1
|
Zhao Z, Hu B, Xu K, Jiang Y, Xu X, Liu Y. A quantitative analysis of artificial intelligence research in cervical cancer: a bibliometric approach utilizing CiteSpace and VOSviewer. Front Oncol 2024; 14:1431142. [PMID: 39296978 PMCID: PMC11408476 DOI: 10.3389/fonc.2024.1431142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 08/16/2024] [Indexed: 09/21/2024] Open
Abstract
Background Cervical cancer, a severe threat to women's health, is experiencing a global increase in incidence, notably among younger demographics. With artificial intelligence (AI) making strides, its integration into medical research is expanding, particularly in cervical cancer studies. This bibliometric study aims to evaluate AI's role, highlighting research trends and potential future directions in the field. Methods This study systematically retrieved literature from the Web of Science Core Collection (WoSCC), employing VOSviewer and CiteSpace for analysis. This included examining collaborations and keyword co-occurrences, with a focus on the relationship between citing and cited journals and authors. A burst ranking analysis identified research hotspots based on citation frequency. Results The study analyzed 927 articles from 2008 to 2024 by 5,299 authors across 81 regions. China, the U.S., and India were the top contributors, with key institutions like the Chinese Academy of Sciences and the NIH leading in publications. Schiffman, Mark, featured among the top authors, while Jemal, A, was the most cited. 'Diagnostics' and 'IEEE Access' stood out for publication volume and citation impact, respectively. Keywords such as 'cervical cancer,' 'deep learning,' 'classification,' and 'machine learning' were dominant. The most cited article was by Berner, ES; et al., published in 2008. Conclusions AI's application in cervical cancer research is expanding, with a growing scholarly community. The study suggests that AI, especially deep learning and machine learning, will remain a key research area, focusing on improving diagnostics and treatment. There is a need for increased international collaboration to maximize AI's potential in advancing cervical cancer research and patient care.
Collapse
Affiliation(s)
- Ziqi Zhao
- School of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Boqian Hu
- Hebei Provincial Hospital of Traditional Chinese Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - Kun Xu
- School of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yizhuo Jiang
- School of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xisheng Xu
- School of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuliang Liu
- School of Basic Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
2
|
Alian A, Avery J, Mylonas G. Tissue palpation in endoscopy using EIT and soft actuators. Front Robot AI 2024; 11:1372936. [PMID: 39184867 PMCID: PMC11341308 DOI: 10.3389/frobt.2024.1372936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 07/16/2024] [Indexed: 08/27/2024] Open
Abstract
The integration of soft robots in medical procedures has significantly improved diagnostic and therapeutic interventions, addressing safety concerns and enhancing surgeon dexterity. In conjunction with artificial intelligence, these soft robots hold the potential to expedite autonomous interventions, such as tissue palpation for cancer detection. While cameras are prevalent in surgical instruments, situations with obscured views necessitate palpation. This proof-of-concept study investigates the effectiveness of using a soft robot integrated with Electrical Impedance Tomography (EIT) capabilities for tissue palpation in simulated in vivo inspection of the large intestine. The approach involves classifying tissue samples of varying thickness into healthy and cancerous tissues using the shape changes induced on a hydraulically-driven soft continuum robot during palpation. Shape changes of the robot are mapped using EIT, providing arrays of impedance measurements. Following the fabrication of an in-plane bending soft manipulator, the preliminary tissue phantom design is detailed. The phantom, representing the descending colon wall, considers induced stiffness by surrounding tissues based on a mass-spring model. The shape changes of the manipulator, resulting from interactions with tissues of different stiffness, are measured, and EIT measurements are fed into a Long Short-Term Memory (LSTM) classifier. Train and test datasets are collected as temporal sequences of data from a single training phantom and two test phantoms, namely, A and B, possessing distinctive thickness patterns. The collected dataset from phantom B, which differs in stiffness distribution, remains unseen to the network, thus posing challenges to the classifier. The classifier and proposed method achieve an accuracy of 93 % and 88.1 % on phantom A and B, respectively. Classification results are presented through confusion matrices and heat maps, visualising the accuracy of the algorithm and corresponding classified tissues.
Collapse
Affiliation(s)
| | | | - George Mylonas
- The Hamlyn Centre, Imperial College London, London, United Kingdom
| |
Collapse
|
3
|
Levin G, Siedhoff M, Wright KN, Truong MD, Hamilton K, Brezinov Y, Gotlieb W, Meyer R. Robotic surgery in obstetrics and gynecology: a bibliometric study. J Robot Surg 2023; 17:2387-2397. [PMID: 37429970 PMCID: PMC10492767 DOI: 10.1007/s11701-023-01672-1] [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: 04/19/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023]
Abstract
We aimed to identify the trends and patterns of robotic surgery research in obstetrics and gynecology since its implementation. We used data from Clarivate's Web of Science platform to identify all articles published on robotic surgery in obstetrics and gynecology. A total of 838 publications were included in the analysis. Of these, 485 (57.9%) were from North America and 281 (26.0%) from Europe. 788 (94.0%) articles originated in high-income countries and none from low-income countries. The number of publications per year reached a peak of 69 articles in 2014. The subject of 344 (41.1%) of articles was gynecologic oncology, followed by benign gynecology (n = 176, 21.0%) and urogynecology (n = 156, 18.6%). Articles discussing gynecologic oncology had lower representation in low- and middle-income countries (LMIC) (32.0% vs. 41.6%, p < 0.001) compared with high income countries. After 2015 there has been a higher representation of publications from Asia (19.7% vs. 7.7%) and from LMIC (8.4% vs. 2.6%), compared to the preceding years. In a multivariable regression analysis, journal's impact factor [aOR 95% CI 1.30 (1.16-1.41)], gynecologic oncology subject [aOR 95% CI 1.73 (1.06-2.81)] and randomized controlled trials [aOR 95% CI 3.67 (1.47-9.16)] were associated with higher number of citations per year. In conclusion, robotic surgery research in obstetrics & gynecology is dominated by research in gynecologic oncology and reached a peak nearly a decade ago. The disparity in the quantity and quality of robotic research between high income countries and LMIC raises concerns regarding the access of the latter to high quality healthcare resources such as robotic surgery.
Collapse
Affiliation(s)
- Gabriel Levin
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Matthew Siedhoff
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Kelly N Wright
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Mireille D Truong
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Kacey Hamilton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Yoav Brezinov
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Walter Gotlieb
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Raanan Meyer
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
| |
Collapse
|
4
|
Lee YL, Chiang KJ, Lin CK, Chao TK, Yu MH, Liu YL, Wang YC. Robotic Hysterectomy with Ureter Identification and Uterine Artery Ligation for Benign Gynecological Conditions: An Early-Year Single-Center Experience. Diagnostics (Basel) 2023; 13:diagnostics13101809. [PMID: 37238293 DOI: 10.3390/diagnostics13101809] [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: 04/06/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
The use and application of robotic systems with a high-definition, three-dimensional vision system and advanced EndoWrist technology have become widespread. We sought to share our clinical experience with ureter identification and preventive uterine artery ligation in robotic hysterectomy. The records of patients undergoing robotic hysterectomy between May 2014 and December 2015, including patient preoperative characteristics, operative time, and postoperative outcomes, were analyzed. We evaluated the feasibility and safety of using early ureteral identification and preventive uterine artery ligation in robotic hysterectomy in patients with benign gynecological conditions. Overall, 49 patients diagnosed with benign gynecological conditions were evaluated. The mean age of the patients and mean uterine weight were 46.2 ± 5.3 years and 348.7 ± 311.8 g, respectively. Robotic hysterectomy achieved satisfactory results, including a short postoperative hospital stay (2.7 ± 0.8 days), low conversion rate (n = 0), and low complication rate (n = 1; 2%). The average estimated blood loss was 109 ± 107.2 mL. Our results suggest that robotic hysterectomy using early ureteral identification and preventive uterine artery ligation is feasible and safe in patients with benign gynecological conditions.
Collapse
Affiliation(s)
- Yi-Liang Lee
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Department of Obstetrics and Gynecology, Kang-Ning General Hospital, Kang Ning University, Taipei 114, Taiwan
| | - Kai-Jo Chiang
- Department of Nursing, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- School of Nursing, National Defense Medical Center, Taipei 114, Taiwan
| | - Chi-Kung Lin
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Tai-Kuang Chao
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Mu-Hsien Yu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Yung-Liang Liu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Yu-Chi Wang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| |
Collapse
|
5
|
Tannus S, Giannini A, Magrina JF, Crosson J, Kosiorek H, Yi J, Butler KA. Same-day Discharge after Robotic Hysterectomy for Benign Conditions: Feasibility and Safety. J Minim Invasive Gynecol 2022; 30:277-283. [PMID: 36528258 DOI: 10.1016/j.jmig.2022.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVE To investigate the feasibility and predictive factors for same-day discharge (SDD) after robotic hysterectomy (RH) for benign indications to optimize patient selection by incorporating preoperative, intraoperative, and postoperative variables. DESIGN A single-center retrospective cohort study. SETTING Tertiary academic hospital. PATIENTS Patients undergoing RH for benign indications. INTERVENTIONS Patients were designated for SDD by implementing enhanced recovery after surgery protocol. MEASUREMENTS AND MAIN RESULTS The study included 890 patients who underwent RH for benign indications between the years 2016 and 2021. Of these, 618 (69.4%) were discharged the same day and 272 (30.5%) were admitted for overnight stay. Both groups had similar age (46.4 vs 46.2 years), body mass index (28.3 vs 28.9), and indications for surgery. In multivariable logistic regression, factors that were significant for overnight stay were American Society of Anesthesiologists score 3, Charlson comorbidity index, previous laparotomy, and operative time. Other factors such as surgery start time and preoperative hemoglobin levels were not statistically significant. Postoperative outcomes were comparable for both groups with similar readmission and reoperation rates. CONCLUSION The likelihood of SDD after RH in this cohort after implementing enhanced recovery after surgery protocol was almost 70%, and most of the predictive factors for overnight stay were nonmodifiable. Importantly, both groups had similar outcomes after surgery.
