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Ayuso SA, Marturano MN, Katzen MM, Aladegbami BG, Augenstein VA. Laparoscopic versus robotic inguinal hernia repair: a single-center case-matched study. Surg Endosc 2023; 37:631-637. [PMID: 35902404 DOI: 10.1007/s00464-022-09368-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 05/23/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Robotic inguinal hernia repair (RIHR) is becoming increasingly common and is the minimally invasive alternative to laparoscopic inguinal hernia repair (LIHR). Thus far, there is little data directly comparing LIHR and RIHR. The purpose of this study will be to compare outcomes for LIHR and RIHR at a single center. METHODS A prospective institutional hernia database was queried for patients who underwent transabdominal LIHR or RIHR from 2012 to 2020. The patients were then matched based on the surgeon performing the operation (single, expert hernia surgeon) and laterality of repair. Standard descriptive statistics were used. RESULTS There were 282 patients who met criteria for the study, 141 LIHR and 141 RIHR; 32.6% of patients in each group had a bilateral repair (p = 1.00). LIHR patients were slightly younger (54.4 ± 15.6 vs 58.6 ± 13.8; p = 0.03) but similar in terms of BMI (27.1 ± 5.1 vs 29.1 ± 2.1; p = 0.70) and number of comorbidities (2.9 ± 2.5 vs 2.6 ± 2.2; p = 0.59). Operative time was found to be longer in the RIHR group, but when evaluating RIHR at the beginning of the study versus the end of the study, there was a 50-min decrease in operative time (p < 0.01). Recurrence rates were low for both groups (0.7% vs 1.4%; p = 0.38) with mean follow-up time 13.0 ± 13.3 months. There was only one wound infection, which was in the robotic group. No patients required return to the operating room for complications relating to their surgery. There were no 30-day readmissions in the LIHR group and three 30-day readmissions in the RIHR group (p = 0.28). CONCLUSION LIHR and RIHR are both performed with low morbidity and have comparable overall outcomes. The total charges were increased in the RIHR group. Either LIHR or RIHR may be considered when performing inguinal hernia repair and should depend on surgeon and patient preference; continued evaluation of the outcomes is warranted.
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Affiliation(s)
- Sullivan A Ayuso
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - Matthew N Marturano
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - Michael M Katzen
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - Bola G Aladegbami
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - Vedra A Augenstein
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA.
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Bernhard L, Krumpholz R, Krieger Y, Czempiel T, Meining A, Navab N, Lüth T, Wilhelm D. PLAFOKON: a new concept for a patient-individual and intervention-specific flexible surgical platform. Surg Endosc 2021; 36:5303-5312. [PMID: 34919177 PMCID: PMC9160157 DOI: 10.1007/s00464-021-08908-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022]
Abstract
Background Research in the field of surgery is mainly driven by aiming for trauma reduction as well as for personalized treatment concepts. Beyond laparoscopy, other proposed approaches for further reduction of the therapeutic trauma have failed to achieve clinical translation, with few notable exceptions. We believe that this is mainly due to a lack of flexibility and high associated costs. We aimed at addressing these issues by developing a novel minimally invasive operating platform and a preoperative design workflow for patient-individual adaptation and cost-effective rapid manufacturing of surgical manipulators. In this article, we report on the first in-vitro cholecystectomy performed with our operating platform. Methods The single-port overtube (SPOT) is a snake-like surgical manipulator for minimally invasive interventions. The system layout is highly flexible and can be adapted in design and dimensions for different kinds of surgery, based on patient- and disease-specific parameters. For collecting and analyzing this data, we developed a graphical user interface, which assists clinicians during the preoperative planning phase. Other major components of our operating platform include an instrument management system and a non-sterile user interface. For the trial surgery, we used a validated phantom which was further equipped with a porcine liver including the gallbladder. Results Following our envisioned preoperative design workflow, a suitable geometry of the surgical manipulator was determined for our trial surgery and rapidly manufactured by means of 3D printing. With this setup, we successfully performed a first in-vitro cholecystectomy, which was completed in 78 min. Conclusions By conducting the trial surgery, we demonstrated the effectiveness of our PLAFOKON operating platform. While some aspects – especially regarding usability and ergonomics – can be further optimized, the overall performance of the system is highly promising, with sufficient flexibility and strength for conducting the necessary tissue manipulations. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08908-x.
