filtered, interpreted, integrated, and analyzed. The subject of this technology is the study of how computers may learn from data and imitate human mental processes. Both an increase in the learning capacity and the provision of a decision support system at a size that is redefining the future of healthcare are enabled by AI and ML. This article offers a survey of the uses of AI and ML in the healthcare industry, with a particular emphasis on clinical, developmental, administrative, and global health implementations to support the healthcare infrastructure as a whole, along with the impact and expectations of each component of healthcare. Additionally, possible future trends and scopes of the utilization of this technology in medical infrastructure have also been discussed.
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Affiliation(s)
- Kamlesh Kumar
- Department of Electrical and Computer Science Engineering, Institute of Infrastructure Technology Research And Management, Ahmedabad 380026, India
| | - Prince Kumar
- Department of Electrical and Computer Science Engineering, Institute of Infrastructure Technology Research And Management, Ahmedabad 380026, India
| | - Dipankar Deb
- Department of Electrical and Computer Science Engineering, Institute of Infrastructure Technology Research And Management, Ahmedabad 380026, India
- Correspondence:
| | | | - Vlad Muresan
- Department of Automation, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
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Surgeon perception of factors affecting the efficiency of conventional and robotic laparoscopy: A Pan India study. Heliyon 2022; 8:e12561. [PMID: 36619437 PMCID: PMC9813728 DOI: 10.1016/j.heliyon.2022.e12561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 11/09/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022] Open
Abstract
Background Laparoscopic surgery, being minimally invasive, offers many benefits including faster patient recovery, reduced scarring and lower mortality rate. It is, however, technically challenging and requires a long learning curve. These issues can be overcome by Robot-Assisted Surgery (RAS) systems, which incorporate computer-controlled motions enabling enhanced precision and accuracy. Methods This study involves identifying and verifying various difficulties related to laparoscopy and the role of RAS in their mitigation. It involved 93 surgeons across India, covering a range of demographics, medical specialties and experience. They were interviewed to understand the current status and to compare RAS with conventional laparoscopy. The questionnaire developed for the purpose tests a set of hypotheses related to instruments, comfort, and other factors derived from the available literature as well as inputs from leading laparoscopy surgeons and domain experts. Results A grading system was adopted to evaluate the hypotheses based on the surgeons' responses. A statistical method based on T-test was employed to gain useful inferences from the study. The results showed that early-career surgeons preferred haptic enabled systems. As the experience of the surgeon increases, tissue identification becomes easier, thereby reducing the need for haptic feedback-enabled instruments. Conclusions The surgeons from across the demographics were strongly in the favour of the need for articulated instruments with surgeon-controlled camera systems. They reported a reduction in physical and mental discomfort during surgical procedures using RAS. They also confirmed the similarity in patient outcomes for both conventional laparoscopy and RAS. These insights are expected to be interesting and useful for further research and development in this field.
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Evaluation and comparison of basic gestures in ex vivo laparoscopic surgery using a robotic instrument and traditional laparoscopic instruments. Prog Urol 2019; 30:58-63. [PMID: 31889630 DOI: 10.1016/j.purol.2019.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/22/2019] [Accepted: 11/28/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The robotic Dextérité Surgical™ arm (DEX) is an instrument used in laparoscopy that provides 6 degrees of freedom and 360 degrees of rotation with a needle holder and scissors. To evaluate the benefits this instrument offers, we asked novice surgeons to use DEX and a conventional laparoscopic instrument on a pelvitrainer and compared the results. METHODS The participants were asked to perform two exercises with DEX and then with a conventional laparoscopic instrument on a pelvitrainer that contained a synthetic reproduction of a male pelvis. For the stitching exercise, the distance from the marked points and any tears caused were analyzed. For the cutting, the participants were judged by how well they respected the marked extremities, the form and the amount of "hacking" observed on a multi-criteria scale. The amount of time required to carry out the exercises was recorded. RESULTS All twelve urology interns all succeeded in using DEX. Of the 36 stitches, seven were giving a failing grade (19.4%) when using the conventional laparoscopic needle holder and one (0.3%) was recorded when using DEX. All of the criteria (entry and exit points, tears and duration) for the results obtained were better when using DEX compared to the classic laparoscopic tool. This difference was statistically significant for horizontal stitches and tearing. Concerning the cuts made, the global score obtained, following a multi-criteria scale, favored the use of DEX for 10 out of 12 candidates (83.3%) with an average score of +2.6 (±2.1). No significant difference was recorded for the duration of each exercise. CONCLUSION It does not take novice operators long to understand how to use DEX. It enables precise stitching and reduces tearing while improving the quality of cuts compared to conventional laparoscopic instruments, all without slowing the user down. LEVEL OF EVIDENCE 4.
