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Helgstrand F, Rietz G, Törnqvist B, Lambrecht JR, Gaupset R, Rautio T, Vironen J. Robotic Assisted Hernia Repair in Four Nordic Countries - Status and Challenges. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2024; 3:13224. [PMID: 38993476 PMCID: PMC11236569 DOI: 10.3389/jaws.2024.13224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/07/2024] [Indexed: 07/13/2024]
Affiliation(s)
| | - Göran Rietz
- Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Björn Törnqvist
- Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Tero Rautio
- Oulu University Hospital, Oulu Medical Research Center, Oulu, Finland
| | - Jaana Vironen
- Helsinki University Hospital, Abdominal Center, Helsinki University, Helsinki, Finland
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Awad L, Reed B, Bollen E, Langridge BJ, Jasionowska S, Butler PEM, Ponniah A. The emerging role of robotics in plastic and reconstructive surgery: a systematic review and meta-analysis. J Robot Surg 2024; 18:254. [PMID: 38878229 PMCID: PMC11180031 DOI: 10.1007/s11701-024-01987-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/19/2024] [Indexed: 06/19/2024]
Abstract
The role of robotics has grown exponentially. There is an active interest amongst practitioners in the transferability of the potential benefits into plastic and reconstructive surgery; however, many plastic surgeons report lack of widespread implementation, training, or clinical exposure. We report the current evidence base, and surgical opportunities, alongside key barriers, and limitations to overcome, to develop the use of robotics within the field. This systematic review of PubMed, Medline, and Embase has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PROSPERO (ID: CRD42024524237). Preclinical, educational, and clinical articles were included, within the scope of plastic and reconstructive surgery. 2, 181, articles were screened; 176 articles met the inclusion criteria across lymph node dissection, flap and microsurgery, vaginoplasty, craniofacial reconstruction, abdominal wall reconstruction and transoral robotic surgery (TOR). A number of benefits have been reported including technical advantages such as better visualisation, improved precision and accuracy, and tremor reduction. Patient benefits include lower rate of complications and quicker recovery; however, there is a longer operative duration in some categories. Cost presents a significant barrier to implementation. Robotic surgery presents an exciting opportunity to improve patient outcomes and surgical ease of use, with feasibility for many subspecialities demonstrated in this review. However, further higher quality comparative research with careful case selection, which is adequately powered, as well as the inclusion of cost-analysis, is necessary to fully understand the true benefit for patient care, and justification for resource utilisation.
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Affiliation(s)
- Laura Awad
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK.
- Department of Plastic Surgery, Royal Free Hospital, London, UK.
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK.
| | - Benedict Reed
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - Edward Bollen
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
| | - Benjamin J Langridge
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK
| | - Sara Jasionowska
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - Peter E M Butler
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK
| | - Allan Ponniah
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
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Sánchez A, Rodríguez O, Medina M, Vegas L, Couto F, Mogollon I, Inchausti C, Galvis L. Is YouTube a reliable tool for approaching robotic assisted transabdominal preperitoneal surgery? A critical review of the available resources. Cir Esp 2024; 102:188-193. [PMID: 38224772 DOI: 10.1016/j.cireng.2023.08.007] [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: 06/11/2023] [Accepted: 08/08/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION The robotic transabdominal preperitoneal approach (rTAPP) is a relatively recent technique for the treatment of inguinal hernia. To achieve optimal results, the 10 golden rules described must be followed. Surgeons in training often review videos to familiarize themselves with new techniques, YouTube being one of the most used platforms. The objective of this study is to carry out an evaluation of the 10 most viewed videos on YouTube of inguinal hernia repair by transabdominal preperitoneal approach (rTAPP) to determine if the 10 golden rules are met. METHODS Identify and evaluate the 10 videos with the highest number of views related to rTAPP. Three experienced Surgeons evaluated compliance with the 10 golden rules using a Likert scale. Data were analyzed in Excel (Microsoft) and plotted with Tableau (Tableau Inc). The consistency between evaluators was determined using Cronbach's alpha, considering a value >0.7 acceptable. RESULTS The average overall evaluation was 3.63 with a range of 2.6 to 4.9. The scores related to compliance with the rules 1, 2, 9, 10 were satisfactory; on the other hand, rules 3, 4, 5, 7 and 8 were weak, particularly rule number 7. Internal consistency was observed between raters with a Cronbach's alpha of 0.98. CONCLUSIONS The lack of compliance with the 10 golden rules in most of the videos demonstrates that the use of videos (YouTube) is not an adequate resource for learning robot-assisted inguinal hernia cure.
