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Hu X, Ruan M, Zhu L, Huang M, Qi L, Huang M, Zou S, Lin L, Zheng W, Wang L, Duan P. This is the first in-human trial and prospective case series of a novel single-port robotic system for gynaecological surgery: An IDEAL stage 2a study. Int J Med Robot 2024; 20:e2657. [PMID: 39303291 DOI: 10.1002/rcs.2657] [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: 02/26/2024] [Revised: 05/27/2024] [Accepted: 06/29/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND The Shurui® system (SR-ENS-600) is a novel fully integrated single-port robotic system with bioinspired serpentine surgical manipulators and a camera. METHODS This was a single-centre prospective case-series study according to the IDEAL stage 2a guidelines to evaluate the feasibility, safety and potential efficacy of the Shurui® system for gynaecological surgeries and to improve the operating process. RESULTS Ten patients with a gradient of surgical difficulty who had indications for laparoscopic surgery and who volunteered to participate in a clinical trial were enrolled in the study. All 10 subjects successfully completed the procedure without converting to other procedures. No serious complications were reported at the 3-month follow-up. Subjects recover faster after surgery and are highly satisfied with the incision. CONCLUSIONS Gynaecological single-site laparoscopic surgery with the Shurui® system was technically feasible for well-selected patients with minimal alterations in technique. Further prospective multicenter large-sample studies are necessary. REGISTRATION NUMBER ChiCTR2300075431. URL: https://www.chictr.org.cn/showproj.html?proj=189995.
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Affiliation(s)
- Xueli Hu
- Oncology Discipline Group, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Wenzhou Medical University, Wenzhou, China
| | - Mengjia Ruan
- Oncology Discipline Group, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Wenzhou Medical University, Wenzhou, China
| | - Luoyi Zhu
- Oncology Discipline Group, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Wenzhou Medical University, Wenzhou, China
| | - Menghan Huang
- Oncology Discipline Group, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Wenzhou Medical University, Wenzhou, China
| | - Lifang Qi
- Oncology Discipline Group, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Min Huang
- Oncology Discipline Group, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shuangwei Zou
- Oncology Discipline Group, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lili Lin
- Oncology Discipline Group, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenwen Zheng
- Oncology Discipline Group, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lizhi Wang
- Oncology Discipline Group, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ping Duan
- Oncology Discipline Group, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Wenzhou Medical University, Wenzhou, China
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Heo JE, Han HH, Lee J, Choi YD, Jang WS. Single-port robot-assisted pyeloplasty using the da Vinci SP system versus multi-port pyeloplasty: Comparison of outcomes and costs. Asian J Surg 2024; 47:3841-3846. [PMID: 38614849 DOI: 10.1016/j.asjsur.2024.03.175] [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: 04/26/2023] [Revised: 11/08/2023] [Accepted: 03/28/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVE To investigate the feasibility of single-port (SP) robotic pyeloplasty by comparing perioperative outcomes with those of multiport (MP) robotic pyeloplasty. MATERIALS AND METHODS We reviewed the data from patients who underwent robot-assisted pyeloplasty for ureteropelvic junction obstruction (UPJO) at a single tertiary institution between March 2016 and May 2022. Radiographic and symptomatic improvements were assessed 3 months postoperatively. Propensity score matching was performed for age, sex, body mass index, and hydronephrosis grade. RESULTS Of the 15 S P-pyeloplasty and 28 MP-pyeloplasty cases, 14 from each group were matched using 1:1 matching. The SP group had shorter console and operative times without significant differences. Blood loss was lower in the SP group than in the MP group (p = 0.019). The length of hospital stay, opioid use on the operative day, and pain score at discharge did not differ between the two groups. The mean cost for surgery was higher in the SP group than in the MP group (p < 0.001). The mean cost of hospitalization was comparable between the two groups (p = 0.083). The cosmetic numerical rating scale scores were significantly higher in the SP group (p = 0.014). Symptoms improved in all patients, and the radiographic improvement rates were 92.9% in the SP group and 100% in the MP group. CONCLUSION SP-pyeloplasty showed cosmetic benefits, lower blood loss, operative time, and console time compared with MP-pyeloplasty. In patients who underwent surgery for UPJO for the first time, SP surgery can show comparable outcomes when compared to MP surgery.
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Affiliation(s)
- Ji Eun Heo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ho Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jongsoo Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
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Chen K, Zhang J, Beeraka NM, Lu P. Robotic nipple sparing mastectomy and immediate breast reconstruction: significant attempts with the latissimus dorsi muscle without island flap. Minerva Surg 2024; 79:411-418. [PMID: 38757888 DOI: 10.23736/s2724-5691.24.10244-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND This study presents preliminary results of robot-assisted nipple-sparing immediate breast reconstruction (R-NSMIBR) with gel implant combined with latissimus dorsi muscle flap without island flap and validation of the safety and utility of this novel surgical modality. METHODS Records pertinent to R-NSMIBR with gel implants combined with latissimus dorsi muscle flap surgery for breast reconstruction between September 2022 and May 2023 were examined. A total of 13 patients who underwent R-NSMIBR were analyzed, nine of which were performed without skin island. RESULTS We divided the patients with and without skin islands into two groups and recorded the operation time and bleeding respectively. The mean total operative time for R-NSMIBR was 436.5±56.88 minutes and 355.75±69.68 minutes. As experience in learning increased, time required to create the operating space and position the robotic arm decreased significantly. Not creating an island of skin also saves a great deal of surgical time. Average total blood loss was 37.5±6.45 mL and 26.25±7.5 mL. No cases of nipple-areolar complex necrosis or perioperative complications or no local recurrences were reported. There were no local recurrences or deaths that occurred during a mean follow-up period of 3±1 months. CONCLUSIONS All the patients expressed satisfaction with the aesthetic outcome following surgery. There were no significant differences between two groups. This surgical method shows promise for future promotion in the field.
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Affiliation(s)
- Kuo Chen
- Department of Breast Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jin Zhang
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Narasimha M Beeraka
- Raghavendra Institute of Pharmaceutical Education and Research (RIPER), Chiyyedu, India
- Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Pediatrics, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Pengwei Lu
- Department of Breast Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China -
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Soputro NA, Chavali JS, Ferguson EL, Ramos-Carpinteyro R, Calvo RS, Nguyen J, Moschovas MC, Wilder S, Okhawere K, De La Rosa RS, Saini I, Peabody J, Badani KK, Rogers C, Joseph J, Nix J, Patel V, Stifelman M, Ahmed M, Crivellaro S, Kim M, Kaouk JH. Complications of single-port robot-assisted radical prostatectomy: multi-institutional analysis from the Single-Port Advanced Research Consortium (SPARC). BJU Int 2024; 134:54-62. [PMID: 37971182 DOI: 10.1111/bju.16228] [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: 11/19/2023]
Abstract
OBJECTIVE To evaluate the perioperative complications of single-port robot-assisted radical prostatectomy (SP-RARP). PATIENTS AND METHODS A retrospective review was performed on the prospectively maintained, Institutional Review Board-approved, multi-institutional Single-Port Advanced Research Consortium (SPARC) database. A total of 1103 patients were identified who underwent three different approaches of SP-RARP between 2019 and 2022 using the purpose-built SP robotic platform. In addition to baseline clinical, perioperative outcomes, this study comprehensively analysed for any evidence of intraoperative complication, as well as postoperative complication and readmission within 90 days of the respective surgery. RESULTS Of the 244, 712, and 147 patients who underwent transperitoneal, extraperitoneal, and transvesical SP-RARP, respectively, intraoperative complications were noted in five patients (0.4%), all of which occurred during the transperitoneal approach. Two patients had bowel serosal tears, two had posterior button-holing of the bladder necessitating repair, and one patient had an obturator nerve injury. Postoperative complications were noted in 143 patients (13%) with major complications (Clavien-Dindo Grade ≥III) only identified in 3.7% of the total cohort. The most common complications were lymphocele (3.9%), acute urinary retention (2%), and urinary tract infection (1.9%). The 90-day re-admission rate was 3.9%. CONCLUSION The SP-RARP is a safe and effective procedure with low complication and readmission rates regardless of the approach. These results are comparable to current multi-port RARP literature.
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Affiliation(s)
- Nicolas A Soputro
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jaya Sai Chavali
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ethan L Ferguson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Indu Saini
- Mount Sinai Hospital, New York City, NY, USA
| | | | | | | | - Jean Joseph
- University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey Nix
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vipul Patel
- Advent Health Medical Group Urology, Celebration, FL, USA
| | - Michael Stifelman
- Hackensack University Medical Center, Hackensack, NJ, USA
- Hackensack Meridien School of Medicine, Hackensack, NJ, USA
| | - Mutahar Ahmed
- Hackensack University Medical Center, Hackensack, NJ, USA
- Hackensack Meridien School of Medicine, Hackensack, NJ, USA
| | | | - Moses Kim
- Orange County Urology Associates, Laguna Hills, CA, USA
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Franco A, Ditonno F, Manfredi C, Pellegrino AA, Licari LC, Bologna E, Feng C, Antonelli A, De Sio M, De Nunzio C, Porpiglia F, Cherullo EE, Kaouk J, Crivellaro S, Autorino R. Single port robot-assisted radical and simple prostatectomy: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00787-2. [PMID: 38263281 DOI: 10.1038/s41391-024-00787-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Aim of our study was to review the current evidence on single port robot-assisted radical prostatectomy (SP-RARP) and SP robot-assisted simple prostatectomy (SP-RASP) procedures. METHODS A comprehensive bibliographic search on multiple databases was conducted in July 2023. Studies were included if they assessed patients with non-metastatic prostate cancer or candidate for benign prostatic hyperplasia surgery (P) who underwent SP-RARP or SP-RASP, respectively, (I), compared or not with other surgical techniques (C), evaluating perioperative, oncological, or functional outcomes (O). Prospective and retrospective original articles were included (S). A meta-analysis of comparative studies between SP-RARP and MP-RARP was performed. RESULTS A total of 21 studies investigating 1400 patients were included in our systematic review, 18 were related to SP-RARP while 3 to SP-RASP. Only 8 comparative studies were eligible for meta-analysis. Mean follow-up was 8.1 (±5.8) months. Similar outcomes were observed for SP-RARP and MP-RARP in terms of operative time, catheterization time, pain score, complications rate, continence and potency rates, positive surgical margin, and biochemical recurrence. Length of hospital stay was shorter in the SP group after sensitivity analysis (WMD -0.58, 95% IC -1.17 to -0.9, p < 0.05). Subgroup analysis by extraperitoneal approach did not show any statistical difference, except for a lower positive margins rate in the SP extraperitoneal technique compared to MP-RARP. Overall, SP-RASP exhibited shorter hospital stay and lower rate of de novo urinary incontinence when compared to other techniques, while no differences were reported in terms of postoperative International Prostate Symptom Score, post void residual and maximum flow. CONCLUSIONS Overall comparable oncological, functional, and perioperative outcomes can be achieved with SP platform. Subgroup analysis by different approaches did not reveal significant variations in outcomes. However, the retrospective nature of the studies, the limited follow-up, and the relatively small sample size of selected Centers may impact these results.