Collapse
Affiliation(s)
- Samer Tannus
- Department of Medical and Surgical Gynecology, Mayo Clinic (Drs. Tannus, Giannini, and Magrina; Ms. Crosson, and Drs. Yi and Butler), Phoenix, Arizona.
| | - Andrea Giannini
- Department of Medical and Surgical Gynecology, Mayo Clinic (Drs. Tannus, Giannini, and Magrina; Ms. Crosson, and Drs. Yi and Butler), Phoenix, Arizona
| | - Javier F Magrina
- Department of Medical and Surgical Gynecology, Mayo Clinic (Drs. Tannus, Giannini, and Magrina; Ms. Crosson, and Drs. Yi and Butler), Phoenix, Arizona
| | - Jacque Crosson
- Department of Medical and Surgical Gynecology, Mayo Clinic (Drs. Tannus, Giannini, and Magrina; Ms. Crosson, and Drs. Yi and Butler), Phoenix, Arizona
| | - Heidi Kosiorek
- Department of Quantitative Health Sciences, Mayo Clinic (Ms. Kosiorek), Scottsdale, Arizona
| | - Johnny Yi
- Department of Medical and Surgical Gynecology, Mayo Clinic (Drs. Tannus, Giannini, and Magrina; Ms. Crosson, and Drs. Yi and Butler), Phoenix, Arizona
| | - Kristina A Butler
- Department of Medical and Surgical Gynecology, Mayo Clinic (Drs. Tannus, Giannini, and Magrina; Ms. Crosson, and Drs. Yi and Butler), Phoenix, Arizona
| |
Collapse
|
6
|
Truong MD, Tholemeier LN. Role of Robotic Surgery in Benign Gynecology. Obstet Gynecol Clin North Am 2022; 49:273-286. [DOI: 10.1016/j.ogc.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Minimally Invasive Surgery for Cervical Cancer in Light of the LACC Trial: What Have We Learned? Curr Oncol 2022; 29:1093-1106. [PMID: 35200592 PMCID: PMC8871281 DOI: 10.3390/curroncol29020093] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Cervical cancer is the most common gynecologic malignancy and the fourth most common cancer in women worldwide. Over the last two decades, minimally invasive surgery (MIS) emerged as the mainstay in the surgical management of cervical cancer, bringing advantages such as lower operative morbidity and shorter hospital stay compared to open surgery while maintaining comparable oncologic outcomes in numerous retrospective studies. However, in 2018, a prospective phase III randomized controlled trial, “Laparoscopic Approach to Carcinoma of the Cervix (LACC)”, unexpectedly reported that MIS was associated with a statistically significant poorer overall survival and disease-free survival compared to open surgery in patients with early-stage cervical cancer. Various hypotheses have been raised by the authors to try to explain these results, but the LACC trial was not powered to answer those questions. In this study, through an exhaustive literature review, we wish to explore some of the potential causes that may explain the poorer oncologic outcomes associated with MIS, including the type of MIS surgery, the size of the lesion, the impact of CO2 pneumoperitoneum, prior conization, the use of uterine manipulator, the use of protective measures, and the effect of surgical expertise/learning curve.
Collapse
|
8
|
Bixel K, Barrington DA, Vetter MH, Suarez AA, Felix AS. Determinants of Surgical Approach and Survival Among Women with Endometrial Carcinoma. J Minim Invasive Gynecol 2022; 29:219-230. [PMID: 34348183 PMCID: PMC8803987 DOI: 10.1016/j.jmig.2021.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVE To investigate determinants of surgical approach among women with endometrial carcinoma (EC) and associations between surgical approach and overall survival (OS). DESIGN Retrospective cohort. SETTING The National Cancer Database, 2010 to 2015. PATIENTS A total of 140 470 patients with histologically confirmed EC who underwent hysterectomy. INTERVENTIONS Patients were grouped according to surgical approach. MEASUREMENTS AND MAIN RESULTS A total of 140 470 patients with EC were included. Robotic-assisted laparoscopy (RAL) was the most common surgical approach (48.8%), followed by laparotomy (33.6%) and traditional laparoscopy (17.6%). Use of RAL increased over the study period, and the percentages of cases managed by laparotomy decreased. Older women, those with insurance, residing in ZIP codes with lower proportions of individuals who did not graduate from high school, and those treated at noncommunity cancer programs were less likely to undergo laparotomy than RAL, and non-white women, those diagnosed with high-grade histology, and those with advanced-stage EC were more likely to undergo laparotomy than RAL. Compared with RAL, all other surgical approaches were associated with worse OS (laparotomy: hazard ratio 1.21; 95% confidence interval, 1.18-1.25; traditional laparoscopy: hazard ratio 1.06; 95% confidence interval, 1.02-1.09). Significant effect modification of the surgical approach and OS relationship according to age, race, histology, stage, and adjuvant treatment was observed. CONCLUSION RAL increased in frequency over the study period and was associated with improved OS, supporting the continued use of RAL for EC management.
Collapse
Affiliation(s)
- Kristin Bixel
- Division of Gynecologic Oncology (Drs. Bixel and Barrington).
| | | | - Monica H Vetter
- Division of Gynecologic Oncology, Baptist Health Medicine Group, Lexington, Kentucky (Dr. Vetter)
| | - Adrian A Suarez
- Division of Surgical Pathology (Dr. Suarez), College of Medicine
| | - Ashley S Felix
- Division of Epidemiology, College of Public Health (Dr. Felix), The Ohio State University, Columbus, Ohio
| |
Collapse
|
9
|
Gressel GM, George K, Woodland MB, Banks E. Residents' Confidence in Performing Robotic Hysterectomy in Obstetrics and Gynecologic Training Programs. J Minim Invasive Gynecol 2021; 28:1882-1888.e5. [PMID: 33962023 DOI: 10.1016/j.jmig.2021.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/08/2021] [Accepted: 04/24/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To compare residents' perceptions of readiness to perform robotic-assisted laparoscopic hysterectomy with the perceptions of residency program directors in obstetrics and gynecology programs throughout the United States. DESIGN A survey was administered to all residents taking the 2019 Council on Resident Education in Obstetrics and Gynecology Exam and concurrently to program directors in all Accreditation Council for Graduate Medical Education-accredited training programs. SETTING The survey was designed to assess resident confidence to perform robotic hysterectomies by the time of graduation. PATIENTS No patients were included in the study. INTERVENTIONS The only intervention was administration of the survey. MEASUREMENTS AND MAIN RESULTS De-identified survey data were analyzed using chi-squared and Fisher's exact tests. A total of 5473 resident respondents and 241 residency program directors were included in the study. Fifty-two percent of graduating residents reported that they felt they were given surgical autonomy to perform robotic hysterectomies, and 53.7% reported that they could perform one independently (if it was an "emergency" and they had to). By the time of graduation, only 59% of residents reported confidence performing a robotic hysterectomy, and only 56% reported they felt that it would be an important procedure for their future career. Program directors were significantly more likely to report that their residents were given autonomy to perform robotic hysterectomy by graduation (61.0% [95% confidence interval (CI), 54.3-67.3]), could perform a robotic hysterectomy independently (60.9% [95% CI, 53.9-67.6]), or could perform a robotic hysterectomy by graduation (70.2% [95% CI, 63.5-76.3]) than residents themselves (38.6% [95% CI, 37.2-40.0], 22.8% [95% CI, 21.6-24.0], 62.6% [95% CI, 61.2-64.0], respectively). CONCLUSION At the time of graduation, residents' confidence in performing robotic hysterectomy independently is lower than their confidence in performing all other approaches to hysterectomy.
Collapse
Affiliation(s)
- Gregory M Gressel
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York (Drs. Gressel and Banks)
| | - Karen George
- Department of Obstetrics & Gynecology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia (Dr. George)
| | - Mark B Woodland
- Department of Obstetrics & Gynecology, Reading Hospital/Tower Health, Drexel University College of Medicine, Reading, Pennsylvania (Dr. Woodland)
| | - Erika Banks
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York (Drs. Gressel and Banks).
| |
Collapse
|
10
|
Azadi S, Green IC, Arnold A, Truong M, Potts J, Martino MA. Robotic Surgery: The Impact of Simulation and Other Innovative Platforms on Performance and Training. J Minim Invasive Gynecol 2020; 28:490-495. [PMID: 33310145 DOI: 10.1016/j.jmig.2020.12.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To review the current status of robotic training and the impact of various training platforms on the performance of robotic surgical trainees. DATA SOURCES Literature review of Google Scholar and PubMed. The search terms included a combination of the following: "robotic training," "simulation," "robotic curriculum," "obgyn residency robotic training," "virtual reality robotic training," "DaVinci training," "surgical simulation," "gyn surgical training." The sources considered for inclusion included peer-reviewed articles, literature reviews, textbook chapters, and statements from various institutions involved in resident training. METHODS OF STUDY SELECTION A literature search of Google Scholar and PubMed using terms related to robotic surgery and robotics training, as mentioned in the "Data Sources" section. RESULTS Multiple novel platforms that use machine learning and real-time video feedback to teach and evaluate robotic surgical skills have been developed over recent years. Various training curricula, virtual reality simulators, and other robotic training tools have been shown to enhance robotic surgical education and improve surgical skills. The integration of didactic learning, simulation, and intraoperative teaching into more comprehensive training curricula shows positive effects on robotic skills proficiency. Few robotic surgery training curricula have been validated through peer-reviewed study, and there is more work to be completed in this area. In addition, there is a lack of information about how the skills obtained through robotics curricula and simulation translate into operating room performance and patient outcomes. CONCLUSION Data collected to date show promising advances in the training of robotic surgeons. A diverse array of curricula for training robotic surgeons continue to emerge, and existing teaching modalities are evolving to keep up with the rapidly growing demand for proficient robotic surgeons. Futures areas of growth include establishing competency benchmarks for existing training tools, validating existing curricula, and determining how to translate the acquired skills in simulation into performance in the operating room and patient outcomes. Many surgical training platforms are beginning to expand beyond discrete robotic skills training to procedure-specific and team training. There is still a wealth of research to be done to understand how to create an effective training experience for gynecologic surgical trainees and robotics teams.
Collapse
Affiliation(s)
- Shirin Azadi
- Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, Pennsylvania (Drs. Azadi, Potts, and Martino)
| | - Isabel C Green
- Department of Gynecology and Obstetric, Mayo Clinic, Rochester, Minnesota (Dr. Green)
| | - Anne Arnold
- American College of Obstetricians and Gynecologists, University of Pennsylvania Graduate School of Education, Philadelphia, PA (Ms. Arnold)
| | - Mireille Truong
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California (Dr. Truong)
| | - Jacqueline Potts
- Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, Pennsylvania (Drs. Azadi, Potts, and Martino)
| | - Martin A Martino
- Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, Pennsylvania (Drs. Azadi, Potts, and Martino); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida (Dr. Martino).
| |
Collapse
|
11
|
Capmas P, Suarthana E, Larouche M. Conversion rate of laparoscopic or robotic to open sacrocolpopexy: are there associated factors and complications? Int Urogynecol J 2020; 32:2249-2256. [PMID: 33104825 DOI: 10.1007/s00192-020-04570-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the conversion rate of laparoscopic or robotic to open sacrocolpopexy and to identify associated factors in a large population-based database. METHODS We used Health Care Cost and Utilization Project-National Inpatient Sample (HCUP-NIS) databases 2005-2014. We extracted data on apical suspension and synthetic mesh with laparoscopy or robot in adult women using International Classification of Diseases, ninth edition, Clinical Modification (ICD-9-CM) codes. We evaluated the rate of conversion and used logistic regression to study the association with risk factors. RESULTS We identified 3295 women with laparoscopic or robotic sacrocolpopexies. There were 2777 robotic procedures with 37 conversion (1.33%) and 518 laparoscopic procedures with 37 conversions (7.14%), with an overall conversion rate of 2.2%. Median age was 62 years [interquartile range (IQR) = 55-69]. Concomitant hysterectomy was significantly more frequent in the robotic than laparascopic group (41.7% versus 13.9%, p < 0.01) and was not associated with conversion. Factors associated with lower conversion included a robotic approach (adjusted odd ratio (aOR) 0.32 [95% CI 0.19-0.54]) and private insurance (aOR 0.53 [95% CI 0.32-0.86]). Factors associated with higher conversion were obesity (aOR 3.27 [95% CI 1.72-6.19]) and lysis of adhesions (aOR 3.32 [95% CI 1.89-5.85]). Accidental organ puncture was significantly associated with conversion (14.9% versus 3.8%; p < 0.01). CONCLUSION In this American database, the rate of conversion of laparoscopic or robotic to open sacrocolpopexy was low. The majority (84%) of minimally invasive sacrocolpopexies used a robotic approach, which was associated with a lower risk of conversion. Obesity and lysis of adhesions were associated with a higher risk of conversion.