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Affiliation(s)
- Alexis Sánchez
- Director Programa de Cirugía Robótica. Orlando Health, Orlando, USA
| | - Omaira Rodríguez
- Programa de Cirugía Robótica, Hospital de Clínicas Caracas. Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | - Manuel Medina
- Departamento de Cirugía, Hospital Universitario del Henares, Madrid, Spain
| | - Liumariel Vegas
- Departamento de Cirugía, Hospital de Linares, Linares, Chile
| | - Francisco Couto
- Cirujano General, Grupo de Cirugía General. Orlando Health, Orlando, USA
| | - Ivan Mogollon
- Research Fellow, Programa de Cirugía Robótica ORMC, Orlando Health, Orlando, EE.UU
| | - Cristina Inchausti
- Research Fellow, Programa de Cirugía Robótica ORMC, Orlando Health, Orlando, EE.UU.
| | - Luz Galvis
- Unidad de Cirugía Robótica e Invasión minima, Caracas, Venezuela
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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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Lomanto D, Tan L, Lee S, Wijerathne S. Robotic Platform: What It Does and Does Not Offer in Hernia Surgery. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2024; 3:12701. [PMID: 38425788 PMCID: PMC10899468 DOI: 10.3389/jaws.2024.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Davide Lomanto
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
| | - Lydia Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sean Lee
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sujith Wijerathne
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
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de'Angelis N, Schena CA, Moszkowicz D, Kuperas C, Fara R, Gaujoux S, Gillion JF, Gronnier C, Loriau J, Mathonnet M, Oberlin O, Perez M, Renard Y, Romain B, Passot G, Pessaux P. Robotic surgery for inguinal and ventral hernia repair: a systematic review and meta-analysis. Surg Endosc 2024; 38:24-46. [PMID: 37985490 DOI: 10.1007/s00464-023-10545-5] [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: 07/06/2023] [Accepted: 10/13/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND This systematic review and meta-analysis assessed the effectiveness of robotic surgery compared to laparoscopy or open surgery for inguinal (IHR) and ventral (VHR) hernia repair. METHODS PubMed and EMBASE were searched up to July 2022. Meta-analyses were performed for postoperative complications, surgical site infections (SSI), seroma/hematoma, hernia recurrence, operating time (OT), intraoperative blood loss, intraoperative bowel injury, conversion to open surgery, length of stay (LOS), mortality, reoperation rate, readmission rate, use of opioids, time to return to work and time to return to normal activities. RESULTS Overall, 64 studies were selected and 58 were used for pooled data analyses: 35 studies (227 242 patients) deal with IHR and 32 (158 384 patients) with VHR. Robotic IHR was associated with lower hernia recurrence (OR 0.54; 95%CI 0.29, 0.99; I2: 0%) compared to laparoscopic IHR, and lower use of opioids compared to open IHR (OR 0.46; 95%CI 0.25, 0.84; I2: 55.8%). Robotic VHR was associated with lower bowel injuries (OR 0.59; 95%CI 0.42, 0.85; I2: 0%) and less conversions to open surgery (OR 0.51; 95%CI 0.43, 0.60; I2: 0%) compared to laparoscopy. Compared to open surgery, robotic VHR was associated with lower postoperative complications (OR 0.61; 95%CI 0.39, 0.96; I2: 68%), less SSI (OR 0.47; 95%CI 0.31, 0.72; I2: 0%), less intraoperative blood loss (- 95 mL), shorter LOS (- 3.4 day), and less hospital readmissions (OR 0.66; 95%CI 0.44, 0.99; I2: 24.7%). However, both robotic IHR and VHR were associated with significantly longer OT compared to laparoscopy and open surgery. CONCLUSION These results support robotic surgery as a safe, effective, and viable alternative for IHR and VHR as it can brings several intraoperative and postoperative advantages over laparoscopy and open surgery.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France.
- Faculty of Medicine, University of Paris Cité, Paris, France.