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Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Urology Unit, "Luigi Vanvitelli" University, Naples, Italy
| | | | - Leslie Claire Licari
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Carol Feng
- Department of Urology, Rush University, Chicago, IL, USA
| | | | - Marco De Sio
- Urology Unit, "Luigi Vanvitelli" University, Naples, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Jihad Kaouk
- Department of Urology, Glickman Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
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Safdar M, Ullah M, Wahab A, Hamayun S, Ur Rehman M, Khan MA, Khan SU, Ullah A, Din FU, Awan UA, Naeem M. Genomic insights into heart health: Exploring the genetic basis of cardiovascular disease. Curr Probl Cardiol 2024; 49:102182. [PMID: 37913933 DOI: 10.1016/j.cpcardiol.2023.102182] [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: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023]
Abstract
Cardiovascular diseases (CVDs) are considered as the leading cause of death worldwide. CVD continues to be a major cause of death and morbidity despite significant improvements in its detection and treatment. Therefore, it is strategically important to be able to precisely characterize an individual's sensitivity to certain illnesses. The discovery of genes linked to cardiovascular illnesses has benefited from linkage analysis and genome-wide association research. The last 20 years have seen significant advancements in the field of molecular genetics, particularly with the development of new tools like genome-wide association studies. In this article we explore the profound impact of genetic variations on disease development, prognosis, and therapeutic responses. And the significance of genetics in cardiovascular risk assessment and the ever-evolving realm of genetic testing, offering insights into the potential for personalized medicine in this domain. Embracing the future of cardiovascular care, the article explores the implications of pharmacogenomics for tailored treatments, the promise of emerging technologies in cardiovascular genetics and therapies, including the transformative influence of nanotechnology. Furthermore, it delves into the exciting frontiers of gene editing, such as CRISPR/Cas9, as a novel approach to combat cardiovascular diseases. And also explore the potential of stem cell therapy and regenerative medicine, providing a holistic view of the dynamic landscape of cardiovascular genomics and its transformative potential for the field of cardiovascular medicine.
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Affiliation(s)
- Mishal Safdar
- Department of Biological Sciences, National University of Medical Sciences (NUMS) Rawalpindi 46000, Punjab, Pakistan
| | - Muneeb Ullah
- Department of Pharmacy, Kohat University of Science, and technology (KUST), Kohat, 26000, Khyber Pakhtunkhwa, Pakistan
| | - Abdul Wahab
- Department of Pharmacy, Kohat University of Science, and technology (KUST), Kohat, 26000, Khyber Pakhtunkhwa, Pakistan
| | - Shah Hamayun
- Department of Cardiology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, 04485 Punjab, Pakistan
| | - Mahboob Ur Rehman
- Department of Cardiology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, 04485 Punjab, Pakistan
| | - Muhammad Amir Khan
- Department of Foreign Medical education, Fergana Medical institute of Public Health, 2A Yangi Turon street, Fergana 150100, Uzbekistan
| | - Shahid Ullah Khan
- Department of Biochemistry, Women Medical and Dental College, Khyber Medical University, Abbottabad, 22080, Khyber Pakhtunkhwa, Pakistan
| | - Aziz Ullah
- Department of Chemical Engineering, Pukyong National University, Busan 48513, Republic of Korea
| | - Fakhar Ud Din
- Department of Pharmacy, Quaid-i-Azam University, 45320, Islamabad, Pakistan
| | - Uzma Azeem Awan
- Department of Biological Sciences, National University of Medical Sciences (NUMS) Rawalpindi 46000, Punjab, Pakistan
| | - Muhammad Naeem
- Department of Biological Sciences, National University of Medical Sciences (NUMS) Rawalpindi 46000, Punjab, Pakistan.
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Chen K, Zhang J, Beeraka NM, Song D, Sinelnikov MY, Lu P. Robot-assisted nipple-sparing mastectomy and immediate breast reconstruction with gel implant and latissimus dorsi muscle flap: Our initial experience. Int J Med Robot 2023; 19:e2528. [PMID: 37194617 DOI: 10.1002/rcs.2528] [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: 02/10/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND This study reports the preliminary results of da Vinci robot XI robot-assisted nipple-sparing mastectomy immediate breast reconstruction (R-NSMIBR) with gel implant and latissimus dorsi muscle flap. METHODS A total of 15 patients who underwent R-NSMIBR with gel implant and latissimus dorsi muscle flap surgery for breast cancer between September 2022 and November 2022 were evaluated. RESULTS Mean total operative time for R-NSMIBR was 361.9 ± 77.0 min. As the learning curve increased, the robot arm docking time decreased rapidly from the initial 25-10 min. Average total blood loss was 27.8 ± 10.7 mL and posterior surgical margin positivity rate was 0%. Perioperative complications and local recurrences or deaths were not observed at a mean follow-up of 3 ± 1 month 15 patients were satisfied with postoperative aesthetic results. CONCLUSIONS R-NSMIBR with a gel implant and latissimus dorsi muscle flap could be a new therapeutic option for breast reconstruction.
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Affiliation(s)
- Kuo Chen
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jin Zhang
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Narasimha M Beeraka
- Raghavendra Institute of Pharmaceutical Education and Research (RIPER), Anantapur, India
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Mikhail Y Sinelnikov
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
- Sinelab Biomedical Research Centre, Minnesota, New York, USA
- Research Institute of Human Morphology, Russian Scientific Center of Surgery, Moscow, Russia
| | - Pengwei Lu
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Heo JE, Kang SK, Lee J, Koh D, Kim MS, Lee YS, Ham WS, Jang WS. Outcomes of single-port robotic ureteral reconstruction using the da Vinci SP ® system. Investig Clin Urol 2023; 64:373-379. [PMID: 37417562 DOI: 10.4111/icu.20230005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/19/2023] [Accepted: 04/23/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE The da Vinci SP® robotic system enables three double-jointed wristed instruments and a fully wristed three-dimensional camera to be placed through a single port. This study presents our experience with robot-assisted ureteral reconstruction using the SP system and reports its outcomes. MATERIALS AND METHODS Between December 2018 and April 2022, a single surgeon performed robotic ureteral reconstruction using the SP system in 39 patients: 18 underwent pyeloplasty and 21 received ureteral reimplantation. Demographic and perioperative patient data were collected and analyzed. Radiographic and symptomatic improvements were assessed 3 months after surgery. RESULTS In pyeloplasty group, 12 patients (66.7%) were female and two patients (11.1%) had undergone previous surgery for ureteral obstruction. The median operative time was 152 minutes, the median blood loss was 8 mL, and the median length of stay in hospital was 3 days. There was one case of a complication involving postoperative percutaneous nephrostomy (PCN). In ureteral reimplantation group, 19 patients (90.5%) were female and ten patients (47.6%) had undergone gynecological surgery that caused ureteral obstruction. The median operative time was 152 minutes, the median blood loss was 10 mL, and the median length of stay in hospital was 4 days. We observed one case of open conversion and two cases of complications (colonic serosal tearing and postoperative PCN after ileal ureter replacement). The radiographic results and symptoms successfully improved following both surgeries. CONCLUSIONS Despite adhesion-related complications, the SP system appears to be safe and effective for use in robot-assisted ureteral reconstruction.
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Affiliation(s)
- Ji Eun Heo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ku Kang
- Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jongsoo Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Koh
- Department of Urology, Konyang University College of Medicine, Daejeon, Korea
| | - Min Seok Kim
- Department of Urology, Chosun University School of Medicine, Gwangju, Korea
| | - Yong Seung Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Ham
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
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Gu L, Li Y, Li X, Liu W. Single-Port vs Multiple-Port Robot-Assisted Laparoscopic Pyeloplasty for the Treatment of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis. J Endourol 2023; 37:681-687. [PMID: 37051695 DOI: 10.1089/end.2023.0064] [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: 04/14/2023] Open
Abstract
Background: Single-port robot-assisted pyeloplasty (SP-RP) has been performed in recent years. However, the advantages and disadvantages of SP-RP compared with multiple-port robot-assisted pyeloplasty (MP-RP) remain unclear. The purpose of this meta-analysis was to compare the safety and feasibility of the two technologies. Materials and Methods: Through a literature search using MEDLINE, EMBASE, and the Cochrane Library, studies comparing SP-RP and MP-RP were identified for meta-analysis. Comparisons of perioperative and postoperative outcomes between the groups were analyzed using weighted mean difference (WMD) and risk ratio. Results: Five retrospective cohort studies with 179 patients were included in this meta-analysis. The results showed that SP-RP was associated with shorter hospital stay (WMD: -0.6 minutes, 95% confidence interval [CI]: -1.19 to -0.02, p = 0.04), less postoperative pain (pain score, WMD: -0.84, 95% CI: -1.62 to -0.07, p = 0.03), and superior cosmetic appearance compared with MP-RP. In addition, no differences were found between the SP-RP and MP-RP groups in terms of operative time, blood loss, rate of complications, and recovery of renal function. Conclusion: SP-RP provided comparable effectiveness, safety, and superior outcomes in terms of cosmetic appearance and pain compared with MP-RP, which gives surgeons the confidence to adopt and promote these ultraminimal invasive surgeries.
