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Hui S, Qingya Y, Xinbao Y, Ming L, Gonghui L, Jun C. Two-shift operation mode can improve the efficiency and comfort of flexible ureteroscopic holmium laser lithotripsy for the treatment of renal calculi larger than 1.5cm. Int Braz J Urol 2019; 45:1161-1166. [PMID: 31808404 PMCID: PMC6909873 DOI: 10.1590/s1677-5538.ibju.2019.0219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/13/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose: To compare two-shift operation mode and single player mode different impact on surgical results and operator comfort in flexible ureteroscopic holmium laser lithotripsy for renal calculi larger than 1.5cm. Materials and Methods: From december 2017 to december 2018, 92 patients with renal calculi admitted to Qilu Hospital and were treated through flexible ureteroscopy. They were randomized in two-shift group (n=50) and single player group (n=42). The operative time, blood loss, hospitalization stay after operation, residual fragments (≥4mm) rate, fragmentation speed, postoperative complications and operator's fatigue score were compared. Results: There was no significant difference between two groups regarding age, gender, illness side, stone size, blood loss, operative time, postoperative hospitalization stay, complications, etc (p >0.05). The fragmentation speed was 44.5±20.0mm3/min in two-shift group compared with 34.2±17.3mm3/min in single player group (p=0.037). Residual fragments (≥4mm) rate after first surgery was 18% in two-shift group, while the residual fragments (≥4mm) rate was 40.5% after first surgery in single player group (p=0.017). The total fatigue score of two-shift group was 8.4 compared to 29.9 in single player group (p <0.001). Conclusion: In flexible ureteroscopic holmium laser lithotripsy for the treatment of renal calculi larger than 1.5cm, two-shift operation mode can raise the fragmentation speed and stone clearance rate, as well as significantly lower operator's fatigue level and improve operator's comfort.
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Affiliation(s)
- Sun Hui
- Qilu Hospital of Shandong University, Qingdao, China
| | - Yang Qingya
- Qilu Hospital of Shandong University, Qingdao, China
| | - Yin Xinbao
- Qilu Hospital of Shandong University, Qingdao, China
| | - Liu Ming
- Qilu Hospital of Shandong University, Qingdao, China
| | - Li Gonghui
- Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, China
| | - Chen Jun
- Qilu Hospital of Shandong University, Qingdao, China
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Kun Y, Hubert J, Bin L, Huan WX. Self-debriefing Model Based on an Integrated Video-Capture System: An Efficient Solution to Skill Degradation. JOURNAL OF SURGICAL EDUCATION 2019; 76:362-369. [PMID: 30292454 DOI: 10.1016/j.jsurg.2018.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/09/2018] [Accepted: 08/19/2018] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Video-based teaching is considered highly effective in debriefing, especially in minimally invasive surgeries. In this study, the benefits of using a new integrated video recording system, were investigated and compared to those of the standard basic skills robotic training procedure. DESIGN Fifty residents from the 2nd and 3rd year medical faculty without any experience of robot usage or laparoscopy were randomized into 2 groups: group A--a natural self-training group without a trainer, and group B--a self-training group assisted by an integrated video recording system during training. The training was divided into four 2-hour sessions, with a 72-hour delay between each session. Two tasks were selected for testing on the dV-Trainer, a virtual reality based robotic simulator: Match board 2 and Thread the Rings 1. After each session, the practice video recorded by the system of group B was transferred to the residents' smartphones for self-debriefing. At the end of each session, the performance score was evaluated automatically by using the simulator to plot learning curves A and B. RESULTS Group A showed a significant drop in performance score due to skill decay caused by the 72-hour delay. Group B exhibited a regular stepwise rising learning curve. At the end of the training, group B showed a significantly higher performance score both in Match board 2 and Thread the Rings 1. The autoanalysis and capture function, which selects only the critical errors and most valuable parts, could facilitate time saving. CONCLUSIONS The use of an integrated video recording system makes the self-manipulated protocol with own smartphone feasible to improve training efficiency and overcome the skill decay during robotic surgical training.
