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Cadière GB, Himpens J, Poras M, Boyer N, Cadière B. Feasibility and Safety Study of the Use of a New Robot (Maestro™) for Laparoscopic Surgery. Obes Surg 2024; 34:3561-3568. [PMID: 39090429 DOI: 10.1007/s11695-024-07409-9] [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: 04/22/2024] [Revised: 07/01/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND In laparoscopic surgery, telerobotic systems such as Da Vinci™ were developed, among other things, to give back exposure and vision control to the operating surgeon. However, new limitations such as the separation of the operating surgeon from the operating table, cost, and size were unveiled. A new device, Maestro™, appears promising in addressing these limitations. The current work evaluates the feasibility, safety, and surgeon satisfaction with the assistance provided by the Maestro System. METHODS Non-consecutive patients who were candidates for laparoscopic digestive surgery were enrolled in a descriptive prospective, monocentric study. Case selection was solely based on the availability of the device, but not on the patient's characteristics. Surgery was performed by a leading surgeon with the help of one less experienced surgeon. Feasibility was defined by the maintenance of the initial surgical plan. Safety was assessed by the absence of serious adverse events related to the device and surgeon satisfaction was evaluated by a questionnaire following the intervention. RESULTS All 50 procedures were completed without conversion in laparotomy and without adjustment of the surgical team. Four complications were recorded during the study; however, none related to the use of the Maestro System. In 92% of the cases, the surgeon was satisfied with the assistance provided by the Maestro System. CONCLUSIONS In standard elective digestive procedures by laparoscopy, the use of the Maestro System is feasible and safe. It is beneficial to the surgeon and operative room organization by limiting the size of the surgical team.
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Affiliation(s)
| | - Jacques Himpens
- Digestive Surgery, Hôpital Universitaire St Pierre, ULB, Brussels, Belgium
| | - Mathilde Poras
- Digestive Surgery, Hôpital Universitaire St Pierre, ULB, Brussels, Belgium.
- CHU St Pierre, Brussels, Belgium.
| | - Nicolas Boyer
- Digestive Surgery, Hôpital Universitaire St Pierre, ULB, Brussels, Belgium
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Celotto F, Ramacciotti N, Mangano A, Danieli G, Pinto F, Lopez P, Ducas A, Cassiani J, Morelli L, Spolverato G, Bianco FM. Da Vinci single-port robotic system current application and future perspective in general surgery: A scoping review. Surg Endosc 2024; 38:4814-4830. [PMID: 39110221 PMCID: PMC11362253 DOI: 10.1007/s00464-024-11126-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/27/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND The da Vinci Single-Port Robot System (DVSP) allows three robotic instruments and an articulated scope to be inserted through a single small incision. It received FDA approval in 2014 and was first introduced in 2018. The aim of this new system was to overcome the limitations of single-incision laparoscopic and robotic surgery. Since then, it has been approved for use only for urologic and transoral surgeries in some countries. It has been used as part of experimental protocols in general surgery. OBJECTIVE By obtaining the CE mark at the end of January 2024, DVSP will soon enter the European market. This review aims to comprehensively describe the applications of DVSP in general surgery. DESIGN A search of PubMed, Embase, and Ebsco databases up to March 2024 was conducted, with registration in PROSPERO (CRD42024536430), following the preferred reporting items for Systematic reviews and Meta-analyses for scoping review (PRISMA-Scr) guidelines. All the studies about the use of DVSP in general surgery were included. RESULTS Fifty-six studies were included. The following surgical areas of use were identified: transabdominal and transanal colorectal, cholecystectomy, abdominal wall repair, upper gastroesophageal tract, liver, pancreas, breast, and thyroid surgery. The reported surgical and short-term outcomes are promising; a wide range of procedures have been performed safely. Some groups have found advantages, such as faster discharge, shorter operative time, and less postoperative pain compared to multiport robotic surgery. CONCLUSION Five years after its initial clinical applications, the use of the DVSP in general surgery procedures has demonstrated feasibility and safety. Hernia repair, cholecystectomy, and colorectal surgery emerge as the most frequently conducted interventions with this robotic system. Nevertheless, there is anticipation for further studies with larger sample sizes and extended follow-up periods to provide more comprehensive insights and data on the long-term outcomes, including the incidence of incisional hernia.
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Affiliation(s)
- Francesco Celotto
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.
| | - Niccolò Ramacciotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alberto Mangano
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Giacomo Danieli
- Unit of Biostatistics, Epidemiology and Public Health (UBEP), Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Federico Pinto
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Paula Lopez
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Alvaro Ducas
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Jessica Cassiani
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Luca Morelli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gaya Spolverato
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Francesco Maria Bianco
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
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Ceccarelli G, Catena F, Avella P, Tian BW, Rondelli F, Guerra G, De Rosa M, Rocca A. Emergency robotic surgery: the experience of a single center and review of the literature. World J Emerg Surg 2024; 19:28. [PMID: 39154016 PMCID: PMC11330055 DOI: 10.1186/s13017-024-00555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/22/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUNDS Laparoscopic surgery is widely used in abdominal emergency surgery (AES), and the possibility of extending this approach to the more recent robotic surgery (RS) arouses great interest. The slow diffusion of robotic technology mainly due to high costs and the longer RS operative time when compared to laparoscopy may represent disincentives, especially in AES. This study aims to report our experience in the use of RS in AES assessing its safety and feasibility, with particular focus on intra- and post-operative complications, conversion rate, and surgical learning curve. Our data were also compared to other experiences though an extensive literature review. METHODS We retrospectively analysed a single surgeon series of the last 10 years. From January 2014 to December 2023, 36 patients underwent urgent or emergency RS. The robotic devices used were Da Vinci Si (15 cases) and Xi (21 cases). RESULTS 36 (4.3%) out of 834 robotic procedures were included in our analysis: 20 (56.56%) females. The mean age was 63 years and 30% of patients were ≥ 70 years. 2 (5.55%) procedures were performed at night. No conversions to open were reported in this series. According to the Clavien-Dindo classification, 2 (5.5%) major complications were collected. Intraoperative and 30-day mortality were 0%. CONCLUSIONS Our study demonstrates that RS may be a useful and reliable approach also to AES and intraoperative laparoscopic complications when performed in selected hemodynamically stable patients in very well-trained robotic centers. The technology may increase the minimally invasive use and conversion rate in emergent settings in a completely robotic or hybrid approach.
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Affiliation(s)
- Graziano Ceccarelli
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Fausto Catena
- Division of General Surgery, Bufalini Hospital, Cesena, Italy
| | - Pasquale Avella
- Department of General Surgery and Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy.
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy.
| | - Brian Wca Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Fabio Rondelli
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Germano Guerra
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Michele De Rosa
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Aldo Rocca
- Department of General Surgery and Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
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Watanabe T, Sasaki K, Nozawa H, Murono K, Emoto S, Matsuzaki H, Yokoyama Y, Abe S, Nagai Y, Shinagawa T, Sonoda H, Sukchol L, Ishihara S. Robotic Versus Laparoscopic Abdominoperineal Resection for Locally Advanced Rectal Cancer Following Preoperative Chemoradiotherapy. In Vivo 2024; 38:1834-1840. [PMID: 38936926 PMCID: PMC11215614 DOI: 10.21873/invivo.13636] [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: 04/01/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND/AIM The usefulness of robotic surgery compared to laparoscopic surgery for rectal cancer has been reported; however, few reports exist on robotic abdominoperineal resection (APR). The aim of this study was to compare the outcomes of robotic and laparoscopic surgery to determine their usefulness in patients with locally advanced rectal cancer who had undergone preoperative chemoradiotherapy (CRT). PATIENTS AND METHODS This retrospective study included 43 patients with locally advanced rectal cancer who underwent preoperative CRT and robotic (22 patients) or laparoscopic APR (21 patients) between December 2012 and September 2022. We examined the short- and long-term outcomes in the robotic and laparoscopic groups. RESULTS The median follow-up durations were 36 and 48 months for the robotic and laparoscopic groups, respectively. No significant differences in operative time, intraoperative blood loss, or overall complication rates were observed. However, the incidence of organ/space surgical site infection (SSI) was significantly lower in the robotic surgery group than in the laparoscopic group (9.1% vs. 38.1%, p=0.034) and the 3-year overall survival rate was significantly higher in the robotic surgery group than in the laparoscopic group (95% vs. 67%, p=0.029). CONCLUSION Robotic APR was associated with a significantly lower rate of organ/space SSIs than the laparoscopic approach, indicating the usefulness of the robotic approach.
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Affiliation(s)
- Tatsuki Watanabe
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Matsuzaki
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuichiro Yokoyama
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinya Abe
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuzo Nagai
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takahide Shinagawa
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Lim Sukchol
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Perri D, Rocco B, Sighinolfi MC, Bove P, Pastore AL, Volpe A, Minervini A, Antonelli A, Zaramella S, Galfano A, Cacciamani GE, Celia A, Dalpiaz O, Crivellaro S, Greco F, Pini G, Porreca A, Pacchetti A, Calcagnile T, Berti L, Buizza C, Mazzoleni F, Bozzini G. Open versus Robot-Assisted Radical Cystectomy for the Treatment of pT4a Bladder Cancer: Comparison of Perioperative Outcomes. Cancers (Basel) 2024; 16:1329. [PMID: 38611006 PMCID: PMC11011112 DOI: 10.3390/cancers16071329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/17/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
We compared the perioperative outcomes of open (ORC) vs. robot-assisted (RARC) radical cystectomy in the treatment of pT4a MIBC. In total, 212 patients underwent ORC (102 patients, Group A) vs. RARC (110 patients, Group B) for pT4a bladder cancer. Patients were prospectively followed and retrospectively reviewed. We assessed operative time, estimated blood loss (EBL), intraoperative and postoperative complications, length of stay, transfusion rate, and oncological outcomes. Preoperative features were comparable. The mean operative time was 232.8 vs. 189.2 min (p = 0.04), and mean EBL was 832.8 vs. 523.7 mL in Group A vs. B (p = 0.04). An intraoperative transfusion was performed in 32 (31.4%) vs. 11 (10.0%) cases during ORC vs. RARC (p = 0.03). The intraoperative complications rate was comparable. The mean length of stay was shorter after RARC (12.6 vs. 7.2 days, p = 0.02). Postoperative transfusions were performed in 36 (35.3%) vs. 13 (11.8%) cases (p = 0.03), and postoperative complications occurred in 37 (36.3%) vs. 29 (26.4%) patients in Groups A vs. B (p = 0.05). The positive surgical margin (PSM) rate was lower after RARC. No differences were recorded according to the oncological outcomes. ORC and RARC are feasible treatments for the management of pT4a bladder tumors. Minimally invasive surgery provides shorter operative time, bleeding, transfusion rate, postoperative complications, length of stay, and PSM rate.