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Affiliation(s)
- Li Gu
- Department of Gastroenterology and The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yijian Li
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xurui Li
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wentao Liu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
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Ghazi A, Schuler N, Saba P, Holler T, Steinmetz A, Yuen K, Doersch K, Ellis E, Tabayoyong W, Bloom J, Rashid H, Kavoussi N, Joseph J. Do Skills Naturally Transfer Between Multiport and Single-Port Robotic Platforms? A Comparative Study in a Simulated Environment. J Endourol 2023; 37:233-239. [PMID: 36006300 DOI: 10.1089/end.2022.0467] [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: 02/07/2023] Open
Abstract
Introduction and Objective: With introduction of the da Vinci single-port (SP) system, we evaluated which multiport (MP) robotic skills are naturally transferable to the SP platform. Methods: Three groups of urologists: Group 1 (5 inexperienced in MP and SP), Group 2 (5 experienced in MP without SP experience), and Group 3 (2 experienced in both MP and SP) were recruited to complete a validated urethrovesical anastomosis simulation using MP followed by SP robots. Performance was graded using both GEARS and RACE scales. Subjective cognitive load measurements (Surg-TLX and difficulty ratings [/20] of instrument collisions camera and EndoWrist movement) were collected. Results: GEARS and RACE scores for Groups 1 and 3 were maintained on switching from MP to SP (Group 3 scored significantly higher on both systems). Surg-TLX and difficulty scores were also maintained for both groups on switching from MP and SP except for a significant increase in SP camera movement (+7.2, p = 0.03) in Group 1 compared to Group 3 that maintained low scores on both. Group 2 demonstrated significant lower GEARS (-2.9, p = 0.047) and RACE (-5.1, p = 0.011) scores on SP vs MP. On subanalysis, GEARS subscores for force sensitivity and robotic control (-0.7, p = 0.04; -0.9, p = 0.02) and RACE subscores for needle entry, needle driving, and tissue approximation (-0.9, p = 0.01; -1.0, p = 0.02; -1.0, p < 0.01) significantly decreased. GEARS (depth perception, bimanual dexterity, and efficiency) and RACE subscores (needle positioning and suture placement) were maintained. All participants scored significantly lower in knot tying on the SP robot (-1.0, p = 0.03; -1.2, p = 0.02, respectively). Group 2 reported higher Surg-TLX (+13 pts, p = 0.015) and difficulty ratings on SP vs MP (+11.8, p < 0.01; +13.6, p < 0.01; +14 pts, p < 0.01). Conclusions: The partial skill transference across robots raises the question regarding SP-specific training for urologists proficient in MP. Novices maintained difficulty scores and cognitive load across platforms, suggesting that concurrent SP and MP training may be preferred.
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Affiliation(s)
- Ahmed Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Nathan Schuler
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Patrick Saba
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Tyler Holler
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Alexis Steinmetz
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Kit Yuen
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Karen Doersch
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Elizabeth Ellis
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - William Tabayoyong
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jonathan Bloom
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Hani Rashid
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Nicholas Kavoussi
- Department of Urology Department, Vanderbilt University, Nashville, Tennessee, USA
| | - Jean Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
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11
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Carbonara U, Amparore D, Borregales LD, Caliò A, Ciccarese C, Diana P, Erdem S, Marandino L, Marchioni M, Muselaers CH, Palumbo C, Pavan N, Pecoraro A, Roussel E, Warren H, Wu ZJ, Campi R, Bertolo R. Single-port robotic partial nephrectomy: impact on perioperative outcomes and hospital stay. Ther Adv Urol 2023; 15:17562872231172834. [PMID: 37325290 PMCID: PMC10265377 DOI: 10.1177/17562872231172834] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/13/2023] [Indexed: 06/17/2023] Open
Abstract
Single-port (SP) robotic surgery is a novel technology and is at the beginning of its adoption curve in urology. The goal of this narrative review is to provide an overview of SP-robotic partial nephrectomy (PN) 4 years after the introduction of the da Vinci SP dedicated platform, focusing on perioperative outcomes, length of stay, and surgical technique. A nonsystematic review of the literature was conducted. The research included the most updated articles that referred to SP robotic PN. Since its commercial release in 2018, several institutions have reproduced robotic PN by using the SP platform, both via a transperitoneal and a retroperitoneal approach. The published SP-robotic PN series are generally based on preliminary experiences by surgeons who had previous experience with conventional multi-arms robotic platforms. The reported outcomes are encouraging. Overall, three studies reported that SP-robotic PN cases had nonsignificantly different operative time, estimated blood loss, overall complications rate, and length of stay compared to the conventional 'multi-arms' robotic PN. However, in all these series, renal masses treated by SP had overall lower complexity. Moreover, two studies underlined decreased postoperative pain as a major pro of adopting the SP system. This should reduce/avoid the need for opioids after surgery. No study compared SP-robotic versus multi-arms robotic PN in cost-effectiveness. Published experience with SP-robotic PN has reported the feasibility and safety of the approach. Preliminary results are encouraging and at least noninferior with respect to those from the multi-arms series. Prospective comparative studies with long-term oncologic and functional results are awaited to draw more definitive conclusions and better establish the more appropriate indications of SP robotics in the field of PN.
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Affiliation(s)
| | - Daniele Amparore
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Turin, Italy
| | - Leonardo D. Borregales
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, Weill Cornell Medicine, New York-Presbyterian, New York, NY, USA
| | - Anna Caliò
- Department of Pathology and Diagnostic, University of Verona, Verona, Italy
| | - Chiara Ciccarese
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Pietro Diana
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Selcuk Erdem
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Division of Urologic Oncology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Laura Marandino
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele Marchioni
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, SS Annunziata Hospital, ‘G. D’Annunzio’ University of Chieti, Chieti, Italy
| | - Constantijn H.J. Muselaers
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carlotta Palumbo
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands; Urology Unit, Ospedale Maggiore della Carità, Novara, Italy
| | - Nicola Pavan
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Urology Clinic, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy
| | - Angela Pecoraro
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Eduard Roussel
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Hannah Warren
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Zhen-Jie Wu
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Riccardo Campi
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Bertolo
- Renal Cancer Working Group, Young Academic Urologists (YAU), European Association of Urology (EAU), Arnhem, The Netherlands
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
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12
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Kim KH, Ahn HK, Kim M, Yoon H. Technique and perioperative outcomes of single-port robotic surgery using the da Vinci SP platform in urology. Asian J Surg 2023; 46:472-477. [PMID: 35691801 DOI: 10.1016/j.asjsur.2022.05.128] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To describe surgical technique for single port robotic surgery using the da Vinci SP system and report the perioperative outcomes. PATIENTS AND METHODS Between Jan 2019 and Jan 2021, single-port robotic urologic surgeries were performed in 120 patients by a single surgeon. Clinicopathologic data and perioperative outcomes were collected. All surgical procedures were performed with a transperitoneal approach through an umbilical single port. Additional assistant port was used in complex procedures for malignant disease. Surgeries were carried out using both above and below camera position for effective retraction. For reconstructive surgery using intestine, an extra-intracorporeal hybrid method was used. Surgical procedures involving both kidney and pelvis were performed without change of patient position or trocar placement. RESULTS Mean age was 62.7 years and 102 patients were male. For oncologic indication, 105 patients underwent surgeries including 66 radical prostatectomy, 25 partial nephrectomy, six radical nephrectomies, five nephroureterectomy and three radical cystectomy with urinary diversion. Fifteen cases with benign indication included four ureterolithotomy, seven uretero/pyeloplasty, three ureteroneocystostomy, and one ileal ureter reconstruction. All surgeries were performed successfully without conversion to other surgical approach. Clavien-Dindo grade III complication occurred in two patients. CONCLUSIONS The da Vinci SP system provides a new robotic surgical platform for single port surgery while maintaining the major features of robotic surgery similar to multi-port surgery. Various single port urologic surgeries can be safely performed with this platform.
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Affiliation(s)
- Kwang Hyun Kim
- Department of Urology, Ewha Womans University Seoul Hospital, Seoul, South Korea.
| | - Hyun Kyu Ahn
- Department of Urology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Myong Kim
- Department of Urology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Hana Yoon
- Department of Urology, Ewha Womans University Seoul Hospital, Seoul, South Korea
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13
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Coaxial-Robotic Single-Site Myomectomy: Surgical Outcomes Compared with Robotic Single-Site Myomectomy by Propensity Score Matching Analysis. J Pers Med 2022; 13:jpm13010017. [PMID: 36675678 PMCID: PMC9864450 DOI: 10.3390/jpm13010017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The aim of this study was to introduce a coaxial-robotic single-site myomectomy (C-RSSM) technique to compensate for the shortcomings of robotic single-site myomectomy (RSSM) using semi-rigid instruments and to compare the surgical outcomes of C-RSSM and RSSM. METHODS The medical records of 13 consecutive women who had undergone C-RSSM and 131 consecutive women who had undergone RSSM were retrospectively reviewed. Patient characteristics and surgical outcomes after propensity score matching were evaluated and compared between the two groups. RESULTS According to the propensity score matching results, the C-RSSM group had a lower estimated blood loss (75.0 vs. 210.5 mL, p = 0.001) and a shorter operating time (101.0 vs. 146.1 min, p = 0.008) relative to the RSSM group. In RSSM, there was one case of conversion to conventional laparoscopy and four cases of conversion to the multi-site robotic approach. There was no case of conversion from C-RSSM to conventional laparoscopy or the multi-site robotic approach. CONCLUSIONS C-RSSM was found to be associated with shorter operative time and lower estimated blood loss. However, further prospective studies are needed to confirm these advantages.
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14
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Robot-Assisted Minimally Invasive Breast Surgery: Recent Evidence with Comparative Clinical Outcomes. J Clin Med 2022; 11:jcm11071827. [PMID: 35407434 PMCID: PMC8999956 DOI: 10.3390/jcm11071827] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 12/24/2022] Open
Abstract
In recent times, robot-assisted surgery has been prominently gaining pace to minimize overall postsurgical complications with minimal traumatization, due to technical advancements in telerobotics and ergonomics. The aim of this review is to explore the efficiency of robot-assisted systems for executing breast surgeries, including microsurgeries, direct-to-implant breast reconstruction, deep inferior epigastric perforators-based surgery, latissimus dorsi breast reconstruction, and nipple-sparing mastectomy. Robot-assisted surgery systems are efficient due to 3D-based visualization, dexterity, and range of motion while executing breast surgery. The review describes the comparative efficiency of robot-assisted surgery in relation to conventional or open surgery, in terms of clinical outcomes, morbidity rates, and overall postsurgical complication rates. Potential cost-effective barriers and technical skills were also delineated as the major limitations associated with these systems in the clinical sector. Furthermore, instrument articulation of robot-assisted surgical systems (for example, da Vinci systems) can enable high accuracy and precision surgery due to its promising ability to mitigate tremors at the time of surgery, and shortened learning curve, making it more beneficial than other open surgery procedures.