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Affiliation(s)
- Yang Kun
- Department of Urology, ZhongNan hospital, Wuhan University, China; Medicine - remote mapping associated laboratory, Wuhan University, China
| | - Jacques Hubert
- Department of Urology, CHU Nancy, Nancy, France; IADI/Inserm U947, Lorraine University, Nancy, France
| | - Luo Bin
- Medicine - remote mapping associated laboratory, Wuhan University, China; State Key Laboratory of Information Engineering in Surveying, Mapping and Remote Sensing, Wuhan University, China
| | - Wang Xing Huan
- Department of Urology, ZhongNan hospital, Wuhan University, China; Medicine - remote mapping associated laboratory, Wuhan University, China.
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Rassweiler JJ, Autorino R, Klein J, Mottrie A, Goezen AS, Stolzenburg JU, Rha KH, Schurr M, Kaouk J, Patel V, Dasgupta P, Liatsikos E. Future of robotic surgery in urology. BJU Int 2017; 120:822-841. [PMID: 28319324 DOI: 10.1111/bju.13851] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To provide a comprehensive overview of the current status of the field of robotic systems for urological surgery and discuss future perspectives. MATERIALS AND METHODS A non-systematic literature review was performed using PubMed/Medline search electronic engines. Existing patents for robotic devices were researched using the Google search engine. Findings were also critically analysed taking into account the personal experience of the authors. RESULTS The relevant patents for the first generation of the da Vinci platform will expire in 2019. New robotic systems are coming onto the stage. These can be classified according to type of console, arrangement of robotic arms, handles and instruments, and other specific features (haptic feedback, eye-tracking). The Telelap ALF-X robot uses an open console with eye-tracking, laparoscopy-like handles with haptic feedback, and arms mounted on separate carts; first clinical trials with this system were reported in 2016. The Medtronic robot provides an open console using three-dimensional high-definition video technology and three arms. The Avatera robot features a closed console with microscope-like oculars, four arms arranged on one cart, and 5-mm instruments with six degrees of freedom. The REVO-I consists of an open console and a four-arm arrangement on one cart; the first experiments with this system were published in 2016. Medicaroid uses a semi-open console and three robot arms attached to the operating table. Clinical trials of the SP 1098-platform using the da Vinci Xi for console-based single-port surgery were reported in 2015. The SPORT robot has been tested in animal experiments for single-port surgery. The SurgiBot represents a bedside solution for single-port surgery providing flexible tube-guided instruments. The Avicenna Roboflex has been developed for robotic flexible ureteroscopy, with promising early clinical results. CONCLUSIONS Several console-based robots for laparoscopic multi- and single-port surgery are expected to come to market within the next 5 years. Future developments in the field of robotic surgery are likely to focus on the specific features of robotic arms, instruments, console, and video technology. The high technical standards of four da Vinci generations have set a high bar for upcoming devices. Ultimately, the implementation of these upcoming systems will depend on their clinical applicability and costs. How these technical developments will facilitate surgery and whether their use will translate into better outcomes for our patients remains to be determined.