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France.
| | - David Moszkowicz
- Service de Chirurgie Générale et Digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, Colombes, France
| | | | - Régis Fara
- Department of Digestive Surgery, Hôpital Européen, Marseille, France
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | | | - Caroline Gronnier
- Eso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Jérôme Loriau
- Department of Digestive Surgery, St-Joseph Hospital, Paris, France
| | - Muriel Mathonnet
- Department of General, Endocrine and Digestive Surgery, University Hospital of Limoges, Limoges, France
| | - Olivier Oberlin
- Service de Chirurgie, Groupe Hospitalier Privé Ambroise-Paré - Hartmann, Paris, France
| | - Manuela Perez
- Département de chirurgie viscérale, métabolique et cancérologie (CVMC), CHRU de Nancy-hôpitaux de Brabois, Vandœuvre-lès-Nancy, France
| | - Yohann Renard
- Departement of General Surgery, Reims Champagne-Ardenne University, Reims, France
| | - Benoît Romain
- Department of Digestive Surgery, Strasbourg University, Strasbourg, France
| | - Guillaume Passot
- Department of Surgical Oncology, Hopital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Patrick Pessaux
- Visceral and Digestive Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France
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Sanchez A, Herrera L, Teixeira A, Cheatham M, Gibson D, Lam V, Guevara O. Improving efficiency and reducing costs in robotic surgery: a Lean Six Sigma approach to optimize turnover time. J Robot Surg 2023; 17:2059-2064. [PMID: 37191820 DOI: 10.1007/s11701-023-01606-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/23/2023] [Indexed: 05/17/2023]
Abstract
Operating room (OR) turnover time (TOT) is the time it takes to prepare an OR for the next surgery after the previous one has been completed. Reducing OR TOT can improve the efficiency of the OR, reduce costs, and improve surgeons' and patients' satisfaction. The objective of this study is to evaluate the effectiveness of an operating room (OR) turnover time (TOT) reduction initiative using the Lean Six Sigma methodology (DMAIC) in the bariatric and thoracic service lines. Performance improvement strategies consist of simplifying steps (surgical tray optimization) and concurrent steps (parallel task execution). We compared 2-month pre-implementation vs. post-implementation. A paired t-test was used to assess whether the difference in the measurements was statistically significant. The study found that TOT was reduced by 15.6% from an average of 35.6 ± 8.1 to minutes 30.09 ± 9.7 min (p < 0.05). Specifically, in the bariatric service line, TOT was reduced by 17.15% and in the thoracic service line, TOT was reduced by 9.6%. No adverse events related to the initiative were reported. The results of this study indicate that the TOT reduction initiative was effective in reducing TOT. The efficient use of operating rooms is crucial in hospital management, as it not only impacts finances but also affects the satisfaction of surgical teams and patients. This study shows the effectiveness of Lean Six Sigma methodology in reducing TOT and improving the efficiency in the OR.
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Affiliation(s)
- Alexis Sanchez
- Orlando Health Robotic Surgery Program, Orlando, FL, USA.
| | - Luis Herrera
- Rod Taylor Thoracic Cancer Care Center, Orlando Health, Orlando, FL, USA
| | - Andre Teixeira
- Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, FL, USA
| | | | - Desrene Gibson
- Chief Surgical Quality Office, ORMC, Orlando Health, Orlando, FL, USA
| | - Victoria Lam
- Orlando Health Robotic Surgery Program, Orlando, FL, USA
| | - Oriana Guevara
- Orlando Health Robotic Surgery Program, Orlando, FL, USA
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Tokuno J, Carver TE, Fried GM. Measurement and Management of Cognitive Load in Surgical Education: A Narrative Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:208-215. [PMID: 36335034 DOI: 10.1016/j.jsurg.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/18/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cognitive load should be considered in designing optimal educational programs in health care. Despite the highly demanding nature of surgery and surgical education, a consensus on how to manage cognitive load has not been established. The objective of this review is to map out how recent surgical education research incorporates cognitive load. METHODS A literature search was performed using keywords related to cognitive load and digital education up to December 2021. Studies published in English relevant to assessment and management of cognitive load in surgical education were included. Terminology, assessment tools, association with different surgical procedures and training modalities, and programs considering cognitive load were reported. RESULTS We identified several terms to describe cognitive load. Cognitive load was measured by subjective, self-reported questionnaires and by objective measurements, such as physiological parameters or estimated by reaction time to secondary tasks. Subjective measurements reported cognitive load in one or multiple dimensions. Correlations between subjective and objective measurements were shown in multiple studies. Overall, higher cognitive load was observed in training for more complex tasks and high-fidelity modalities, and among less experienced trainees. Cognitive load theory has been lately incorporated into designing teaching programs. CONCLUSIONS A broad range of terms and assessment tools were identified for cognitive load. To maximize the learning outcome, management of cognitive load is necessary in surgical education. This review summarizes the current knowledge in assessment and management of cognitive load in surgical education and provides suggestions for future studies.