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15
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Zhang W, Xia P, Liu S, Huang X, Zhao X, Liu Z, Dang H, Li X, Niu G. A coordinate positioning puncture method under robot-assisted CT-guidance: phantom and animal experiments. MINIM INVASIV THER 2022; 31:206-215. [PMID: 32633586 DOI: 10.1080/13645706.2020.1787451] [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: 10/23/2022]
Abstract
PURPOSE To evaluate the accuracy of the robot-assisted computed tomography (CT)-guided coordinate positioning puncture method by phantom and animal experiments. MATERIAL AND METHODS In the phantom experiment, seven robot-assisted punctures were made to evaluate the accuracy of the method. In the animal experiment, 18 punctures (nine robotic and nine manual) were made in the livers of nine rabbits. The indicators, such as needle-tract length, angle deviation, puncture accuracy, number of scans required, and radiation exposure dose were compared between manual and robotic punctures. The paired-samples t-test was used for analysis. RESULTS In the phantom experiment, the mean accuracy of seven punctures was 2.67 mm. In the animal experiment, there was no significant difference in needle-tract length (32.58 mm vs. 34.04 mm, p = .606), angle deviation (17.21° vs. 21.23° p = .557) and puncture accuracy (8.42 vs. 8.77 mm, p = .851) between the two groups. However, the number CT scans required (2.44 vs. 3.33, p = .002), and the radiation exposure dose (772.98 vs. 1077.89 mGy/cm, p = .003) were lower in the robot group than in the manual group. CONCLUSIONS The coordinate positioning puncture method under robot-assisted CT-guidance can reach an accuracy that is comparable to that of the traditional manual CT-guided puncture method and with fewer CT scanning times accompanied with a lower radiation dosage.
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Affiliation(s)
- Weifan Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Peng Xia
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Shijie Liu
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, PR China
| | - Xiaowei Huang
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, PR China
| | - Xinhui Zhao
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Zhao Liu
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Hui Dang
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
| | - Xiaohu Li
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, PR China
| | - Gang Niu
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
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16
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Vazquez-Martul D, García-Expósito MA, Rodríguez-Rey S, García-Sobrino R, Barbagelata-López A, Ponce Díaz-Reixa JL, Chantada-Abal V. Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique. Actas Urol Esp 2021; 45:609-614. [PMID: 34764053 DOI: 10.1016/j.acuroe.2021.04.013] [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: 11/11/2020] [Accepted: 04/18/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVE The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain. MATERIAL AND METHODS We collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4 cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment. RESULTS From December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6 ± 16.3 min, with <150 mL bleeding, mean length of stay of 35.8 ± 13.3 h and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8 ± 18 mm. No complications were reported according to the Clavien-Dindo scale. CONCLUSIONS Even in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.
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Affiliation(s)
- D Vazquez-Martul
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
| | - M A García-Expósito
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - S Rodríguez-Rey
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - R García-Sobrino
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - A Barbagelata-López
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J L Ponce Díaz-Reixa
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - V Chantada-Abal
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
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17
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Donat H, Gu J, Steil JJ. Real-Time Shape Estimation for Concentric Tube Continuum Robots with a Single Force/Torque Sensor. Front Robot AI 2021; 8:734033. [PMID: 34671648 PMCID: PMC8521199 DOI: 10.3389/frobt.2021.734033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
Shape-sensing in real-time is a key requirement for the development of advanced algorithms for concentric tube continuum robots when safe interaction with the environment is important e.g., for path planning, advanced control, and human-machine interaction. We propose a real-time shape-estimation algorithm for concentric tube continuum robots based on the force-torque information measured at the tubes' basis. It extends a shape estimation algorithm for elastic rods based on discrete Kirchhoff rod theory. For simplicity and efficiency of calculation, we combine it with a model under piece-wise constant curvature assumption, in which we model a concentric tube continuum robot as a combination of segments of planar constant curvatures lying on different equilibrium planes. We evaluate our approach for a single and two combined additively manufactured tubes and achieve an estimation frequency of 333 Hz for two combined tubes with a mean deviation along the backbone of the tubes of 1.91-5.22 mm.
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Affiliation(s)
- Heiko Donat
- Institute for Robotics and Process Control, TU Braunschweig, Braunschweig, Germany
| | - Jiecong Gu
- Institute for Robotics and Process Control, TU Braunschweig, Braunschweig, Germany
| | - Jochen J Steil
- Institute for Robotics and Process Control, TU Braunschweig, Braunschweig, Germany
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18
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Garden EB, Al-Alao O, Razdan S, Mullen GR, Florman S, Palese MA. Robotic Single-Port Donor Nephrectomy with the da Vinci SP® Surgical System. JSLS 2021; 25:e2021.00062. [PMID: 34949909 PMCID: PMC8692076 DOI: 10.4293/jsls.2021.00062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The da Vinci SP® Surgical System received U.S. Food and Drug Administration approval for urological procedures in 2018. Here, we describe the first experience performing single-port robot-assisted donor nephrectomy (RADN) using the da Vinci SP® surgical system, present 90-day clinical outcomes, and discuss tips for operative success. METHODS Seven consecutive patients underwent single-port RADN at a single institution between September 1, 2020 and March 31, 2021. Surgery was performed through a single, 60 mm Pfannenstiel incision with a 12 mm periumbilical assistant port for suction and vascular stapling. Donor characteristics, operative details, 90-day donor clinical outcomes, and recipient renal function were retrospectively evaluated. RESULTS Four female and three male patients successfully underwent single-port RADN without conversion to standard multiport or open approach. Six cases were left-sided. Estimated blood loss for each procedure was ≤ 50 mL. Mean operative time, warm ischemia time, and extraction time were 218.3 minutes (standard deviation [SD]: 16.3 minutes), 5 minutes 4 seconds (SD: 56 seconds), and 3 minutes 37 seconds (SD: 38 seconds). Mean pre-operative creatinine and estimated glomerular filtration rate were 0.79 mg/dL and 107.3 mL/min/1.73m2, respectively. At six week's follow up, they were 1.22 mg/dL and 66.1 mL/min/1.73m2. Average pain score at 48 hours postoperatively was 1.7/10. There were no Clavien-Dindo grade ≥ III complications within 90 days. All recipients experienced immediate and sustained return of renal function post-transplant. CONCLUSION Single-port RADN is a technically feasible and safe procedure with the da Vinci SP® system and can confer acceptable functional and cosmetic outcomes. Future studies are needed to define long-term outcomes and compare with previously established techniques for donor nephrectomy.
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Affiliation(s)
- Evan B Garden
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Osama Al-Alao
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Gregory R Mullen
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Sander Florman
- The Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Michael A Palese
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
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19
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Chen K, M Beeraka N, Zhang J, Reshetov IV, Nikolenko VN, Sinelnikov MY, Mikhaleva LM. Efficacy of da Vinci robot-assisted lymph node surgery than conventional axillary lymph node dissection in breast cancer - A comparative study. Int J Med Robot 2021; 17:e2307. [PMID: 34270843 DOI: 10.1002/rcs.2307] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND da Vinci robot-assisted axillary lymph node dissection (dVALND) can be a minimally invasive technique to minimize post-operative complications. OBJECTIVE To explore the clinical efficacy of dVALND in breast cancer (BC) patients for mitigating the postoperative complications than conventional ALND. METHODS Total 60 female patients with BC were admitted to our hospitals since September 2018, and these patients segregated into two groups of 30 patients each. Modified radical mastectomy for BC was performed to the patients in both groups. In Group 1 (control group), ALND was performed using conventional mode of axillary lymph node surgery. In Group 2 (Test group), the dVALND was performed using da Vinci robot-assisted surgery. Wound healing, aesthetic effect and patient's satisfaction were evaluated after conventional method and dVALND. RESULTS Postoperative complications viz., wound infection (1/30 (3.33%), p < 0.05), fat necrosis (3/30 (10%), p < 0.05) and lymphedema of upper limbs (2/30 (6.67%), p < 0.05) were observed in dVALND than conventional surgery. Local recurrence or metastasis was minimized and overall aesthetic effect not observed during follow-up. CONCLUSION dVALND improved the overall patient's quality of life by mitigating postoperative complications than ALND.
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Affiliation(s)
- Kuo Chen
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Narasimha M Beeraka
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia.,Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR), Department of Biochemistry, JSS Academy of Higher Education and Research (JSS AHER), JSS Medical College, Mysuru, India
| | - Jin Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Igor V Reshetov
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Vladimir N Nikolenko
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Mikhail Y Sinelnikov
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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Vazquez-Martul D, García-Expósito MA, Rodríguez-Rey S, García-Sobrino R, Barbagelata-López A, Ponce Díaz-Reixa JL, Chantada-Abal V. Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique. Actas Urol Esp 2021; 45:S0210-4806(21)00086-3. [PMID: 34127287 DOI: 10.1016/j.acuro.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/10/2021] [Accepted: 04/18/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVE The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain. MATERIAL AND METHODS We collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment. RESULTS From December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6±16.3minutes, with <150mL bleeding, mean length of stay of 35.8±13.3hours and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8±18mm. No complications were reported according to the Clavien-Dindo scale. CONCLUSIONS Even in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.
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Affiliation(s)
- D Vazquez-Martul
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España.
| | - M A García-Expósito
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - S Rodríguez-Rey
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - R García-Sobrino
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - A Barbagelata-López
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - J L Ponce Díaz-Reixa
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - V Chantada-Abal
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
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21
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Koukourikis P, Rha KH. Robotic surgical systems in urology: What is currently available? Investig Clin Urol 2021; 62:14-22. [PMID: 33381927 PMCID: PMC7801159 DOI: 10.4111/icu.20200387] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/19/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022] Open
Abstract
Robotic assistance in laparoscopic surgery was introduced at the turn of this millennium, marking a milestone in the history of surgery. Urologists were early adopters of robotic technology and the indications of robot-assisted surgery in urology are expanding. Over the last 20 years, the da Vinci surgical system was the dominant system in the robotic surgical market. However, the recent expiration of Intuitive patents has allowed new systems to enter the market more freely. We performed a nonsystematic literature review using the PubMed/MEDLINE search engines. The aim of this review was to briefly summarize the currently available robotic surgical systems for laparoscopic urologic surgery. New surgical devices have already been launched in the robotic market and the da Vinci systems have some competition. The innovation of robotic technology is continuing, and new features such as an open-console design, haptic feedback, smaller instruments, and separately mounted robotic arms have been introduced. A new robotic era is rising, and new systems and technologies enhancing patient care are welcomed.