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Affiliation(s)
- Davide Perri
- Department of Urology, ASST Lariana, 22100 Como, Italy (G.B.)
| | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | | | - Pierluigi Bove
- Department of Urology, Ospedale San Carlo di Nancy, 00165 Rome, Italy
| | | | - Alessandro Volpe
- Department of Urology, Ospedale Maggiore della Carità, 28100 Novara, Italy
| | - Andrea Minervini
- Department of Urology, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy
| | | | | | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | | | - Antonio Celia
- Department of Urology, Ospedale San Bassiano, 36061 Bassano del Grappa, Italy
| | - Orietta Dalpiaz
- Department of Urology, Medical University of Graz, 8010 Graz, Austria
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Francesco Greco
- Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy
| | | | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme, 35031 Padova, Italy
| | | | | | - Lorenzo Berti
- Department of Urology, Ospedale di Busto Arsizio, 21052 Busto Arsizio, Italy
| | - Carlo Buizza
- Department of Urology, Ospedale di Busto Arsizio, 21052 Busto Arsizio, Italy
| | | | - Giorgio Bozzini
- Department of Urology, ASST Lariana, 22100 Como, Italy (G.B.)
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Jebakumar SGS, Swain SK, Munikrishnan V, Jayapal L, Kumar RS, Baskaran A, Tasgaonkar S, Srivatsan S. Robotic hernia repair with the novel HUGO robot system - An initial experience from a tertiary centre. J Minim Access Surg 2024:01413045-990000000-00041. [PMID: 38340085 DOI: 10.4103/jmas.jmas_193_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/25/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Hernia repair using robotic platforms has been on the rise in the last decade. The HUGO robotic-assisted surgery (RAS) system, introduced in 2021, is a new addition to the field. In this study, we share our experience with this innovative system for the management of ventral and groin hernias. PATIENTS AND METHODS The aim of our study was to evaluate the feasibility and safety of using the HUGO robotic platform for hernia surgeries. We conducted a retrospective analysis of all hernia surgeries performed with the HUGO system over a 1-year study period. The study assessed various aspects, including the technical manoeuvres of the robotic system, duration of surgery, length of hospital stay, post-operative pain levels and 30-day morbidity rates. RESULTS AND CONCLUSIONS A total of seven hernia surgeries were performed using the HUGO system, including five ventral hernias and two groin hernias. The average duration of surgery was 128 min, with a docking duration of 22.8 min. Notably, there were no intraoperative or post-operative adverse events reported during these procedures. The HUGO system features an open console that provides a panoramic view of the operating room. In addition, the individual arm carts can be easily manoeuvred around the operating table, facilitating improved access to multiple quadrants during surgery. In our case series, Robotic hernia repair using the HUGO system has demonstrated feasibility, with post-operative outcomes comparable to traditional approaches. This innovative system serves as an additional tool in the armamentarium of hernia surgery and shows potential for improving surgical outcomes. However, further investigation through large-scale prospective studies is necessary to comprehensively evaluate its efficacy and benefits.
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Yeung TM, Larkins KM, Warrier SK, Heriot AG. The rise of robotic colorectal surgery: better for patients and better for surgeons. J Robot Surg 2024; 18:69. [PMID: 38329595 DOI: 10.1007/s11701-024-01822-z] [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: 07/27/2023] [Accepted: 01/10/2024] [Indexed: 02/09/2024]
Abstract
Robotic colorectal surgery represents a major technological advancement in the treatment of patients with colorectal disease. Several recent randomized controlled trials comparing robotic colorectal surgery with laparoscopic surgery have demonstrated improved short-term patient outcomes in the robotic group. Whilst the primary focus of research in robotic surgery has been on patient outcomes, the robotic platform also provides unparalleled benefits for the surgeon, including improved ergonomics and surgeon comfort, with the potential to reduce occupational injuries and prolong career longevity. It is becoming clear that robotic surgical systems improve patient outcomes and may provide significant benefits to the surgical workforce.
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Affiliation(s)
- Trevor M Yeung
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC, 3000, Australia.
- Department of Colorectal Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Kirsten M Larkins
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC, 3000, Australia
| | - Satish K Warrier
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC, 3000, Australia
| | - Alexander G Heriot
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC, 3000, Australia
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8
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Clanahan JM, Awad MM, Dimou FM. Use of targeted educational resources to improve robotic bariatric surgery training. Surg Endosc 2024; 38:894-901. [PMID: 37823946 DOI: 10.1007/s00464-023-10436-9] [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: 03/31/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Evidence for how to best train surgical residents for robotic bariatric procedures is lacking. We developed targeted educational resources to promote progression on the robotic bariatric learning curve. This study aimed to characterize the effect of resources on resident participation in robotic bariatric procedures. METHODS Performance metrics from the da Vinci Surgical System were retrospectively reviewed for sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) cases involving general surgery trainees with a single robotic bariatric surgeon. Pictorial case guides and narrated operative videos were developed for these procedures and disseminated to trainees. Percent active control time (%ACT)-amount of trainee console time spent in active instrument manipulations over total active time from both consoles-was the primary outcome measure following dissemination. One-way ANOVA, Student's t-tests, and Pearson correlations were applied. RESULTS From September 2020 to July 2021, 50 cases (54% SG, 46% RYGB) involving 14 unique trainees (PGY1-PGY5) were included. From November 2021 to May 2022 following dissemination, 29 cases (34% SG, 66% RYGB) involving 8 unique trainees were included. Mean %ACT significantly increased across most trainee groups following resource distribution: 21% versus 38% for PGY3s (p = 0.087), 32% versus 45% for PGY4s (p = 0.0009), and 38% versus 57% for PGY5s (p = 0.0015) and remained significant when stratified by case type. Progressive trainee %ACT was not associated with total active time for SG cases before or after intervention (pre r = - 0.0019, p = 0.9; post r = - 0.039, p = 0.9). It was moderately positively associated with total active time for RYGB cases before dissemination (r = 0.46, p = 0.027) but lost this association following intervention (r = 0.16, p = 0.5). CONCLUSION Use of targeted educational resources promoted increases in trainee participation in robotic bariatric procedures with more time spent actively operating at the console. As educators continue to develop robotic training curricula, efforts should include high-quality resource development for other sub-specialty procedures. Future work will examine the impact of increased trainee participation on clinical and patient outcomes.
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Affiliation(s)
- Julie M Clanahan
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Surgery, Washington University in St. Louis, 660 South Euclid Avenue, Mailstop 8109-22-9905, St. Louis, MO, 63110-1093, USA.
| | - Michael M Awad
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca M Dimou
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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9
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Taha A, Taha-Mehlitz S, Bach L, Ochs V, Bardakcioglu O, Honaker MD, Cattin PC. Robotic colorectal surgery: quality assessment of patient information available on the internet using webscraping. Comput Assist Surg (Abingdon) 2023; 28:2187275. [PMID: 36905397 DOI: 10.1080/24699322.2023.2187275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
The primary goal of this study is to assess current patient information available on the internet concerning robotic colorectal surgery. Acquiring this information will aid in patients understanding of robotic colorectal surgery. Data was acquired through a web-scraping algorithm. The algorithm used two Python packages: Beautiful Soup and Selenium. The long-chain keywords incorporated into Google, Bing and Yahoo search engines were 'Da Vinci Colon-Rectal Surgery', 'Colorectal Robotic Surgery' and 'Robotic Bowel Surgery'. 207 websites resulted, were sorted and evaluated according to the ensuring quality information for patients (EQIP) score. Of the 207 websites visited, 49 belonged to the subgroup of hospital websites (23.6%), 46 to medical centers (22.2%), 45 to practitioners (21.7%), 42 to health care systems (20,2%), 11 to news services (5.3%), 7 to web portals (3.3%), 5 to industry (2.4%), and 2 to patient groups (0.9%). Only 52 of the 207 websites received a high rating. The quality of available information on the internet concerning robotic colorectal surgery is low. The majority of information was inaccurate. Medical facilities involved in robotic colorectal surgery, robotic bowel surgery and related robotic procedures should develop websites with credible information to guide patient decisions.
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Affiliation(s)
- Anas Taha
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | - Stephanie Taha-Mehlitz
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Laura Bach
- Faculty of Medicine, University of Erlangen, Erlangen, Germany
| | - Vincent Ochs
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
| | | | - Michael D Honaker
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Philippe C Cattin
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Allschwil, Switzerland
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10
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Marks JH, Yang J, Spitz EM, Salem J, Agarwal S, de Paula TR, Schoonyoung HP, Keller DS. A prospective phase II clinical trial/IDEAL Stage 2a series of single-port robotic colorectal surgery for abdominal and transanal cases. Colorectal Dis 2023; 25:2335-2345. [PMID: 37907449 DOI: 10.1111/codi.16788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/30/2023] [Accepted: 09/17/2023] [Indexed: 11/02/2023]
Abstract
AIM Slow laparoscopy adoption accelerated the uptake of robotic surgery. However, the current robotic platforms have limitations in transanal applications and multiple port sites. The da Vinci single-port (SP) robot is currently used on trial for colorectal surgery, and broad assessment of outcomes is needed. We aimed to report findings of a phase II clinical trial of SP robotic colorectal surgery. METHODS A sequentially reported prospective case series was performed on patients using SP robotics at a tertiary referral centre from 1 October 2018 to 31 August 2021. Cases were stratified into abdominal and transanal cohorts. Demographics, intra-operative variables and 30-day postoperative outcomes were evaluated. Univariate analysis was performed, with statistical process control for the docking process. Main outcomes were conversion rates, morbidity, mortality and point of standardization of docking. RESULTS In all, 133 patients were included: 93 (69.92%) abdominal and 40 (30.08%) transanal. The main diagnosis was rectal cancer (n = 59) and the procedure performed a robotic transanal abdominal transanal radical proctosigmoidectomy (n = 30). There were no conversions to open surgery. Two abdominal (2.15%) and three transanal cases (7.50%) were converted to laparoscopy. All colorectal adenocarcinomas had negative margins, proper lymph node harvest and complete mesorectal excision, as appropriate. Docking became a standardized process at cases 34 (abdominal) and 23 (anorectal). After surgery, bowel function returned on mean day 2 (abdominal) and 1 (transanal). The morbidity rate was 15.05% (abdominal) and 27.50% (transanal). There were two major morbidities in each cohort. Overall, there were three (2.65%) readmissions, one reoperation and no mortality. CONCLUSIONS Single-port robotics is feasible for all types of colorectal procedures, with good clinical and oncological outcomes. With this development in colorectal surgery, further studies can develop best practices with this novel technology.