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Xourafas D, Cloyd JM, Clancy TE, Pawlik TM, Ashley SW. Identifying Hospital Cost Savings Opportunities by Optimizing Surgical Approach for Distal Pancreatectomy. J Gastrointest Surg 2019; 23:1172-1179. [PMID: 30334179 DOI: 10.1007/s11605-018-4002-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/04/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The economic implications of relevant clinicopathologic factors on the surgical approach to distal pancreatectomy (DP) should be clearly defined and understood to potentially allow the implementation of cost reduction strategies. METHODS Administrative and clinical datasets of patients undergoing a DP between 2012 and 2016 were merged and queried. Univariate and multivariate analyses were used to identify clinicopathologic predictors of cost differentials for minimally invasive DP (MIDP) relative to open DP (ODP). Time trends in cost were also assessed to identify opportunities for cost containment. RESULTS Among two hundred and twenty five patients, 128 underwent an ODP (57%) and 97 a MIDP (43%). The DP groups were comparable with regard to relevant perioperative and disease characteristics. Total hospitalization and total OR costs for MIDP were significantly lower (- 12%, P = 0.0048) and higher (+ 16%, P < 0.0001) respectively, compared to ODP. On univariate analysis, age > 60 (- 12%, P = 0.0262), BMI > 25 (- 10%, P = 0.0222), ASA class ≥ 3 (- 11%, P = 0.0045), OpTime > 230 min (- 16%, P = 0.0004), and T stage ≥ 3 (- 8%, P = 0.0452) were associated with decreased total costs after MIDP compared to ODP. Linear regression analysis revealed that BMI > 25 (Estimate - 0.31, SE 0.15, P = 0.0482), ASA class ≥ 3 (Estimate - 0.36, SE 0.17, P = 0.0344), and T stage ≥ 3 (Estimate - 0.57, SE 0.26, P = 0.0320) were associated with decreased hospitalization costs after MIDP compared to ODP. Overtime, total hospitalization cost for MIDP increased from - 21 to 1% (P = 0.0197), while OR costs for MIDP decreased from + 41% to - 2% (P = 0.0049), nearly equalizing the cost differences between ODP and MIDP. CONCLUSIONS Relevant clinicopathologic factors predicted decreased hospitalization costs after MIDP relative to ODP. In equivalent stages of disease, optimizing the surgical approach to DP based on specific clinicopathologic characteristics may afford significant cost-saving opportunities.
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Affiliation(s)
- Dimitrios Xourafas
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA. .,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Jordan M Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thomas E Clancy
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stanley W Ashley
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
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Cost-analysis and quality of life after laparoscopic and robotic ventral mesh rectopexy for posterior compartment prolapse: a randomized trial. Tech Coloproctol 2019; 23:461-470. [PMID: 31069557 PMCID: PMC6620369 DOI: 10.1007/s10151-019-01991-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/15/2019] [Indexed: 12/15/2022]
Abstract
Background The aim of this study was to assess, whether robotic-assistance in ventral mesh rectopexy adds benefit to laparoscopy in terms of health-related quality of life (HRQoL), cost-effectiveness and anatomical and functional outcome. Methods A prospective randomized study was conducted on patients who underwent robot-assisted ventral mesh rectopexy (RVMR) or laparoscopic ventral mesh rectopexy (LVMR) for internal or external rectal prolapse at Oulu University Hospital, Finland, recruited in February–May 2012. The primary outcomes were health care costs from the hospital perspective and HRQoL measured by the 15D-instrument. Secondary outcomes included anatomical outcome assessed by pelvic organ prolapse quantification method and functional outcome by symptom questionnaires at 24 months follow-up. Results There were 30 females (mean age 62.5 years, SD 11.2), 16 in the RVMR group and 14 in the LVMR group. The surgery-related costs of the RVMR were 1.5 times higher than the cost of the LVMR. At 3 months the changes in HRQoL were ‘much better’ (RVMR) and ‘slightly better’ (LVMR) but declined in both groups at 2 years (RVMR vs. LVMR, p > 0.05). The cost-effectiveness was poor at 2 years for both techniques, but if the outcomes were assumed to last for 5 years, it improved significantly. The incremental cost-effectiveness ratio for the RVMR compared to LVMR was €39,982/quality-adjusted life years (QALYs) at 2 years and improved to €16,707/QALYs at 5 years. Posterior wall anatomy was restored similarly in both groups. The subjective satisfaction rate was 87% in the RVMR group and 69% in the LVMR group (p = 0.83). Conclusions Although more expensive than LVMR in the short term, RVMR is cost-effective in long-term. The minimally invasive VMR improves pelvic floor function, sexual function and restores posterior compartment anatomy. The effect on HRQoL is minor, with no differences between techniques.
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Abrishami P, Boer A, Horstman K. When the Evidence Basis Breeds Controversies: Exploring the Value Profile of Robotic Surgery Beyond the Early Introduction Phase. Med Care Res Rev 2019; 77:596-608. [PMID: 30902036 DOI: 10.1177/1077558719832797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This article investigates qualitatively the value profile of the da Vinci® surgical robot after almost two decades of extensive clinical use and research. We aimed to understand whether the swiftly growing body of published studies on robotic prostate surgery can now, that is, beyond an early stage, guide decisions on the acquisition, procurement, and public provision of this innovation. We explored both published studies and the perspectives of diverse stakeholders in the Netherlands. Both arenas represent conflicting, often polarised arguments on the (added) value of da Vinci surgery. What was unclear a decade ago due to lack of evidence is now unclear because of controversies about evidence. The article outlines controversial value issues and indicates the unlikelihood that awaiting more research - amid the mantra "further studies are needed" - will resolve the controversy. The study underscores multi-stakeholder deliberation to resolve controversies regarding the value of advanced medical innovations.