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Affiliation(s)
- Periklis Koukourikis
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
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22
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Yang YS. Robotic glove port technique for the endowristed rigid instruments in robotic single-site transabdominal and transvaginal surgery. J Robot Surg 2020; 15:241-249. [PMID: 32506299 DOI: 10.1007/s11701-020-01093-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
Although robotic single-site (RSS) surgery employing cross setup of semirigid instruments allows effective triangulation of instruments, it has some limitations in performing RSS transabdominal and transvaginal surgeries. We introduced the robotic glove port technique (RGPT) using parallel setup of endowristed rigid instruments in performing RSS transabdominal surgery and transvaginal surgery in July of 2017. Thirty-five patients underwent RSS surgery with RGPT. Twenty-one patients had RSS transabdominal reconstructive or fertility-preserving surgeries such as myomectomy (12 patients), adenomyomectomy (3 patients), and ovarian endometriosis cystectomy (6 patients). Fourteen patients underwent robotic transvaginal surgery for natural orifice transluminal endoscopic surgery (NOTES) hysterectomy. All procedures were successfully performed, and no postoperative complications were observed. In all patients, the median total operative time, console time, and docking time were 160 min (range 106-240), 120 min (range 65-180), and 10 min (range 4-25), respectively. There was no conversion to another type of surgery, such as conventional laparoscopy, laparotomy, or traditional multiport robotic surgery. The findings showed that RSS surgery via the RGPT is safe and feasible, using the parallel setup of endowristed rigid instruments is easily performed on transvaginal routes and transabdominal routes. Therefore, this procedure may be an important complement to gynecologic surgeons' armamentarium in the field of robotic reconstructive or fertility-preserving surgeries such as myomectomy, adenomyomectomy, ovarian cystectomy, and transvaginal surgery for NOTES hysterectomy. Nevertheless, further prospective controlled studies are needed to determine its full clinical application.
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Affiliation(s)
- Yun Seok Yang
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University, 1306 Doonsan-dong, Daejeon, 302-799, Korea.
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23
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Aminsharifi A, Kaouk J. AUTHOR REPLY. Urology 2020; 140:84. [PMID: 32456873 DOI: 10.1016/j.urology.2019.11.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Alireza Aminsharifi
- Fellowship in advanced robotic urology surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Associate professor of urology, Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jihad Kaouk
- Zegarac-Pollock Professor of Surgery, Director, Center for Laparoscopic and Robotic Surgery Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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24
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Zhang C, Fu B, Xu S, Zhou XC, Cheng XF, Fu WQ, Wang GX. Robot-assisted retroperitoneal laparoscopic excision of perirenal vascular tumor: A case report. World J Clin Cases 2020; 8:2050-2055. [PMID: 32518800 PMCID: PMC7262712 DOI: 10.12998/wjcc.v8.i10.2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/01/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A vascular tumor is a benign tumor with unique clinical and pathological features. Perirenal vascular tumor is extremely rare and has not yet been reported. Clinically, it manifests as soreness and swelling. Color ultrasound and renal angiography illustrated the perirenal mass, which was closely connected with the kidney and the surrounding tissues and organs. Histology showed extensive embedded perirenal fat, and thin-walled vascular tissue displayed a pink stain due to red blood cells.
CASE SUMMARY Herein, a case of robot-assisted retroperitoneal laparoscopic excision of a perirenal vascular tumor is reported. Analysis of the clinical, biological, and histological features of the perirenal vascular tumor can provide an in-depth understanding of the disease, which provides a theoretical and practical basis for better diagnosis and treatment.
CONCLUSION This study contributes to a practical basis for the diagnosis and treatment of perirenal hemangiom.
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Affiliation(s)
- Cheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, JiangXi Province, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, JiangXi Province, China
| | - Song Xu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, JiangXi Province, China
| | - Xiao-Chen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, JiangXi Province, China
| | - Xiao-Feng Cheng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, JiangXi Province, China
| | - Wen-Qing Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, JiangXi Province, China
| | - Gong-Xian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, JiangXi Province, China
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Checcucci E, De Cillis S, Pecoraro A, Peretti D, Volpi G, Amparore D, Piramide F, Piana A, Manfredi M, Fiori C, Autorino R, Dasgupta P, Porpiglia F. Single-port robot-assisted radical prostatectomy: a systematic review and pooled analysis of the preliminary experiences. BJU Int 2020; 126:55-64. [PMID: 32248613 DOI: 10.1111/bju.15069] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To summarize the clinical experiences with single-port (SP) robot-assisted radical prostatectomy (RARP) reported in the literature and to describe the peri-operative and short-term outcomes of this procedure. MATERIAL AND METHODS A systematic review of the literature was performed in December 2019 using Medline (via PubMed), Embase (via Ovid), Cochrane databases, Scopus and Web of Science (PROSPERO registry number 164129). All studies that reported intra- and peri-operative data on SP-RARP were included. Cadaveric series and perineal or partial prostatectomy series were excluded. RESULTS The pooled mean operating time, estimated blood loss, length of hospital stay and catheterization time were 190.55 min, 198.4 mL, 1.86 days and 8.21 days, respectively. The pooled mean number of lymph nodes removed was 8.33, and the pooled rate of positive surgical margins was 33%. The pooled minor complication rate was 15%. Only one urinary leakage and one major complication (transient ischaemic attack) were recorded. Regarding functional outcomes, pooled continence and potency rates at 12 weeks were 55% and 42%, respectively. CONCLUSIONS The present analysis confirms that SP-RARP is safe and feasible. This novel robotic platform resulted in similar intra-operative and peri-operative outcomes to those obtained with the standard multiport da Vinci system. The advantages of single incision can be translated into a preservation of the patient's body image and self-esteem and cosmesis, which have a great impact on a patient's quality of life.
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Affiliation(s)
- Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Sabrina De Cillis
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Angela Pecoraro
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Dario Peretti
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Gabriele Volpi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Federico Piramide
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Matteo Manfredi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | | | | | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
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Billah MS, Stifelman M, Munver R, Tsui J, Lovallo G, Ahmed M. Single port robotic assisted reconstructive urologic surgery-with the da Vinci SP surgical system. Transl Androl Urol 2020; 9:870-878. [PMID: 32420202 PMCID: PMC7214978 DOI: 10.21037/tau.2020.01.06] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Single port (SP) robotic assisted laparoscopic surgery was approved by the FDA for urologic surgery and clinically available in 2018. This new robotic system enables a camera and 3 separate instruments, with fully wristed motions, to be placed through a single 25 mm port. This system was designed to perform complex surgery in narrow deep spaces making it very suitable for complex urinary tract reconstruction surgery. This paper will describe our early experience of using the SP system for several types of urinary reconstruction procedures and will present our lessons learned, surgical philosophy to using the SP and early data. As with all new technologies, there is an associated learning curve and nuances to be discovered and overcome. Methods The da Vinici SP™ surgical system was acquired and delivered to at our institution in January 2019. Five high volume robotic urologic surgeons at our institutions underwent certification with the da Vinci SP™ and have been adding this technology into their armamentarium. Almost all cases were recorded for quality improvement initiatives and evaluated with the goal of creating standard operating procedures in terms of access, steps of procedure and minimizing pit falls. Data from all patients undergoing SP urinary tract reconstruction that were entered into our prospective institutional database were reported. Results From 1/2019 to 8/2019 we have performed 71 urologic SP cases with the SP of which 18 were for urinary tract reconstructive procedures. These cases included 15 pyeloplasties, 1 buccal mucosa ureteroplasty, 1 ureteral implant and 1 repair of vesico-vaginal fistula. This paper outlines our standard operating procedures for table positioning, port placement, access and surgical steps for these complex SP cases. Our early data suggests that use of the SP system for urinary reconstruction is safe and reproducible. Conclusions The SP robotic surgical system has the potential to be used for nearly all robotic urologic reconstructive procedures. Advantages include a superior cosmetic result and ability to access all surgical quadrants without re-docking or repositioning. Limitations include no near infrared fluorescence imaging, smaller working space and slightly increased difficulty with retraction. We believe these obstacles will be overcome with time and experience. The da Vinci SP™ surgical system, in our initial experience, appears to be as safe and effective as its multiport counterpart for reconstructive surgeries.
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Affiliation(s)
- Mubashir Shabil Billah
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Michael Stifelman
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Ravi Munver
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Johnson Tsui
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Gregory Lovallo
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
| | - Mutahar Ahmed
- Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, NJ, USA
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27
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Kim S, Min KJ, Lee S, Hong JH, Song JY, Lee JK, Lee NW. Robotic single-site surgery versus laparo-endoscopic single-site surgery in ovarian cystectomy: A retrospective analysis in single institution. ACTA ACUST UNITED AC 2020. [DOI: 10.36637/grs.2019.00038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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28
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Kaouk J, Aminsharifi A, Sawczyn G, Kim S, Wilson CA, Garisto J, Fareed K. Single-Port Robotic Urological Surgery Using Purpose-Built Single-Port Surgical System: Single-Institutional Experience With the First 100 Cases. Urology 2020; 140:77-84. [PMID: 32142725 DOI: 10.1016/j.urology.2019.11.086] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To present a comprehensive report regarding our experience with single-port robotic surgery in our first 100 consecutive patients. We describe the diversity of procedures that can be performed with this platform as well as the challenges and complications we had with the application of this novel technology. METHODS Between September 2018 and August 2019, data on 100 patients who underwent single-port robotic surgery were consecutively collected. Preoperative, intraoperative and early postoperative outcomes after various urologic procedures were recorded and analyzed. RESULTS During the study period, 100 patients (age [range] 35-84 years; 88 [88%] Male) underwent various single-port robotic surgeries for different indications (Retroperitoneal [n = 14], Pelvic surgeries [n = 86]). Transperitoneal (n = 37), extraperitoneal (n = 53) and transvesical (n = 10) approaches have been used to access the target organs. Of these procedures, 73 (73%) were for different oncological indications: Radical prostatectomy (n = 60), Partial nephrectomy (n = 6), Retroperitoneal lymph node dissection (n = 1) and Radical cystectomy with intracorporeal diversion (n = 6). Surgery was successfully completed in all but 1 patient, in whom the surgery was converted to open surgery due to dense adhesions and failure to progress. Grades II-III postoperative complications were detected in (n = 9) patients. CONCLUSION The purpose-built single-port robotic platform can be safely incorporated into the minimally invasive armamentarium. A wide range of pelvic and retroperitoneal urological procedures can be done with different approaches using this platform. Randomized trials with adequate sample size and postoperative follow up period is advisable for further evaluation of the outcomes and to determine the added value of this emerging technology.