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Affiliation(s)
- Jens J Rassweiler
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | | | - Jan Klein
- Department of Urology, Medical School, University of Ulm, Ulm, Germany
| | - Alex Mottrie
- Department of Urology, OLV Clinic, Aalst, Belgium
| | - Ali Serdar Goezen
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | | | - Koon H Rha
- Department of Urology, Yonsei University, Seoul, Korea
| | - Marc Schurr
- IHCI-Institute, Steinbeis University Berlin, Tübingen, Germany
| | - Jihad Kaouk
- Department of Urology, OLV Clinic, Aalst, Belgium
| | - Vipul Patel
- Global Robotics Institute, Florida Hospital Celebration Health, Orlando, FL, USA
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Tokas T, Gözen AS, Avgeris M, Tschada A, Fiedler M, Klein J, Rassweiler J. Combining of ETHOS Operating Ergonomic Platform, Three-dimensional Laparoscopic Camera, and Radius Surgical System Manipulators Improves Ergonomy in Urologic Laparoscopy: Comparison with Conventional Laparoscopy and da Vinci in a Pelvi Trainer. Eur Urol Focus 2016; 3:413-420. [PMID: 28753821 DOI: 10.1016/j.euf.2016.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/21/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Posture, vision, and instrumentation limitations are the main predicaments of conventional laparoscopy. OBJECTIVE To combine the ETHOS surgical chair, the three-dimensional laparoscope, and the Radius Surgical System manipulators, and compare the system with conventional laparoscopy and da Vinci in terms of task completion times and discomfort. DESIGN, SETTING, AND PARTICIPANTS Fifteen trainees performed the three main laparoscopic suturing tasks of the Heilbronn training program (IV: simulation of dorsal venous complex suturing; V: circular suturing of tubular structure; and VI: urethrovesical anastomosis) in a pelvi trainer. The tasks were performed conventionally, utilizing the three devices, and robotically. Task completion times were recorded and the surgeon discomfort was evaluated using questionnaires. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Task completion times were compared using nonparametric Wilcoxon signed rank test and ergonomic scores were compared using Pearson chi-square test. RESULTS AND LIMITATIONS The use of the full laparoscopic set (ETHOS chair, three-dimensional laparoscopic camera, Radius Surgical System needle holders), resulted in a significant improvement of the completion time of the three tested tasks compared with conventional laparoscopy (p<0.001) and similar to da Vinci surgery. After completing Tasks IV, V, and VI conventionally, 12 (80%), 13 (86.7%), and 13 (86.7%) of the 15 trainees, respectively, reported heavy total discomfort. The full laparoscopic system nullified heavy discomfort for Tasks IV and V and minimized it (6.7%) for the most demanding Task VI. Especially for Task VI, all trainees gained benefit, by using the system, in terms of task completion times and discomfort. The limited trainee robotic experience and the questionnaire subjectivity could be a potential limitation. CONCLUSIONS The ergonomic laparoscopic system offers significantly improved task completion times and ergonomy than conventional laparoscopy. Furthermore, it demonstrates comparable results to robotic surgery. PATIENT SUMMARY The study was conducted in a pelvi trainer and no patients were recruited.
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Affiliation(s)
- Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, Hall in Tirol, Austria; Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany.
| | - Ali Serdar Gözen
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Margaritis Avgeris
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Athens, Athens, Greece
| | - Alexandra Tschada
- Medical School Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Marcel Fiedler
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Jan Klein
- Department of Urology, University of Ulm, Ulm, Germany
| | - Jens Rassweiler
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
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Rassweiler JJ, Klein J, Tschada A, Gözen AS. Laparoscopic retroperitoneal partial nephrectomy using an ergonomic chair: demonstration of technique and matched-pair analysis. BJU Int 2016; 119:349-357. [DOI: 10.1111/bju.13627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Jens J. Rassweiler
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Jan Klein
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Alexandra Tschada
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Ali Serdar Gözen
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn Germany
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Abstract
In the past 10 years, laparoscopy has been challenged by robotic surgery; nevertheless, laparoscopic techniques are subject to continuous change. Ultrahigh definition is the next development in video technology, it delivers fourfold more detail than full high definition resulting in improved fine detail, increased texture, and an almost photographic emulsion of smoothness of the image. New 4K ultrahigh-definition technology might remove the current need for the use of polarized glasses. New devices for laparoscopy include advanced sealing devices, instruments with six degrees of freedom, ergonomic platforms with armrests and a chest support, and camera holders. A manually manipulated robot-like device is still at the experimental stage. Robot-assisted surgery has substantially revolutionized laparoscopy, increasing its distribution; however, robot-assisted surgery is associated with considerable costs. All technical improvements of laparoscopic surgery are extremely valuable to further simplify the use of classical laparoscopy.
