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Mehmood K, Singh R, Kumar A, Mandal AK. Robot-assisted and conventional urology surgical procedures: comparison of average length of stay, economic status, operative time and patient's expenditure in a tertiary care hospital of North India. J Robot Surg 2023; 17:89-97. [PMID: 35355201 DOI: 10.1007/s11701-022-01396-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
Robot-assisted surgeries allows the surgeons to operate using remote-controlled robotic arms that are more effective in comparison to conventional (open/laparoscopic) surgeries. However, there is substantial lack of evidence on the effectiveness of robot-assisted surgeries in low to middle income countries (LMICs) like India. A study was conducted with an aim to evaluate the average length of stay (ALOS), Operative time, economic status (patient's) and cost borne by the patient (patient's expenditure) for undergoing robot-assisted surgeries and conventional surgeries. Grouping of the surgical procedures was done wherein patients who were treated with robot-assisted surgical procedures were placed in Group-01 whereas those treated with conventional surgical procedures were placed under Group-02. Comparative evaluation of the two surgical groups revealed that in robot-assisted surgical procedure, the ALOS was less (18.43 vs. 23.14 days, p = 0.06) whereas operative time (316.7 vs. 252.63 min, p = 0.05) and patient's expenditure were more (INR 70,654.29 vs. INR 41,314.73, p = 0.00). However, there was no significant difference between the economic statuses of patients in both groups. The study concluded that in this era of rapidly expanding health care scenario; targeted, regular, rigorous and repeated training programmes in future may shorten the learning curve thereby paving a way to reduce the cost as well as the operative time of robot-assisted surgeries in LMICs.
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Affiliation(s)
- Khalid Mehmood
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - Ranjana Singh
- Department of Hospital Administration, PGIMER, Chandigarh, India.
| | - Ashok Kumar
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - A K Mandal
- Department of Urology, PGIMER, Chandigarh, India
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Shepherd ARH, Bunjo Z, Sutherland P, Fuller A. Robotic-assisted radical cystectomy with intracorporeal urinary diversion: Initial South Australian experience. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221084828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: The aim of this study was to describe the initial experience with robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) performed by two robotic surgeons at a single, Australian centre. Methods: Retrospective analysis was conducted on 30 consecutive patients who underwent RARC with ICUD with curative intent for muscle-invasive and high-risk non-muscle-invasive bladder cancer between 2017 and 2021. Variables analysed included patient baseline characteristics, operative and peri-operative outcomes, as well as short-term pathological outcomes. Results: A total 30 patients were included; 87% were male and the median age was 71 years. Half of patients had muscle-invasive bladder cancer and 93% had ileal conduit formation (with the remaining two patients undergoing neobladder formation). The median operating time was 247 minutes. The median estimated blood loss was 450 mL and 20% of patients received a blood transfusion. A high-grade complication (Clavien III–V) was encountered in 13% of patients post-operatively. At 90 days, 30 overall complications (Clavien I–V) occurred across 67% of the patients. Conclusion: This series provides further support for the safe introduction of RARC with ICUD in Australia. Further studies with extended duration of follow-up, including oncological outcomes, are required to support widespread adoption of RARC. Level of evidence: Level 4 (case series)
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Affiliation(s)
- Andrew RH Shepherd
- Department of Urology, Royal Adelaide Hospital, Australia
- Adelaide Medical School, The University of Adelaide, Australia
| | - Zachary Bunjo
- Department of Urology, Royal Adelaide Hospital, Australia
- Adelaide Medical School, The University of Adelaide, Australia
| | | | - Andrew Fuller
- Department of Urology, Royal Adelaide Hospital, Australia
- South Terrace Urology, Australia
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Elsayed AS, Aldhaam NA, Nitsche L, Siam A, Jing Z, Hussein AA, Shigemura K, Fujisawa M, Guru KA. Robot‐assisted radical cystectomy: Review of surgical technique, and perioperative, oncological and functional outcomes. Int J Urol 2020; 27:194-205. [DOI: 10.1111/iju.14178] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/04/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Ahmed S Elsayed