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Affiliation(s)
- John H Marks
- Lankenau Institute for Medical Research and Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Jane Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Elizabeth M Spitz
- Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Jean Salem
- Department of Surgery, Saline Health System, Benton, Arkansas, USA
| | - Samir Agarwal
- Department of Surgery, Physician First Group, Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Thais Reif de Paula
- Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Henry P Schoonyoung
- Lankenau Institute for Medical Research and Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Deborah S Keller
- Lankenau Institute for Medical Research and Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
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11
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Kakkilaya HB, Ganapathi SK, Christopher PJ, Pawar J, Maharaj R, Subbiah R, Rudhramoorthy S, Chinnusamy P. Robotic Totally Extraperitoneal Hernia Repair: An Initial Experience with Cambridge Medical Robotics Versius. J Laparoendosc Adv Surg Tech A 2023; 33:1167-1175. [PMID: 37906106 DOI: 10.1089/lap.2023.0282] [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] [Indexed: 11/02/2023] Open
Abstract
Background: Total extraperitoneal approach for laparoscopic inguinal hernia repair (L-TEP) allows for better dissection, lesser chance of bowel injury, and quicker operating time. However robotic groin hernia repair is currently performed only through transabdominal route as it allows for more mobility of the arms. This study is aimed at studying the feasibility and outcomes of robotic totally extraperitoneal (R-TEP). Methods: A prospective nonrandomized comparative study was conducted to compare R-TEP with L-TEP. Out of a total of 88 patients with inguinal hernia, 44 patients underwent R-TEP and other 44 patients underwent L-TEP over a period of 15 months. All R-TEP were performed with Cambridge Medical Robotics (CMR) Versius. The outcomes were analyzed over a minimum follow-up period of 6 months. Results: All patients were males with a mean age of 45.9 years. Average body mass index was 28.7. Mean docking time for R-TEP was 12.7 minutes. Overall time taken for R-TEP (mean 60.47 minutes) was significantly higher (P < .001) than L-TEP (mean 38.45 minutes). When the console time of R-TEP and overall time of L-TEP were compared, there was no significant difference (P = .053). A RCT (RIVAL Trial) conducted by Prabhu et al. showed their robotic transabdominal preperitoneal (R-TAPP) time of median 75.5 (59.0-93.8) minutes. Kimberly et al. had their overall time of 77.5 minutes and Andre Luiz et al. had a console time of 58 minutes. When we compared the data, the overall time of R-TEP is lesser compared with R-TAPP. Postoperative pain on POD-1 showed that the robotic group had significantly lower pain. There were no recurrences noted in the study period. Conclusion: With our study, we have shown that R-TEP performed using the principle of laparoscopic triangulation technique with CMR Versius is feasible and reproducible. Although the overall time is significantly more in R-TEP when compared with L-TEP, console times of R-TEP and overall times of L-TEP were very similar. Console times of R-TEP are much lesser compared with other studies on R-TAPP. R-TEP can be a better alternative to R-TAPP and can be considered at par with L-TEP. A systematic RCT would provide a better picture.
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Affiliation(s)
| | - Senthil Kumar Ganapathi
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
| | | | - Jayadatt Pawar
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
| | - Rajiv Maharaj
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
| | - Rajapandian Subbiah
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
| | | | - Palanivelu Chinnusamy
- Department of Surgical Gastroenterology, GEM Hospital and Research Center, Coimbatore, India
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12
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Kallidonis P, Tatanis V, Peteinaris A, Katsakiori P, Gkeka K, Faitatziadis S, Vagionis A, Vrettos T, Stolzenburg JU, Liatsikos E. Robot-assisted pyeloplasty for ureteropelvic junction obstruction: initial experience with the novel avatera system. World J Urol 2023; 41:3155-3160. [PMID: 37668715 DOI: 10.1007/s00345-023-04586-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE This pilot study was designed to interpret the technically specific features of the avatera robotic system and present our initial experience with this novel platform in robot-assisted pyeloplasty (RAP). METHODS A single-center prospective study was conducted including all patients who underwent RAP with the avatera robotic system from June 2022 to October 2022 in our Department. Transperitoneal robot-assisted dismembered pyeloplasty was performed in all cases. The trocar placement and the surgical technique were similar in all patients. The successful completion of the procedures, operation time (including draping, docking and console time), decrease in hemoglobin postoperatively, and presence of any complications were the study's primary endpoints. RESULTS In total, nine patients underwent RAP using the avatera system. All procedures were successfully completed. The draping of the robotic unit was completed in a median time of 10 min (range 7-15), while the median docking time was 17 min (range 10-24). The median console time was 88 min (range 78-116) and no complications were noticed. The median hemoglobin drop was calculated to 0.7 g/dL (range 0.4-1). During the mean follow-up of 9.33 ± 2.78 months, no late postoperative complications were noticed. CONCLUSION The early outcomes of the use of the novel avatera system in RAP are presented. All operations were successfully completed with safety and efficacy, without complications or significant blood loss.
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Affiliation(s)
| | | | | | | | | | | | | | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece.
- Department of Urology, Medical University of Vienna, Vienna, Austria.
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.
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13
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Żelechowski M, Faludi B, Karnam M, Gerig N, Rauter G, Cattin PC. Automatic patient positioning based on robot rotational workspace for extended reality. Int J Comput Assist Radiol Surg 2023; 18:1951-1959. [PMID: 37296352 PMCID: PMC10589133 DOI: 10.1007/s11548-023-02967-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Understanding the properties and aspects of the robotic system is essential to a successful medical intervention, as different capabilities and limits characterize each. Robot positioning is a crucial step in the surgical setup that ensures proper reachability to the desired port locations and facilitates docking procedures. This very demanding task requires much experience to master, especially with multiple trocars, increasing the barrier of entry for surgeons in training. METHODS Previously, we demonstrated an Augmented Reality-based system to visualize the rotational workspace of the robotic system and proved it helps the surgical staff to optimize patient positioning for single-port interventions. In this work, we implemented a new algorithm to allow for an automatic, real-time robotic arm positioning for multiple ports. RESULTS Our system, based on the rotational workspace data of the robotic arm and the set of trocar locations, can calculate the optimal position of the robotic arm in milliseconds for the positional and in seconds for the rotational workspace in virtual and augmented reality setups. CONCLUSIONS Following the previous work, we extended our system to support multiple ports to cover a broader range of surgical procedures and introduced the automatic positioning component. Our solution can decrease the surgical setup time and eliminate the need to repositioning the robot mid-procedure and is suitable both for the preoperative planning step using VR and in the operating room-running on an AR headset.
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Affiliation(s)
- Marek Żelechowski
- Center for medical Image Analysis & Navigation (CIAN), Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
| | - Balázs Faludi
- Center for medical Image Analysis & Navigation (CIAN), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Murali Karnam
- Bio-Inspired RObots for MEDicine-Laboratory (BIROMED-lab), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Nicolas Gerig
- Bio-Inspired RObots for MEDicine-Laboratory (BIROMED-lab), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Georg Rauter
- Bio-Inspired RObots for MEDicine-Laboratory (BIROMED-lab), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Philippe C Cattin
- Center for medical Image Analysis & Navigation (CIAN), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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14
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Panico G, Mastrovito S, Campagna G, Monterossi G, Costantini B, Gioè A, Oliva R, Ferraro C, Ercoli A, Fanfani F, Scambia G. Robotic docking time with the Hugo™ RAS system in gynecologic surgery: a procedure independent learning curve using the cumulative summation analysis (CUSUM). J Robot Surg 2023; 17:2547-2554. [PMID: 37542580 PMCID: PMC10492716 DOI: 10.1007/s11701-023-01693-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
Robot-assisted surgery has been proven to offer improvements in term of surgical learning curve and feasibility of minimally invasive surgery, but has often been criticized for its longer operative times compared to conventional laparoscopy. Additional times can be split into time required for system set-up, robotic arms docking and calibration of robotic instruments; secondly, surgeon's learning curve. One of the newest systems recently launched on the market is the Hugo™ RAS (MEDTRONIC Inc, United States). As some of the earliest adopters of the Hugo™ RAS system technology, we present our data on robotic docking learning curve for the first 192 gynecologic robotic cases performed at our institution. Our data indicates that robotic set-up and docking with the new Hugo™ RAS robotic surgical system can be performed time-effectively and that the specific robotic docking learning curve is comparable to preexisting data for other platforms. This preliminary insights into this recently released system may be worthwhile for other centers which may soon adopt this new technology and may need some relevant information on topics such as OR times. Further studies are necessary to assess the different features of the Hugo™ RAS considering other technical and surgical aspects, to fully become familiar with this novel technology.
