Feasibility of bilateral internal thoracic artery harvesting using the da Vinci SP system

Soft Tissue Robotic Assisted Orbital Surgery Using da Vinci SP: A Cadaveric Experience

PURPOSE

Robotic surgical techniques have transformed many surgical specialties however robotic techniques and applications have been much more limited in ophthalmology. This study aims to evaluate the feasibility of robotic assisted orbital surgery using a single-port novel robotic platform, the da Vinci SP.

METHODS

A series of orbital procedures were performed in cadaveric specimens utilizing the da Vinci SP robotic system. The procedures performed included lacrimal gland dissection and biopsy, medial and lateral orbital wall dissections, enucleation, and lid-sparing orbital exenteration. Successful completion of each procedure was defined by the operating surgeon and was considered the primary outcome and marker of feasibility.

RESULTS

Seven cadaveric procedures were performed in 3 cadaveric specimens. All 7 procedures were completed successfully without complication. Setup optimization occurred throughout the study and setup and operative times were acceptable. Three instrument arms and 1 endoscope were utilized throughout the study allowing 3 arm operating and dynamic retraction. Instrument size was found to limit surgical access and precision particular at the orbital apex.

CONCLUSIONS

This preclinical study demonstrates that the da Vinci SP can be utilized within the orbit and is feasible for several applications. Robotic surgical systems offer significant advantages over conventional techniques and should be embraced. However, current commercially available robotic platforms are not optimized for the orbit and have their limitations although they may be suitable for some clinical applications.

Subcostal bilateral internal thoracic artery harvesting with the da Vinci Single Port system: an experimental feasibility study

We evaluated the feasibility of harvesting bilateral internal thoracic arteries with the da Vinci Single Port system (SP) through a single left-sided subcostal incision. Complete bilateral mobilization with sufficiently long conduits for multivessel grafting was possible in 2 human cadavers and 2 live porcine. Creating the subcostal access and docking the SP system took between 14 and 21 min and the total harvest time ranged from 65 to 125 min in all models. No major bleeding was observed in the live porcine and hemostasis was managed with the available instrumentation. One porcine deceased during surgery due to ventricular fibrillation followed by cardiac arrest. The robotic harvesting was technically easily reproduced by the surgeons and required no additional rib-spreading. Further studies will be required to assess if this subcostal approach with the da Vinci SP system yields true clinical benefits in patients.

Initial experience with and surgical outcomes of da Vinci single-port system in general thoracic surgery

Background

The da Vinci single-port system (SPS) (Model SP1098, Intuitive Surgical Inc., Sunnyvale, CA, USA) has been used in genitourinary and general surgical procedures; however, its clinical application in general thoracic surgery has not been attempted. This retrospective study investigated the clinical outcomes of SPS in general thoracic surgery.

Methods

After approval from the Ministry of Food and Drug Safety in Korea, the surgical details of SPS in simple thoracic surgeries at two independent institutions were collected and retrospectively reviewed.

Results

Overall, 17 surgeries were performed using SPS without conversion to multiport surgery. The patients included six males, and the overall median age was 52 years (range, 28–83 years). The commonest pathological diagnoses were thymoma (8 cases) and benign cystic lesions (6 cases). The approach for SPS was subxiphoid, subcostal, and intercostal in 11, 4, and 2 cases, respectively. All patients underwent the surgeries without complications. The median operation time and peak pain score were 120 minutes (range, 58–250 minutes) and 3 (range, 2–4). The median duration of in situ chest tube and hospital stay was 1 day (range, 1–2 days) and 3 days (range, 2–7 days), respectively. SPS showed a shorter duration of in situ chest tube and hospital stay than robotic single-site surgeries.

Conclusions

The application of SPS in the field of general thoracic surgery is feasible and can be successful. Although this study reported preliminary data and the cases were relatively simple, advanced and complex procedures should be attempted with the SPS in the near future.