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Naif A Aldhaam
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Lindsay Nitsche
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Alat Siam
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Zhe Jing
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Ahmed A Hussein
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | | | - Masato Fujisawa
- Department of Urology Kobe University Hospital Kobe Hyogo Japan
| | - Khurshid A Guru
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
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Damian DD, Price K, Arabagi S, Berra I, Machaidze Z, Manjila S, Shimada S, Fabozzo A, Arnal G, Van Story D, Goldsmith JD, Agoston AT, Kim C, Jennings RW, Ngo PD, Manfredi M, Dupont PE. In vivo tissue regeneration with robotic implants. Sci Robot 2018; 3:3/14/eaaq0018. [DOI: 10.1126/scirobotics.aaq0018] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/19/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Dana D. Damian
- Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- University of Sheffield, Sheffield S13JD, UK
| | - Karl Price
- Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Slava Arabagi
- Helbling Precision Engineering, Cambridge, MA 02142, USA
| | - Ignacio Berra
- National Pediatric Hospital J.P. Garrahan, Buenos Aires 01712, Argentina
| | - Zurab Machaidze
- Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sunil Manjila
- McLaren Bay Neurosurgery Associates, Bay City, MI 48706, USA
| | | | | | - Gustavo Arnal
- Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - David Van Story
- Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - Agoston T. Agoston
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Chunwoo Kim
- Korea Institute of Science and Technology, Seoul 02792, Republic of Korea
| | | | - Peter D. Ngo
- Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Michael Manfredi
- Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Pierre E. Dupont
- Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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Fiani B, Quadri SA, Ramakrishnan V, Berman B, Khan Y, Siddiqi J. Retrospective Review on Accuracy: A Pilot Study of Robotically Guided Thoracolumbar/Sacral Pedicle Screws Versus Fluoroscopy-Guided and Computerized Tomography Stealth-Guided Screws. Cureus 2017; 9:e1437. [PMID: 28924524 PMCID: PMC5587408 DOI: 10.7759/cureus.1437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/28/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Pedicle screw insertion is the mainstay of thora-cic and lumbosacral posterior spinal instrumentation. However, it may be associated with complications such as screw mal-positioning. The purpose of this study was to develop a pilot study to compare the accuracy of robot-guided screw insertion versus hand-guided screw placement for spinal instrumentation. The hand-guided screws were placed with assistance from computerized tomography (CT) stealth guidance or fluoroscopy. Materials and methods A retrospective analysis of medical records was done for all patients that had pedicle screw insertion for instrumentation between the dates of December 2013 and January 2016 with post-screw placement CT imaging. The analysis was conducted on screw accuracy between the two categories based on the Gertzbein-Robbins classification. Results A total of 49 screws were analyzed for accuracy in six patients. There was no statistically significant difference between the accuracy of hand-placed pedicle screws versus the robotically placed screws (p = 0.311). There was no statistically significant difference in blood loss (p = 0.616), length of procedure (p = 0.192), or post-operative length of stay (p = 0.587). Conclusion The findings of our pilot study agree with most prior studies that there was no statistically significant difference in the accuracy of pedicle screw placement between the two methods of screw placement. Therefore, the techniques are equivocal in accuracy. The new technology (robotic-guidance) is as safe as conventional techniques for screw placement. Just like in any surgery, the technique preference should remain surgeon dependent. The results are only from a small sample size in the development of a pilot study so a strong reliance on the data would not be suggested. The study was a preliminary study that will be used as a template and learning process to create a future prospective study to investigate CT stealth and robotically guided screw placement versus "free hand" guided screws.