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Affiliation(s)
- Giovanni Panico
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Chirurgia Ginecologica, 00168, Rome, Italy
| | - Sara Mastrovito
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Chirurgia Ginecologica, 00168, Rome, Italy
| | - Giuseppe Campagna
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Chirurgia Ginecologica, 00168, Rome, Italy.
| | - Giorgia Monterossi
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Ginecologia Oncologica, 00168, Rome, Italy
| | - Barbara Costantini
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Ginecologia Oncologica, 00168, Rome, Italy
| | - Alessandro Gioè
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Ginecologia Oncologica, 00168, Rome, Italy
| | - Riccardo Oliva
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Ginecologia Oncologica, 00168, Rome, Italy
- IRCAD, Research Institute Against Digestive Cancer, 1, Place de l'Hôpital, 67091, Strasbourg, France
| | - Chiara Ferraro
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Chirurgia Ginecologica, 00168, Rome, Italy
| | - Alfredo Ercoli
- PID Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Università Degli Studi di Messina, Policlinico G.Martino, 98124, Messina, Italy
| | - Francesco Fanfani
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Chirurgia Ginecologica, 00168, Rome, Italy
| | - Giovanni Scambia
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Chirurgia Ginecologica, 00168, Rome, Italy
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15
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Piro A, Piramide F, Balestrazzi E, Paciotti M, Bravi CA, Peraire Lores M, Sorce G, Ticonosco M, Frego N, Rebuffo S, Collá-Ruvolo C, Inferrera A, De Naeyer G, De Groote R, Greco F, Mottrie A. Initial Experience of Robot-Assisted Simple Prostatectomy with Hugo Robot-Assisted Surgery System: Step-by-Step Description of Two Different Techniques. J Endourol 2023; 37:1021-1027. [PMID: 37493565 DOI: 10.1089/end.2023.0277] [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] [Indexed: 07/27/2023] Open
Abstract
Introduction: There are only a few clinical data on nononcologic procedures performed with the new Hugo™ robot-assisted surgery (RAS) system. Robot-assisted simple prostatectomy (RASP) is a minimally invasive treatment option for benign prostatic hyperplasia, and it demonstrated equal early functional and better perioperative outcomes as compared with open simple prostatectomy. In this article, we reported the first large series of RASP performed with Hugo RAS system. Methods: This Supplementary Video S1 is a step-by-step description of two different techniques for RASP. We analyzed the data of 20 consecutive patients who underwent RASP at OLV Hospital (Belgium) between February 2022 and March 2023. Patients baseline characteristics, perioperative and pathologic, and 1-month postoperative outcomes were reported, using the median (interquartile range [IQR]) and frequencies, as appropriate. Results: Median age (IQR) and preoperative prostate specific antigen (PSA) were 72 (67-76) years, and 7.7 (5.0-13.4) ng/mL, respectively. A total of 11 patients experienced an episode of preoperative acute urinary retention, and 8 men had an indwelling bladder catheter at the time of the surgery. No intraoperative complication occurred, and there was no need for conversion to open surgery. Median operative and console time were 165 (121-180) and 125 (101-148) minutes. On the first postoperative day the urethral catheter was removed in 80% of the patients. Median length of stay was 3 (3-4) days. Three patients had minor postoperative complications. On final pathology report, median prostate volume was 120 (101-154) g. On postoperative uroflowmetry, median Qmax and postvoid residual were 16 (13-26) mL/s and 15 (0-34) mL, respectively. Conclusions: This series represents the first report of surgical outcomes of RASP executed with Hugo RAS system. Awaiting study with longer follow-up, our study suggests that Hugo RAS has multiple applications, and it can ensure optimal outcomes in nononcologic procedures.
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Affiliation(s)
- Adele Piro
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Department of Urology, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Piramide
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Eleonora Balestrazzi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Paciotti
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Department of Urology, Humanitas Research Hospital-IRCCS, Rozzano, Italy
| | - Carlo Andrea Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Peraire Lores
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Gabriele Sorce
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Ticonosco
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Department of Urology, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Frego
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Department of Urology, Humanitas Research Hospital-IRCCS, Rozzano, Italy
| | - Silvia Rebuffo
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Claudia Collá-Ruvolo
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Napoli, Italy
| | | | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | | | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
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16
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Pandolfo SD, Del Giudice F, Chung BI, Manfredi C, De Sio M, Damiano R, Cherullo EE, De Nunzio C, Cacciamani GE, Cindolo L, Porpiglia F, Mirone V, Imbimbo C, Autorino R, Crocerossa F. Robotic assisted simple prostatectomy versus other treatment modalities for large benign prostatic hyperplasia: a systematic review and meta-analysis of over 6500 cases. Prostate Cancer Prostatic Dis 2023; 26:495-510. [PMID: 36402815 DOI: 10.1038/s41391-022-00616-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/20/2022] [Accepted: 11/07/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Current guidelines recommend simple prostatectomy or endoscopic enucleation of the prostate (EEP) as treatment of choice for bladder prostatic obstruction (BPO) caused by large prostate glands. We aimed to provide a wide-ranging analysis of the currently available evidence, comparing safety and effectiveness of robot-assisted simple prostatectomy (RASP) versus open simple prostatectomy (OSP), laparoscopic simple prostatectomy (LSP), and laser EEP. METHODS A systematic search was performed across MEDLINE, EMBASE, and Web of Science databases for retrospective and prospective studies comparing RASP to OSP or LSP or laser EEP (HoLEP/ThuLEP). Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations were followed to design the search strategies, selection criteria, and evidence report. A meta-analysis evaluated perioperative safety and effectiveness outcomes. The weighted mean difference and risk ratio were used to compare continuous and dichotomous variables, respectively. Quality was assessed using the Newcastle-Ottawa scale and the Cochrane Collaboration's tool for RCT article assessing risk of bias. RESULTS 15 studies, including 6659 patients, were selected for meta-analysis: 13 observational studies, 1 non-randomized prospective study, and 1 randomized controlled trial. RASP was associated with statistically significant longer operative time (OT) and lower postoperative complication rate, length of stay (LOS), estimated blood loss (EBL), and transfusion rate (TR) compared to OSP. LSP showed longer LOS and lower postoperative SHIM score, with no difference in OT, EBL, and complications. Compared to laser EEP, RASP presented longer LOS and catheterization time and higher TR. ThuLEP presented shorter OT than RASP. No difference were found in functional outcomes between groups both subjectively (IPSS, QoL) and objectively (Qmax, PVR). CONCLUSION RASP has become a size-independent treatment for the management of BPO caused by a large prostate gland. It can duplicate the functional outcomes of OSP while offering a better safety profile. When compared to LSP, the latter still stands as a valid lower-cost option, but it requires solid laparoscopic skill sets and therefore it is unlikely to spread on larger scale. When compared to laser EEP, RASP offers a shorter learning curve, but it still suffers from longer catheterization time and LOS.
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Affiliation(s)
- Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
- Department of Urology, Stanford Medical Center, Stanford, CA, USA
| | - Benjamin I Chung
- Department of Urology, Stanford Medical Center, Stanford, CA, USA
| | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rocco Damiano
- Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Edward E Cherullo
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Cosimo De Nunzio
- Urology Unit, Ospedale Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Luca Cindolo
- Department of Urology, Villa Stuart, Private Hospital, Rome, Italy
| | - Francesco Porpiglia
- Division of Urology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA.
| | - Fabio Crocerossa
- Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
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17
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Shima T, Arita A, Sugimoto S, Takayama S, Yamamoto M, Lee SW, Okuda J. Feasibility and learning curve for robotic surgery in a small hospital: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e34010. [PMID: 37335658 DOI: 10.1097/md.0000000000034010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Robotic surgery rates, typified by the use of the da Vinci Surgical System, have increased in recent years. However, robotic surgery is mostly performed in large hospitals and has not been fully implemented in small hospitals. Therefore, we aimed to verify the feasibility of robotic surgery in small hospitals and verify the number of cases in which perioperative preparation for robotic surgery is stable by creating a learning curve in small hospitals. Forty robot-assisted rectal cancer surgeries performed in large and small hospitals by a surgeon with extensive experience in robotic surgery were validated. Draping and docking times were recorded as perioperative preparation times. Unexpected surgical interruptions, intraoperative adverse events, conversion to laparoscopic or open surgery, and postoperative complications were recorded. Cumulative sum analysis was used to derive the learning curve for perioperative preparation time. Draping times were significantly longer in the small hospital group (7 vs 10 minutes, P = .0002), while docking times were not significantly different (12 vs 13 minutes, P = .098). Surgical interruptions, intraoperative adverse events, and conversions were not observed in either group. There were no significant differences in the incidence of severe complications (25% [5/20] vs 5% [1/20], P = .184). In the small hospital group, phase I of the draping learning curve was completed in 4 cases, while phase I of the docking learning curve was completed in 7 cases. Robotic surgery is feasible for small hospitals, and the preoperative preparation time required for robotic surgery stabilizes relatively early.
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Affiliation(s)
- Takafumi Shima
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, Shoji, Toyonaka-shi, Osaka, Japan
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Daigaku-machi, Takatsuki-shi, Osaka, Japan
| | - Asami Arita
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, Shoji, Toyonaka-shi, Osaka, Japan
| | - Satoshi Sugimoto
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, Shoji, Toyonaka-shi, Osaka, Japan
| | - Shoichi Takayama
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, Shoji, Toyonaka-shi, Osaka, Japan
| | - Masashi Yamamoto
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, Shoji, Toyonaka-shi, Osaka, Japan
| | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Daigaku-machi, Takatsuki-shi, Osaka, Japan
| | - Junji Okuda
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, Shoji, Toyonaka-shi, Osaka, Japan
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18
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Mogollón-González M, Conde-Muiño R, Rodríguez-Fernández A, Navarro-Pelayo M, Domínguez-Bastante M, Palma P. Impact of routine preoperative 18 FDG PET/CT on the surgical management of primary colorectal cancer. J Surg Oncol 2023. [PMID: 37092877 DOI: 10.1002/jso.27291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVES Determine the usefulness of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography (18 FDG-PET/CT) in the preoperative setting of colorectal cancer (CRC), assessing its impact on changes in management strategy. METHODS Retrospective study of CRC patients who underwent preoperative 18 FDG-PET/CT and CT staging scans in a single referral center. The agreement between 18 FDG-PET/CT, contrast-enhanced CT, and colonoscopy for the surgical location was compared using the κ coefficient. Maximum standardized uptake (SUVmax ) value was obtained. Univariate and multivariate analyses were conducted. RESULTS One hundred ninety-five patients were included. 18 FDG-PET/CT improved tumor localization in 84.6% (165/195) of cases (κ value 0.798, p < 0.001), thus correcting endoscopic errors 69.7% (30/43) of the time. In patients with incomplete colonoscopies, 18 FDG-PET/CT detected synchronous tumors in 2.5% (5/195) patients, overlooked by CT staging scans. Based on extracolonic 18 FDG-uptake, the second primary malignancy was diagnosed in 7(3.6%,7/195) patients and total accuracy for lymph node and distant metastasis was 66.1% and 98.4%, respectively. The treatment plan was altered in 30 (15.4%, 30/196) patients. There was a significant association between the SUVmax and tumor size (odds ratio [OR] 4.254, p = 0.003) and the depth of tumor invasion (OR 1.696, p = 0.026). CONCLUSIONS Based on its ability to aid in preoperative evaluation and definitively alter surgical treatment planning, 18 FDG-PET/CT should be further evaluated in primary CRC.