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A Comparative Study in Learning Curves of Two Different Intracorporeal Knot Tying Techniques. Minim Invasive Surg 2016; 2016:3059434. [PMID: 27022482 PMCID: PMC4789041 DOI: 10.1155/2016/3059434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 01/06/2016] [Accepted: 01/28/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives. In our study we are aiming to analyse the learning curves in our surgical trainees by using two standard methods of intracorporeal knot tying. Material and Method. Two randomized groups of trainees are trained with two different intracorporeal knot tying techniques (loop and winding) by single surgeon for eight sessions. In each session participants were allowed to make as many numbers of knots in thirty minutes. The duration for each set of knots and the number of knots for each session were calculated. At the end each session, participants were asked about their frustration level, difficulty in making knot, and dexterity. Results. In winding method the number of knots tied was increasing significantly in each session with less frustration and less difficulty level. Discussion. The suturing and knotting skill improved in every session in both groups. But group B (winding method) trainees made significantly higher number of knots and they took less time for each set of knots than group A (loop method). Although both knotting methods are standard methods, the learning curve is better in loop method. Conclusion. The winding method of knotting is simpler and easier to perform, especially for the surgeons who have limited laparoscopic experience.
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Gözen AS, Tokas T, Tschada A, Jalal A, Klein J, Rassweiler J. Direct comparison of the different conventional laparoscopic positions with the ethos surgical platform in a laparoscopic pelvic surgery simulation setting. J Endourol 2015; 29:95-9. [PMID: 25112534 DOI: 10.1089/end.2014.0051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Laparoscopic surgery can be harmful to surgeons requiring a prolonged learning curve due to significant ergonomic drawbacks. Based on preliminary clinical experience, we present an experimental evaluation of the second-generation ETHOS™ operating chair by comparing it with two different operating positions of conventional laparoscopic pelvic surgery. MATERIALS AND METHODS The ETHOS operation platform consists of a seat like a saddle and five more parts that can be adjusted individually to support the surgeon's trunk and extremities. This operation platform was tested in 30 trainees who performed three standard suturing exercises in a pelvitrainer, approximating a linear and a U-shaped incision, made on the skin of a chicken leg, and completing an urethrovesical anastomosis, on a pig bladder specimen model, using interrupted sutures. The trainees performed each exercise in standing laterally to pelvitrainer (torero position) vs standing behind pelvi-trainer and sitting on ETHOS. The mean values, from all times and for each exercise and position, were documented, and the participants filled out a validated questionnaire focusing on ergonomic issues. RESULTS There were no significant differences among the different training modalities, in step 1 and step 2. However, in step 3, which mimics the urethrovesical anastomosis, the mean times were statistically significant significantly less by using ETHOS (p<0.0001). The mean times of training in step 3 were 41.2 minutes in the behind the camera position, 49 minutes in torero position, and 39.7 minutes by using ETHOS. The position that was maintained, during the exercises, was mainly responsible for the improvement noted in the ergonomic scores. CONCLUSIONS The new operating platform (ETHOS chair) can significantly improve ergonomics in laparoscopy particularly concerning difficult steps like intracorporeal suturing. This may also improve the urethrovesical anastomosis times in a clinical setting.