Collapse
Affiliation(s)
- Perrine Capmas
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada. .,Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, and Faculty of Medicine, University Paris Sud, 94276, Le Kremlin Bicêtre, France.
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Maryse Larouche
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| |
Collapse
|
12
|
|
13
|
Yoo HK, Cho A, Cho EH, Kim SJ, Shim JE, Lee SR, Jeong K, Moon HS. Robotic single-site surgery in benign gynecologic diseases: Experiences and learning curve based on 626 robotic cases at a single institute. J Obstet Gynaecol Res 2020; 46:1885-1892. [PMID: 32686302 DOI: 10.1111/jog.14372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/21/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023]
Abstract
AIM The purpose of this study was to report on 626 cases of successful robotic single-site (RSS) surgeries to address various types of gynecologic disease and to evaluate the outcomes and learning curve inherent to RSS surgery in the gynecology field. METHODS A total of 626 cases of RSS surgeries were performed by 3 gynecologic surgeons at Ewha Womans University Medical Center, Robot Surgery Center from November 2014 to January 2018 were collected retrospectively. All of the patients' charts were reviewed, and the clinical characteristics and surgical variables were analyzed. RESULTS Among the total of 626 cases, there were 220 cases of RSS myomectomy (RSSM), 182 cases of RSS hysterectomy (RSSH), 195 of RSS adnexectomy, 24 of RSS sacrocolpopexy (RSS SCP) and 5 were classified as other RSS surgeries. The patient's mean age was 38.98 ± 10.07 years. There was 3.99 ± 2.15 min of mean docking time and 117.78 ± 51.18 min of mean operating time. The surgical variables were analyzed annually. The total operating time was seen to decrease significantly according to each period. The docking time declined significantly and gradually after 1 year. We also analyzed each of the surgical types by time. The operating time of RSSH, RSSM, RSS adnexectomy and RSS SCP fell over time. The tendency found was for operating time to decline sharply following the first 10 cases. When we analyzed the data at annual intervals, the operating time was most significantly less and stable following the first year. There were a few intraoperative or perioperative complications in 16 cases (2.6%). CONCLUSION Robotic single-site surgery is a feasible and safe procedure for treating various kinds of gynecologic diseases. The learning curve was approximately 10 cases of RSS surgery in gynecologic disease, having a greater amount of experience at performing RSS surgery was revealed to be key to achieving better surgical outcomes.
Collapse
Affiliation(s)
- Hae K Yoo
- Department of Obstetrics and Gynecology, Robot Surgery Center, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Ahyoung Cho
- Department of Obstetrics and Gynecology, Robot Surgery Center, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Eun H Cho
- Department of Obstetrics and Gynecology, Robot Surgery Center, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Soo J Kim
- Department of Obstetrics and Gynecology, Robot Surgery Center, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Ji E Shim
- Department of Obstetrics and Gynecology, Robot Surgery Center, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Sa R Lee
- Department of Obstetrics and Gynecology, Robot Surgery Center, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Kyungah Jeong
- Department of Obstetrics and Gynecology, Robot Surgery Center, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Hye-Sung Moon
- Department of Obstetrics and Gynecology, Robot Surgery Center, College of Medicine, Ewha Womans University, Seoul, South Korea
| |
Collapse
|
14
|
Tyan P, Klebanoff JS, Frangieh M, North A, Smith S, Amdur R, Kazma J, Moawad GN. Safety and feasibility of the three-port robot-assisted hysterectomy across uterine weights. J Robot Surg 2020; 15:259-264. [PMID: 32557096 DOI: 10.1007/s11701-020-01101-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
One strategy thought to reduce direct costs associated with robotic surgery is minimizing the number of robotic arms used for a surgery. We aim to demonstrate the safety and feasibility of the three-port robot-assisted hysterectomy across uterine weights. Retrospective cohort study in a tertiary care university hospital of consecutive patients undergoing a three-port robot-assisted hysterectomy for benign indications. All surgeries were performed between 2012 and 2018 by fellowship-trained minimally invasive gynecologic surgeons. Data from 232 patients were collected. Eighty-eight (37.9%) patients had a uterine weight < 250 g, 63 (27.2%) had a uterine weight between 250 and 500 g, 51 (22.0%) had a uterine weight between 500 and 1000 g, and 30 (12.9%) had a uterine weight ≥ 1000 g. Multivariable regression analysis revealed no statistically significant differences between uterine weight groups and time spent in PACU, the total length of hospital stay, or direct cost. When setting the < 250 g as referent, patients with uterine weights between 500 and 1000 g, and more than 1000 g had an operative time that was on average 23.4% and 91.6% longer than patients with uterine weight < 250 g, respectively (p < 0.01). Patients with uterine weights between 500 and 1000 g and more than 1000 g had an EBL that was on average 35% and 156% higher than patients with uterine weight < 250 g, respectively (p < 0.01). Our data support the safety and feasibility of the three-port robot-assisted hysterectomy technique across uterine weights.
Collapse
Affiliation(s)
- Paul Tyan
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jordan S Klebanoff
- Department of Obstetrics and Gynecology, George Washington University, 900 23rd St NW, Washington, DC, 20037, USA
| | - Michael Frangieh
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Alexandra North
- University of South Carolina School of Medicine Greenville Campus, Greenville, SC, USA
| | - Savannah Smith
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Richard Amdur
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Jamil Kazma
- Department of Obstetrics and Gynecology, George Washington University, 900 23rd St NW, Washington, DC, 20037, USA
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, George Washington University, 900 23rd St NW, Washington, DC, 20037, USA.
| |
Collapse
|
15
|
Giannini A, Malacarne E, Sergiampietri C, Mannella P, Perutelli A, Cela V, Stomati M, Melfi F, Simoncini T. Comparison of perioperative outcomes and technical features using da Vinci Si and Xi robotic platforms for early stages of endometrial cancer. J Robot Surg 2020; 15:195-201. [PMID: 32447594 DOI: 10.1007/s11701-020-01091-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
We directly compared perioperative outcomes and technical features between previous da Vinci Si and the newer Xi robotic platform during total hysterectomy plus salpingo-oophorectomy with or without lymphadenectomy for early-stage endometrial cancer. We retrospectively analyzed147 patients with histological confirmation of endometrial carcinoma stage IA: grade 1-2, 3 and stage IB: grade 1-2 who underwent surgery with da Vinci Si or Xi system between January 2016 and December 2018. Perioperative data, technical features and postoperative complications were considered. 91 patients underwent surgery with the Si system and 56 with the Xi system. Docking time using the Xi system was significantly shorter (p < 0.002), while overall operating time was similar. There were no significant differences in the number of harvested lymph nodes, conversion rate, mean hospital stay, complications, and technical aspects between the two groups. Our study detected similar perioperative outcomes and the trend toward shorter docking and operating time for Xi over Si robot.
Collapse
Affiliation(s)
- Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Elisa Malacarne
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Claudia Sergiampietri
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Paolo Mannella
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Alessandra Perutelli
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Vito Cela
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Massimo Stomati
- Unit of Obstetrics and Gynecology, Francavilla Fontana Hospital, Francavilla Fontana, Italy
| | - Franca Melfi
- Multidisciplinary Center of Robotic Surgery, University Hospital Cisanello, Pisa, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
| |
Collapse
|
16
|
Klebanoff JS, Tyan P, Nishikawa M, North A, Amdur R, Sparks A, Kazma JM, Moawad GN. Cost variance across obesity class for women undergoing laparoscopic hysterectomy by high-volume gynecologic surgeons. J Robot Surg 2020; 14:903-907. [PMID: 32253574 DOI: 10.1007/s11701-020-01074-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/28/2020] [Indexed: 01/23/2023]
Abstract
Health-care costs are affected by obesity with both the direct and indirect costs of health care increasing as body mass index (BMI) increases. However, one important aspect of obesity that lacks rigorous study is what impact BMI has on direct surgical cost. We performed a retrospective cohort study of women undergoing a laparoscopic hysterectomy at our single academic university center between January 2012 and December 2017. Women were excluded if their surgery was performed by anyone other than those surgeons with subspecialty training in minimally invasive gynecologic surgery (MIGS), if their hysterectomy was performed by a modality other than conventional laparoscopy or with robotic assistance, or if the indication for hysterectomy was related to any gynecologic malignancy. We identified 600 patients who underwent laparoscopic hysterectomy during the study period. Women who underwent robotic hysterectomy, compared to laparoscopic, had a shorter operative time, lower estimated blood loss, and shorter length of stay. Mean direct cost (± standard deviation) for the cohort was $6398.53 ± $2304.67, age was 44.5 ± 7.5 years, and BMI was 32.2 ± 7.6. Direct cost for all laparoscopic hysterectomies was evaluated across the five different BMI quintiles and no significant difference between groups was found. There was no significant difference in direct cost across procedures between obese and non-obese patients (p = 0.62) and this remained true when separated out by surgical modality. However, when evaluating morbidly obese patients, there appears to be a trend toward cost reduction with robotic hysterectomy compared to conventional laparoscopy. It does not appear that BMI has a statistically significant impact on direct cost between robotic-assisted and conventional laparoscopic hysterectomy. However, these findings may be due to surgical proficiency and warrant further investigation among surgeons with lesser volume.