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Affiliation(s)
- Payam Abrishami
- Maastricht University, Maastricht, The Netherlands.,National Health Care Institute, Diemen, The Netherlands
| | - Albert Boer
- Erasmus University Rotterdam, Rotterdam, The Netherlands
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Caba Molina D, Lambreton F, Arrangoiz Majul R. Trends in Robotic Pancreaticoduodenectomy and Distal Pancreatectomy. J Laparoendosc Adv Surg Tech A 2019; 29:147-151. [DOI: 10.1089/lap.2018.0421] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Chen K, Pan Y, Zhang B, Maher H, Cai XJ. Laparoscopic versus open pancreatectomy for pancreatic ductal adenocarcinoma: A systematic review and meta-analysis. Int J Surg 2018; 53:243-256. [DOI: 10.1016/j.ijsu.2017.12.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/16/2017] [Accepted: 12/30/2017] [Indexed: 12/11/2022]
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Kim M, Lee C, Hong N, Kim YJ, Kim S. Development of stereo endoscope system with its innovative master interface for continuous surgical operation. Biomed Eng Online 2017. [PMID: 28646865 PMCID: PMC5483295 DOI: 10.1186/s12938-017-0376-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Although robotic laparoscopic surgery has various benefits when compared with conventional open surgery and minimally invasive surgery, it also has issues to overcome and one of the issues is the discontinuous surgical flow that occurs whenever control is swapped between the endoscope system and the operating robot arm system. This can lead to problems such as collision between surgical instruments, injury to patients, and increased operation time. To achieve continuous surgical operation, a wireless controllable stereo endoscope system is proposed which enables the simultaneous control of the operating robot arm system and the endoscope system. Methods The proposed system consists of two improved novel master interfaces (iNMIs), a four-degrees of freedom (4-DOFs) endoscope control system (ECS), and a simple three-dimensional (3D) endoscope. In order to simultaneously control the proposed system and patient side manipulators of da Vinci research kit (dVRK), the iNMIs are installed to the master tool manipulators of dVRK system. The 4-DOFs ECS consists of four servo motors and employs a two-parallel link structure to provide translational and fulcrum point motion to the simple 3D endoscope. The images acquired by the endoscope undergo stereo calibration and rectification to provide a clear 3D vision to the surgeon as available in clinically used da Vinci surgical robot systems. Tests designed to verify the accuracy, data transfer time, and power consumption of the iNMIs were performed. The workspace was calculated to estimate clinical applicability and a modified peg transfer task was conducted with three novice volunteers. Results The iNMIs operated for 317 min and moved in accordance with the surgeon’s desire with a mean latency of 5 ms. The workspace was calculated to be 20378.3 cm3, which exceeds the reference workspace of 549.5 cm3. The novice volunteers were able to successfully execute the modified peg transfer task designed to evaluate the proposed system’s overall performance. Conclusions The experimental results verify that the proposed 3D endoscope system enables continuous surgical flow. The workspace is suitable for the performance of numerous types of surgeries. Therefore, the proposed system is expected to provide much higher safety and efficacy for current surgical robot systems.
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Affiliation(s)
- Myungjoon Kim
- Interdisciplinary Program for Bioengineering, Graduate School, Seoul National University, Seoul, 03080, South Korea
| | - Chiwon Lee
- Korea Electrotechnology Research Institute, Ansan, 15588, South Korea
| | - Nhayoung Hong
- Interdisciplinary Program for Bioengineering, Graduate School, Seoul National University, Seoul, 03080, South Korea
| | - Yoon Jae Kim
- Interdisciplinary Program for Bioengineering, Graduate School, Seoul National University, Seoul, 03080, South Korea
| | - Sungwan Kim
- Institute of Medical and Biological Engineering, Seoul National University, Seoul, 08826, South Korea. .,Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, 03080, South Korea.
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Gkegkes ID, Mamais IA, Iavazzo C. Robotics in general surgery: A systematic cost assessment. J Minim Access Surg 2017; 13:243-255. [PMID: 28000648 PMCID: PMC5607789 DOI: 10.4103/0972-9941.195565] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The utilisation of robotic-assisted techniques is a novelty in the field of general surgery. Our intention was to examine the up to date available literature on the cost assessment of robotic surgery of diverse operations in general surgery. PubMed and Scopus databases were searched in a systematic way to retrieve the included studies in our review. Thirty-one studies were retrieved, referring on a vast range of surgical operations. The mean cost for robotic, open and laparoscopic ranged from 2539 to 57,002, 7888 to 16,851 and 1799 to 50,408 Euros, respectively. The mean operative charges ranged from 273.74 to 13,670 Euros. More specifically, for the robotic and laparoscopic gastric fundoplication, the cost ranged from 1534 to 2257 and 657 to 763 Euros, respectively. For the robotic and laparoscopic colectomy, it ranged from 3739 to 17,080 and 3109 to 33,865 Euros, respectively. For the robotic and laparoscopic cholecystectomy, ranged from 1163.75 to 1291 and from 273.74 to 1223 Euros, respectively. The mean non-operative costs ranged from 900 to 48,796 from 8347 to 8800 and from 870 to 42,055 Euros, for robotic, open and laparoscopic technique, respectively. Conversions to laparotomy were present in 34/18,620 (0.18%) cases of laparoscopic and in 22/1488 (1.5%) cases of robotic technique. Duration of surgery robotic, open and laparoscopic ranged from 54.6 to 328.7, 129 to 234, and from 50.2 to 260 min, respectively. The present evidence reveals that robotic surgery, under specific conditions, has the potential to become cost-effective. Large number of cases, presence of industry competition and multidisciplinary team utilisation are some of the factors that could make more reasonable and cost-effective the robotic-assisted technique.