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Affiliation(s)
- Junko Tokuno
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Science, Montreal, Quebec, Canada
| | - Tamara E Carver
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Science, Montreal, Quebec, Canada; Department of Surgery, McGill University, Montreal, Quebec, Canada; Institute for Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Gerald M Fried
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Department of Surgery, McGill University, Montreal, Quebec, Canada; Institute for Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
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Shugaba A, Lambert JE, Bampouras TM, Nuttall HE, Gaffney CJ, Subar DA. Should All Minimal Access Surgery Be Robot-Assisted? A Systematic Review into the Musculoskeletal and Cognitive Demands of Laparoscopic and Robot-Assisted Laparoscopic Surgery. J Gastrointest Surg 2022; 26:1520-1530. [PMID: 35426034 PMCID: PMC9296389 DOI: 10.1007/s11605-022-05319-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/26/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgeons are among the most at risk of work-related musculoskeletal health decline because of the physical demands of surgery, which is also associated with cognitive fatigue. Minimally invasive surgery offers excellent benefits to patients but the impact of robotic or laparoscopic surgery on surgeon well-being is less well understood. This work examined the musculoskeletal and cognitive demands of robot-assisted versus standard laparoscopic surgery. METHODS Medline, Embase and Cochrane databases were systematically searched for 'Muscle strain' AND 'musculoskeletal fatigue' AND 'occupational diseases' OR 'cognitive fatigue' AND 'mental fatigue' OR 'standard laparoscopic surgery' AND 'robot-assisted laparoscopic surgery'. Primary outcomes measured were electromyographic (EMG) activity for musculoskeletal fatigue and questionnaires (NASA-TLX, SMEQ, or Borg CR-10) for cognitive fatigue. A systematic review was conducted in accordance with the Synthesis Without Meta-analysis (SWiM) Guidelines. The study was preregistered on Prospero ID: CRD42020184881. RESULTS Two hundred and ninety-eight original titles were identified. Ten studies that were all observational studies were included in the systematic review. EMG activity was consistently lower in robotic than in laparoscopic surgery in the erector spinae and flexor digitorum muscles but higher in the trapezius muscle. This was associated with significantly lower cognitive load in robotic than laparoscopic surgery in 7 of 10 studies. CONCLUSIONS Evidence suggests a reduction in musculoskeletal demands during robotic surgery in muscles excluding the trapezius, and this is associated with most studies reporting a reduced cognitive load. Robotic surgery appears to have less negative cognitive and musculoskeletal impact on surgeons compared to laparoscopic surgery.
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Affiliation(s)
- Abdul Shugaba
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YG, UK.
- Royal Blackburn Hospital, East Lancashire NHS Hospitals Trust, Blackburn, BB2 3HH, UK.
| | - Joel E Lambert
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YG, UK
- Royal Blackburn Hospital, East Lancashire NHS Hospitals Trust, Blackburn, BB2 3HH, UK
| | | | - Helen E Nuttall
- Department of Psychology, Lancaster University, Lancaster, LA1 4YG, UK
| | | | - Daren A Subar
- Royal Blackburn Hospital, East Lancashire NHS Hospitals Trust, Blackburn, BB2 3HH, UK
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10
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Voskens FJ, van der Schans EM, Ruurda JP, Broeders IAMJ. Endoscopic surgery suturing techniques: a randomized study on learning. BMC Surg 2022; 22:59. [PMID: 35172810 PMCID: PMC8851769 DOI: 10.1186/s12893-022-01513-2] [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: 06/21/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgeons have widely adopted endoscopic suturing techniques using conventional laparoscopic instruments and the more advanced robotic systems. The FlexDex is a novel articulating laparoscopic needle driver providing enhanced dexterity in laparoscopic surgery. This study evaluates and compares the learning curve of endoscopic suturing with conventional laparoscopy, the FlexDex and robotic suturing in novices. METHODS Participants performed a minimal invasive suturing task in three different ways in a randomized order: with a conventional laparoscopic needle driver, using the FlexDex needle driver and third, using the Da Vinci Si surgical system. Primary outcome was suturing task time. Secondary outcome parameters were assessment of suturing quality and workload perception. RESULTS A total of 10 novice participants were included and completed a total of 300 sessions. Median (IQR) suturing time of the first 5 sessions was 231 s (188-291) in the laparoscopic group versus 378 s (282-471) in the FlexDex group versus 189 s (160-247) in the DaVinci Si group. The last 5 sessions showed significant reduction of median suturing time of 143 s (120-190), 232 s (180-265) and 172 s (134-199) respectively. Analysis identified that the learning curve for the laparoscopic needle driver and Da Vinci Si was reached in 5 sessions, compared to 8 sessions for the Flexdex. The laparoscopic needle driver and Da Vinci Si showed a significant shorter median suturing time compared to the FlexDex (p = 0.00). The FlexDex quality assessment scores were significantly lower compared to the laparoscopic (p = 0.00) and robotic (p = 0.00) scores and perceived workload remains high for the FlexDex users. CONCLUSIONS Ex vivo endoscopic suturing with the FlexDex demonstrated a prolonged learning curve compared to laparoscopic and robotic suturing. The learning curve of the FlexDex is fundamentally different from conventional laparoscopic and robotic instruments. This study provides further insights in the implementation and training of endoscopic suturing techniques.