Collapse
Affiliation(s)
- Jordan S Klebanoff
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA
| | - Paul Tyan
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Moena Nishikawa
- The George Washington University School of Medicine, Washington, DC, USA
| | - Alexandra North
- The University of South Carolina Medical School Greenville Campus, Greenville, SC, USA
| | - Richard Amdur
- Department of Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Andrew Sparks
- Department of Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Jamil M Kazma
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA.
| |
Collapse
|
17
|
Yang YS. Robotic natural orifice transluminal endoscopic surgery (NOTES) hysterectomy as a scarless and gasless surgery. Surg Endosc 2019; 34:492-500. [DOI: 10.1007/s00464-019-07115-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 08/29/2019] [Indexed: 12/12/2022]
|
18
|
Bixel KL, Fowler JM. Fertility-sparing surgery for early-stage cervical cancer: does surgical approach have an impact on disease outcomes? Am J Obstet Gynecol 2019; 220:417-419. [PMID: 31076039 DOI: 10.1016/j.ajog.2019.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 02/02/2023]
|
19
|
Implementing robotic assisted myomectomy in surgical practice – a retrospective cohort study. ACTA ACUST UNITED AC 2019. [DOI: 10.1186/s10397-019-1059-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abstract
Background
To compare surgical outcomes of patients with leiomyomas after robotic-assisted laparoscopic myomectomy (RALM), laparoscopic myomectomy (LsM), or laparotomic myomectomy (LtM) and to construct a useful algorithm for the best modus operandi for uterine leiomyomas.
Methods
Design: A retrospective chart review. Data included patient (age and BMI) and fibroid characteristics (number, measurements of the primary fibroid, type, and location), operating time, blood loss, hospitalization length, complications during and after surgery, and complications during posttreatment pregnancies. Comparisons were based on chi-square and two-sample t tests. Setting: University teaching hospital. Patients: Between 1 January 2009 and 31 December 2016, 51 RALMs, 84 LsMs, and 52 LtMs were performed at our institution. Interventions: Three different approaches of myomectomy were performed: robotic-assisted laparoscopy (RALM), laparoscopy (LsM), and laparotomy (LtM).
Results
There was no significant difference in the distribution of the location and the type of myoma between the three groups. The mean size of the largest myoma removed by LsM, RALM, and LtM was 60.9, 70.8, and 92.6 mm (p < 0.05), respectively. Surgical outcomes between the three modalities were comparable except for increased mean blood loss and postoperative bleeding and longer hospital stay for patients with LtM and for longer operation time when performing RALM.
Conclusion
RALM should replace open surgery if feasible and should not replace traditional laparoscopy unless other benefits are proven.
Collapse
|
20
|
Wu CZ, Klebanoff JS, Tyan P, Moawad GN. Review of strategies and factors to maximize cost-effectiveness of robotic hysterectomies and myomectomies in benign gynecological disease. J Robot Surg 2019; 13:635-642. [PMID: 30919259 DOI: 10.1007/s11701-019-00948-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/19/2019] [Indexed: 12/15/2022]
Abstract
Common benign gynecologic procedures include hysterectomies and myomectomies, with hysterectomy being the most common gynecologic procedure in the United States [1]. While historically performed via laparotomy, the field of gynecologic surgery was revolutionized with the advent of laparoscopic techniques, with the most recent advancement being the introduction of robotic-assisted surgery in 2005. Robotic surgery has all the benefits of laparoscopic surgery such as decreased blood loss, quicker return to activities, and shorter length of hospital stay. Additional robotic-specific advantages include but are not limited to improved ergonomics, 3D visualization, and intuitive surgical movements. Despite these advantages, one of the most commonly cited drawbacks of robotic surgery is the associated cost. While the initial cost to purchase the robotic console and its associated maintenance costs are relatively high, robotic surgery can be cost-effective when utilized correctly.This article reviews application strategies and factors that can offset traditional costs and maximize the benefits of robotic surgery.
Collapse
Affiliation(s)
- Catherine Z Wu
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA
| | - Jordan S Klebanoff
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA
| | - Paul Tyan
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The University of North Carolina, Chapel Hill, NC, USA
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA.
| |
Collapse
|
21
|
Giannini A, Russo E, Malacarne E, Cecchi E, Mannella P, Simoncini T. Role of robotic surgery on pelvic floor reconstruction. ACTA ACUST UNITED AC 2018; 71:4-17. [PMID: 30318878 DOI: 10.23736/s0026-4784.18.04331-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the past two decades, minimally invasive surgery (MIS) abdominal surgery has increasingly been used to treat pelvic organ prolapse. Besides the several advantages associated with minimal invasiveness, this approach bridged the gap between the benefits of vaginal surgery and the surgical success rates of open abdominal procedures. The most commonly performed procedure for suspension of the vaginal apex for postoperative vaginal prolapse by robotic-assisted laparoscopy is the sacrocolpopexy. Conventional laparoscopic application of this procedure was first reported in 1994 by Nezhat et al. and had not gained widespread adoption due to lengthy learning curve associated with laparoscopic suturing. Since FDA approval of the da Vinci® robot for gynecologic surgery in 2005, minimally invasive abdominal surgery for pelvic organ prolapse has become increasingly popular, as robotic-assisted laparoscopic sacrocolpopexy is an option for those surgeons without experience or training in the conventional route. Robotic surgery has made its way into the armamentarium of POP treatment and has allowed pelvic surgeons to adapt the "gold standard" technique of abdominal sacrocolpopexy to a minimally invasive approach with improved intraoperative morbidity and decreased convalescence. In fact, repair of pelvic organ prolapse can be performed robotically, and sometimes surgeons can feel suturing and dissection during the procedures less challenging with the assistance of the robot. However, even if robotic surgery may confer many benefits over conventional laparoscopy, these advantages should continue to be weighed against the cost of the technology. To date, as long-term outcomes, evidence about robotic sacrocolpopexy for a repair of pelvic organ prolapse are not conclusive, and much more investigations are needed to evaluate subjective and objective outcomes, perioperative and postoperative adverse events, and costs associated with these procedures. It is plausible to think that the main advantage is that robotics may lead to a widespread adoption of minimally invasive techniques in the field of pelvic floor reconstructive surgery. The following review will address the development and current state of robotic assistance in treating pelvic floor reconstruction discussing available data about the techniques of robotic prolapse repair as well as morbidity, costs and clinical outcomes.
Collapse
Affiliation(s)
- Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy
| | - Eleonora Russo
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy
| | - Elisa Malacarne
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy
| | - Elena Cecchi
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy
| | - Paolo Mannella
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy -
| |
Collapse
|
22
|
Luo C, Liu M, Li X. Efficacy and safety outcomes of robotic radical hysterectomy in Chinese older women with cervical cancer compared with laparoscopic radical hysterectomy. BMC WOMENS HEALTH 2018; 18:61. [PMID: 29716555 PMCID: PMC5930733 DOI: 10.1186/s12905-018-0544-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 03/16/2018] [Indexed: 12/02/2022]
Abstract
Background Recently, as a complex integrating a number of modern high-tech means, robotic surgery system is a well-deserved revolutionary tool in globally minimally invasive surgical field. For the first time in China, the objective of this study was to evaluate the efficacy and safety outcomes of robotic radical hysterectomy (RRH) in Chinese older women with cervical cancer compared with laparoscopic radical hysterectomy (LRH). Methods In this prospective, randomized and double-blinded study, 60 Chinese older women with cervical cancer were evenly divided to accept the RRH or LRH. Follow-up period lasted for 24 months. Results Median age for the entire cohort was 65 (range: 61-69) years. There was no difference in International Federation of Gynecology and Obstetrics (FIGO) stages and cell types between two groups (p > 0.05 for all). Uterine size, tumor size, vaginal length and numbers of left and right pelvic lymph nodes did not differ between two groups (p > 0.05 for all). No difference was observed in numbers of left and right lymph node metastasis (p > 0.05 for all). All patients had negative margins without conversion to laparotomy. There were significantly less postoperative complications in the RRH group than in the LRH group (p < 0.05). Shorter indwelling time of bladder and drain catheters was observed in the RRH group than in the LRH group (p < 0.05 for all). Length of postoperative hospital stay in the RRH group was significantly shorter compared with that in the LRH group (p < 0.05). Patients in two groups similarly experienced the recurrence and death (p > 0.05 for all). Conclusions This study demonstrated that RRH provided additional benefits for Chinese older women with cervical cancer because of less complications and faster recovery compared with LRH. Meanwhile, this study supported an equivalence of surgical qualities and survival outcomes of RRH to LRH. Robotics-assisted surgical method is effective, safe and feasible for Chinese older women with cervical cancer.
Collapse
Affiliation(s)
- Cheng Luo
- Department of Gynecology, Chinese People's Liberation Army General Hospital and Hainan Branch, Haitang Bay, Sanya, China
| | - Mei Liu
- Department of Oncology, Chinese People's Liberation Army General Hospital and Hainan Branch, Sanya, China
| | - Xiuli Li
- Department of Gynecology, Chinese People's Liberation Army General Hospital and Hainan Branch, Haitang Bay, Sanya, China.
| |
Collapse
|
23
|
Borahay MA, Tapısız ÖL, Alanbay İ, Kılıç GS. Outcomes of robotic, laparoscopic, and open hysterectomy for benign conditions in obese patients. J Turk Ger Gynecol Assoc 2018; 19:72-77. [PMID: 29699956 PMCID: PMC5994808 DOI: 10.4274/jtgga.2018.0018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective: To compare outcomes of robotic-assisted (RAH), total laparoscopic hysterectomy (LH), and total abdominal hysterectomy (TAH) for benign conditions in obese patients. Material and Methods: Retrospective cohort (Class II-2) analysis. All obese patients who underwent RAH, LH or TAH for benign conditions by a single surgeon at the University of Texas Medical Branch between January 2009 and December 2011 were identified and their charts reviewed. The patients’ characteristics, operative data, and post-operative outcomes were collected and statistically analyzed. Results: A total of 208 patients who underwent RAH (n=51), LH (n=24) or TAH (n=133) were analyzed. There were no significant differences among the groups in demographic characteristics, indications for surgery or pathologic findings. RAH and LH were associated with lower estimated blood loss (EBL) (p<0.001) and shorter length of hospital stay (LOS) (p<0.001) compared with TAH. In addition, RAH and LH had lower intraoperative and early postoperative (≤6 weeks) complications compared with TAH (p=0.002). However, the procedure time was longer in RAH and LH (p<0.001). No significant differences were noted among the groups for late post-operative complications (after 6 weeks) or unscheduled post-operative visits. Conclusion: Minimally invasive hysterectomy appears to be safe in obese patients with the advantages of less EBL, fewer intraoperative complications, and shorter LOS.