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Affiliation(s)
- Brian Fiani
- Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca
| | | | - Vivek Ramakrishnan
- Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca
| | - Blake Berman
- Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca
| | - Yasir Khan
- Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca
| | - Javed Siddiqi
- Institute of Clinical Orthopedic and Neurosciences (Icon), Desert Regional Medical Center, Palm Springs, Ca
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Solomiichuk V, Fleischhammer J, Molliqaj G, Warda J, Alaid A, von Eckardstein K, Schaller K, Tessitore E, Rohde V, Schatlo B. Robotic versus fluoroscopy-guided pedicle screw insertion for metastatic spinal disease: a matched-cohort comparison. Neurosurg Focus 2017; 42:E13. [DOI: 10.3171/2017.3.focus1710] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVERobot-guided pedicle screw placement is an established technique for the placement of pedicle screws. However, most studies have focused on degenerative disease. In this paper, the authors focus on metastatic spinal disease, which is associated with osteolysis. The associated lack of dense bone may potentially affect the automatic recognition accuracy of radiography-based surgical assistance systems. The aim of the present study is to compare the accuracy of the SpineAssist robot system with conventional fluoroscopy-guided pedicle screw placement for thoracolumbar metastatic spinal disease.METHODSSeventy patients with metastatic spinal disease who required instrumentation were included in this retrospective matched-cohort study. All 70 patients underwent surgery performed by the same team of experienced surgeons. The decision to use robot-assisted or fluoroscopy-guided pedicle screw placement was based the availability of the robot system. In patients who underwent surgery with robot guidance, pedicle screws were inserted after preoperative planning and intraoperative fluoroscopic matching. In the “conventional” group, anatomical landmarks and anteroposterior and lateral fluoroscopy guided placement of the pedicle screws. The primary outcome measure was the accuracy of screw placement on the Gertzbein-Robbins scale. Grades A and B (< 2-mm pedicle breach) were considered clinically acceptable, and all other grades indicated misplacement. Secondary outcome measures included an intergroup comparison of direction of screw misplacement, surgical site infection, and radiation exposure.RESULTSA total of 406 screws were placed at 206 levels. Sixty-one (29.6%) surgically treated levels were in the upper thoracic spine (T1–6), 74 (35.9%) were in the lower thoracic spine, and the remaining 71 (34.4%) were in the lumbosacral region. In the robot-assisted group (Group I; n = 35, 192 screws), trajectories were Grade A or B in 162 (84.4%) of screws. The misplacement rate was 15.6% (30 of 192 screws). In the conventional group (Group II; n = 35, 214 screws), 83.6% (179 of 214) of screw trajectories were acceptable, with a misplacement rate of 16.4% (35 of 214). There was no difference in screw accuracy between the groups (chi-square, 2-tailed Fisher’s exact, p = 0.89). One screw misplacement in the fluoroscopy group required a second surgery (0.5%), but no revisions were required in the robot group. There was no difference in surgical site infections between the 2 groups (Group I, 5 patients [14.3%]; Group II, 8 patients [22.9%]) or in the duration of surgery between the 2 groups (Group I, 226.1 ± 78.8 minutes; Group II, 264.1 ± 124.3 minutes; p = 0.13). There was also no difference in radiation time between the groups (Group I, 138.2 ± 73.0 seconds; Group II, 126.5 ± 95.6 seconds; p = 0.61), but the radiation intensity was higher in the robot group (Group I, 2.8 ± 0.2 mAs; Group II, 2.0 ± 0.6 mAs; p < 0.01).CONCLUSIONSPedicle screw placement for metastatic disease in the thoracolumbar spine can be performed effectively and safely using robot-guided assistance. Based on this retrospective analysis, accuracy, radiation time, and postoperative infection rates are comparable to those of the conventional technique.
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Affiliation(s)
| | | | - Granit Molliqaj
- 3Department of Neurosurgery, University Hospital Geneva, Université de Genève, Faculté de Médecine, Geneva, Switzerland
| | | | | | | | - Karl Schaller
- 3Department of Neurosurgery, University Hospital Geneva, Université de Genève, Faculté de Médecine, Geneva, Switzerland
| | - Enrico Tessitore
- 3Department of Neurosurgery, University Hospital Geneva, Université de Genève, Faculté de Médecine, Geneva, Switzerland
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Yock TI, Constine LS, Mahajan A. Protons, the brainstem, and toxicity: ingredients for an emerging dialectic. Acta Oncol 2014; 53:1279-82. [PMID: 25327262 DOI: 10.3109/0284186x.2014.957415] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Torunn I Yock
- Massachusetts General Hospital, Francis H. Burr Proton Therapy Center , Boston , USA
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8
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Schatlo B, Molliqaj G, Cuvinciuc V, Kotowski M, Schaller K, Tessitore E. Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison. J Neurosurg Spine 2014; 20:636-43. [PMID: 24725180 DOI: 10.3171/2014.3.spine13714] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Recent years have been marked by efforts to improve the quality and safety of pedicle screw placement in spinal instrumentation. The aim of the present study is to compare the accuracy of the SpineAssist robot system with conventional fluoroscopy-guided pedicle screw placement.