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Affiliation(s)
- Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| | - Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Guilherme Sawczyn
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Soodong Kim
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Clark A Wilson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Khaled Fareed
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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29
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Hernández Fernández C. The endless evolution of laparoscopic approach. Actas Urol Esp 2020; 44:59-61. [PMID: 31917019 DOI: 10.1016/j.acuro.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 11/25/2022]
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30
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Donnely E, Griffin MF, Butler PE. Robotic Surgery: A Novel Approach for Breast Surgery and Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2578. [PMID: 32095394 PMCID: PMC7015621 DOI: 10.1097/gox.0000000000002578] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Breast cancer is the most prevalent cancer and second leading cause of cancer-related deaths in both the US and UK female population, a prominent cause of morbidity and cost to both health services. All surgically fit patients are offered breast reconstruction following the initial surgery, and this is traditionally an open approach: either implant-based or an autologous tissue flap. Both lead to scarring that is difficult to conceal. This paper aims to evaluate the novel minimally invasive technique of robotic-assisted surgery. Methods: A systematic review was conducted using Medline (OvidSP) and Embase (OvidSP) to evaluate the current application of robotic-assisted surgery in breast surgery and reconstruction. Results: Twenty-one articles were identified and discussed, composing of level 4 and 5 evidence comparing different surgeons' experiences, techniques, and outcomes. To date, the robotic system has been utilized to harvest the latissimus dorsi muscle for use as a tissue flap (total harvest time of 92 minutes), to perform nipple-sparing mastectomy with immediate breast reconstruction (total operation time 85 minutes) and lately to harvest a deep inferior epigastric perforator flap via an intraabdominal approach. Conclusions: Robotic-assisted surgery can successfully and reproducibly perform a nipple-sparing mastectomy with breast reconstruction. It can minimize the size of scarring and is superior to the laparoscopic technique, with improved 3-dimensional visualization, dexterity, and range of motion able to guide around the curvature of the breast. The main limiting factors are the lack of the US Food and Drug Administration approval, cost of the robot, and specialized skills required.
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Affiliation(s)
- Edward Donnely
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, UK
| | - Michelle F Griffin
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, UK
| | - Peter E Butler
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, UK
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Cianci S, Rosati A, Rumolo V, Gueli Alletti S, Gallotta V, Turco LC, Corrado G, Vizzielli G, Fagotti A, Fanfani F, Scambia G, Uccella S. Robotic Single-Port Platform in General, Urologic, and Gynecologic Surgeries: A Systematic Review of the Literature and Meta-analysis. World J Surg 2019; 43:2401-2419. [PMID: 31187247 DOI: 10.1007/s00268-019-05049-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Robotic platforms have recently acquired progressive importance in different surgical fields, such as urology, gynecology, and general surgery. Through the years, new surgical robots have become available as single-port robotic platform. The study is aimed to value the single-port robotic platform characteristics in different surgical specialties. METHODS The terms "LESS" OR "single port" OR "single site" AND "robot" OR "robotic" were systematically used to search the PubMed and Scopus databases. A total of 57 studies were considered eligible for the present review. The articles included were divided according to the surgical field in which the study was conducted: General surgery (29 articles), Gynecology (18 articles), Urology (10 articles). RESULTS Most part of the articles showed the feasibility of robotic single-port surgical procedures and described advantages in terms of cosmetic, hospital stay, and in some series even cost reduction. A meta-analysis was conducted, showing a significant increment of complications using RSP if compared with SLPS and a trend (P = 0.008) when RSP was compared with LESS. The comparison of different techniques in terms of conversion to laparotomy did not show any significant difference. CONCLUSION Robotic single port potentially furnishes an important surgical and post-operatory improvement; however, some limits still prolong the surgical time and complication rate.
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Affiliation(s)
- S Cianci
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, Rome, Italy.
| | - A Rosati
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, Rome, Italy
| | - V Rumolo
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, Rome, Italy
| | - S Gueli Alletti
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, Rome, Italy
| | - V Gallotta
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, Rome, Italy
| | - L C Turco
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, Rome, Italy
| | - G Corrado
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, Rome, Italy
| | - G Vizzielli
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, Rome, Italy
| | - A Fagotti
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Fanfani
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Scambia
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Uccella
- Obstetrics and Gynecology Department, Nuovo Ospedale degli Infermi, Biella, Italy
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32
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Ng C, Teoh JY, Chiu PK, Yee C, Chan C, Hou SS, Kaouk J, Chan ES. Robot‐assisted single‐port radical prostatectomy: A phase 1 clinical study. Int J Urol 2019; 26:878-883. [DOI: 10.1111/iju.14044] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/26/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Chi‐Fai Ng
- S.H. Ho Urology Center, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Jeremy Yuen‐Chun Teoh
- S.H. Ho Urology Center, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Peter Ka‐Fung Chiu
- S.H. Ho Urology Center, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Chi‐Hang Yee
- S.H. Ho Urology Center, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Chi‐Kwok Chan
- S.H. Ho Urology Center, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Simon See‐Ming Hou
- S.H. Ho Urology Center, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute Cleveland Ohio USA
| | - Eddie Shu‐Yin Chan
- S.H. Ho Urology Center, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
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Heo JE, Kang SK, Koh DH, Na JC, Lee YS, Han WK, Choi YD, Jang WS. Pure single-site robot-assisted pyeloplasty with the da Vinci SP surgical system: Initial experience. Investig Clin Urol 2019; 60:326-330. [PMID: 31294143 PMCID: PMC6607072 DOI: 10.4111/icu.2019.60.4.326] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/19/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose Laparoendoscopic single-site surgery (LESS) reduces the limited invasiveness of conventional laparoscopy while providing superior cosmetic results. However, LESS remains a challenging surgical technique, even in robotic surgery, primarily due to the lack of triangulation and limited instrument movement. The da Vinci SP surgical system (Intuitive Surgical) was recently introduced to overcome these limitations. We describe our initial experience with pure single-site robot-assisted pyeloplasty (RAP) for ureteropelvic junction obstruction (UPJO) using the da Vinci SP surgical system. Materials and Methods Three consecutive patients who were diagnosed with UPJO underwent RAP with the da Vinci SP surgical system from December 2018 to February 2019 at our institution. The surgical technique involved reproducing the steps of multi-port RAP. A 30-mm umbilical incision was made and the GelPOINT was inserted. The multichannel robotic port and the assistant's port were placed through the GelSeal cap. In all patients, Anderson–Hynes dismembered pyeloplasty was performed. The ureteral double J stent was inserted antegrade, and the drain was not placed. Results The procedures were successfully completed using a pure single-site approach. There was no need for additional port placement or conversion to laparoscopic or open surgery. Total operative time in the three patients was 139, 180, and 213 minutes, respectively. No intraoperative complications occurred, and blood loss was minimal. The postoperative course of all patients was uneventful with no complications greater than Clavien–Dindo grade I surgical complications. Conclusions Pure single-site RAP using the da Vinci SP surgical system is feasible and safe.
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Affiliation(s)
- Ji Eun Heo
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ku Kang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Koh
- Department of Urology, Konyang University College of Medicine, Daejeon, Korea
| | - Joon Chae Na
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Seung Lee
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Jang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Agarwal DK, Sharma V, Toussi A, Viers BR, Tollefson MK, Gettman MT, Frank I. Initial Experience with da Vinci Single-port Robot-assisted Radical Prostatectomies. Eur Urol 2019; 77:373-379. [PMID: 31010600 DOI: 10.1016/j.eururo.2019.04.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/03/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Single-port robotic surgery is being adopted for various surgical procedures. There have been interest in and clinical use of single-port robot-assisted radical prostatectomy (spRARP), but little reported data on feasibility and early outcomes. OBJECTIVE To describe our institution's initial experience with spRARP utilizing the da Vinci single-port (SP) robotic system. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of the initial experience of three high-volume robotic prostate surgeons performing an spRARP utilizing the da Vinci SP robotic system was carried out. SURGICAL PROCEDURE An spRARP using the da Vinci SP robotic system was performed following the traditional retropubic or Retzius-sparing approach. MEASUREMENTS Patient demographics, operative time, blood loss, postoperative hospital stay, complications, and catheter duration were obtained and analyzed. RESULTS AND LIMITATIONS In a cohort of 49 patients undergoing spRARP, median age was 62yr and prostate-specific antigen 6.4. Of the patients, 35 (71%) had cT1c disease on presentation, 92% had Gleason grade group ≥2 disease, and 85% were pT2 on final pathology. Median operative time was 161min. Median blood loss was 200ml. Seven Retzius-sparing cases were performed. Four Clavien 2 complications occurred (complication rate 8.1%). Median hospital stay was 1d and median catheter duration 7d. Operative time was <200min for all three surgeons by their third case. CONCLUSIONS The da Vinci SP system spRARP is safe and feasible, with acceptable operative time and blood loss. Further research is needed to establish noninferiority to the da Vinci Xi and Si systems, and impact of spRARP on patient-assessed cosmesis and pain. PATIENT SUMMARY Robotic prostatectomy using a purpose-built da Vinci single-port robotic system is safe and feasible, and warrants further study to determine whether it can improve patient outcomes.
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Affiliation(s)
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Amir Toussi
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN, USA.