Collapse
Affiliation(s)
- Mostafa A Borahay
- Department of Obstetrics and Gynecology, Johns Hopkins University, Maryland, USA,Department of Obstetrics and Gynecology, University of Texas Medical Branch, Texas, USA
| | - Ömer Lütfi Tapısız
- Department of Obstetrics and Gynecology, University of Health Sciences, Etlik Zübeyde Hanım Women’s Diseases Training and Research Hospital, Ankara, Turkey
| | - İbrahim Alanbay
- Department of Obstetrics and Gynecology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Gökhan Sami Kılıç
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Texas, USA
| |
Collapse
|
24
|
Faragasso A, Bimbo J, Stilli A, Wurdemann HA, Althoefer K, Asama H. Real-Time Vision-Based Stiffness Mapping †. SENSORS 2018; 18:s18051347. [PMID: 29701704 PMCID: PMC5981855 DOI: 10.3390/s18051347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/20/2018] [Accepted: 04/21/2018] [Indexed: 11/22/2022]
Abstract
This paper presents new findings concerning a hand-held stiffness probe for the medical diagnosis of abnormalities during palpation of soft-tissue. Palpation is recognized by the medical community as an essential and low-cost method to detect and diagnose disease in soft-tissue. However, differences are often subtle and clinicians need to train for many years before they can conduct a reliable diagnosis. The probe presented here fills this gap providing a means to easily obtain stiffness values of soft tissue during a palpation procedure. Our stiffness sensor is equipped with a multi degree of freedom (DoF) Aurora magnetic tracker, allowing us to track and record the 3D position of the probe whilst examining a tissue area, and generate a 3D stiffness map in real-time. The stiffness probe was integrated in a robotic arm and tested in an artificial environment representing a good model of soft tissue organs; the results show that the sensor can accurately measure and map the stiffness of a silicon phantom embedded with areas of varying stiffness.
Collapse
Affiliation(s)
- Angela Faragasso
- Department of Precision Engineering, School of Engineering, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 113-8656, Japan.
| | - João Bimbo
- Istituto Italiano di Tecnologia (IIT), Via Morego, 30 16163 Genova, Italy.
| | - Agostino Stilli
- Department of Computer Science, University College London, London WC1E 6BT, UK.
| | - Helge Arne Wurdemann
- Department of Mechanical Engineering, University College London, London WC1E 7JE, UK.
| | - Kaspar Althoefer
- Centre for Advanced Robotics at Queen Mary (ARQ), Faculty of Science & Engineering, Queen Mary University of London, Mile End Road, London E1 4NS, UK.
| | - Hajime Asama
- Department of Precision Engineering, School of Engineering, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 113-8656, Japan.
| |
Collapse
|
25
|
Gupta N, Mohling S, Mckendrick R, Elkattah R, Holcombe J, Furr RS, Boren T, DePasquale S. Perioperative outcomes of robotic hysterectomy with mini-laparotomy versus open hysterectomy for uterus weighing more than 250 g. J Robot Surg 2018; 12:641-645. [PMID: 29453729 DOI: 10.1007/s11701-018-0792-7] [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: 12/14/2017] [Accepted: 02/12/2018] [Indexed: 11/25/2022]
Abstract
To compare perioperative outcomes in patients undergoing robotic hysterectomy and extraction of specimen via mini-laparotomy (RHML) versus open hysterectomy (OH) when uterus weighs more than 250 g. To study the factors determining the length of hospital stay in 2 groups. A retrospective analysis of all hysterectomies performed for uterus weighing more than 250 g from the year 2012 to 2015 was conducted. A total of 140 patients were divided into 2 groups based on the type of surgery; RHML (n = 82) and OH (n = 58). Mini-laparotomy consisted of a customised incision connecting 2 left lateral port sites for specimen extraction after completing the hysterectomy robotically. Patient factors and perioperative outcomes were compared using Student's t tests and Chi-square analysis. Mean length of stay (RHML = 1.4 days; OH = 3.4 days), estimated blood loss (EBL) (RHML = 119.9 ml; OH = 547.5 ml) and operative time (RHML = 191.5 min; OH = 162.8 min) were significantly different. No significant differences were noted for patient BMI, age, comorbidities, intraoperative complications, pathology of uterus and uterus weight. Postoperative complications were significantly different between two groups (RHML = 6.0%; OH = 15.5%; p = .021). None of the patients stayed less than 24 h in OH group compared to 59.8% patients in RHML group. Type of procedure (p = .004) and EBL (p = .002) significantly predicted the length of stay. Patients undergoing RHML have significantly shorter length of stay, EBL and postoperative complications than OH. The operative time for RHML was longer than OH, but the overall decreased length of stay overcomes this disadvantage. RHML approach retains the benefits of da Vinci, while simultaneously preserving the specimen.
Collapse
Affiliation(s)
- Natasha Gupta
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA.
- Dept. of Obstetrics and Gynecology, Erlanger Health System, 979 E. 3rd Street, Suite C720, Chattanooga, TN, 37403, USA.
| | - Shanti Mohling
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
| | - Rebecca Mckendrick
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
- Department of Gynecologic Oncology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
| | - Rayan Elkattah
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
| | - Jenny Holcombe
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
- Department of Gynecologic Oncology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
| | - Robert S Furr
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
| | - Todd Boren
- Department of Gynecologic Oncology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
| | - Stephen DePasquale
- Department of Gynecologic Oncology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
| |
Collapse
|
26
|
Arm reduced robotic-assisted laparoscopic hysterectomy with transvaginal cuff closure. Wideochir Inne Tech Maloinwazyjne 2017; 12:271-276. [PMID: 29062448 PMCID: PMC5649497 DOI: 10.5114/wiitm.2017.68772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/26/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The use of robotics for benign etiology in gynecology has not proven to be more beneficial when compared to traditional laparoscopy. The major concern regarding robotic hysterectomy stems from its high cost. AIM To evaluate the clinical utility and effectiveness of one-arm reduced robotic-assisted laparoscopic hysterectomy as a cost-effective surgical option for total robotic hysterectomy. MATERIAL AND METHODS A sample population of 54 women who underwent robotic-assisted laparoscopic surgery for benign gynecologic indications was evaluated, and two groups were identified: (1) the two-armed robotic-assisted laparoscopic surgery group (n = 38 patients), and (2) the three-armed robotic-assisted laparoscopic surgery group (n = 16 patients). RESULTS An increased cost was observed when three-armed robotic surgery was employed for benign gynecologic surgery (p < 0.001). The cost reduction observed in the study group was primarily derived from one robotic arm reduction and vaginal closure of the cuff. This cost reduction was achieved without an increase in complication rates or undesirable postoperative outcomes. An estimated profit between $399.5 and $421.5 was made for each patient depending on the suture material chosen for cuff closure. Two-armed surgery resulted in an 18.6% reduction in procedure-specific costs for robotic hysterectomy. CONCLUSIONS Two-armed robotic-assisted laparoscopic hysterectomy appears to be a cost-effective solution for robotic gynecologic surgery. This surgical solution can be performed as effectively as classical three-armed robotic hysterectomies for benign indications without the risk of increased surgical-related morbidities. This approach has the potential to be a widely preferred surgical approach in medical communities where cost reduction is one of the primary determinants of surgery type.
Collapse
|
27
|
Lee MR, Lee GI. Does a robotic surgery approach offer optimal ergonomics to gynecologic surgeons?: a comprehensive ergonomics survey study in gynecologic robotic surgery. J Gynecol Oncol 2017; 28:e70. [PMID: 28657231 PMCID: PMC5540729 DOI: 10.3802/jgo.2017.28.e70] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/02/2017] [Accepted: 06/07/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To better understand the ergonomics associated with robotic surgery including physical discomfort and symptoms, factors influencing symptom reporting, and robotic surgery systems components recommended to be improved. METHODS The anonymous survey included 20 questions regarding demographics, systems, ergonomics, and physical symptoms and was completed by experienced robotic surgeons online through American Association of Gynecologic Laparoscopists (AAGL) and Society of Robotic Surgery (SRS). RESULTS There were 289 (260 gynecology, 22 gynecology-oncology, and 7 urogynecology) gynecologic surgeon respondents regularly practicing robotic surgery. Statistical data analysis was performed using the t-test, χ² test, and logistic regression. One hundred fifty-six surgeons (54.0%) reported experiencing physical symptoms or discomfort. Participants with higher robotic case volume reported significantly lower physical symptom report rates (p<0.05). Gynecologists who felt highly confident about managing ergonomic settings not only acknowledged that the adjustments were helpful for better ergonomics but also reported a lower physical symptom rate (p<0.05). In minimizing their symptoms, surgeons changed ergonomic settings (32.7%), took a break (33.3%) or simply ignored the problem (34%). Fingers and neck were the most common body parts with symptoms. Eye symptom complaints were significantly decreased with the Si robot (p<0.05). The most common robotic system components to be improved for better ergonomics were microphone/speaker, pedal design, and finger clutch. CONCLUSION More than half of participants reported physical symptoms which were found to be primarily associated with confidence in managing ergonomic settings and familiarity with the system depending on the volume of robotic cases. Optimal guidelines and education on managing ergonomic settings should be implemented to maximize the ergonomic benefits of robotic surgery.
Collapse
Affiliation(s)
- Mija Ruth Lee
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Gyusung Isaiah Lee
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
28
|
Simpson KM, Advincula AP. The Essential Elements of a Robotic-Assisted Laparoscopic Hysterectomy. Obstet Gynecol Clin North Am 2017; 43:479-93. [PMID: 27521880 DOI: 10.1016/j.ogc.2016.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Robotic-assisted laparoscopic hysterectomies are being performed at higher rates since the da Vinci Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA, USA) received US Food and Drug Administration approval in 2005 for gynecologic procedures. Despite the technological advancements over traditional laparoscopy, a discrepancy exists between what the literature states and what the benefits are as seen through the eyes of the end-user. There remains a significant learning curve in the adoption of safe and efficient robotic skills. The authors present important considerations when choosing to perform a robotic hysterectomy and a step-by-step technique. The literature on perioperative outcomes is also reviewed.
Collapse
Affiliation(s)
- Khara M Simpson
- Gynecologic Specialty Surgery, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, PH 16, Room 127, New York, NY 10032, USA
| | - Arnold P Advincula
- Department of Obstetrics and Gynecology, Sloane Hospital for Women, Simulation Center, Columbia University Medical Center, New York-Presbyterian Hospital, 622 West 168th Street, PH 16, Room 127, New York, NY 10032, USA.
| |
Collapse
|
29
|
Liu Z, Li X, Tian S, Zhu T, Yao Y, Tao Y. Superiority of robotic surgery for cervical cancer in comparison with traditional approaches: A systematic review and meta-analysis. Int J Surg 2017; 40:145-154. [PMID: 28238959 DOI: 10.1016/j.ijsu.2017.02.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To review the safety and effectiveness of da Vinci robotic surgery for cervical cancer in comparison with the traditional open surgery and conventional laparoscopic operation. METHODS Based on Medline, the Cochrane library, Embase, and the Journal of Robotic Surgery prior to December 30st, 2015, we searched for controlled trials and observational studies. A systematic review with meta-analyses was conducted to compare the clinical efficacy between the da Vinci robotic surgery, open surgery, and laparoscopic surgery for cervical cancer. Data were pooled using the random effects meta-analysis. RESULTS Compared with the open surgery, the robotic surgery for cervical cancer would be advantageous in terms of the length of hospital stay, incidence of complications, volume of blood loss and blood transfusion. The operative time of robotic surgery was longer than that of the open surgery, but the prediction intervals indicated that they could be shorter in future studies. Meanwhile, compared with conventional laparoscopic surgery, the robotic surgery could offer more benefits in terms of the length of hospital stay, while no difference was found in terms of the incidence of complications and the volume of blood loss. CONCLUSIONS Compared to open surgery, the robotic surgery would be advantageous for cervical cancer patients in terms of the length of hospital stay, the incidence of complications, blood loss and blood transfusion. Compared with conventional laparoscopic surgery, the robotic surgery would result in longer OT, more BL and shorter LOS. The study quality was poor.