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Affiliation(s)
- Ioannis D Gkegkes
- Department of Surgery, General Hospital of Attica "KAT", Athens, Greece
| | - Ioannis A Mamais
- Department of Medicine, Medical School of Athens, University of Athens, Athens, Greece
| | - Christos Iavazzo
- Department of Gynaecological Oncology, Christie Hospital, Manchester, United Kingdom
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Li XL, Du DF, Jiang H. The learning curves of robotic and three-dimensional laparoscopic surgery in cervical cancer. J Cancer 2016; 7:2304-2308. [PMID: 27994668 PMCID: PMC5166541 DOI: 10.7150/jca.16653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/18/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND: The 3D laparoscopy systems and robotic systems have been introduced into clinical practice for a few years. But the comparison of robotic and 3D laparoscopic gynecologic surgery is still needed. OBJECTIVE: To retrospectively compare the learning curves of robotic and 3D laparoscopic hysterectomy and pelvic lymphadenectomy in cervical cancer. STUDY DESIGN: The operational duration, blood loss, peritoneal drainage of first 24 hours after operation, total hospitalization days, hospitalization days after operation, lymph nodes collected, learning curves and cost of robotic and 3D laparoscopic hysterectomy and pelvic lymphadenectomy in cervical cancer performed by one experienced surgeon were studied. RESULTS: There was one surgeon who performed 37 cases of robotic and 24 cases of 3D laparoscopic hysterectomy and pelvic lymphadenectomy, and the turning point of learning curves was case 13th and case 10th. The differences of duration of operation, blood loss, peritoneal drainage of first 24 hours after operation, total hospitalization days, hospitalization days after operation, lymph nodes collected and perioperative complications were not statistically significant. But the cost of each robotic operation was higher than 3D operation. CONCLUSIONS: The turning point of the learning curve of 3D laparoscopic hysterectomy and pelvic lymphadenectomy is earlier than that of robotic sugery in patients with cervical cancer, and there is no obvious benefit from robotic surgery than 3D surgery in the terms of short-term medical index and hospitalization cost.
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Affiliation(s)
- Xue-Lian Li
- Department of Gynecology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China.; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Dan-Feng Du
- Department of Gynecology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China.; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Hua Jiang
- Department of Gynecology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China.; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
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Robotic cholecystectomy versus conventional laparoscopic cholecystectomy: A meta-analysis. Surgery 2016; 161:628-636. [PMID: 28011011 DOI: 10.1016/j.surg.2016.08.061] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/07/2016] [Accepted: 08/16/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Robotic cholecystectomy is a novel approach that offers the surgeon improved high-definition, 3-dimensional views and enhanced instrument ergonomics, which represent a technical development from previous operative platforms that include conventional and single-incision laparoscopy. This review compares its short-term outcomes with conventional laparoscopic cholecystectomy by a meta-analysis. METHODS A literature search was conducted using the MEDLINE, EMBASE, and PubMed databases (January 1990-October 2015). Studies identified were appraised with standard selection criteria. Data were extracted and a meta-analysis performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. RESULTS Thirteen studies, 12 retrospective trials and one randomized controlled trial comprising 1,589 patients (laparoscopic cholecystectomy, n = 921; robotic cholecystectomy, n = 668) were examined. There was a trend of a greater median total operative time (115.3 min vs 128.0 min; pooled MD = 31.22, 95% confidence interval = -2.48 to 59.96; Z = 2.13; P = .03) and preoperative time (32.4 min vs 53.4 min; pooled MD = 20.98, 95% confidence interval = 15.74 to 26.23; Z = 7.84; P < .001) in the robotic cholecystectomy group. Intraoperative complications (P = .52), conversion rate (P = .06), estimated blood loss (P = .55), postoperative complications (P = .28), duration of hospital stay (P = .36), and readmission rate (P = .85) were similar between both groups. CONCLUSION Robotic cholecystectomy is associated with greater operative times related primarily to the preparatory phase of the operation but with similar safety and perioperative outcome as conventional laparoscopic cholecystectomy. For it to gain acceptance, future studies are required to define specific measures to quantify equipment benefits to the surgeon and to evaluate the potential advantage of its use in the acute setting.
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Abstract
BACKGROUND Debate exists regarding the role of robotic-assisted surgery in colorectal cancer. Robotic-assisted surgery has been promoted as a strategy to increase the availability of minimally invasive surgery, which is associated with improved short-term morbidity; however, robotic-assisted surgery is much more expensive than laparoscopic surgery. OBJECTIVE We aimed to understand hospital and patient trends in the adoption of robotic-assisted surgery. DESIGN The study used cross-sectional and longitudinal designs. SETTINGS The study included 2010 and 2012 American Hospital Association surveys, as well as the 2010-2012 Nationwide Inpatient Sample. PATIENTS US hospitals responding to the American Hospital Association survey were included to measure patients with colorectal cancer who were undergoing elective minimally invasive surgery or open resection. MAIN OUTCOME MEASURES Robotic-assisted surgery adoption by US hospitals was measured, regarding specifically patients with colorectal cancer who were treated with robotic surgery. RESULTS In 2010, 20.1% of hospitals adopted robotic-assisted surgery, increasing to 27.4% by 2012. Hospitals more likely to adopt robotic-assisted surgery included teaching hospitals, those with more advanced imaging services, those in metropolitan rather than rural areas, and those performing the highest inpatient surgery volume. Robotic-assisted surgery only accounted for 1.3% of colorectal cancer operations during 2010-2012, but patient probability of robotic-assisted surgery ranged from 0.1% to 15.2%. The percentage of patients with colorectal cancer who were treated robotically among those undergoing minimally invasive surgery increased over time (2010, 1.5%; 2012, 3.6%). Robotic-assisted surgery is increasing more rapidly for patients with rectal cancer with minimally invasive surgery (2010, 5.5%; 2012, 13.3%) versus patients with colon cancer treated with minimally invasive surgery (2010, 1.3%; 2012, 3.3%). LIMITATIONS The study was limited by its observational study design. CONCLUSIONS Robotic-assisted surgery uptake remains low for colon cancer but higher for rectal cancer surgery, suggesting a more thoughtful adoption of robotic-assisted surgery for colorectal cancer by focusing its use on more technically challenging cases.