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Affiliation(s)
- Ali Serdar Gözen
- Department of Urology, SLK-Kliniken, University of Heidelberg , Heilbronn, Germany
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9
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Tung KD, Shorti RM, Downey EC, Bloswick DS, Merryweather AS. The effect of ergonomic laparoscopic tool handle design on performance and efficiency. Surg Endosc 2014; 29:2500-5. [PMID: 25537377 DOI: 10.1007/s00464-014-4005-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 10/25/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many factors can affect a surgeon's performance in the operating room; these may include surgeon comfort, ergonomics of tool handle design, and fatigue. A laparoscopic tool handle designed with ergonomic considerations (pistol grip) was tested against a current market tool with a traditional pinch grip handle. The goal of this study is to quantify the impact ergonomic design considerations which have on surgeon performance. We hypothesized that there will be measurable differences between the efficiency while performing FLS surgical trainer tasks when using both tool handle designs in three categories: time to completion, technical skill, and subjective user ratings. METHODS The pistol grip incorporates an ergonomic interface intended to reduce contact stress points on the hand and fingers, promote a more neutral operating wrist posture, and reduce hand tremor and fatigue. The traditional pinch grip is a laparoscopic tool developed by Stryker Inc. widely used during minimal invasive surgery. Twenty-three (13 M, 10 F) participants with no existing upper extremity musculoskeletal disorders or experience performing laparoscopic procedures were selected to perform in this study. During a training session prior to testing, participants performed practice trials in a SAGES FLS trainer with both tools. During data collection, participants performed three evaluation tasks using both handle designs (order was randomized, and each trial completed three times). The tasks consisted of FLS peg transfer, cutting, and suturing tasks. RESULTS Feedback from test participants indicated that they significantly preferred the ergonomic pistol grip in every category (p < 0.05); most notably, participants experienced greater degrees of discomfort in their hands after using the pinch grip tool. Furthermore, participants completed cutting and peg transfer tasks in a shorter time duration (p < 0.05) with the pistol grip than with the pinch grip design; there was no significant difference between completion times for the suturing task. Finally, there was no significant interaction between tool type and errors made during trials. CONCLUSIONS There was a significant preference for as well as lower pain experienced during use of the pistol grip tool as seen from the survey feedback. Both evaluation tasks (cutting and peg transfer) were also completed significantly faster with the pistol grip tool. Finally, due to the high degree of variability in the error data, it was not possible to draw any meaningful conclusions about the effect of tool design on the number or degree of errors made.
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Affiliation(s)
- Kryztopher D Tung
- Mechanical Engineering Department, University of Utah, Salt Lake City, USA,
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Szold A, Bergamaschi R, Broeders I, Dankelman J, Forgione A, Langø T, Melzer A, Mintz Y, Morales-Conde S, Rhodes M, Satava R, Tang CN, Vilallonga R. European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery. Surg Endosc 2014; 29:253-88. [PMID: 25380708 DOI: 10.1007/s00464-014-3916-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/19/2014] [Indexed: 12/14/2022]
Abstract
Following an extensive literature search and a consensus conference with subject matter experts the following conclusions can be drawn: 1. Robotic surgery is still at its infancy, and there is a great potential in sophisticated electromechanical systems to perform complex surgical tasks when these systems evolve. 2. To date, in the vast majority of clinical settings, there is little or no advantage in using robotic systems in general surgery in terms of clinical outcome. Dedicated parameters should be addressed, and high quality research should focus on quality of care instead of routine parameters, where a clear advantage is not to be expected. 3. Preliminary data demonstrates that robotic system have a clinical benefit in performing complex procedures in confined spaces, especially in those that are located in unfavorable anatomical locations. 4. There is a severe lack of high quality data on robotic surgery, and there is a great need for rigorously controlled, unbiased clinical trials. These trials should be urged to address the cost-effectiveness issues as well. 5. Specific areas of research should include complex hepatobiliary surgery, surgery for gastric and esophageal cancer, revisional surgery in bariatric and upper GI surgery, surgery for large adrenal masses, and rectal surgery. All these fields show some potential for a true benefit of using current robotic systems. 6. Robotic surgery requires a specific set of skills, and needs to be trained using a dedicated, structured training program that addresses the specific knowledge, safety issues and skills essential to perform this type of surgery safely and with good outcomes. It is the responsibility of the corresponding professional organizations, not the industry, to define the training and credentialing of robotic basic skills and specific procedures. 7. Due to the special economic environment in which robotic surgery is currently employed special care should be taken in the decision making process when deciding on the purchase, use and training of robotic systems in general surgery. 8. Professional organizations in the sub-specialties of general surgery should review these statements and issue detailed, specialty-specific guidelines on the use of specific robotic surgery procedures in addition to outlining the advanced robotic surgery training required to safely perform such procedures.