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Affiliation(s)
- Mónica Mogollón-González
- Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Clinical Medicine and Public Health PhD Programme, University of Granada, Granada, Spain
- Instituto de Investigación Sanitaria de Granada (IBS Granada), Granada, Spain
| | - Raquel Conde-Muiño
- Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Sanitaria de Granada (IBS Granada), Granada, Spain
| | - Antonio Rodríguez-Fernández
- Instituto de Investigación Sanitaria de Granada (IBS Granada), Granada, Spain
- Department of Nuclear Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Mar Navarro-Pelayo
- Department of Nuclear Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Pablo Palma
- Department of Surgery, Campus Sant Cugat, International University of Catalonia, Barcelona, Spain
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19
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Sokolov YY, Efremenkov AM, Zykin AP, Kirgizov IV, Shakhbanov RR. [Robot-assisted choledochal cyst resection in a child]. Khirurgiia (Mosk) 2023:52-57. [PMID: 36800869 DOI: 10.17116/hirurgia202303152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The generally accepted method for choledochal cysts is total resection of cystic extrahepatic bile ducts and gallbladder followed by biliodigestive anastomosis. Minimally invasive interventions have recently become the «gold» standard in pediatric hepatobiliary surgery. However, laparoscopic resection of choledochal cysts has certain disadvantages related to difficult positioning of instruments in narrow surgical field. The disadvantages of laparoscopy can be compensated by surgical robots. A 13-year-old girl underwent robot-assisted resection of hepaticocholedochal cyst, cholecystectomy and Roux-en-Y hepaticojejunostomy. Total anesthesia time was 6 hours. Laparoscopic stage took 55 min, docking of robotic complex - 35 min. Robotic stage of surgery required 230 min, removal of cyst and suturing the wounds - 35 min. Postoperative period was uneventful. Enteral nutrition was started after 3 days, and drainage tube was removed after 5 day. The patient was discharged after 10 postoperative days. The follow-up period was 6 months. Thus, robot-assisted resection of choledochal cysts in children is possible and safe.
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Affiliation(s)
- Yu Yu Sokolov
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia.,Central Clinical Hospital with Polyclinic of the Presidential Administration of the Russian Federation, Moscow, Russia
| | - A M Efremenkov
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia.,Central Clinical Hospital with Polyclinic of the Presidential Administration of the Russian Federation, Moscow, Russia
| | - A P Zykin
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia.,Central Clinical Hospital with Polyclinic of the Presidential Administration of the Russian Federation, Moscow, Russia
| | - I V Kirgizov
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia.,Central Clinical Hospital with Polyclinic of the Presidential Administration of the Russian Federation, Moscow, Russia
| | - R R Shakhbanov
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia.,Central Clinical Hospital with Polyclinic of the Presidential Administration of the Russian Federation, Moscow, Russia
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20
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ROBOT Assisted Laparoscopic Surgeries For Nononcological Urologic Disease: Initial Experience With Hugo Ras System. Urology 2023; 174:118-125. [PMID: 36804552 DOI: 10.1016/j.urology.2023.01.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To report our initial experience with the use of HUGO Robotic Assisted Surgery System (RAS) for nononcological urologic disease. METHODS We collected retrospective data describing clinical outcomes from patients undergoing surgeries for nononcological urologic disease with the new HUGO RAS. Analysis included: total surgery and console time, docking time, estimated bleeding, complications, and pain after surgery. RESULTS There were 5 patients operated for nononcological urologic disease. The mean age was 50 years (range 32-70), comorbidities were mild (2 patients with chronic hypertension) and American Society of Anesthesiologists (ASA) classification was 2. Total surgical time ranged from 150 to 257 minutes, and console time from 89 to 164 minutes, each depending on the intervention. The mean docking time was 8.5 minutes (range 5.7-11). No intraoperative complications, instrument clashes, or system failure that compromised the surgery's completion were recorded. Mean blood loss ranged from 10-30 mL, and there were no postoperative complications. Postoperative pain classified from 0-10 at 1, 6, and 12 hours was low (range 0-3), and pain before discharge was 0 for all patients. Hospital stay ranged from 2 to 5 days, depending on the intervention. CONCLUSION Robotic surgery was introduced in early 2000s and was rapidly adopted. Initially, this technology was reserved for oncological surgery, later expanding to nononcological conditions. These preliminary results are comparable to the previous robotic systems, suggesting the multiple potential uses of the HUGO RAS. The adoption of this technology has the potential to improve patient accessibility for less-invasive therapies in developing countries.
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21
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Green CA, Lin JA, Huang E, O'Sullivan P, Higgins RM. Enhancing robotic efficiency through the eyes of robotic surgeons: sub-analysis of the expertise in perception during robotic surgery (ExPeRtS) study. Surg Endosc 2023; 37:571-579. [PMID: 35579701 DOI: 10.1007/s00464-022-09315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 04/27/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Robotic technology affords surgeons many novel and useful features, but two stereotypes continue to prevail: robotic surgery is expensive and inefficient. To identify educational opportunities and improve operative efficiency, we analyzed expert commentary on videos of robotic surgery. METHODS Expert robotic surgeons, identified through high case volumes and contributions to the surgical literature, reviewed eight anonymous video clips portraying key portions of two robotic general surgery procedures. While watching, surgeons commented on what they saw on the screen. All interactions with participants were in person, recorded, transcribed, and subsequently analyzed. Using content analysis, researchers double-coded each transcript applying a consensus developed codebook. RESULTS Seventeen surgeons participated. The average participant was male (82.4%), 47 (SD = 6.6) years old, had 13.2 (SD = 8.23) years of teaching experience, worked in urban academic hospitals (64.7%) and had performed 643 (SD = 467) robotic operations at the time of interviews. Emphasis on efficiency (or lack thereof) surfaced across three main themes: overall case progression, robotic capabilities, and instrumentation. Experts verbally rewarded purposeful and "ergonomically sound" movements while language reflecting impatience with repetitive and indecisive movements was attributed to presumed inexperience. Efficient robotic capabilities included enhanced visualization, additional robotic arms to improve exposure, and wristed instruments. Finally, experts discussed instrument selection with regards to energy modality, safety features, cost, and versatility. CONCLUSION This study highlights three areas for improved efficiency: case progression, robotic capabilities, and instrumentation. Development of education materials within these themes could help surgical educators overcome one of robotic technology's persistent challenges.
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Affiliation(s)
- Courtney A Green
- Division of Trauma, Department of Surgery, Critical Care and General Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Joseph A Lin
- Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143-0470, USA
| | - Emily Huang
- Department of Surgery, The Ohio State University Wexner Medical Center, Suite 670, 395 W. 12th Avenue, Columbus, OH, 43210-1267, USA
| | - Patricia O'Sullivan
- Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA, 94143-0470, USA.,Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, Room M994, San Francisco, CA, 94122, USA
| | - Rana M Higgins
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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22
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McKechnie T, Khamar J, Daniel R, Lee Y, Park L, Doumouras AG, Hong D, Bhandari M, Eskicioglu C. The Senhance Surgical System in Colorectal Surgery: A Systematic Review. J Robot Surg 2022; 17:325-334. [PMID: 36127508 DOI: 10.1007/s11701-022-01455-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
The Senhance Surgical System allows for infrared eye tracking, haptic feedback, and an adjustable upright seat allowing for improved ergonomics. This systematic review was designed with the aim of reviewing the current literature pertaining to the use of the Senhance Surgical System in colorectal surgery. Medline, EMBASE, and CENTRAL were searched. Articles were eligible for inclusion if they evaluated adults undergoing colorectal surgery with the Senhance Surgical System. The primary outcome was intraoperative efficacy; as defined by operative time, estimated blood loss (EBL), and conversion. A DerSimonian and Laird inverse variance random-effects meta-analysis was used to generate overall effect size estimates and narrative review was provided for each outcome. Six observational studies with 223 patients (mean age: 63.7, 41.2% female, mean BMI: 24.4 kg/m2) were included. The most common indication for surgery was colorectal cancer (n = 180, 80.7%) and the most common operation was anterior resection (n = 72, 32.3%). Meta-analyses demonstrated a pooled total operative time of 229.8 min (95% CI 189.3-270.4, I2 = 0%), console time of 141.3 min (95% CI 106.5-176.1, I2 = 0%), and docking time of 10.8 min (95% CI 6.4-15.2, I2 = 0%). The pooled EBL was 37.0 mL (95% CI 24.7-49.2, I2 = 20%). Overall, there were nine (4.0%) conversions to laparoscopy/laparotomy. The Senhance Surgical System has an acceptable safety profile, reasonable docking and console times, low conversion rates, and an affordable case cost across a variety of colorectal surgeries. Further prospective, comparative trials with other robotic surgical platforms are warranted.