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Gavriilidis P, Lim C, Menahem B, Lahat E, Salloum C, Azoulay D. Robotic versus laparoscopic distal pancreatectomy - The first meta-analysis. HPB (Oxford) 2016; 18:567-74. [PMID: 27346136 PMCID: PMC4925795 DOI: 10.1016/j.hpb.2016.04.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/22/2016] [Accepted: 04/22/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Minimally invasive pancreaticoduodenectomy is considered hazardous for the majority of authors and minimally distal pancreatectomy is still a debated topic. The aim of this study was to compare robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP) using meta-analysis. METHOD EMBASE, Medline and PubMed were searched systematically to identify full-text articles comparing robotic and laparoscopic distal pancreatectomies. The meta-analysis was performed by using Review Manager 5.3. RESULTS Nine studies fulfilled the inclusion criteria and included 637 patients (246 robotic and 391 laparoscopic). RDP had a shorter hospital length of stay by 1 day (P = 0.01). On the other hand, LDP had shorter operative time by 30 min, although this was statistically nonsignificant (P = 0.12). RDP showed a significantly increased readmission rate (P = 0.04). There was no difference in the conversion rate, incidence of postoperative pancreatic fistula, International Study Group of Pancreatic Fistula grade B-C rate, major morbidity, spleen preservation rate and perioperative mortality. All surgical specimens of RDP reported R0 negative margins, whereas 7 specimens in the LDP group had affected margins. CONCLUSIONS In terms of feasibility, safety and oncological adequacy, there is no essential difference between the two techniques so far. The 30 min longer operative time of the RDP is due to the docking and undocking of the robot. The shorter length of stay by 1 day should be judged in combination with the increased 90-day readmission rate.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Chetana Lim
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Benjamin Menahem
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Eylon Lahat
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Chady Salloum
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France
| | - Daniel Azoulay
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France,INSERM U 955, Créteil, France,Correspondence Daniel Azoulay, Department of Hepato-Pancreato-Biliary Surgery and Liver transplantation, Henri Mondor Hospital, 51 avenue De Lattre De Tassigny, 94010 Créteil, France. Tel: +33 1 49 81 25 48. Fax: +33 1 49 81 24 32.Department of Hepato-Pancreato-Biliary and Liver transplantationHenri Mondor Hospital51 avenue De Lattre De TassignyCréteil94010France
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17
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van der Linden YTK, Brenkman HJF, van der Horst S, van Grevenstein WMU, van Hillegersberg R, Ruurda JP. Robotic Single-Port Laparoscopic Cholecystectomy Is Safe but Faces Technical Challenges. J Laparoendosc Adv Surg Tech A 2016; 26:857-861. [PMID: 27258800 DOI: 10.1089/lap.2016.0183] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND For cholecystectomy, multiport laparoscopy is the recommended surgical approach. Single-port laparoscopy (SPL) was introduced to reduce postoperative pain and provide better cosmetic results, but has technical disadvantages. Robotic SPL (RSPL) was developed to overcome these disadvantages. In this prospective study, we aim to describe intraoperative results and postoperative outcomes of RSPL cholecystectomies and evaluate technical aspects of the technique. METHODS A prospective database of all patients who underwent a RSPL cholecystectomy between January 2012 and December 2014 was analyzed. Intraoperative results and postoperative complications were evaluated. RESULTS A total of 27 patients underwent RSPL cholecystectomy. Median age was 59 (20-78) years and median body mass index was 25 (19-35) kg/m2. The majority of patients had American Society of Anesthesiologists (ASA) II classification (67%) and 89% underwent surgery for cholecystolithiasis or cholecystitis. The median operating time was 81 (41-115) minutes. Conversion to a multiport procedure occurred in 2; one due to insufficient length of the robotic instruments. In the second and third patients, conversion to an open procedure was necessary due to inadequate exposure caused by liver cirrhosis and purulent ascites, respectively. In seven procedures, spill occurred due to rupture of the gallbladder. Postoperative complications occurred in 4 patients, including 1 bleeding (no reintervention), 1 peritonitis, and 2 wound infections. After a median follow-up of 33 (10-44) months, 5 (19%) trocar-site hernias were seen. CONCLUSION RSPL cholecystectomy is feasible, however, encountered by technical challenges due to inadequate length of the nonwristed robotic instruments. A high incidence of gallbladder rupture and trocar-site hernias may limit its application.