Collapse
Affiliation(s)
- Zhongyu Liu
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing, PR China; Department of Obstetrics, The General Hospital of Jinan Military Command, Jinan, PR China
| | - Xiuli Li
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing, PR China
| | - Shuang Tian
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing, PR China
| | - Tongyu Zhu
- Department of Obstetrics, The General Hospital of Jinan Military Command, Jinan, PR China
| | - Yuanqing Yao
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing, PR China.
| | - Ye Tao
- Department of Ophthalmology, PLA General Hospital, Beijing, PR China.
| |
Collapse
|
30
|
Evaluation of Pulmonary Complications in Robotic-Assisted Gynecologic Surgery. J Minim Invasive Gynecol 2017; 24:280-285. [DOI: 10.1016/j.jmig.2016.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 10/28/2016] [Accepted: 11/02/2016] [Indexed: 11/22/2022]
|
31
|
Moawad GN, Abi Khalil ED, Tyan P, Shu MK, Samuel D, Amdur R, Scheib SA, Marfori CQ. Comparison of cost and operative outcomes of robotic hysterectomy compared to laparoscopic hysterectomy across different uterine weights. J Robot Surg 2017; 11:433-439. [PMID: 28144809 DOI: 10.1007/s11701-017-0674-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/02/2017] [Indexed: 12/16/2022]
Abstract
Operative cost and outcomes between robotic and laparoscopic hysterectomy across different uterine weights. Retrospective cohort study including patients undergoing robotic and laparoscopic hysterectomy for benign disease at an Academic university hospital. One hundred and ninety six hysterectomies were identified (101 robotic versus 95 laparoscopic). Demographic and surgical characteristics were statistically equivalent. Robotic group had a higher body mass index (±SD) (32.9 ± 6.5 versus 30.4 ± 7.1, p 0.012) and more frequent history of adnexal surgery (12.9 versus 4.2%, p 0.031). Laparoscopic group had a higher number of concurrent salpingectomy (81 versus 66.3%, p 0.02). Estimated blood loss did not differ between procedures. Compared to robotic hysterectomies, laparoscopic procedures added 47 min (CI: 31-63 min; p < 0.001) of operative time, costed $1648 more (CI: 500-2797; p = 0. 005) and had triple the odds of having an overnight admission (OR = 2.94 CI: 1.34-6.44; p = 0.007). After stratification of cases by uterine weight, the mean operative time difference between the two groups in uteri between 750 and 1000 g and in uteri >1000 g was 81.3 min (CI: 51.3-111.3, p < 0.0001) and 70 min (CI: 26-114, p < 0.005), respectively, in favor of the robotic group. Mean direct cost difference in uteri between 750 and 1000 g and uteri >1000 g was 1859$ (CI: 629-3090, p < 0.006) and 4509$ (CI: 377-8641, p < 0.004), respectively, also in favor of the robotic group. In expert hands, robotic hysterectomy for uteri weighing more than 750 g may be associated with shorter operative time and improved cost profile.
Collapse
Affiliation(s)
- Gaby N Moawad
- Department of Obstetrics & Gynecology, George Washington University Hospital, 2150 Pennsylvania Avenue NW, Suite 6A429, 20037, Washington, DC, USA
| | - Elias D Abi Khalil
- Department of Obstetrics & Gynecology, George Washington University Hospital, 2150 Pennsylvania Avenue NW, Suite 6A429, 20037, Washington, DC, USA.
| | - Paul Tyan
- Department of Obstetrics & Gynecology, George Washington University Hospital, 2150 Pennsylvania Avenue NW, Suite 6A429, 20037, Washington, DC, USA
| | - Michael K Shu
- George Washington University School of Medicine, Washington, DC, USA
| | - David Samuel
- George Washington University School of Medicine, Washington, DC, USA
| | - Richard Amdur
- Department of Surgery, George Washington University Hospital, Washington, DC, USA
| | - Stacey A Scheib
- Department of Obstetrics & Gynecology, Johns Hopkins Hospital, Washington, DC, USA
| | - Cherie Q Marfori
- Department of Obstetrics & Gynecology, George Washington University Hospital, 2150 Pennsylvania Avenue NW, Suite 6A429, 20037, Washington, DC, USA
| |
Collapse
|
32
|
Robotic and Advanced Laparoscopic Surgical Training in European Gynecological Oncology Trainees. Int J Gynecol Cancer 2017; 27:375-381. [PMID: 28114237 DOI: 10.1097/igc.0000000000000879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Advanced minimal access surgical training is an important component of training in gynecological oncology (GO). Europe-wide data on this topic are lacking. We present data on availability and trainee experience of advanced laparoscopic surgical (ALS) and robotic surgical (RS) training in GO across Europe. METHOD A prospective web-based anonymized survey of European GO trainees was sent to the European Network of Young Gynaecological Oncologists members/trainees. It included sociodemographic information and specific questions pertaining to training experience or satisfaction in laparoscopic and robotic surgery. χ test was used for evaluating categorical variables and Mann-Whitney/Kruskal-Wallis (nonparametric) tests for continuous variables between 2 and more independent groups. RESULTS A total of 113 GO trainees from 29 countries responded. The mean (standard deviation) age was 35.2 (6.1) years, 59.3% were men, 40.7% were women, and 46% were in accredited training posts. The ALS and RS training was offered in only 43% and 23% of institutes respectively, and 54% and 23% of trainees had undergone some form of formal or informal training in ALS and RS respectively. A total of 62.4% felt that RS should be a formal component of GO training programs. A total of 61% and 35% planned to go outside their institute for ALS or RS training respectively. Trainees rating (1-5 scale) of their open surgery and ALS or RS skills (3.3/2.6/1.9) and training experience (3.5/2.8/2.1), respectively, were higher for open surgery than ALS or RS (P < 0.0005). Accredited posts were more likely than nonaccredited posts to offer ALS training (60%/31%, P = 0.002), formal training schedules (27.9%/4.4%, P = 0.003), and use of logbooks (46%/23%, P = 0.035). CONCLUSIONS Training and experience in ALS and RS are poorly rated by GO trainees across Europe, and only few centers offer this. There is an urgent need to expand and harmonize training opportunities for ALS and RS. Most trainees want RS included as a formal component of their training.
Collapse
|
33
|
Crusco S, Jackson T, Advincula A. Comparing the da Vinci si single console and dual console in teaching novice surgeons suturing techniques. JSLS 2016; 18:JSLS-D-13-00218. [PMID: 25392618 PMCID: PMC4154408 DOI: 10.4293/jsls-d-13-0021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Robot-assisted laparoscopic surgery is often taught with the surgical mentor at the surgeon console and the trainee at the patient's bedside. The da Vinci dual console (Intuitive Surgical, Sunnyvale, California) allows a surgical mentor to teach with both the mentor and the trainee working at a surgeon console simultaneously. The purpose of this study is to evaluate the effectiveness of the dual console versus the single console for teaching medical students robotic tasks. METHODS Forty novice medical students were randomized to either the da Vinci single-console or dual-console group and were taught 4 knot-tying techniques by a surgical mentor. The students were timed while performing the tasks. RESULTS No statistically significant differences in mean task times were observed between the single- and dual-console groups: interrupted stitch with a 2-handed knot (300 seconds for single vs 294 seconds for dual, P=.59), interrupted stitch with a 1-handed knot (198 seconds for single vs 212 seconds for dual, P=.88), figure-of-8 stitch with a 2-handed knot (261 seconds for single vs 219 seconds for dual, P=.20), and figure-of-8 stitch with a 1-handed knot (200 seconds for single vs 199 seconds for dual, P=.53). CONCLUSION No significant difference was observed in performance time when teaching knot-tying techniques to medical students using the da Vinci dual console compared with the single console. More research needs to be performed on the utility of the da Vinci dual console in surgical training.
Collapse
Affiliation(s)
- Salvatore Crusco
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | | | | |
Collapse
|
34
|
Sinha RY, Raje SR, Rao GA. Three-dimensional laparoscopy: Principles and practice. J Minim Access Surg 2016; 13:165-169. [PMID: 27143695 PMCID: PMC5485803 DOI: 10.4103/0972-9941.181761] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The largest challenge for laparoscopic surgeons is the eye–hand coordination within a three-dimensional (3D) scene observed on a 2D display. The 2D view on flat screen laparoscopy is cerebrally intensive. The loss of binocular vision on a 2D display causes visual misperceptions, mainly loss of depth perception and adds to the surgeon's fatigue. This compromises the safety of laparoscopy. The 3D high-definition view with great depth perception and tactile feedback makes laparoscopic surgery more acceptable, safe and cost-effective. It improves surgical precision and hand–eye coordination, conventional and all straight stick instruments can be used, capital expenditure is less and recurring cost and annual maintenance cost are less. In this article, we have discussed the physics of 3D laparoscopy, principles of depth perception, and the different kinds of 3D systems available for laparoscopy. We have also discussed our experience of using 3D laparoscopy in over 2000 surgeries in the last 4 years.
Collapse
Affiliation(s)
- Rakesh Y Sinha
- Women's Hospital, Centre for Minimally Invasive Gynecological Surgery, Mumbai, Maharashtra, India
| | - Shweta R Raje
- Women's Hospital, Centre for Minimally Invasive Gynecological Surgery, Mumbai, Maharashtra, India
| | - Gayatri A Rao
- Women's Hospital, Centre for Minimally Invasive Gynecological Surgery, Mumbai, Maharashtra, India
| |
Collapse
|
35
|
Albright BB, Witte T, Tofte AN, Chou J, Black JD, Desai VB, Erekson EA. Robotic Versus Laparoscopic Hysterectomy for Benign Disease: A Systematic Review and Meta-Analysis of Randomized Trials. J Minim Invasive Gynecol 2015; 23:18-27. [PMID: 26272688 DOI: 10.1016/j.jmig.2015.08.003] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/09/2015] [Accepted: 08/01/2015] [Indexed: 12/23/2022]
Abstract
We conducted a systematic review and meta-analysis to assess the safety and effectiveness of robotic vs laparoscopic hysterectomy in women with benign uterine disease, as determined by randomized studies. We searched MEDLINE, EMBASE, the Cochrane Library, ClinicalTrials.gov, and Controlled-Trials.com from study inception to October 9, 2014, using the intersection of the themes "robotic" and "hysterectomy." We included only randomized and quasi-randomized controlled trials of robotic vs laparoscopic hysterectomy in women for benign disease. Four trials met our inclusion criteria and were included in the analyses. We extracted data, and assessed the studies for methodological quality in duplicate. For meta-analysis, we used random effects to calculate pooled risk ratios (RRs) and weighted mean differences. For our primary outcome, we used a modified version of the Expanded Accordion Severity Grading System to classify perioperative complications. We identified 41 complications among 326 patients. Comparing robotic and laparoscopic hysterectomy, revealed no statistically significant differences in the rate of class 1 and 2 complications (RR, 0.66; 95% confidence interval [CI], 0.23-1.89) or in the rate of class 3 and 4 complications (RR, 0.99; 95% CI, 0.22-4.40). Analyses of secondary outcomes were limited owing to heterogeneity, but showed no significant benefit of the robotic technique over the laparoscopic technique in terms of length of hospital stay (weighted mean difference, -0.39 day; 95% CI, -0.92 to 0.14 day), total operating time (weighted mean difference, 9.0 minutes; 95% CI, -31.27 to 47.26 minutes), conversions to laparotomy, or blood loss. Outcomes of cost, pain, and quality of life were reported inconsistently and were not amenable to pooling. Current evidence demonstrates neither statistically significant nor clinically meaningful differences in surgical outcomes between robotic and laparoscopic hysterectomy for benign disease. The role of robotic surgery in benign gynecology remains unclear.