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Affiliation(s)
- Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jigish Khamar
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ryan Daniel
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Lily Park
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Aristithes G Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.,Division of General Surgery, Department of Surgery, McMaster University. St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.,Division of General Surgery, Department of Surgery, McMaster University. St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Mohit Bhandari
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. .,Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada. .,Division of General Surgery, Department of Surgery, McMaster University. St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
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23
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Olson B, Cahill E, Imanguli M. Feasibility and safety of the da Vinci Xi surgical robot for transoral robotic surgery. J Robot Surg 2022; 17:571-576. [PMID: 35972598 DOI: 10.1007/s11701-022-01449-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Abstract
The collective experience supporting the safety and efficacy of transoral robotic surgery continues to grow. The surgical robot da Vinci Xi has been used successfully off-label for head and neck surgery, including transoral robotic surgery. We evaluated operative outcomes and efficacy of the da Vinci Xi surgical robot for transoral surgery and compared our experience with the da Vinci Si and published da Vinci Xi experiences in transoral surgery. Nineteen total cases were retrospectively reviewed, six with the Si and thirteen with the Xi. Our experience with the da Vinci Xi showed similar peri- and postoperative outcomes to our Si experience the available da Vinci Xi literature. We advocate for careful patient selection while also considering the surgical team's experience with TORS. Transoral robotic surgery with the da Vinci Xi has specific advantages, and support is accumulating for its use in TORS. However, this indication remains off-label, and we do not anticipate the manufacturer will seek approval for this indication given the ongoing development and regulatory approvals of da Vinci Single Port for similar indications.
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Affiliation(s)
- Birk Olson
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ellen Cahill
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Matin Imanguli
- Division of Head and Neck Oncologic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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24
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Xu W, Dong J, Xie Y, Liu G, Zhou J, Wang H, Zhang S, Wang H, Ji Z, Cui L. Robot-assisted partial nephrectomy with a new robotic surgical system: feasibility and perioperative outcomes. J Endourol 2022; 36:1436-1443. [PMID: 35838131 DOI: 10.1089/end.2022.0140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the feasibility and safety of a novel robotic system (KD-SR-01) for partial nephrectomy. METHODS Seventeen patients with small renal mass (SRM) (≤4 cm) underwent KD-SR-01 robotic partial nephrectomy (KD-RPN) from December 2020 to March 2021 in our institution. The operative outcomes and perioperative data, including clinical and histological data, were prospectively collected and analyzed. RESULTS In total, 10 men and 7 women, with a median age of 51 years, underwent KD-RPN. Four transperitoneal procedures and 13 retroperitoneal procedures were successfully performed without conversion to open or conventional laparoscopic surgery. The docking time and robotic operative time were 3.3 min and 68.6 min, respectively. The warm ischemia time was 16.9 min. No major intraoperative or postoperative complications (Clavien grade ≥ III) occurred. The duration of postoperative hospital stay was 5 days. Pathologic examination revealed nine clear cell carcinomas, two papillary cell carcinomas, one oncocytoma, and five angiomyolipoma. All surgical margins were negative. The estimated globular filtration rate (eGFR) on the 1st postoperative day was significantly decreased compared to the preoperative eGFR (91.7±12.9 ml/min vs. 97.9±10.7 ml/min, P =0.036). However, no significant difference was observed between the preoperative eGFR and the value on the 4th postoperative day (95.7±13.4 ml/min vs. 97.9±10.7 ml/min, P=0.427). CONCLUSION KD-RPN was safe and feasible for the treatment of SRM. The early oncologic and functional outcomes were promising. Long-term follow-up and well-designed prospective comparative studies with the da Vinci platform are needed to corroborate these findings.
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Affiliation(s)
- Weifeng Xu
- Peking Union Medical College Hospital, 34732, Department of Urology, Beijing, China;
| | - Jie Dong
- Peking Union Medical College Hospital, 34732, Department of Urology, Beijing, China;
| | - Yi Xie
- Peking Union Medical College Hospital, 34732, Department of Urology, Beijing, China;
| | - Guanghua Liu
- Peking Union Medical College Hospital, 34732, Department of Urology, Beijing, China;
| | - Jingmin Zhou
- Peking Union Medical College Hospital, 34732, Department of Urology, Beijing, China;
| | - Huizhen Wang
- Peking Union Medical College Hospital, 34732, Department of operating room, Beijing, China;
| | - Shengjie Zhang
- Peking Union Medical College Hospital, 34732, Department of operating room, Beijing, China;
| | - Hui Wang
- Peking Union Medical College Hospital, 34732, Department of operating room, Beijing, China;
| | - Zhigang Ji
- Peking Union Medical College Hospital, 34732, Department of Urology, Beijing, China;
| | - Liang Cui
- Civil Aviation General Hospital, 117987, Department of Urology, Beijing, China;
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25
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Bianchi G, de’Angelis N, Musa N, Beghdadi N, Hentati H, Ammendola M, Inchingolo R, Laurent A, Sommacale D, Memeo R. Short-term outcomes of da Vinci Xi versus Si robotic systems for minor hepatectomies. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022223. [PMID: 36300236 PMCID: PMC9686165 DOI: 10.23750/abm.v93i5.12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/28/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND In the recent years, robotic technology has been drastically improved and the last generation of robotic platforms is hardly comparable with the earlier ones. The present study aims to investigate the short-term outcomes of minor hepatectomies performed with da Vinci Xi surgical system vs. Si surgical systems. METHODS Consecutive patients operated on between 2013 and 2020 in two referral centers were selected if underwent elective robotic minor hepatectomy (<3 consecutive segments) for primarily resectable benign or malignant lesions. Operative, postoperative, and cost outcomes were compared between the two groups by univariate and multivariate analyses. RESULTS Eighty-nine patients were selected (64 in the Si system vs. 25 in the Xi system group). Wedge resection was the most commonly performed procedure (49.4%). The Si system group showed a significantly greater total incisional length (+8.99 mm; p<0.0001) related to the use of a higher number of robotic/laparoscopic ports. Pedicle clamping was more frequent in patients operated on by the Xi system (80% vs. 21.9%; p<0.0001) but without group differences in ischemia duration when clamping. A significantly shorter time to flatus (-0.75 days; p=0.015) was observed for patients operated on by the Xi system, whereas no group differences were found for operative time, conversion rate, estimated blood loss, postoperative complications, mortality, use of analgesics, and costs. CONCLUSION The da Vinci Xi system represents a technological advancement with a potential clinical relevance, although further studies are needed to clearly detect the clinical impact of the use of this robotic platform in liver surgery.
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Affiliation(s)
- Giorgio Bianchi
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, CARE Department, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Nicola de’Angelis
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, CARE Department, Henri Mondor Hospital, AP-HP, Créteil, France, Université Paris Est, Faculté de Santé, UPEC, Créteil, France
| | - Nicola Musa
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, CARE Department, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Nassiba Beghdadi
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, CARE Department, Henri Mondor Hospital, AP-HP, Créteil, France, Université Paris Est, Faculté de Santé, UPEC, Créteil, France
| | - Hassen Hentati
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, CARE Department, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Michele Ammendola
- Department of Health Sciences, General Surgery, Magna Græcia University, Medicine School of Germaneto, Catanzaro, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Alexis Laurent
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, CARE Department, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Daniele Sommacale
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, CARE Department, Henri Mondor Hospital, AP-HP, Créteil, France, Université Paris Est, Faculté de Santé, UPEC, Créteil, France
| | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, General Regional Hospital “F.Miulli”, Acquaviva delle Fonti, Bari, Italy
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26
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Lei KY, Xie WJ, Fu SQ, Ma M, Sun T. A comparison of the da Vinci Xi vs. da Vinci Si surgical systems for radical prostatectomy. BMC Surg 2021; 21:409. [PMID: 34847882 PMCID: PMC8638093 DOI: 10.1186/s12893-021-01406-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To compare the perioperative and short-term efficacy and cost of the da Vinci Xi and da Vinci Si surgical systems for radical prostatectomy. METHODS We retrospectively analyzed the clinical data of 175 patients with prostate cancer who underwent radical prostatectomy with the da Vinci Si or Xi surgical systems in our hospital from June 2019 to June 2020. Of the 175 patients, 82 underwent robot-assisted laparoscopic radical prostatectomy with the da Vinci Xi surgery system, and 93 patients underwent robot-assisted laparoscopic radical prostatectomy with the da Vinci Si surgical system. The perioperative outcomes, short-term efficacy and costs were compared between the two groups. RESULTS The anesthesia time, operation time, docking time, indwelling catheter time and postoperative bed rest time in the Xi group were shorter than those in the Si group (respectively, 268.8 min vs. 219.3 min, P = 0.001; 228.2 min vs. 259.6 min, P < 0.001; 7.4 min vs. 12.7 min, P < 0.001; 8.6 d vs. 9.7 d, P = 0.036; 2.2 d vs. 2.6 d, P = 0.002). However, the total cost of hospitalization and the cost of intraoperative consumables in the Xi group were higher than those in the Si group (84,740.7 vs. 76,739.1 ¥, P = 0.003; 13,199.4 vs. 10,823.0 ¥, P = 0.019). CONCLUSIONS Although the cost of robot-assisted radical prostatectomy is higher, compared with the Si system, the Xi system has better perioperative outcomes and can provide similar short-term efficacy and oncology outcomes.
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Affiliation(s)
- Kun-Yang Lei
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Wen-Jie Xie
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Sheng-Qiang Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Ming Ma
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China
| | - Ting Sun
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi, China.
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27
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Żelechowski M, Karnam M, Faludi B, Gerig N, Rauter G, Cattin PC. Patient positioning by visualising surgical robot rotational workspace in augmented reality. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2021. [DOI: 10.1080/21681163.2021.2002192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Marek Żelechowski
- Center for Medical Image Analysis & Navigation (CIAN), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Murali Karnam
- Bio-Inspired RObots for MEDicine-Laboratory (BIROMED-lab), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Balázs Faludi
- Center for Medical Image Analysis & Navigation (CIAN), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Nicolas Gerig
- Bio-Inspired RObots for MEDicine-Laboratory (BIROMED-lab), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Georg Rauter
- Bio-Inspired RObots for MEDicine-Laboratory (BIROMED-lab), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Philippe C. Cattin
- Center for Medical Image Analysis & Navigation (CIAN), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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28
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Yamada K, Kogure N, Ojima H. Learning curve for robotic bedside assistance for rectal cancer: application of the cumulative sum method. J Robot Surg 2021; 16:1027-1035. [PMID: 34779988 DOI: 10.1007/s11701-021-01322-4] [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: 07/13/2021] [Accepted: 10/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This investigation assesses the learning curve for dedicated bedside assistance at a facility that recently adopted robot-assisted rectal resection. METHODS Data from patients with rectal cancer who underwent robotic rectal resections from September 2019 through April 2020 were retrospectively analyzed. Before starting robotic surgery, we set the rule that a console surgeon would not enter the sterile field and all of those maneuvers would be left to a dedicated physician. Docking time was analyzed using the cumulative sum (CUSUM) method to evaluate the learning curve. Different phases in the learning curve were identified according to CUSUM plot configuration. A comparison was made of phases 1 and 2 combined, and phase 3. RESULT The procedures were performed in 30 patients. Median docking time, console time was 13 min. A total of nine patients had histories of abdominal surgery. CUSUM analysis of docking time demonstrated 3 phases. Each docking time was longer in Phase 1 (the first 3 cases) than the average docking time over the all cases. The docking time in Phase 2 (the 9 middle cases) approximated the average time over the all cases. Phase 3 (the remaining 18 cases) showed further improvement of the docking procedure and time was reduced. A comparison of Phases 1 and 2 combined, and Phase 3, revealed that Phase 3 had a significantly higher rate of history of abdominal surgery. CONCLUSION Docking manipulation proficiency was achieved in approximately 10 cases without the influence of surgical difficulty.