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Affiliation(s)
- Amir Szold
- Technology Committee, EAES, Assia Medical Group, P.O. Box 58048, Tel Aviv, 61580, Israel,
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Saglam R, Muslumanoglu AY, Tokatlı Z, Caşkurlu T, Sarica K, Taşçi Aİ, Erkurt B, Süer E, Kabakci AS, Preminger G, Traxer O, Rassweiler JJ. A new robot for flexible ureteroscopy: development and early clinical results (IDEAL stage 1-2b). Eur Urol 2014; 66:1092-100. [PMID: 25059998 DOI: 10.1016/j.eururo.2014.06.047] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/27/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND An improved armamentarium has had a significant impact on the emerging role of flexible ureteroscopy (FURS) for the management of nephrolithiasis; however, FURS still represents a challenging technique. OBJECTIVE To examine a robotic device designed for FURS for its impact on ergonomics and outcome of the procedure based on the IDEAL (idea, development, evaluation, assessment, long-term study) framework. DESIGN, SETTING, AND PARTICIPANTS Roboflex Avicenna consists of a surgeon's console and a manipulator for the flexible ureterorenoscope. Following experimental evaluation of the prototype (IDEAL stage 1) and receipt of ethical approval, seven surgeons treated 81 patients (mean age: 42 yr [range: 6-68]) with renal calculi (mean volume: 1296±544 mm(3) [range: 432-3100 mm3]) in an observational study (IDEAL stage 2). SURGICAL PROCEDURE Robotic FURS was performed with the Roboflex Avicenna robotic device. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Numerical data were analysed with the Mann-Whitney test, and categorical variables were analysed using the chi-square test or Fisher exact test. P values <0.05 were considered statistically significant. RESULTS AND LIMITATIONS Mean robot docking time was 59.6±45 s. Mean operative time was 74min (range: 40-182). Mean fragmentation speed was 29.1±6.1 mm3/min. Ergonomics based on a validated questionnaire showed significant advantage for robotic FURS (total score: 5.6 vs 31.3; p<0.01). A 10/12F-access sheath was used in 72 patients. Two cases required secondary FURS, one because of malfunction of the flexible digital ureteroscope and another because of larger residual fragments. In the remaining 79 cases, complete stone disintegration was accomplished. CONCLUSIONS Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement of ergonomics. Future studies should evaluate its impact on the clinical outcome of FURS. PATIENT SUMMARY Robotic flexible ureteroscopy (FURS) was performed with the Roboflex Avicenna robotic device. Results showed that Roboflex Avicenna provides a suitable and safe platform for robotic FURS with significant improvement of ergonomics.
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Affiliation(s)
- Remzi Saglam
- Department of Urology, Medicana International Hospital, Ankara, Turkey
| | | | - Zafer Tokatlı
- Department of Urology, Medicana International Hospital, Ankara, Turkey
| | - Turhan Caşkurlu
- Department of Urology, Medeniyet University Hospital, Istanbul, Turkey
| | - Kemal Sarica
- Department of Urology, Kartal Training Hospital, Istanbul, Turkey
| | - Ali İhsan Taşçi
- Department of Urology, Bakırköy Training Hospital, Istanbul, Turkey
| | - Bülent Erkurt
- Department of Urology, Medipol University Medical School Hospital, Istanbul, Turkey
| | - Evren Süer
- Department of Urology, Ankara University Medical School Hospital, Ankara, Turkey
| | | | - Glenn Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Olivier Traxer
- Department of Urology, Université Pierre et Marie Curie, Hôpital Tenon, Paris, France
| | - Jens J Rassweiler
- Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany; Department of Urology, University of Heidelberg, Heidelberg, Germany.