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Affiliation(s)
- F J Voskens
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands. .,University of Twente, Robotics and Mechatronics, Enschede, The Netherlands.
| | - E M van der Schans
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands.,University of Twente, Robotics and Mechatronics, Enschede, The Netherlands
| | - J P Ruurda
- Department of Gastro-Intestinal and Oncologic Surgery, University Medical Center, Utrecht, The Netherlands
| | - I A M J Broeders
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands.,University of Twente, Robotics and Mechatronics, Enschede, The Netherlands
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Ou HC, Huang LH, Chang KH, Ou YC, Tung MC, Weng WC, Hsu CY, Lin YS, Lu CH, Tsao TY. Robotic Incisional Hernia Repair After Robotic-assisted Radical Prostatectomy (RARP): A 3-port Approach. In Vivo 2021; 34:3407-3412. [PMID: 33144448 DOI: 10.21873/invivo.12179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Incisional hernia is a complication that occurs occasionally, and surgical intervention is required to prevent more severe sequela. While there are several options for management, robotic-assisted incisional repair has not been well discussed yet. We herein report a case series of 10 patients who underwent robotic-assisted incisional hernia repair (RIHR) after robotic-assisted radical prostatectomy (RARP). The aim of the study was to examine the feasibility of incisional hernia repair with da Vinci® robotics. PATIENTS AND METHODS We recruited patients from a group of 2,000 consecutive patients who underwent RARP from December, 2005 to June, 2020 by a single surgeon. Patient characteristics included age, body mass index (BMI), PSA level, pathology Gleason score, and pathology TNM staging. The variants regarding the patients' incisional hernia included incisional hernia occurrence time after RARP, defect size, operation time, console time, blood loss, and follow-up time after the herniation occurrence. Furthermore, we established a defect size of 3x2 cm2 as the cutoff value for using mesh reinforcement or not. RESULTS The mean defect area was 27.7 cm2, and the average operative time was 114.8 min, with a mean console time of 87 min. Blood loss was 32.5 ml, and the hospital stay for all patients was 3 days without complications. The mean follow-up period was 29.5 months, with no recurrence. CONCLUSION RIHR is a feasible surgical method that is not inferior to the traditional open or laparoscopic repair. Furthermore, RIHR can possibly lessen the burden of both the surgeon and patient.
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Affiliation(s)
- Hsien-Che Ou
- Division of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan, R.O.C.,Post-graduate Year Training (PGY), Department of Medical Education, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Li-Hua Huang
- Division of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan, R.O.C
| | - Kuang-Hsi Chang
- Department of Research, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan, R.O.C.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C.,General Education Center, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan, R.O.C
| | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan, R.O.C. .,Post-graduate Year Training (PGY), Department of Medical Education, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.,Department of Research, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan, R.O.C
| | - Min-Che Tung
- Division of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan, R.O.C
| | - Wei-Chun Weng
- Division of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan, R.O.C
| | - Chao-Yu Hsu
- Division of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan, R.O.C
| | - Yi-Sheng Lin
- Division of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan, R.O.C
| | - Chin-Heng Lu
- Division of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan, R.O.C
| | - Tang-Yi Tsao
- Department of Anatomical Pathology, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan, R.O.C
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Are Surgeons Working Smarter or Harder? A Systematic Review Comparing the Physical and Mental Demands of Robotic and Laparoscopic or Open Surgery. World J Surg 2021; 45:2066-2080. [PMID: 33772324 DOI: 10.1007/s00268-021-06055-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Minimally invasive surgical techniques such as robotic surgical platforms have provided favourable outcomes for patients, but the impact on surgeons is not well described. This systematic review aims to synthesize and evaluate the physical and mental impact of robotic surgery on surgeons compared to standard laparoscopic or open surgery. METHODS A search strategy was developed to identify peer-reviewed English articles published from inception to end of December 2019 on the following databases: MEDLINE, PubMed, PsycINFO and Embase. The articles were assessed using a modified Newcastle-Ottawa tool. RESULTS Of the 6563 papers identified, 30 studies were included in the qualitative synthesis of this review. Most of the included studies presented a high risk of bias. A total of 13 and 21 different physical and mental tools, respectively, were used to examine the impact on surgeons. The most common tool used to measure physical and mental demand were surface electromyography (N = 9) and the NASA Task Load Index (NASA-TLX; N = 8), respectively. Majority of studies showed mixed results for physical (N = 10) and mental impact (N = 7). This was followed by eight and six studies favouring RS over other surgical modalities for physical and mental impact, respectively. CONCLUSION Most studies showed mixed physical and mental outcomes between the three surgical modalities. There was a high risk of bias and methodological heterogeneity. Future studies need to correlate mental and physical stress with long-term impact on the surgeons.