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Affiliation(s)
- Kazunosuke Yamada
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, 617-1, Nishimachi, Oota, Gunma, 373-0828, Japan.
| | - Norimichi Kogure
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, 617-1, Nishimachi, Oota, Gunma, 373-0828, Japan
| | - Hitoshi Ojima
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, 617-1, Nishimachi, Oota, Gunma, 373-0828, Japan
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Abstract
Robotic transanal surgery is the culmination of major developments in rectal cancer management and minimally invasive surgery. It is the result of continuous efforts to tackle the challenges inherent to rectal cancer surgery. This latest technology holds great promise and excitement for the care of the rectal cancer patient. In this article, we will describe the evolution of transanal rectal cancer surgery and describe how the convergence of transanal transabdominal, transanal endoscopic microsurgery, transanal minimally invasive surgery (TAMIS), transanal total mesorectal excision (taTME), and the different robotic platforms have culminated in the development of single port robotic transanal minimally invasive surgery (SP rTAMIS) and single port robotic transanal total mesorectal excision (SP rtaTME). We will describe the indications, technical aspects, outcomes, benefits, and limitations of the SP rTAMIS and SP rtaTME.
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Affiliation(s)
- John H Marks
- Department of Colorectal Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Rafael E Perez
- Department of Colorectal Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Jean F Salem
- Department of Colorectal Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania
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Bonatti J, Kiaii B, Alhan C, Cerny S, Torregrossa G, Bisleri G, Komlo C, Guy TS. The role of robotic technology in minimally invasive surgery for mitral valve disease. Expert Rev Med Devices 2021; 18:955-970. [PMID: 34325594 DOI: 10.1080/17434440.2021.1960506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Robotic mitral valve surgery has developed for more than 20 years. The main purpose of robotic assistance is to use multiwristed instruments for surgical endothoracic maneuvers on the mitral valve without opening the chest. The surgeon controls the instruments remotely from a console but is virtually immersed into the operative field. AREAS COVERED This review outlines indications and contraindication for the procedure. Intra- and postoperative results as available in the literature are reported. Further areas focus on the technological development, advances in surgical techniques, training methods, and learning curves. Finally we give an outlook on the potential future of this operation. EXPERT OPINION Robotic assistance allows for the surgically least invasive form of mitral valve operations. All variations of robotic mitral valve repair and replacement are feasible and indications have recently been broadened. Improved dexterity of instrumentation, 3D and HD vision, introduction of a robotic left atrial retractor, and adjunct technology enable most complex forms of minimally invasive mitral valve interventions through ports on the patient's right chest wall. Application of robotics results in significantly reduced surgical trauma while maintaining safety and outcome standards in mitral valve surgery.
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Affiliation(s)
- Johannes Bonatti
- UPMC Heart and Vascular Institute and Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bob Kiaii
- Department of Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Stepan Cerny
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Main Line Health - Lankenau Heart Institute, Wynnewood, PA, USA
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Caroline Komlo
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - T Sloane Guy
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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First Clinical Experience With Single-Port Robotic Transanal Minimally Invasive Surgery: Phase II Trial of the Initial 26 Cases. Dis Colon Rectum 2021; 64:1003-1013. [PMID: 34001709 DOI: 10.1097/dcr.0000000000001999] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many transanal platforms have been developed to address the challenge of reach and vision when operating transanally. The single-port robot was specifically designed for narrow-aperture surgery and is a promising platform for minimally invasive transanal surgery. OBJECTIVE The purpose of this phase II trial is to evaluate the safety and feasibility of the initial clinical experience with single-port robot transanal minimally invasive surgery. DESIGN In a prospective phase II trial, patients with rectal neoplasms eligible for local excision were enrolled for single-port robotic transanal minimally invasive surgery. SETTING The study was conducted between October 2018 and March 2020 at a tertiary referral hospital. PATIENTS/INTERVENTION Twenty-six consecutive patients underwent single-port robotic transanal minimally invasive surgery resection of rectal lesions. MAIN OUTCOME MEASURES The primary end point of the study was the efficacy and safety of single-port robotic transanal minimally invasive surgery. RESULTS There were 13 men and 13 women, with an average lesion size of 2.9 cm (range, 1.0-6.0 cm) and average level of 4.8 cm from the anorectal ring (range, 0-30 cm). Ten patients had a preoperative diagnosis of adenocarcinoma, 7 of whom received neoadjuvant chemoradiation (range, 4500-5580 cGy with concurrent oral capecitabine). Eighty-eight percent of cases were completed by single-port robotic transanal minimally invasive surgery; 2 were converted to transanal endoscopic microsurgery, and 1 patient underwent a low anterior resection. There were no piecemeal extractions, and all margins were negative on final pathology. There were no mortalities, and the morbidity rate was 15.4%. There have been no local recurrences, with a mean follow-up of 5.8 months (range, 0-15.9 months). LIMITATIONS The study was limited by small sample size, short-term follow up, and a single-surgeon experience. CONCLUSION Single-port robotic transanal minimally invasive surgery procedures are safe and feasible in patients with select benign and malignant rectal lesions. Future trials will need to evaluate the long-term safety and efficacy of single-port robotic transanal minimally invasive surgery. See Video Abstract at http://links.lww.com/DCR/B605. PRIMERA EXPERIENCIA CLNICA CON CIRUGA MNIMAMENTE INVASIVA TRANSANAL ROBTICA DE PUERTO NICO ENSAYO DE FASE II DE LOS CASOS INICIALES ANTECEDENTES:Se han desarrollado muchas plataformas transanales para abordar el desafío del alcance y la visión cuando se opera de manera transanal. El robot de un solo puerto fue diseñado específicamente para la cirugía de apertura estrecha y es una plataforma prometedora para la cirugía transanal mínimamente invasiva.OBJETIVO:El propósito de este ensayo de fase II es evaluar la seguridad y viabilidad de la experiencia clínica inicial con la cirugía mínimamente invasiva transanal con robot de puerto único.DISEÑO:En un ensayo prospectivo de fase II, los pacientes con neoplasias rectales elegibles para la escisión local se inscribieron para la cirugía mínimamente invasiva transanal robótica de puerto único.AJUSTE:El estudio se realizó entre octubre de 2018 y marzo de 2020 en un hospital de referencia terciario.PACIENTES / INTERVENCIÓN:Veintiséis pacientes consecutivos fueron sometidos a cirugía mínimamente invasiva transanal robótica de puerto único para resección de lesiones rectales.PRINCIPALES MEDIDAS DE RESULTADO:El criterio de valoración principal del estudio fue la eficacia y seguridad de la cirugía mínimamente invasiva transanal robótica de puerto único.RESULTADOS:Hubo 13 hombres y 13 mujeres, con un tamaño de lesión promedio de 2.9 cm (rango 1.0-6.0 cm) y un nivel promedio de 4.8 cm del anillo anorrectal (rango 0-30 cm). Diez pacientes tenían un diagnóstico preoperatorio de adenocarcinoma, 7 de los cuales recibieron quimiorradiación neoadyuvante (rango 4500-5580 cGy con capecitabina oral concurrente). El 88% de los casos se completaron mediante cirugía mínimamente invasiva transanal robótica de puerto único; 2 se convirtieron a microcirugía endoscópica transanal y 1 se sometió a una resección anterior baja. No hubo extracciones parciales y todos los márgenes fueron negativos en la patología final. No hubo mortalidad y una tasa de morbilidad del 15,4%. No ha habido recidivas locales, con un seguimiento medio de 5,8 meses (rango 0-15,9 meses).LIMITACIONES:El estudio estuvo limitado por un tamaño de muestra pequeño, un seguimiento a corto plazo y la experiencia de un solo cirujano.CONCLUSIÓN:Los procedimientos de cirugía mínimamente invasiva transanal robótica de puerto único son seguros y factibles en pacientes con lesiones rectales benignas y malignas seleccionadas. Los ensayos futuros deberán evaluar la seguridad y eficacia a largo plazo de la cirugía mínimamente invasiva transanal robótica de puerto único. Consulte Video Resumen en http://links.lww.com/DCR/B605. (Traducción-Dr. Eduardo Londoño-Schimmer).