Methods
Ninety-five patients suffering from degenerative disease and requiring elective lumbar instrumentation were included in the study. The robot cohort (Group I; 55 patients, 244 screws) consisted of an initial open robot-assisted subgroup (Subgroup IA; 17 patients, 83 screws) and a percutaneous cohort (Subgroup IB, 38 patients, 161 screws). In these groups, pedicle screws were placed under robotic guidance and lateral fluoroscopic control. In the fluoroscopy-guided cohort (Group II; 40 patients, 163 screws) screws were inserted using anatomical landmarks and lateral fluoroscopic guidance. The primary outcome measure was accuracy of screw placement on the Gertzbein-Robbins scale (Grade A to E and R [revised]). Secondary parameters were duration of surgery, blood loss, cumulative morphine, and length of stay.
Results
In the robot group (Group I), a perfect trajectory (A) was observed in 204 screws (83.6%). The remaining screws were graded B (n = 19 [7.8%]), C (n = 9 [3.7%]), D (n = 4 [1.6%]), E (n = 2 [0.8%]), and R (n = 6 [2.5%]). In the fluoroscopy-guided group (Group II), a completely intrapedicular course graded A was found in 79.8% (n = 130). The remaining screws were graded B (n = 12 [7.4%]), C (n = 10 [6.1%]), D (n = 6 [3.7%]), and E (n = 5 [3.1%]). The comparison of “clinically acceptable” (that is, A and B screws) was neither different between groups (I vs II [p = 0.19]) nor subgroups (Subgroup IA vs IB [p = 0.81]; Subgroup IA vs Group II [p = 0.53]; Subgroup IB vs Group II [p = 0.20]). Blood loss was lower in the robot-assisted group than in the fluoroscopy-guided group, while duration of surgery, length of stay, and cumulative morphine dose were not statistically different.
Conclusions
Robot-guided pedicle screw placement is a safe and useful tool for assisting spine surgeons in degenerative spine cases. Nonetheless, technical difficulties remain and fluoroscopy backup is advocated.
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Affiliation(s)
- Bawarjan Schatlo
- 1Departments of Neurosurgery and
- 2Department of Neurosurgery, Georg-August-University of Göttingen, Göttingen, Germany
| | | | - Victor Cuvinciuc
- 3Neuroradiology, DISIM, Hôpitaux Universitaires de Genève, Faculty of Medicine, University of Geneva
| | - Marc Kotowski
- 4Department of Neurosurgery, University Hospital Lausanne, Switzerland; and
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Chen A, Nikitczuk K, Nikitczuk J, Maguire T, Yarmush M. Portable robot for autonomous venipuncture using 3D near infrared image guidance. TECHNOLOGY 2013; 1:72-87. [PMID: 26120592 PMCID: PMC4482475 DOI: 10.1142/s2339547813500064] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Venipuncture is pivotal to a wide range of clinical interventions and is consequently the leading cause of medical injury in the U.S. Complications associated with venipuncture are exacerbated in difficult settings, where the rate of success depends heavily on the patient's physiology and the practitioner's experience. In this paper, we describe a device that improves the accuracy and safety of the procedure by autonomously establishing a peripheral line for blood draws and IV's. The device combines a near-infrared imaging system, computer vision software, and a robotically driven needle within a portable shell. The device operates by imaging and mapping in real-time the 3D spatial coordinates of subcutaneous veins in order to direct the needle into a designated vein. We demonstrate proof of concept by assessing imaging performance in humans and cannulation accuracy on an advanced phlebotomy training model.
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Affiliation(s)
- Alvin Chen
- VascuLogic, LLC, Piscataway NJ 08854, USA
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Sabin ND, Merchant TE, Harreld JH, Patay Z, Klimo P, Qaddoumi I, Armstrong GT, Wright K, Gray J, Indelicato DJ, Gajjar A. Imaging changes in very young children with brain tumors treated with proton therapy and chemotherapy. AJNR Am J Neuroradiol 2012; 34:446-50. [PMID: 22821924 DOI: 10.3174/ajnr.a3219] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY PT promises to reduce side effects in children with brain tumors by sparing normal tissue compared with 3D conformal or intensity-modulated radiation therapy. Information is lacking about the combined effects of PT and chemotherapy in young children. We describe imaging changes in 8 very young children with localized brain tumors who received PT after chemotherapy. Mostly transient signal abnormalities and enhancement in brain parenchyma were observed by serial MR imaging, which were consistent with radiation-induced effects on normal-appearing tissue. Correlation with PT planning data revealed that the areas of imaging abnormality were located within or adjacent to the volume that received the highest radiation dose. Radiologists should be aware of these findings in children who receive PT after chemotherapy. In this report, we describe the time course of these PT-related imaging findings and correlate them with treatment and clinical outcomes.