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Affiliation(s)
- Lukas Bernhard
- Research Group for Minimally Invasive Interdisciplinary Therapeutic Intervention (MITI), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Roman Krumpholz
- Research Group for Minimally Invasive Interdisciplinary Therapeutic Intervention (MITI), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Yannick Krieger
- Institute of Micro Technology and Medical Device Technology, Department of Mechanical Engineering, Technical University of Munich, Munich, Germany
| | - Tobias Czempiel
- Chair for Computer Aided Medical Procedures & Augmented Reality, Technical University of Munich, Munich, Germany
| | - Alexander Meining
- Department of Internal Medicine II, Gastroenterology, University Hospital Würzburg, Würzburg, Germany
| | - Nassir Navab
- Chair for Computer Aided Medical Procedures & Augmented Reality, Technical University of Munich, Munich, Germany
| | - Tim Lüth
- Institute of Micro Technology and Medical Device Technology, Department of Mechanical Engineering, Technical University of Munich, Munich, Germany
| | - Dirk Wilhelm
- Research Group for Minimally Invasive Interdisciplinary Therapeutic Intervention (MITI), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, Klinikum rechts der Isar, Munich, Germany
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Laparoscopic surgery and robotic surgery for single-incision cholecystectomy: an updated systematic review. Updates Surg 2021; 73:2039-2046. [PMID: 33886106 DOI: 10.1007/s13304-021-01056-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/13/2021] [Indexed: 12/15/2022]
Abstract
The role of single-incision laparoscopic cholecystectomy (SILC) and single-incision robotic cholecystectomy (SIRC) is still unclear. We update the summarization of the feasibility and safety of SILC and SIRC. A comprehensive search of SILC and SIRC of English literature published on PubMed database between January 2015 and November 2020 was performed. A total of 70 articles were included: 41 covering SILC alone, 21 showing SIRC alone, 7 reporting both, and 1 study not specified. In total, 7828 cases were recorded (SILC/SIRC/not specified, 6234/1544/50); and the gender of 7423 cases was definitively reported: the female rate was 64.0% (SILC/SIRC/not specified, 62.1%/71.5%/74.0%). The weighted mean for body mass index (BMI), operative time, blood loss and post-operative hospital stay was 25.5 kg/m2 (SILC/SIRC, 25.0/27.0 kg/m2), 73.8 min (SILC/SIRC, 68.2/88.8 min), 12.6 mL (SILC/SIRC, 12.1/14.8 mL) and 2.5 days (SILC/SIRC, 2.8/1.9 days), respectively. The pooled prevalence of an additional port, conversion to open surgery, post-operative complications, intraoperative biliary injury, and incisional hernia was 4.1% (SILC/SIRC, 4.7%/1.9%), 0.9% (SILC/SIRC, 0.7%/1.5%), 5.9% (SILC/SIRC, 6.2%/4.1%), 0.1% (SILC/SIRC, 0.2%/0.09%), and 2.1% (SILC/SIRC, 1.4%/4.8%), respectively. Compared with conventional laparoscopic cholecystectomy, SIRC has experienced more postoperative incisional hernias (risk difference = 0.05, 95% confidence interval 0.02-0.07; P < 0.0001). By far, SILC and SIRC have not been considered a standard procedure. With the innovation of medical devices and gradual accumulation of surgical experience, feasibility and safety of performing SILC and SIRC will improve.
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Wang Y, Yao Y, Dou Y, Tang S, Chen C, Li Y, Chen Y, Deng L, Liang Z. Chopstick technique used in laparoendoscopic single site radical hysterectomy for early stage cervical cancer. Sci Rep 2021; 11:6882. [PMID: 33767229 PMCID: PMC7994798 DOI: 10.1038/s41598-021-85783-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/28/2021] [Indexed: 11/09/2022] Open
Abstract
Laparoendoscopic single-site surgery (LESS) further minimizes the invasiveness of traditional laparoscopic surgery. However, the "chopstick" effect caused by the parallel arrangement of the instruments in the umbilicus is considered an obstacle indelicate operations. The purpose of this study was to introduce a new technique characterized by a double fulcrum formed by instruments, named the "chopstick" technique, which facilitates the expedient accomplishment of complicated surgeries such as LESS radical hysterectomy (LESS-RH). Seventy-three patients who underwent LESS-RH using the "chopstick" technique were retrospectively analyzed. The procedure was performed successfully in 72 patients. The median operative duration was 225 min, and the median intraoperative blood loss was 200 ml. Among the operations in the first 20 patients, intraoperative vascular injuries and bladder injury occurred in two patients and were repaired by LESS. Patients responded positively regarding minimal postoperative pain control. The score of satisfaction with the cosmetic outcome expressed by the patients was eight at discharge and nine 30 days later. In conclusion, this study presents the feasibility of accomplishing complicated procedures, such as radical hysterectomy, by LESS using the “chopstick” technique. This approach provides more options for both selected patients and surgeons.