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Cuk P, Simonsen RM, Komljen M, Nielsen MF, Helligsø P, Pedersen AK, Mogensen CB, Ellebæk MB. Improved perioperative outcomes and reduced inflammatory stress response in malignant robot-assisted colorectal resections: a retrospective cohort study of 298 patients. World J Surg Oncol 2021; 19:155. [PMID: 34022914 PMCID: PMC8141231 DOI: 10.1186/s12957-021-02263-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023] Open
Abstract
Background Robot-assisted surgery is increasingly implemented for the resection of colorectal cancer, although the scientific evidence for adopting this technique is still limited. This study’s main objective was to compare short-term complication rates, oncological outcomes, and the inflammatory stress response after colorectal resection for cancer performed laparoscopic or robot-assisted. Methods We conducted a retrospective cohort study comparing the robot-assisted approach to laparoscopic surgery for elective malignant colorectal neoplasm. Certified colorectal and da Vinci ® robotic surgeons performed resections at a Danish tertiary colorectal high volume center from May 2017 to March 2019. We analyzed the two surgical groups using uni- and multivariate regression analyses to detect differences in intra- and postoperative clinical outcomes and the inflammatory stress response. Results Two hundred and ninety-eight patients were enrolled in the study. Significant differences favoring robot-assisted surgery was demonstrated for; length of hospital stay (4 days, interquartile range (4, 5) versus 5 days, interquartile range (4–7), p < 0.001), and intraoperative blood loss (50 mL, interquartile range (20–100) versus 100 mL, interquartile range (50–150), p < 0.001) compared to laparoscopic surgery. The inflammatory stress response was significantly higher after laparoscopic compared to robot-assisted surgery reflected by an increase in C-reactive protein concentration (exponentiated coefficient = 1.23, 95% confidence interval (1.06–1.46), p = 0.008). No differences between the two groups were found concerning mortality, microradical resection rate, conversion to open surgery, and surgical or medical short-term complication rates. Conclusion Robot-assisted surgery is feasible and can be safely implemented for colorectal resections. The robot-assisted approach, when compared to laparoscopic surgery, was associated with improved intra- and postoperative outcomes. Extensive prospective studies are needed to determine the short- and long-term outcomes of robotic surgery for colorectal cancer.
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Affiliation(s)
- Pedja Cuk
- Department of Surgery, Hospital of Southern Jutland, Aabenraa, Denmark. .,Department of Regional Health Research, Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark. .,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | | | - Mirjana Komljen
- Department of Surgery, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Michael Festersen Nielsen
- Department of Surgery, Hospital of Southern Jutland, Aabenraa, Denmark.,Department of Regional Health Research, Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark
| | - Per Helligsø
- Department of Surgery, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Andreas Kristian Pedersen
- Department of Regional Health Research, Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Christian Backer Mogensen
- Department of Regional Health Research, Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark
| | - Mark Bremholm Ellebæk
- Research Unit for Surgery, Surgical Department, Odense University Hospital, Odense, Denmark
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Lu J, Zheng CH, Xu BB, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Huang CM, Li P. Assessment of Robotic Versus Laparoscopic Distal Gastrectomy for Gastric Cancer: A Randomized Controlled Trial. Ann Surg 2021; 273:858-867. [PMID: 32889876 DOI: 10.1097/sla.0000000000004466] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the short-term outcomes of patients with GC who received RDG or LDG. SUMMARY BACKGROUND DATA Despite the increasing use of RDG in patients with GC, its safety and efficacy compared to those of LDG have not been elucidated in a randomized controlled trial. METHODS Three hundred patients with cT1-4a and N0/+ between September 2017 and January 2020 were enrolled in this randomized controlled trial at a high-volume hospital in China. The short-term outcomes were compared between the groups. RESULTS The modified intention-to-treat analysis included data from 283 patients (RDG group: n = 141) and (LDG group: n = 142). Patients in the RDG group exhibited faster postoperative recovery, milder inflammatory responses, and reduced postoperative morbidity (9.2% vs 17.6%, respectively, P = 0.039). Higher extraperigastric lymph nodes (LNs) were retrieved in the RDG group (17.6 ± 5.8 vs 15.8 ± 6.6, P = 0.018) with lower noncompliance rate (7.7% vs 16.9%, respectively, P = 0.006). Additionally, patients in the RDG group were more likely to initiate adjuvant chemotherapy earlier [median (interquartile range) postoperative days: 28 (24-32) vs 32 (26-42), P = 0.003]. Although total hospital costs were higher in the robotic group than in the laparoscopic group, the direct cost was lower for RDG than for LDG (all P < 0.001). CONCLUSIONS RDG is associated with a lower morbidity rate, faster recovery, milder inflammatory responses, and improved lymphadenectomy. Additionally, faster postoperative recovery in the RDG group enables early initiation of adjuvant chemotherapy. Our results provide evidence for the application of RDG in patients with GC.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
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Panattoni A, Giannini A, Morganti R, Mannella P, Perutelli A, Cela V, Simoncini T. Perioperative outcomes of the first five cases of surgeries for endometrial endometrioid cancer using the new integrated table motion for da Vinci Xi ®. Int J Med Robot 2021; 17:e2254. [PMID: 33749118 DOI: 10.1002/rcs.2254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/15/2021] [Accepted: 03/15/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this study was to evaluate feasibility of integrated table motion (ITM), comparing perioperative outcomes of patients with diagnosed endometrial endometrioid cancer who underwent total robotic hysterectomies (TRHs) and case-related staging procedures with and without ITM. METHODS Five patients underwent surgery with da Vinci Xi system and ITM technology. ITM feasibility, efficacy and safety was compared with a second group of 56 patients, reduced to 10 with propensity score method, who underwent same procedures with da Vinci Xi System without ITM system. RESULTS We report safety of robotic surgery with new ITM even in a preliminary experience of oncologic procedures. No significance in any analysed data between groups TRH with ITM and TRH without ITM are described. CONCLUSION This preliminary study demonstrated the feasibility of ITM in performing da Vinci Xi TRH even in the first cases of surgery for malignancy such as early stage endometrial endometrioid cancer.
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Affiliation(s)
- Andrea Panattoni
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Mannella
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandra Perutelli
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Vito Cela
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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The TransEnterix European Patient Registry for Robotic-Assisted Laparoscopic Procedures in Urology, Abdominal, Thoracic, and Gynecologic Surgery ("TRUST"). Surg Technol Int 2021. [PMID: 33513657 DOI: 10.52198/21.sti.38.gs1394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Robotic surgery was first introduced in the mid-1980s, and at the end of the '90s, the da Vinci® System (Intuitive Surgical Inc., Sunnyvale, California) was introduced in Europe and held a monopoly for years afterward. In 2016, Senhance™ digital laparoscopic platform (TransEnterix Inc., Morrisville, North Carolina) came to the market. This new platform is based on laparoscopic movements and is designed for laparoscopic surgeons. This study shows the surgical outcomes of patients after different visceral, colorectal, gynecological, and urological surgical procedures done with the Senhance™ digital laparoscopic platform with a focus on safety. MATERIALS AND METHODS The study population consists of 871 patients who underwent robotic surgery with the Senhance™ platform. The most common procedures were hernia repairs (unilateral and bilateral), cholecystectomies, and prostatectomies. The procedures were performed in five centers in Europe between February 2017 and July 2020 by experienced laparoscopic surgeons. RESULTS 220 (25.3 %) out of 871 patients had a unilateral hernia repair, 70 (8.0%) a bilateral hernia repair, 159 (18.3%) underwent a cholecystectomy, and 168 (19.3%) a prostatectomy. The other procedures included visceral, colorectal, and gynecological surgery procedures. The median docking time was 7.46 minutes for the four most common procedures. The duration of surgery varied from 32 to 313 minutes, the average time was 114.31 minutes. Adverse events were rare overall. There were 48 (5.5 %) adverse events out of 871 patients, 24 of them (2.8 % of all cases) were severe. Out of all 24 severe adverse events, five events (20.8%) were likely related to the robot, 17 events (70.8%) were unlikely related to the robot, and two events (8.3%) could not be categorized. Regarding complications following unilateral hernia repairs, data from 212 patients was available. Thirteen (6.1%) complications occurred, and six of those (2.8%) were serious. Out of 68 patients with a bilateral hernia repair, six patients (8.8%) developed complications, three of which were severe (4.4%). The complication rate was 2.8% in the patients following a cholecystectomy (4/144); two of them serious. After prostatectomy, six out of 141 patients (4.3 %) had complications; one serious (0.7%) No mortality was observed. Data about unplanned conversions to laparoscopic surgery could be collected from 761 patients which is a rate of 3.7%. There were 12 conversions out of 760 procedures to open surgery (1.6%). CONCLUSIONS Our series shows these procedures are safe and reproducible. The findings suggest that the surgical results after robotic surgery with the Senhance™ system are promising. Long-term data regarding complication rates should be the subject of future studies.
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AlAshqar A, Goktepe ME, Kilic GS, Borahay MA. Predictors of the cost of hysterectomy for benign indications. J Gynecol Obstet Hum Reprod 2020; 50:101936. [PMID: 33039600 DOI: 10.1016/j.jogoh.2020.101936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Hysterectomy is a commonly performed procedure with widely variable costs. As gynecologists divert from invasive to minimally invasive approaches, many factors come into play in determining hysterectomy cost and efforts should be sought to minimize it. Our objective was to identify the predictors of hysterectomy cost. MATERIALS AND METHODS This was a retrospective cohort study where women who underwent hysterectomy for benign conditions at the University of Texas Medical Branch from 2009 to 2016 were identified. We obtained and analyzed demographic, operative, and financial data from electronic medical records and the hospital finance department. RESULTS We identified 1,847 women. Open hysterectomy was the most frequently practiced (35.8 %), followed by vaginal (23.7 %), laparoscopic (23.6 %), and robotic (16.9 %) approaches. Multivariate regression demonstrated that hysterectomy charges can be significantly predicted from surgical approach, patient's age, operating room (OR) time, length of stay (LOS), estimated blood loss, insurance type, fiscal year, and concomitant procedures. Charges increased by $3,723.57 for each day increase in LOS (P <0.001), by $76.02 for each minute increase in OR time (P <0.001), and by $48.21 for each one-year increase in age (P 0.037). Adjusting for LOS and OR time remarkably decreased the cost of open and robotic hysterectomy, respectively when compared with the vaginal approach. CONCLUSION Multiple demographic and operative factors can predict the cost of hysterectomy. Healthcare providers, including gynecologists, are required to pursue additional roles in proper resource management and be acquainted with the cost drivers of therapeutic interventions. Future efforts and policies should target modifiable factors to minimize cost and promote value-based practices.
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Affiliation(s)
- Abdelrahman AlAshqar
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, United States; Department of Obstetrics and Gynecology, Kuwait University, Kuwait City, Kuwait
| | - Metin E Goktepe
- Medical Student, The University of Texas Medical Branch in Galveston, TX, United States
| | - Gokhan S Kilic
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch in Galveston, TX, United States
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, United States.
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