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Kaouk J, Garisto J, Bertolo R. Robotic Urologic Surgical Interventions Performed with the Single Port Dedicated Platform: First Clinical Investigation. Eur Urol 2019; 75:684-691. [DOI: 10.1016/j.eururo.2018.11.044] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/21/2018] [Indexed: 11/25/2022]
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Rumolo V, Rosati A, Tropea A, Biondi A, Scambia G. Senhance robotic platform for gynecologic surgery: a review of literature. Updates Surg 2019; 71:419-427. [PMID: 30659479 DOI: 10.1007/s13304-018-00620-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/29/2018] [Indexed: 12/27/2022]
Abstract
The advantages of endoscopic procedures are well demonstrated in various surgical procedures. In this field, the technological improvement has been significant. One of the most relevant was made by the introduction of robotic surgery that, thanks to the instruments articulation and the precision of movement, made possible to perform even the most complex procedures. The terms "Alf-X" OR "Senhance" OR "robot" OR "robotic" were systematically used to search the PubMed and Scopus databases. The principal findings considered in the present review were: the study design, the number of patients included in each study, operative time, estimated blood loss (EBL), conversion rate to standard laparoscopy (SLPS) or laparotomy (LPT), post-operative complications, post-operative hospital stay, and the possible advantages and disadvantages reported by the authors of the studies. A total of eight studies were considered eligible for the present review. The average operative time for TH reported was 110-140 min. In two case-control studies, the operative time was significantly prolonged (P < 0.05) for robotic procedures when compared with SLPS. The EBL was ≤ 100 ml in all studies. Whereas no statistically significant differences were shown in the two case-control studies in terms of conversion to LPT, all studies were in accordance with the post-operative hospital stay, reporting an average of 2 days for total hysterectomy and 1 day for adnexal surgery.
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Affiliation(s)
- Valerio Rumolo
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Rome, Italy.
| | - Andrea Rosati
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Rome, Italy
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Antonio Biondi
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Giovanni Scambia
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Rome, Italy
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Kaouk JH, Garisto J, Eltemamy M, Bertolo R. Robot-assisted surgery for benign distal ureteral strictures: step-by-step technique using the SP ® surgical system. BJU Int 2019; 123:733-739. [PMID: 30499629 DOI: 10.1111/bju.14635] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the step-by-step techniques for robot-assisted ureteric reimplantation performed using the Vinci SP® surgical system (Intuitive Surgical, Sunnyvale, CA, USA), including different case scenarios with an educational purpose. MATERIALS AND METHODS Three consecutive patients diagnosed with distal benign ureteric strictures were counselled for ureteric reimplantation and consented to undergo surgery performed using the da Vinci SP surgical system. Demographics and peri-operative outcomes were collected after institutional review board approval (IRB 13-780). Patients provided informed consent having received an explanation for the adoption of the novel platform. The first patient was a woman referred to our institution for a left distal ureteric stricture after total hysterectomy for uterine fibroids with ureteric injury. The second patient was a man with BPH and recurrent UTIs, who was diagnosed with a 1.5-cm bladder stone and a large bladder diverticulum compressing the left distal ureter. The third patient was a man diagnosed with bilateral uretero-enteric anastomoses stricture status after radical cystectomy with orthotopic ileal neobladder urinary diversion for bladder cancer. RESULTS The procedures were successfully completed. An extra port through a separate skin incision for the bedside assistant was placed for the first two procedures. In such cases, this additional port was used electively from the start of the procedure and did not represent a change in the treatment plan. Moreover, the port wound was used to accommodate the drainage. The bilateral ureteric reimplantation, however, was completed according to a pure single-site approach (no extra ports were placed out of the GelSeal cap). The mean operating times were 165, 150 and 180 min, respectively. Blood loss was 50 mL in all cases. No intra-operative complications occurred. Patients were discharged on postoperative days 1, 1 and 2, respectively, with normal serum creatinine levels. Neither transfusions nor major complications occurred. CONCLUSION Robot-assisted reconstructive surgery for benign distal ureteric strictures is feasible and safe using the da Vinci SP surgical system.
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Affiliation(s)
- Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Abstract
Modern robotics is an advanced minimally invasive technology with the advantages of wristed capability, three-dimensional optics, and tremor filtration compared with conventional laparoscopy. Urologists have been early adopters of robotic surgical technology: robotics have been used in urologic oncology for more than 20 years and there has been an increasing trend for utilization in benign urologic pathology in the last couple of years. The continuing development and interest in robotics are aimed at surgical efficiency as well as patient outcomes. However, despite its advantages, improvements in haptics, system size, and cost are still desired. This article explores the current use of robotics in urology as well as future improvements on the horizon.
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Affiliation(s)
- Anojan Navaratnam
- Department of Urology, Mayo Clinic in Arizona, Phoenix, AZ, 85054, USA
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Garisto J, Bertolo R, Kaouk J. Transperineal Approach for Intracorporeal Ileal Conduit Urinary Diversion Using a Purpose-built Single-port Robotic System: Step-by-step. Urology 2018; 122:179-184. [DOI: 10.1016/j.urology.2018.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
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Li T, Liang W, Xiao X, Qian Y. Nanotechnology, an alternative with promising prospects and advantages for the treatment of cardiovascular diseases. Int J Nanomedicine 2018; 13:7349-7362. [PMID: 30519019 PMCID: PMC6233477 DOI: 10.2147/ijn.s179678] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular diseases (CVDs) are one of the most important causes of mortality and affecting the health status of patients. At the same time, CVDs cause a huge health and economic burden to the whole world. Although a variety of therapeutic drugs and measures have been produced to delay the progress of the disease and improve the quality of life of patients, most of the traditional therapeutic strategies can only cure the symptoms and cannot repair or regenerate the damaged ischemic myocardium. In addition, they may bring some unpleasant side effects. Therefore, it is vital to find and explore new technologies and drugs to solve the shortcomings of conventional treatments. Nanotechnology is a new way of using and manipulating the matter at the molecular scale, whose functional organization is measured in nanometers. Because nanoscale phenomena play an important role in cell signal transduction, enzyme action and cell cycle, nanotechnology is closely related to medical research. The application of nanotechnology in the field of medicine provides an alternative and novel direction for the treatment of CVDs, and shows excellent performance in the field of targeted drug therapy and the development of biomaterials. This review will briefly introduce the latest applications of nanotechnology in the diagnosis and treatment of common CVDs.
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Affiliation(s)
- Tao Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China,
| | - Weitao Liang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China,
| | - Xijun Xiao
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China,
| | - Yongjun Qian
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China,
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Park SY, Kim HK, Jang DS, Han KN, Kim DJ. Initial Experiences With Robotic Single-Site Thoracic Surgery for Mediastinal Masses. Ann Thorac Surg 2018; 107:242-247. [PMID: 30296424 DOI: 10.1016/j.athoracsur.2018.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 08/02/2018] [Accepted: 08/13/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND The da Vinci Single-Site platform (Intuitive Surgical, Mountain View, CA) has been applied in many fields of surgery, but use of this single-site platform in thoracic surgery has not been reported. This study reported our experiences and surgical outcomes with robotic single-site surgery in the field of thoracic surgery. METHODS We retrospectively reviewed 14 patients who underwent robotic single-site thoracic surgery at 2 different institutions. RESULTS All 14 cases were successfully completed, without conversion to conventional multiport robotic surgery. The most frequent diagnoses were thymic cyst (n = 4) and pericardial cyst (n = 3). The median largest mass size was 4.1 cm (range, 2.0 to 6.5 cm). The median operation time was 105 minutes (range, 27 to 185 minutes). After the operation, pleural effusion occurred in 1 patient (case 7) on the side on which the operation was performed but was managed with conservative treatment. The median duration of chest tube stay was 2 days (range, 1 to 3 days), and hospital stay was 4 days (range, 3 to 11 days). The median peak pain score after the operation was 3 (range, 1 to 7). Compared with thoracoscopic single-port surgery, robotic single-site thoracic surgery showed a longer operative time and higher cost. CONCLUSIONS This study demonstrated that robotic single-site thoracic surgery for mediastinal masses is a safe and feasible procedure. Although this study reports the initial series and the cases were relatively simple, more advanced and complex procedures could be done with the advent of new technology in the near future.
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Affiliation(s)
- Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Dong-Su Jang
- Department of Sculpture, Hongik University, Seoul, Republic of Korea
| | - Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Han HJ, Kang CM. Reduced port minimally invasive distal pancreatectomy: single-port laparoscopic versus robotic single-site plus one-port distal pancreatectomy. Surg Endosc 2018; 33:1091-1099. [DOI: 10.1007/s00464-018-6361-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/06/2018] [Indexed: 12/21/2022]
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Marino MV, Shabat G, Gulotta G, Komorowski AL. From Illusion to Reality: A Brief History of Robotic Surgery. Surg Innov 2018; 25:291-296. [PMID: 29701135 DOI: 10.1177/1553350618771417] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Robotic surgery is currently employed for many surgical procedures, yielding interesting results. METHODS We performed an historical review of robots and robotic surgery evaluating some critical phases of its evolution, analyzing its impact on our life and the steps completed that gave the robotics its current popularity. RESULTS The origins of robotics can be traced back to Greek mythology. Different aspects of robotics have been explored by some of the greatest inventors like Leonardo da Vinci, Pierre Jaquet-Droz, and Wolfgang Von-Kempelen. Advances in many fields of science made possible the development of advanced surgical robots. Over 3000 da Vinci robotic platforms are installed worldwide, and more than 200 000 robotic procedures are performed every year. CONCLUSION Despite some potential adverse events, robotic technology seems safe and feasible. It is strictly linked to our life, leading surgeons to a new concept of surgery and training.
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Affiliation(s)
| | - Galyna Shabat
- 1 P. Giaccone Hospital, University of Palermo, Palermo, Italy
| | - Gaspare Gulotta
- 1 P. Giaccone Hospital, University of Palermo, Palermo, Italy
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Amirabdollahian F, Livatino S, Vahedi B, Gudipati R, Sheen P, Gawrie-Mohan S, Vasdev N. Prevalence of haptic feedback in robot-mediated surgery: a systematic review of literature. J Robot Surg 2017; 12:11-25. [PMID: 29196867 DOI: 10.1007/s11701-017-0763-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/07/2017] [Indexed: 01/27/2023]
Abstract
With the successful uptake and inclusion of robotic systems in minimally invasive surgery and with the increasing application of robotic surgery (RS) in numerous surgical specialities worldwide, there is now a need to develop and enhance the technology further. One such improvement is the implementation and amalgamation of haptic feedback technology into RS which will permit the operating surgeon on the console to receive haptic information on the type of tissue being operated on. The main advantage of using this is to allow the operating surgeon to feel and control the amount of force applied to different tissues during surgery thus minimising the risk of tissue damage due to both the direct and indirect effects of excessive tissue force or tension being applied during RS. We performed a two-rater systematic review to identify the latest developments and potential avenues of improving technology in the application and implementation of haptic feedback technology to the operating surgeon on the console during RS. This review provides a summary of technological enhancements in RS, considering different stages of work, from proof of concept to cadaver tissue testing, surgery in animals, and finally real implementation in surgical practice. We identify that at the time of this review, while there is a unanimous agreement regarding need for haptic and tactile feedback, there are no solutions or products available that address this need. There is a scope and need for new developments in haptic augmentation for robot-mediated surgery with the aim of improving patient care and robotic surgical technology further.