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12
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Broeders IAMJ. Robotics: The next step? Best Pract Res Clin Gastroenterol 2014; 28:225-32. [PMID: 24485268 DOI: 10.1016/j.bpg.2013.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 12/03/2013] [Accepted: 12/03/2013] [Indexed: 01/31/2023]
Abstract
UNLABELLED Robotic systems were introduced 15 years ago to support complex endoscopic procedures. The technology is increasingly used in gastro-intestinal surgery. In this article, literature on experimental- and clinical research is reviewed and ergonomic issues are discussed. METHODS literature review was based on Medline search using a large variety of search terms, including e.g. robot(ic), randomized, rectal, oesophageal, ergonomics. Review articles on relevant topics are discussed with preference. RESULTS There is abundant evidence of supremacy in performing complex endoscopic surgery tasks when using the robot in an experimental setting. There is little high-level evidence so far on translation of these merits to clinical practice. DISCUSSION Robotic systems may appear helpful in complex gastro-intestinal surgery. Moreover, dedicated computer based technology integrated in telepresence systems opens the way to integration of planning, diagnostics and therapy. The first high tech add-ons such as near infrared technology are under clinical evaluation.
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Affiliation(s)
- Ivo A M J Broeders
- Department of Surgery, Meander Medical Centre, Utrechtseweg 160, 3818 ES Amersfoort, The Netherlands; Twente University, Technical Medicine, Carre Building CR 3629, Drienerlolaan 5, 7522 NB Enschede, The Netherlands.
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Rassweiler J, Rassweiler MC, Kenngott H, Frede T, Michel MS, Alken P, Clayman R. The past, present and future of minimally invasive therapy in urology: A review and speculative outlook. MINIM INVASIV THER 2013; 22:200-9. [DOI: 10.3109/13645706.2013.816323] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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14
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Rassweiler JJ. Editorial comment. Urology 2013; 82:99; discussion 99. [PMID: 23642931 DOI: 10.1016/j.urology.2013.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tepeler A, Silay MS, Akman T, Akcay M, Ersoz C, Kardas S, Erdem MR, Armagan A, Onol SY. Comparison of flexible and rigid cystoscopy-assisted ureteral catheter insertion before percutaneous nephrolithotomy: a prospective randomized trial. J Endourol 2013; 27:722-6. [PMID: 23441589 DOI: 10.1089/end.2013.0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE To compare the advantages of flexible and rigid cystoscopy-assisted ureteral catheter placement before prone percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS From March to September 2012, a total of 80 patients with kidney stones underwent PCNL by the same surgical team. The patients were randomly assigned into one of the groups according to the technique used for ureteral catheter insertion: Flexible cystoscopy (group 1, n=40) or rigid cystoscopy (group 2, n=40). Patient demographics and operation-related factors were compared. The preparation period included positioning, cystoscopy-assisted stent insertion, and patient repositioning for PCNL. In addition, discomfort scores of the operating room (OR) staff were measured. RESULTS The demographic values of the groups in terms of patient sex, age, body mass index, and stone size were comparable. While the mean preparation period was calculated as 9.9±2.3 minutes in the flexible cystoscopy group, it was significantly longer (19.7±2.9 minutes) in the rigid cystoscopy group (P<0.0001). In addition, the discomfort score of the OR staff was found to be significantly higher in the rigid cystoscopy group (1.1±0.9 vs 2.05±0.68, P<0.0001). The rest of the operative and postoperative parameters were similar. CONCLUSIONS The insertion of a ureteral catheter with a flexible cystoscope before prone PCNL shortens the preparation period and minimizes the discomfort of OR staff related to patient positioning and transfer.
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Affiliation(s)
- Abdulkadir Tepeler
- Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
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Re: Christian Bolenz, Stephen J. Freedland, Brent K. Hollenbeck, et al. costs of radical prostatectomy for prostate cancer: a systematic review. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2012.08.059. Eur Urol 2013; 63:e53-6. [PMID: 23312570 DOI: 10.1016/j.eururo.2012.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 12/17/2012] [Indexed: 11/23/2022]
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[Comments on radical prostatectomy - laparoscopic versus robotic]. Urologe A 2012; 51:630-2. [PMID: 22532365 DOI: 10.1007/s00120-012-2881-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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