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Berzenji L, Yogeswaran K, Van Schil P, Lauwers P, Hendriks JMH. Use of Robotics in Surgical Treatment of Non-small Cell Lung Cancer. Curr Treat Options Oncol 2020; 21:80. [PMID: 32767154 DOI: 10.1007/s11864-020-00778-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OPINION STATEMENT Robotic-assisted videothoracoscopic surgery (R-VATS) has become increasingly popular and widely used since its introduction and is nowadays considered a standard treatment approach in many centres for the treatment of non-small cell lung cancer. R-VATS was initially developed to overcome the drawbacks of VATS by offering surgeons more flexibility and three-dimensional optics during thoracoscopic surgery. The effectiveness of R-VATS lobectomy regarding oncological outcomes, morbidity, mortality, and postoperative quality of life (QoL) has been shown in an increasing number of studies. More recently, these results have also been corroborated for sublobar resections, more specifically for segmentectomy. However, no well-powered, multicentre randomized trials have been performed to demonstrate the superiority of R-VATS compared with open surgery or conventional types of VATS (total VATS, uniportal VATS, etc.). The majority of the evidence currently available is based on non-randomized studies, and many studies report conflicting results when comparing R-VATS and conventional VATS. Moreover, there is a lack of data regarding the cost and the cost-efficiency of robotic surgery compared with VATS and open surgery. Current evidence suggests that R-VATS costs are higher than VATS and that a deficit can only be prevented when up to 150-300 thoracic surgery procedures are performed annually. Finally, robotic-assisted laparoscopic surgery showed better ergonomics and reduced musculoskeletal disorders compared with non-robotic laparoscopic surgery.
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Affiliation(s)
- Lawek Berzenji
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium
| | - Krishan Yogeswaran
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium.
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Robot-assisted abdominal wall surgery: a systematic review of the literature and meta-analysis. Hernia 2018; 23:17-27. [PMID: 30523566 DOI: 10.1007/s10029-018-1872-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 12/02/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The number of robot-assisted hernia repairs is increasing, but the potential benefits have not been well described. The aim of this study was to evaluate the available literature reporting on outcomes after robot-assisted hernia repairs. METHODS This is a qualitative review and meta-analysis of papers evaluating short-term outcomes after inguinal or ventral robot-assisted hernia repair compared with either open or laparoscopic approach. The primary outcome was postoperative complications and secondary outcomes were duration of surgery, postoperative length of stay and financial costs. RESULTS Fifteen studies were included. Postoperative complications were significantly decreased after robot-assisted inguinal hernia repair compared with open repair. There were no differences in complications between robot-assisted and laparoscopic inguinal hernia repair. For ventral hernia repair, sutured closure of the defect, retromuscular mesh placement and transversus abdominis release is feasible when using the robot. Length of stay was decreased by a mean of 3 days for robot-assisted repairs compared with open approach. There were no differences in postoperative complications and the operative time was significantly longer for robot-assisted ventral hernia repair compared with laparoscopic or open approach. CONCLUSIONS For ventral hernias that would normally require an open procedure, a robot-assisted repair may be a good option, as the use of a minimally invasive approach for these procedures decreases length of stay significantly. For inguinal hernias, the benefit of the robot is questionable. Randomized controlled trials and prospective studies are needed.
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Ergonomics of minimally invasive surgery: an analysis of muscle effort and fatigue in the operating room between laparoscopic and robotic surgery. Surg Endosc 2018; 33:2323-2331. [DOI: 10.1007/s00464-018-6515-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022]
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