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Affiliation(s)
| | - Salvatore Livatino
- School of Engineering, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Behrad Vahedi
- School of Engineering, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Radhika Gudipati
- School of Computer Science, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Patrick Sheen
- School of Engineering, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | | | - Nikhil Vasdev
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, SG1 4AB, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
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Lo IS, Lee HY, Chou YH, Huang CN, Wu WJ, Yeh HC, Yang KF, Lee CH, Li CC. Robot-Assisted Extraperitoneal Radical Prostatectomy, Single Site Plus Two Model. J Laparoendosc Adv Surg Tech A 2017; 28:140-144. [PMID: 29090978 DOI: 10.1089/lap.2017.0421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To demonstrate a feasible procedure of robot-assisted extraperitoneal radical prostatectomy single site plus two model to overcome the limitation of traditional single-port laparoscopic surgery. MATERIALS AND METHODS All consecutive cases of robot-assisted extraperitoneal radical prostatectomy single site plus two model between November 2015 and April 2016 in our institution were included. We analyze the surgical and continence outcome. RESULTS Twenty cases were included in the analysis. All cases successfully completed without any necessity for conversion to a standard laparoscopic approach or open surgery. The average age is 64.3 ± 8.2 years and average body mass index is 24.3 ± 2.9 kg/m2. Eight focal positive margins (40%) (5 in T2 and 3 in T3a disease) were encountered and all occurred at the apex. For continence outcomes, 9 (45%) patients need average 0-1 pads/day and 2 (10%) patients need average 3 pads/day after surgery, but most recover after several months. No intraoperative complications or major postoperative complications were recorded, excluding blood transfusion in one case. CONCLUSIONS Robot-assisted extraperitoneal radical prostatectomy single site plus two model is technically feasible and safe in our experience. It can also be performed in patients that have previously received intraperitoneal abdominal surgery using the extraperitoneal approach. We can take this procedure into account for minimal invasive surgical option.
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Affiliation(s)
- Ing-Shiang Lo
- 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Hsiang-Ying Lee
- 2 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital , Kaohsiung, Taiwan .,3 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Yii-Her Chou
- 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan .,4 Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Chun-Nung Huang
- 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan .,4 Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan .,2 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital , Kaohsiung, Taiwan .,3 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan .,4 Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Hsin-Chih Yeh
- 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan .,2 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital , Kaohsiung, Taiwan .,3 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan .,4 Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Kai Fu Yang
- 5 Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Cheng Hsueh Lee
- 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan
| | - Ching-Chia Li
- 1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan .,2 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital , Kaohsiung, Taiwan .,3 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan .,4 Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University , Kaohsiung, Taiwan
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Advantages of the glove port docking technique in robotic single-site cholecystectomy: comparison with the conventional silicone port. J Robot Surg 2017; 12:437-445. [PMID: 28936582 DOI: 10.1007/s11701-017-0754-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/17/2017] [Indexed: 02/08/2023]
Abstract
Although the da Vinci Single-Site® silicone port allows exact alignment and effective triangulation of instruments, it also has drawbacks. We introduce an alternative docking technique using the Glove port®. From April 2014 to December 2016, respective 50 patients of the conventional silicone port and the glove port group were compared. The mean docking time was 16.6 ± 6.6 min in the silicone port group and 10.6 ± 3.6 min in the glove port group. Re-docking during the operation was needed in three patients in the silicone port group and readjustment of cannulae without re-docking could be simply performed in five patients in the glove port group. Skin injury was observed in 17 patients in the silicone port group and 0 patients in the glove port group without significant complications. Some limitations of the conventional silicone port were improved by the glove port.
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Wang J, Wang S, Li J, Ren X, Briggs RM. Development of a novel robotic platform with controllable stiffness manipulation arms for laparoendoscopic single-site surgery (LESS). Int J Med Robot 2017; 14. [DOI: 10.1002/rcs.1838] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 03/17/2017] [Accepted: 04/19/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Jianchen Wang
- Key Lab for Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering; Tianjin University; Tianjin China
| | - Shuxin Wang
- Key Lab for Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering; Tianjin University; Tianjin China
| | - Jinhua Li
- Key Lab for Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering; Tianjin University; Tianjin China
| | - Xiangyun Ren
- Key Lab for Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering; Tianjin University; Tianjin China
| | - Randall Miller Briggs
- Massachusetts Institute of Technology; Department of Mechanical Engineering, BioInstrumentation Laboratory; Cambridge Massachusetts USA
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Bai W, Cao Q, Leng C, Cao Y, Fujie MG, Pan T. A novel optimal coordinated control strategy for the updated robot system for single port surgery. Int J Med Robot 2017; 13. [PMID: 28758326 DOI: 10.1002/rcs.1844] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 04/29/2017] [Accepted: 05/06/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Research into robotic systems for single port surgery (SPS) has become widespread around the world in recent years. A new robot arm system for SPS was developed, but its positioning platform and other hardware components were not efficient. Special features of the developed surgical robot system make good teleoperation with safety and efficiency difficult. METHODS A robot arm is combined and used as new positioning platform, and the remote center motion is realized by a new method using active motion control. A new mapping strategy based on kinematics computation and a novel optimal coordinated control strategy based on real-time approaching to a defined anthropopathic criterion configuration that is referred to the customary ease state of human arms and especially the configuration of boxers' habitual preparation posture are developed. RESULTS The hardware components, control architecture, control system, and mapping strategy of the robotic system has been updated. A novel optimal coordinated control strategy is proposed and tested. CONCLUSIONS The new robot system can be more dexterous, intelligent, convenient and safer for preoperative positioning and intraoperative adjustment. The mapping strategy can achieve good following and representation for the slave manipulator arms. And the proposed novel control strategy can enable them to complete tasks with higher maneuverability, lower possibility of self-interference and singularity free while teleoperating.
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Affiliation(s)
- Weibang Bai
- Research Institute of Robotics, Research Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Lab of Mechanical Systems and Vibration, Shanghai Jiao Tong University, Shanghai, China
| | - Qixin Cao
- Research Institute of Robotics, Research Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Lab of Mechanical Systems and Vibration, Shanghai Jiao Tong University, Shanghai, China
| | - Chuntao Leng
- Engineering Training Center, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Cao
- The Graduate School of Creative Science and Engineering, Waseda University, Tokyo, Japan
| | - Masakatsu G Fujie
- The Faculty of Science and Engineering, Waseda University, Tokyo, Japan
| | - Tiewen Pan
- Division of Thoracic Surgery, Shanghai Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of the Second Military Medical University, Shanghai, China
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Hallbeck MS, Lowndes BR, McCrory B, Morrow MM, Kaufman KR, LaGrange CA. Kinematic and ergonomic assessment of laparoendoscopic single-site surgical instruments during simulator training tasks. APPLIED ERGONOMICS 2017; 62:118-130. [PMID: 28411722 DOI: 10.1016/j.apergo.2017.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 12/22/2016] [Accepted: 02/02/2017] [Indexed: 06/07/2023]
Abstract
While laparoendoscopic single-site surgery (LESS) appears to be feasible and safe, instrument triangulation, tissue handling, and other bimanual tasks are difficult even for experienced surgeons. Novel technologies emerged to overcome LESS' procedural and ergonomic difficulties of "tunnel vision" and "instrument clashing." Surgeon kinematics, self-reported workload and upper body discomfort were used to compare straight, bent and two articulating instruments while performing two basic surgical tasks in a LESS simulator. All instruments resulted in bilateral elevation and rotation of the shoulders, excessive forearm motion and flexion and ulnar deviation of wrists. Surgeons' adopted non-neutral upper extremity postures and performed excessive joint excursions to compensate for reduced freedom of movement at the single insertion site and to operate the instrument mechanisms. LESS' cosmetic benefits continue to impact laparoscopic surgery and by enabling performance through improved instruments, ergonomic improvement for LESS can reduce negative impact on surgeon well-being and patient safety.
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Affiliation(s)
- M Susan Hallbeck
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; Department of Surgery, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA.
| | - Bethany R Lowndes
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA
| | - Bernadette McCrory
- Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA; Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Melissa M Morrow
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
| | - Kenton R Kaufman
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Chad A LaGrange
- Department of Surgery, Division of Urology, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Ballestero Diego R, Zubillaga Guerrero S, Truan Cacho D, Carrion Ballardo C, Velilla Diez G, Calleja Hermosa P, Gutiérrez Baños JL. Initial experience with the new da Vinci single-port robot-assisted platform. Actas Urol Esp 2017; 41:333-337. [PMID: 27955859 DOI: 10.1016/j.acuro.2016.09.013] [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: 08/10/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe our experience in the first cases of urological surgeries performed with the da Vinci single-port robot-assisted platform. MATERIAL AND METHODS We performed 5 single-port robot-assisted surgeries (R-LESS) between May and October 2014. We performed 3 ureteral reimplant surgeries, one ureteropyeloplasty in an inverted kidney and 1 partial nephrectomy. The perioperative and postoperative results were collected, as well as a report of the complications according to the Clavien classification system. RESULTS Of the 5 procedures, 4 were performed completely by LESS, while 1 procedure was reconverted to multiport robot-assisted surgery. There were no intraoperative complications. We observed perioperative complications in 4 patients, all of which were grade 1 or 2. The mean surgical time was 262minutes (range, 230-300). DISCUSSION In our initial experience with the da Vinci device, R-LESS surgery was feasible and safe. There are still a number of limitations in its use, which require new and improved R-LESS platforms.
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Affiliation(s)
- R Ballestero Diego
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla. Santander, España.
| | - S Zubillaga Guerrero
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla. Santander, España
| | - D Truan Cacho
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla. Santander, España
| | - C Carrion Ballardo
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla. Santander, España
| | - G Velilla Diez
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla. Santander, España
| | - P Calleja Hermosa
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla. Santander, España
| | - J L Gutiérrez Baños
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla. Santander, España
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