Collapse
Affiliation(s)
- Benjamin B Albright
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH; Yale University School of Medicine, New Haven, CT.
| | - Tilman Witte
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH; Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Alena N Tofte
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Jeremy Chou
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Jonathan D Black
- Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Vrunda B Desai
- Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Elisabeth A Erekson
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Hanover, NH
| |
Collapse
|
36
|
Brooks P. Robotic-Assisted Thoracic Surgery for Early-Stage Lung Cancer: A Review. AORN J 2015; 102:40-9. [DOI: 10.1016/j.aorn.2015.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 01/25/2014] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
|
37
|
|
38
|
Mohammadzadeh N, Safdari R. Robotic surgery in cancer care: opportunities and challenges. Asian Pac J Cancer Prev 2014; 15:1081-3. [PMID: 24606422 DOI: 10.7314/apjcp.2014.15.3.1081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Malignancy-associated mortality, decreased productivity, and spiritual, social and physical burden in cancer patients and their families impose heavy costs on communities. Therefore cancer prevention, early detection, rapid diagnosis and timely treatment are very important. Use of modern methods based on information technology in cancer can improve patient survival and increase patient and health care provider satisfaction. Robot technology is used in different areas of health care and applications in surgery have emerged affecting the cancer treatment domain. Computerized and robotic devices can offer enhanced dexterity by tremor abolition, motion scaling, high quality 3D vision for surgeons and decreased blood loss, significant reduction in narcotic use, and reduced hospital stay for patients. However, there are many challenges like lack of surgical community support, large size, high costs and absence of tactile and haptic feedback. A comprehensive view to identify all factors in different aspects such as technical, legal and ethical items that prevent robotic surgery adoption is thus very necessary. Also evidence must be presented to surgeons to achieve appropriate support from physicians. The aim of this review article is to survey applications, opportunities and barriers to this advanced technology in patients and surgeons as an approach to improve cancer care.
Collapse
|
39
|
Yim GW, Kim SW, Nam EJ, Kim S, Kim HJ, Kim YT. Surgical outcomes of robotic radical hysterectomy using three robotic arms versus conventional multiport laparoscopy in patients with cervical cancer. Yonsei Med J 2014; 55:1222-30. [PMID: 25048478 PMCID: PMC4108805 DOI: 10.3349/ymj.2014.55.5.1222] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/18/2014] [Accepted: 03/28/2014] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To compare surgical outcomes of robotic radical hysterectomy (RRH) using 3 robotic arms with those of conventional laparoscopy in patients with early cervical cancer. MATERIALS AND METHODS A retrospective cohort study included 102 patients with stage 1A1-IIA2 cervical carcinoma, of whom 60 underwent robotic and 42 underwent laparoscopic radical hysterectomy (LRH) with pelvic lymph node dissection performed between December 2009 and May 2013. Perioperative outcomes were compared between two surgical groups. RESULTS Robotic approach consisted of 3 robotic arms including the camera arm and 1 conventional assistant port. Laparoscopic approach consisted of four trocar insertions with conventional instruments. There were no conversions to laparotomy. Mean age, body mass index, tumor size, cell type, and clinical stage were not significantly different between two cohorts. RRH showed favorable outcomes over LRH in terms of estimated blood loss (100 mL vs. 145 mL, p=0.037), early postoperative complication rates (16.7% vs. 30.9%, p=0.028), and postoperative complications necessitating intervention by Clavien-Dindo classification. Total operative time (200.5±61.1 minutes vs. 215.6±83.1 minutes, p=0.319), mean number of lymph node yield (23.3±9.3 vs. 21.7±9.8, p=0.248), and median length of postoperative hospital stay (11 days vs. 10 days, p=0.129) were comparable between robotic and laparoscopic group, respectively. The median follow-up time was 44 months with 2 recurrences in the robotic and 3 in the laparoscopic cohort. CONCLUSION Surgical outcomes of RRH and pelvic lymphadenectomy were comparable to that of laparoscopic approach, with significantly less blood loss and early postoperative complications.
Collapse
Affiliation(s)
- Ga Won Yim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wun Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ji Nam
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sunghoon Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
40
|
Silasi DA, Gallo T, Silasi M, Menderes G, Azodi M. Robotic versus abdominal hysterectomy for very large uteri. JSLS 2014; 17:400-6. [PMID: 24018076 PMCID: PMC3771758 DOI: 10.4293/108680813x13693422521755] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We sought to examine the outcomes of patients with myomatous uteri weighing >1000 g who underwent hysterectomy by one of two modalities, either with a robotic system or by laparotomy. METHODS All patients who underwent robotic hysterectomy for uteri weighing >1000 g at our institution between May 2007 and January 2011 were identified, and a retrospective chart review was performed. These patients were matched to a laparotomy control group by body mass index and uterine weight, and the postoperative outcomes in both groups were analyzed and compared. RESULTS Sixty patients with uteri weighing >1000 g underwent hysterectomy, 30 with the robotic system and 30 by laparotomy. The median body mass index was 31.8 kg/m(2) (range, 18.5-56.3 kg/m(2)) and the median uterine weight was 1259 g (range, >1000 -3543 g) in the robotic group versus 30.2 kg/m(2) (range, 18 - 48 kg/m(2)) and 1509 g (range, 1000 -3570 g), respectively, in the laparotomy group (P = .31). The median operating time was 255 minutes (range, 180 -372 minutes) in the robotic group versus 150 minutes (range, 100 -285 minutes) in the laparotomy group (P < .001). There were no conversions to laparotomy. In both groups the operative time was not increased with increasing specimen weight. The median blood loss was 150 mL in the robotic group versus 425 mL in the laparotomy group. Of 30 patients in the robotic group, 23 (76.6%) were discharged from the hospital on postoperative day 1. The median hospital stay for the robotic group was 1 day, and for the laparotomy group, it was 2.5 days (P < .01). CONCLUSION Robotic surgeries for very large myomatous uteri are feasible and have minimal morbidity even in morbidly obese patients. The robotic surgery requires a longer operative time but results in a shorter hospital stay and decreased intraoperative blood loss.
Collapse
Affiliation(s)
- Dan-Arin Silasi
- Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, 333 Cedar St, FMB 328, New Haven, CT 06520, USA.
| | | | | | | | | |
Collapse
|
41
|
Abstract
Strategies to improve the success of robotic hysterectomy in the morbidly obese patient are reviewed in this study. Background and Objectives: The purpose of this study was to present strategies for performing computer-enhanced telesurgery in the morbidly obese patient. Methods: This was a prospective, institutional review board-approved, descriptive feasibility study (Canadian Task Force classification II-2) conducted at a university-affiliated hospital. Twelve class III morbidly obese women with a body mass index of 40 kg/m2 or greater were selected to undergo robotic-assisted total laparoscopic hysterectomy. Robotic-assisted total laparoscopic hysterectomy, classified as type IVE, with complete detachment of the cardinal-uterosacral ligament complex, unilateral or bilateral, with entry into the vagina was performed. Results: The median estimated blood loss was 146.3 mL (range, 15–550 mL), the mean length of stay in the hospital was 25.3 hours (range, 23–48 hours), and the complication rate was 0%. The rate of conversion to laparotomy was 8%. The median surgical time was 109.6 minutes (range, 99–145 minutes). Conclusion: Robotic-assisted total laparoscopic hysterectomy can be a safe and effective method of performing hysterectomies in select morbidly obese patients, allowing them the opportunity to undergo minimally invasive surgery without increased perioperative complications.
Collapse
Affiliation(s)
- Oscar D Almeida
- Department of Obstetrics and Gynecology, University of South Alabama College of Medicine, 176 Mobile Infirmary Blvd, Mobile, AL 36607, USA.
| |
Collapse
|
42
|
Tapper AM, Hannola M, Zeitlin R, Isojärvi J, Sintonen H, Ikonen TS. A systematic review and cost analysis of robot-assisted hysterectomy in malignant and benign conditions. Eur J Obstet Gynecol Reprod Biol 2014; 177:1-10. [PMID: 24703710 DOI: 10.1016/j.ejogrb.2014.03.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 02/19/2014] [Accepted: 03/06/2014] [Indexed: 11/15/2022]
Abstract
In order to assess the effectiveness and costs of robot-assisted hysterectomy compared with conventional techniques we reviewed the literature separately for benign and malignant conditions, and conducted a cost analysis for different techniques of hysterectomy from a hospital economic database. Unlimited systematic literature search of Medline, Cochrane and CRD databases produced only two randomized trials, both for benign conditions. For the outcome assessment, data from two HTA reports, one systematic review, and 16 original articles were extracted and analyzed. Furthermore, one cost modelling and 13 original cost studies were analyzed. In malignant conditions, less blood loss, fewer complications and a shorter hospital stay were considered as the main advantages of robot-assisted surgery, like any mini-invasive technique when compared to open surgery. There were no significant differences between the techniques regarding oncological outcomes. When compared to laparoscopic hysterectomy, the main benefit of robot-assistance was a shorter learning curve associated with fewer conversions but the length of robotic operation was often longer. In benign conditions, no clinically significant differences were reported and vaginal hysterectomy was considered the optimal choice when feasible. According to Finnish data, the costs of robot-assisted hysterectomies were 1.5-3 times higher than the costs of conventional techniques. In benign conditions the difference in cost was highest. Because of expensive disposable supplies, unit costs were high regardless of the annual number of robotic operations. Hence, in the current distribution of cost pattern, economical effectiveness cannot be markedly improved by increasing the volume of robotic surgery.