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Affiliation(s)
- Yanzhou Wang
- Department of Obstetrics and Gynecology, Southwest Hospital Third Military Medical University, Chongqing, 400038, China
| | - Yuanyang Yao
- Department of Obstetrics and Gynecology, Southwest Hospital Third Military Medical University, Chongqing, 400038, China
| | - Yuya Dou
- Department of Obstetrics and Gynecology, Southwest Hospital Third Military Medical University, Chongqing, 400038, China
| | - Shuai Tang
- Department of Obstetrics and Gynecology, Southwest Hospital Third Military Medical University, Chongqing, 400038, China
| | - Cheng Chen
- Department of Obstetrics and Gynecology, Southwest Hospital Third Military Medical University, Chongqing, 400038, China
| | - Yudi Li
- Department of Obstetrics and Gynecology, Southwest Hospital Third Military Medical University, Chongqing, 400038, China
| | - Yong Chen
- Department of Obstetrics and Gynecology, Southwest Hospital Third Military Medical University, Chongqing, 400038, China
| | - Li Deng
- Department of Obstetrics and Gynecology, Southwest Hospital Third Military Medical University, Chongqing, 400038, China.
| | - Zhiqing Liang
- Department of Obstetrics and Gynecology, Southwest Hospital Third Military Medical University, Chongqing, 400038, China
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Stabilization of Single-incision Laparoscopic Cholecystectomy by Needle Puncture and Bendable Retractor. Surg Laparosc Endosc Percutan Tech 2018; 28:375-379. [DOI: 10.1097/sle.0000000000000539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim D, Iqbal SI, Ahari HK, Molgaard CP, Flacke S, Davison BD. Expanding role of percutaneous cholecystostomy and interventional radiology for the management of acute cholecystitis: An analysis of 144 patients. Diagn Interv Imaging 2017; 99:15-21. [PMID: 28506680 DOI: 10.1016/j.diii.2017.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/14/2017] [Accepted: 04/22/2017] [Indexed: 01/11/2023]
Abstract
PURPOSE To investigate the rates of interval cholecystectomy and recurrent cholecystitis after initial percutaneous cholecystostomy (PC) and identify predictors of patient outcome after PC. MATERIALS AND METHODS A total of 144 patients with acute cholecystitis who were treated with PC were included. There were 96 men and 48 women, with a mean age of 71±13 (SD) years (range: 25-100 years). Patient characteristics, diagnostic imaging studies and results of laboratory tests at initial presentation, clinical outcomes after the initial PC treatment were reviewed. RESULTS Among the 144 patients, 56 patients were referred for acute acalculous and 88 patients for calculus cholecystitis. Five procedure-related major complications (3.6%) were observed including bile peritonitis (n=3), hematoma (n=1) and abscess formation (n=1). Recurrent acute cholecystitis after initial clinical resolution and PC tube removal was observed in 8 patients (6.0%). The rate of interval cholecystectomy was 33.6% (47/140) with an average interval period of 100±482 (SD) days (range: 3-1017 days). PC was a definitive treatment in 85 patients (60.7%) whereas 39 patients (27.9%) had elective interval cholecystectomy without having recurrent cholecystitis. The clinical outcomes after PC did not significantly differ between patients with calculous cholecystitis and those with acalculous cholecystitis. Multiple prior abdominal operations were associated with higher rates of recurrent cholecystitis. CONCLUSION For both acute acalculous and calculous cholecystitis, PC is an effective and definitive treatment modality for more than two thirds of our study patients over 3.5-year study period with low rates of recurrent disease and interval cholecystectomy.
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Affiliation(s)
- D Kim
- Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, Massachusetts 01805, USA.
| | - S I Iqbal
- Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, Massachusetts 01805, USA
| | - H K Ahari
- Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, Massachusetts 01805, USA
| | - C P Molgaard
- Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, Massachusetts 01805, USA
| | - S Flacke
- Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, Massachusetts 01805, USA
| | - B D Davison
- Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, Massachusetts 01805, USA
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