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Affiliation(s)
| | - Hylke J F Brenkman
- Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Sylvia van der Horst
- Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands
| | | | | | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands
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18
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Kim M, Lee C, Park WJ, Suh YS, Yang HK, Kim HJ, Kim S. A development of assistant surgical robot system based on surgical-operation-by-wire and hands-on-throttle-and-stick. Biomed Eng Online 2016; 15:58. [PMID: 27206350 PMCID: PMC4875655 DOI: 10.1186/s12938-016-0189-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 05/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Robot-assisted laparoscopic surgery offers several advantages compared with open surgery and conventional minimally invasive surgery. However, one issue that needs to be resolved is a collision between the robot arm and the assistant instrument. This is mostly caused by miscommunication between the surgeon and the assistant. To resolve this limitation, an assistant surgical robot system that can be simultaneously manipulated via a wireless controller is proposed to allow the surgeon to control the assistant instrument. METHODS The system comprises two novel master interfaces (NMIs), a surgical instrument with a gripper actuated by a micromotor, and 6-axis robot arm. Two NMIs are attached to master tool manipulators of da Vinci research kit (dVRK) to control the proposed system simultaneously with patient side manipulators of dVRK. The developments of the surgical instrument and NMI are based on surgical-operation-by-wire concept and hands-on-throttle-and-stick concept from the earlier research, respectively. Tests for checking the accuracy, latency, and power consumption of the NMI are performed. The gripping force, reaction time, and durability are assessed to validate the surgical instrument. The workspace is calculated for estimating the clinical applicability. A simple peg task using the fundamentals of laparoscopic surgery board and an in vitro test are executed with three novice volunteers. RESULTS The NMI was operated for 185 min and reflected the surgeon's decision successfully with a mean latency of 132 ms. The gripping force of the surgical instrument was comparable to that of conventional systems and was consistent even after 1000 times of gripping motion. The reaction time was 0.4 s. The workspace was calculated to be 8397.4 cm(3). Recruited volunteers were able to execute the simple peg task within the cut-off time and successfully performed the in vitro test without any collision. CONCLUSIONS Various experiments were conducted and it is verified that the proposed assistant surgical robot system enables collision-free and simultaneous operation of the dVRK's robot arm and the proposed assistant robot arm. The workspace is appropriate for the performance of various kinds of surgeries. Therefore, the proposed system is expected to provide higher safety and effectiveness for the current surgical robot system.
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Affiliation(s)
- Myungjoon Kim
- />Interdisciplinary Program for Bioengineering, Graduate School, Seoul National University, Seoul, 110-744 South Korea
| | - Chiwon Lee
- />Institute of Medical and Biological Engineering, Seoul National University, Seoul, 151-742 South Korea
| | - Woo Jung Park
- />Interdisciplinary Program for Bioengineering, Graduate School, Seoul National University, Seoul, 110-744 South Korea
| | - Yun Suhk Suh
- />Department of Surgery, Seoul National University College of Medicine, Seoul, 110-799 South Korea
| | - Han Kwang Yang
- />Department of Surgery, Seoul National University College of Medicine, Seoul, 110-799 South Korea
| | - H. Jin Kim
- />Department of Mechanical & Aerospace Engineering, Seoul National University College of Engineering, Seoul, 151-742 South Korea
| | - Sungwan Kim
- />Institute of Medical and Biological Engineering, Seoul National University, Seoul, 151-742 South Korea
- />Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, 110-799 South Korea
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19
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Ahmad A, Ahmad ZF, Carleton JD, Agarwala A. Robotic surgery: current perceptions and the clinical evidence. Surg Endosc 2016; 31:255-263. [PMID: 27194264 DOI: 10.1007/s00464-016-4966-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/29/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND It appears that a discrepancy exists between the perception of robotic-assisted surgery (RAS) and the current clinical evidence regarding robotic-assisted surgery among patients, healthcare providers, and hospital administrators. The purpose of this study was to assess whether or not such a discrepancy exists. METHODS We administered survey questionnaires via face-to-face interviews with surgical patients (n = 101), healthcare providers (n = 58), and senior members of hospital administration (n = 6) at a community hospital that performs robotic surgery. The respondents were asked about their perception regarding the infection rate, operative time, operative blood loss, incision size, cost, length of hospital stay (LOS), risk of complications, precision and accuracy, tactile sensation, and technique of robotic-assisted surgery as compared with conventional laparoscopic surgery. We then performed a comprehensive literature review to assess whether or not these perceptions could be corroborated with clinical evidence. RESULTS The majority of survey respondents perceived RAS as modality to decrease infection rate, increase operative time, decrease operative blood loss, smaller incision size, a shorter LOS, and a lower risk of complications, while increasing the cost. Respondents also believed that robotic surgery provides greater precision, accuracy, and tactile sensation, while improving intra-operative access to organs. A comprehensive literature review found little-to-no clinical evidence that supported the respondent's favorable perceptions of robotic surgery except for the increased costs, and precision and accuracy of the robotic-assisted technique. CONCLUSIONS There is a discrepancy between the perceptions of robotic surgery and the clinical evidence among patients, healthcare providers, and hospital administrators surveyed.