Collapse
Affiliation(s)
- Anna-Maija Tapper
- Department of Gynecology and Pediatrics, Helsinki University Hospital, HUCH, Finland.
| | | | | | - Jaana Isojärvi
- Finohta (Finnish Office for Health Technology)/National Institute for Health and Welfare (THL), Finland.
| | - Harri Sintonen
- Hjelt Institute/Department of Public Health, University of Helsinki, Finland.
| | - Tuija S Ikonen
- Finohta (Finnish Office for Health Technology)/National Institute for Health and Welfare (THL), Hospital District of Southwest Finland, PB 52, 20521 Turku, Finland.
| |
Collapse
|
43
|
Spillane J, Brooks P. Developing a robotic program in thoracic surgery at Cape Cod Hospital. J Robot Surg 2014; 8:213-20. [PMID: 27637680 DOI: 10.1007/s11701-014-0453-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/11/2014] [Indexed: 11/25/2022]
Abstract
This study aimed to elucidate the stepwise progression of robotic skills required, the natural progression from thoracoscopic to robotic technique with a focus on approaching the hilar structures, and the nuances of perioperative care, in a community hospital and solo surgeon practice. It was a case-control analysis comparing 22 consecutive robotic-assisted lobectomy (RAL) procedures with 22 matched historic video-assisted lobectomy (VAL) procedures from June 2011 to December 2012. Patients undergoing VAL had 1.09 days greater length of stay than did patients who underwent RAL. Although hospital charges were significantly higher for RAL patients, patients undergoing VAL had greater blood loss, required longer hospital stay, had greater readmission rates, and were transferred more often to a rehabilitation facility at discharge. Subjectively, dexterity, ergonomics, and optics with the RALs were superior to the VALs. Favorable outcomes were demonstrated for patients undergoing RALs. Effective communication is paramount for the skill set and team building for a safe transition to practice.
Collapse
|
44
|
Sendag F, Zeybek B, Akdemir A, Ozgurel B, Oztekin K. Analysis of the learning curve for robotic hysterectomy for benign gynaecological disease. Int J Med Robot 2013; 10:275-9. [DOI: 10.1002/rcs.1567] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Fatih Sendag
- Department of Obstetrics and Gynaecology; Ege University School of Medicine; Izmir Turkey
| | - Burak Zeybek
- Department of Obstetrics and Gynaecology; Universal Ege Saglik Hospital; Izmir Turkey
| | - Ali Akdemir
- Department of Obstetrics and Gynaecology; Ege University School of Medicine; Izmir Turkey
| | - Banu Ozgurel
- Department of Business Administration; Yasar University; Izmir Turkey
| | - Kemal Oztekin
- Department of Obstetrics and Gynaecology; Ege University School of Medicine; Izmir Turkey
| |
Collapse
|
45
|
Yim GW, Kim SW, Nam EJ, Kim S, Kim YT. Learning curve analysis of robot-assisted radical hysterectomy for cervical cancer: initial experience at a single institution. J Gynecol Oncol 2013; 24:303-12. [PMID: 24167665 PMCID: PMC3805910 DOI: 10.3802/jgo.2013.24.4.303] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 07/17/2013] [Accepted: 07/18/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the learning curve and perioperative outcomes of robot-assisted laparoscopic procedure for cervical cancer. METHODS A series of 65 cases of robot-assisted laparoscopic radical hysterectomies with bilateral pelvic lymph node dissection for early stage cervical cancer were included. Demographic data and various perioperative parameters including docking time, console time, and total operative time were reviewed from the prospectively collected database. Console time was set as a surrogate marker for surgical competency, in addition to surgical outcomes. The learning curve was evaluated using cumulative summation method. RESULTS The mean operative time was 190 minutes (range, 117 to 350 minutes). Two unique phases of the learning curve were derived using cumulative summation analysis; phase 1 (the initial learning curve of 28 cases), and phase 2 (the improvement phase of subsequent cases in which more challenging cases were managed). Docking and console times were significantly decreased after the first 28 cases compared with the latter cases (5 minutes vs. 4 minutes for docking time, 160 minutes vs. 134 minutes for console time; p<0.001 and p<0.001, respectively). There was a significant reduction in blood loss during operation (225 mL vs. 100 mL, p<0.001) and early postoperative complication rates (28% vs. 8.1%, p=0.003) in phase 2. No conversion to laparotomy occurred. CONCLUSION Improvement of surgical performance in robot-assisted surgery for cervical cancer can be achieved after 28 cases. The two phases identified by cumulative summation analysis showed significant reduction in operative time, blood loss, and complication rates in the latter phase of learning curve.
Collapse
Affiliation(s)
- Ga Won Yim
- Institute of Women's Life Medical Science, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
46
|
Ayala-Yáñez R, Olaya-Guzmán EJ, Haghenbeck-Altamirano J. Robotics in Gynecology: Why is this Technology Worth Pursuing? CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2013; 7:71-7. [PMID: 24453521 PMCID: PMC3888078 DOI: 10.4137/cmrh.s10850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Robotic laparoscopy in gynecology, which started in 2005 when the Da Vinci Surgical System (Intuitive Surgical Inc) was approved by the US Food and Drug Administration for use in gynecologic procedures, represents today a modern, safe, and precise approach to pathology in this field. Since then, a great deal of experience has accumulated, and it has been shown that there is almost no gynecological surgery that cannot be approached with this technology, namely hysterectomy, myomectomy, sacrocolpopexia, and surgery for the treatment of endometriosis. Albeit no advantages have been observed over conventional laparoscopy and some open surgical procedures, robotics do seem to be advantageous in highly complicated procedures when extensive dissection and proper anatomy reestablishment is required, as in the case of oncologic surgery. There is no doubt that implementation of better logistics in finance, training, design, and application will exert a positive effect upon robotics expansion in gynecological medicine. Contrary to expectations, we estimate that a special impact is to be seen in emerging countries where novel technologies have resulted in benefits in the organization of health care systems.
Collapse
Affiliation(s)
- Rodrigo Ayala-Yáñez
- Instituto Nacional de Perinatología Mexico City, Mexico. ; Centro Médico ABC, Mexico City, Mexico
| | - Emilio José Olaya-Guzmán
- Instituto Nacional de Perinatología Mexico City, Mexico. ; Centro Médico ABC, Mexico City, Mexico
| | | |
Collapse
|
47
|
AAGL position statement: Robotic-assisted laparoscopic surgery in benign gynecology. J Minim Invasive Gynecol 2013; 20:2-9. [PMID: 23312239 DOI: 10.1016/j.jmig.2012.12.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 12/12/2012] [Indexed: 11/30/2022]
|
48
|
Abstract
OBJECTIVES : Our survey assessed the current trends in hysterectomy experience in US obstetrics and gynecology (OG) residency programs and residents' and program directors' perceptions of robotic surgery's effect on surgical training. METHODS : An online survey was e-mailed to program directors and graduating residents of 42 US OG programs. RESULTS A total of 21 program directors and 35 graduating residents responded. There was no significant difference between the number of hysterectomies residents and program directors thought should be performed. Only 38.1% of program directors and 27.8% of residents reported graduating residents as being "completely prepared" to perform a vaginal hysterectomy compared with 76.2% and 58.3% for abdominal, 28.6% and 22.2% for laparoscopic, and 0% and 2.8% for robotic hysterectomies. Only 12.1% of graduating residents and 17.7% of program directors reported residents sitting at the console "often" or "always" during robotic surgery. Only 34.3% of residents plan to perform robotic hysterectomy after graduation. Both residents (77.2%) and program directors (71.5%) reported that robotic surgery is having a negative impact on residents' training nationally. CONCLUSIONS : Graduating residents report adequate numbers of vaginal and abdominal hysterectomies. Both residents and program directors report that graduating residents are not prepared to perform all types of hysterectomies. Both residents and program directors express concern that robotic surgery is negatively impacting surgical training. Further efforts are needed to ensure that residents are graduating with surgical proficiency in these basic gynecologic procedures.
Collapse
|
49
|
Orady M, Hrynewych A, Nawfal AK, Wegienka G. Comparison of robotic-assisted hysterectomy to other minimally invasive approaches. JSLS 2013; 16:542-8. [PMID: 23484561 PMCID: PMC3558889 DOI: 10.4293/108680812x13462882736899] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study suggests that robotic-assisted hysterectomy has comparable outcomes and possibly fewer complications than other methods of minimally invasive hysterectomy. Objective: To compare surgical outcomes for robotic-assisted total laparoscopic hysterectomy (RH) to other minimally invasive hysterectomy (MIH) types, including total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), and vaginal hysterectomy (VH). Methods: Retrospective cohort study of all patients who underwent RH or MIH for benign indications between January 2007 and May 2010 at 2 Henry Ford Health System teaching hospitals. Age, race, body mass index (BMI), procedure duration, estimated blood loss (EBL), peri-operative hemoglobin change, uterine weight, length of hospital stay (LOS), and complications were collected from electronic medical records and were compared between RH and MIH groups. Results: Included in the analysis were 135 RH and 162 MIH cases (n = 34 VH, n = 82 LAVH, n = 46 TLH). There were no differences in age, race, or BMI between groups, but RH patients had significantly larger uteri (P = .007; RH, 13.5%>500g; MIH 4.0%>500g). MIH patients had significantly greater EBL (P < .001) and drop in hemoglobin (P = .02) than RH patients with a 150 mL difference in median EBL (200 mL versus 50 mL) between groups. RH had longer procedure durations than MIH (P = .0002) overall, but not compared to the TLH subgroup. RH patients had a shorter LOS than MIH patients had (P = .02) who had a longer LOS for LAVH patients. Although readmission and major complication rates were similar in both groups, minor adverse events occurred more frequently in the MIH group (21.6%) than the RH group (8.9%) (P = .003). Conclusion: RH has comparable surgical outcomes, and possibly decreased blood loss, shorter length of stay, and fewer minor complications than other methods of MIH.
Collapse
|
50
|
De Wilde RL, Herrmann A. Robotic surgery - advance or gimmick? Best Pract Res Clin Obstet Gynaecol 2013; 27:457-69. [PMID: 23357200 DOI: 10.1016/j.bpobgyn.2012.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 12/14/2012] [Indexed: 12/15/2022]
Abstract
Robotic surgery is increasingly implemented as a minimally invasive approach to a variety of gynaecological procedures. The use of conventional laparoscopy by a broad range of surgeons, especially in complex procedures, is hampered by several drawbacks. Robotic surgery was created with the aim of overcoming some of the limitations. Although robotic surgery has many advantages, it is also associated with clear disadvantages. At present, the proof of superiority over access by laparotomy or laparoscopy through large randomised- controlled trials is still lacking. Until results of such trials are present, a firm conclusion about the usefulness of robotic surgery cannot be drawn. Robotic surgery is promising, making the advantages of minimally invasive surgery potentially available to a large number of surgeons and patients in the future.
Collapse
Affiliation(s)
- Rudy L De Wilde
- Pius-Hospital, Department of Obstetrics, Gynecology and Gynecological Oncology, Carl-von-Ossietzky-University, Georgstraβe 12, 26121 Oldenburg, Germany.
| | | |
Collapse
|