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Affiliation(s)
- Arif Ahmad
- Department of General and Bariatric Surgery, John T. Mather Memorial Hospital, Port Jefferson, NY, USA. .,Division of General and Bariatric Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA. .,St. Charles Hospital, Port Jefferson, NY, USA.
| | - Zoha F Ahmad
- Department of General and Bariatric Surgery, John T. Mather Memorial Hospital, Port Jefferson, NY, USA
| | - Jared D Carleton
- Department of General and Bariatric Surgery, John T. Mather Memorial Hospital, Port Jefferson, NY, USA
| | - Ashish Agarwala
- Department of General and Bariatric Surgery, John T. Mather Memorial Hospital, Port Jefferson, NY, USA.,Division of General and Bariatric Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
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20
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de Rooij T, Klompmaker S, Abu Hilal M, Kendrick ML, Busch OR, Besselink MG. Laparoscopic pancreatic surgery for benign and malignant disease. Nat Rev Gastroenterol Hepatol 2016; 13:227-38. [PMID: 26882881 DOI: 10.1038/nrgastro.2016.17] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Laparoscopic surgery for benign and malignant pancreatic lesions has slowly been gaining acceptance over the past decade and is being introduced in many centres. Some studies suggest that this approach is equivalent to or better than open surgery, but randomized data are needed to assess outcomes. In this Review, we aim to provide a comprehensive overview of the state of the art in laparoscopic pancreatic surgery by aggregating high-quality published evidence. Various aspects, including the benefits, limitations, oncological efficacy, learning curve and latest innovations, are discussed. The focus is on laparoscopic Whipple procedure and laparoscopic distal pancreatectomy for both benign and malignant disease, but robot-assisted surgery is also addressed. Surgical and oncological outcomes are discussed as well as quality of life parameters and the cost efficiency of laparoscopic pancreatic surgery. We have also included decision-aid algorithms based on the literature and our own expertise; these algorithms can assist in the decision to perform a laparoscopic or open procedure.
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Affiliation(s)
- Thijs de Rooij
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Sjors Klompmaker
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Mohammad Abu Hilal
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD, UK
| | - Michael L Kendrick
- Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, Minnesota 55905, USA
| | - Olivier R Busch
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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21
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Cundy TP, Marcus HJ, Hughes-Hallett A, Khurana S, Darzi A. Robotic surgery in children: adopt now, await, or dismiss? Pediatr Surg Int 2015; 31:1119-25. [PMID: 26416688 DOI: 10.1007/s00383-015-3800-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2015] [Indexed: 12/12/2022]
Abstract
The role of robot-assisted surgery in children remains controversial. This article aims to distil this debate into an evidence informed decision-making taxonomy; to adopt this technology (1) now, (2) later, or (3) not at all. Robot-assistance is safe, feasible and effective in selected cases as an adjunctive tool to enhance capabilities of minimally invasive surgery, as it is known today. At present, expectations of rigid multi-arm robotic systems to deliver higher quality care are over-estimated and poorly substantiated by evidence. Such systems are associated with high costs. Further comparative effectiveness evidence is needed to define the case-mix for which robot-assistance might be indicated. It seems unlikely that we should expect compelling patient benefits when it is only the mode of minimally invasive surgery that differs. Only large higher-volume institutions that share the robot amongst multiple specialty groups are likely to be able to sustain higher associated costs with today's technology. Nevertheless, there is great potential for next-generation surgical robotics to enable better ways to treat childhood surgical diseases through less invasive techniques that are not possible today. This will demand customized technology for selected patient populations or procedures. Several prototype robots exclusively designed for pediatric use are already under development. Financial affordability must be a high priority to ensure clinical accessibility.
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Affiliation(s)
- Thomas P Cundy
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK.
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia.
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia.
| | - Hani J Marcus
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Archie Hughes-Hallett
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Sanjeev Khurana
- Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, South Australia
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia
| | - Ara Darzi
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK
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22
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A prospective non-randomised single-center study comparing laparoscopic and robotic distal pancreatectomy. Surg Endosc 2015; 29:3163-70. [DOI: 10.1007/s00464-014-4043-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/11/2014] [Indexed: 01/08/2023]
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Abstract
IMPORTANCE There is an ever-increasing drive to improve surgical patient outcomes. Given the benefits which robotics has bestowed upon a wide range of industries, from vehicle manufacturing to space exploration, robots have been highlighted by many as essential for continued improvements in surgery. OBJECTIVE The goal of this review is to outline the history of robotic surgery, and detail the key studies which have investigated its effects on surgical outcomes. Issues of cost-effectiveness and patient acceptability will also be discussed. RESULTS AND CONCLUSION Robotic surgery has been shown to shorten hospital stays, decrease complication rates and allow surgeons to perform finer tasks, when compared to the traditional laparoscopic and open approaches. These benefits, however, must be balanced against increased intraoperative times, vast financial costs and the increased training burden associated with robotic techniques. The outcome of such a cost-benefit analysis appears to vary depending on the procedure being conducted; indeed the strongest evidence in favour of its use comes from the fields of urology and gynaecology. It is hoped that with the large-scale, randomised, prospective clinical trials underway, and an ever-expanding research base, many of the outstanding questions surrounding robotic surgery will be answered in the near future.
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Affiliation(s)
- A Hussain
- John Radcliffe Hospital, University of Oxford, Oxford, UK
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24
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Müller S, Grønning LE, Nilsen FS, Mygland V, Patel HRH. Robotic and minimal access surgery: technology and surgical outcomes of radical prostatectomy for prostate cancer. Expert Rev Anticancer Ther 2014; 14:1317-21. [PMID: 25266367 DOI: 10.1586/14737140.2014.965689] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since the 1990s, minimal access surgery has been utilized in urology. In the past 15 years, robotic surgery has evolved and become a natural part of minimal access surgery. The dissemination has been fast and the opportunity of prospective trials has been missed. Nevertheless, robotic surgery has obvious benefits for the surgeon and patient. Even though the scientific evidence is not strong, robotic surgery is here to stay. However, there are lessons to learn from the implementation of the da Vinci system with regards to patient safety and prospective evaluation of the new technology. The future of surgery will include technologies derived from robotic surgery.
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Affiliation(s)
- Stig Müller
- Department of Urology, Akershus University Hospital, Sykehusveien 23, Lørenskog 1478, Norway
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25
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Lee C, Park WJ, Kim M, Noh S, Yoon C, Lee C, Kim Y, Kim HH, Kim HC, Kim S. Pneumatic-type surgical robot end-effector for laparoscopic surgical-operation-by-wire. Biomed Eng Online 2014; 13:130. [PMID: 25189221 PMCID: PMC4167265 DOI: 10.1186/1475-925x-13-130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although minimally invasive surgery (MIS) affords several advantages compared to conventional open surgery, robotic MIS systems still have many limitations. One of the limitations is the non-uniform gripping force due to mechanical strings of the existing systems. To overcome this limitation, a surgical instrument with a pneumatic gripping system consisting of a compressor, catheter balloon, micro motor, and other parts is developed. METHOD This study aims to implement a surgical instrument with a pneumatic gripping system and pitching/yawing joints using micro motors and without mechanical strings based on the surgical-operation-by-wire (SOBW) concept. A 6-axis external arm for increasing degrees of freedom (DOFs) is integrated with the surgical instrument using LabVIEW® for laparoscopic procedures. The gripping force is measured over a wide range of pressures and compared with the simulated ideal step function. Furthermore, a kinematic analysis is conducted. To validate and evaluate the system's clinical applicability, a simple peg task experiment and workspace identification experiment are performed with five novice volunteers using the fundamentals of laparoscopic surgery (FLS) board kit. The master interface of the proposed system employs the hands-on-throttle-and-stick (HOTAS) controller used in aerospace engineering. To develop an improved HOTAS (iHOTAS) controller, 6-axis force/torque sensor was integrated in the special housing. RESULTS The mean gripping force (after 1,000 repetitions) at a pressure of 0.3 MPa was measured to be 5.8 N. The reaction time was found to be 0.4 s, which is almost real-time. All novice volunteers could complete the simple peg task within a mean time of 176 s, and none of them exceeded the 300 s cut-off time. The system's workspace was calculated to be 11,157.0 cm3. CONCLUSIONS The proposed pneumatic gripping system provides a force consistent with that of other robotic MIS systems. It provides near real-time control. It is more durable than the existing other surgical robot systems. Its workspace is sufficient for clinical surgery. Therefore, the proposed system is expected to be widely used for laparoscopic robotic surgery. This research using iHOTAS will be applied to the tactile force feedback system for surgeon's safe operation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul 110-799, South Korea.
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Abrishami P, Boer A, Horstman K. Understanding the adoption dynamics of medical innovations: affordances of the da Vinci robot in the Netherlands. Soc Sci Med 2014; 117:125-33. [PMID: 25063968 DOI: 10.1016/j.socscimed.2014.07.046] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 07/15/2014] [Accepted: 07/17/2014] [Indexed: 01/21/2023]
Abstract
This study explored the rather rapid adoption of a new surgical device - the da Vinci robot - in the Netherlands despite the high costs and its controversial clinical benefits. We used the concept 'affordances' as a conceptual-analytic tool to refer to the perceived promises, symbolic meanings, and utility values of an innovation constructed in the wider social context of use. This concept helps us empirically understand robot adoption. Data from 28 in-depth interviews with diverse purposively-sampled stakeholders, and from medical literature, policy documents, Health Technology Assessment reports, congress websites and patients' weblogs/forums between April 2009 and February 2014 were systematically analysed from the perspective of affordances. We distinguished five interrelated affordances of the robot that accounted for shaping and fulfilling its rapid adoption: 'characteristics-related' affordances such as smart nomenclature and novelty, symbolising high-tech clinical excellence; 'research-related' affordances offering medical-technical scientific excellence; 'entrepreneurship-related' affordances for performing better-than-the-competition; 'policy-related' affordances indicating the robot's liberalised provision and its reduced financial risks; and 'communication-related' affordances of the robot in shaping patients' choices and the public's expectations by resonating promising discourses while pushing uncertainties into the background. These affordances make the take-up and use of the da Vinci robot sound perfectly rational and inevitable. This Dutch case study demonstrates the fruitfulness of the affordances approach to empirically capturing the contextual dynamics of technology adoption in health care: exploring in-depth actors' interaction with the technology while considering the interpretative spaces created in situations of use. This approach can best elicit real-life value of innovations, values as defined through the eyes of (potential) users.
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Affiliation(s)
- Payam Abrishami
- Research School CAPHRI, Department of Health, Ethics and Society, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; National Health Care Institute, P.O. Box 320, 1110 AH Diemen, The Netherlands.
| | - Albert Boer
- National Health Care Institute, P.O. Box 320, 1110 AH Diemen, The Netherlands; Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
| | - Klasien Horstman
- Research School CAPHRI, Department of Health, Ethics and Society, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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