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Affiliation(s)
- N D Sabin
- Department of Radiological Sciences, St. Jude's Children's Research Hospital, Memphis, Tennessee 38105, USA.
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Abstract
A group of Swedish oncologists and hospital physicists have estimated the number of patients in Sweden suitable for proton beam therapy. The estimations have been based on current statistics of tumour incidence, number of patients potentially eligible for radiation treatment, scientific support from clinical trials and model dose planning studies and knowledge of the dose-response relations of different tumours and normal tissues. It is estimated that in paediatric cancers, proton beams are of potential importance in 80-100 children annually in Sweden. About 20 of the patients have medulloblastoma. The main purpose is to reduce late sequelae, but these are also increased chances to avoid myelosupression during e.g. concomitant chemo-radiation and to further intensify the chemotherapy.
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Affiliation(s)
- M. C. Schumacher
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - M. N. Jonsson
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
| | - N. P. Wiklund
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
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13
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Affiliation(s)
- Helen A Shih
- Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
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Wexner SD, Bergamaschi R, Lacy A, Udo J, Brölmann H, Kennedy RH, John H. The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference. Surg Endosc 2008; 23:438-43. [PMID: 19037694 DOI: 10.1007/s00464-008-0202-8] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 10/13/2008] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite the significant benefits of laparoscopic surgery, limitations still exist. One of these limitations is the loss of several degrees of freedom. Robotic surgery has allowed surgeons to regain the two lost degrees of freedom by introducing wristed laparoscopic instruments. METHODS At the first Pelvic Surgery Meeting held in Brescia in June 2007, the participants focused on the role of robotic surgery in pelvic operations surgery for malignancy including prostate, rectal, uterine, and cervical carcinoma. All members of the interdisciplinary panel were asked to define the role of robotic surgery in prostate, rectal, and uterine carcinoma. All key statements were reformulated until a consensus within the group was achieved (Murphy et al., Health Technol Assess 2(i-v):1-88, 1998). For the systematic review, a comprehensive literature search was performed in Medline and the Cochrane Library from January 1997 to June 2007. The keywords used were Da Vinci, telemonitoring, laparoscopy, neoplasms for urology, colorectal, gynecology, visceral surgery, and minimally invasive surgery. The pelvic surgery meeting was supported by Olympus Medical Systems Europa. RESULTS As of December 31, 2007, there were 795 unit shipments worldwide of the Da Vinci((R)): 595 in North America, 136 in Europe, and 64 in the rest of the world (http://investor.intuitivesurgical.com/phoenix.zhtml?c=122359&p=irol-faq#22324 ). It was estimated that, during 2007, approximately 50,000 radical prostatectomies were performed with the Da Vinci robot system in the USA, reflecting market penetration of 60% of radical prostatectomies in the USA. This utilization represents 50% growth as in 2006 only 42% of all radical prostatectomies performed in the USA employed robotics. CONCLUSION While robotic prostatectomy has become the most widely accepted method of prostatectomy, robotic hysterectomy and proctectomy remain far less widely accepted. The theoretical benefits of the increased degrees of freedom and three-dimensional visualization may be outweighed in these areas by the loss of haptic feedback, increased operative times, and increased cost.
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Affiliation(s)
- Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA.
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15
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Tuncel A, Lucas S, Bensalah K, Zeltser IS, Jenkins A, Saeedi O, Park S, Cadeddu JA. A randomized comparison of conventional vs articulating laparoscopic needle-drivers for performing standardized suturing tasks by laparoscopy-naive subjects. BJU Int 2007; 101:727-30. [PMID: 17868415 DOI: 10.1111/j.1464-410x.2007.07220.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the efficacy of conventional and articulating laparoscopic needle-drivers for performing standardized laparoscopic tasks by medical students with no previous surgical experience. SUBJECTS AND METHODS Twenty medical students with no surgical experience were randomly assigned to two equal groups, one using a conventional laparoscopic needle-holder (Karl Storz, Tuttlingen, Germany) and the other using a first-generation articulating laparoscopic needle-holder (Cambridge Endo, Framingham, MA, USA). Each student performed a series of four standardized laparoscopic tasks, during which speed and accuracy were assessed. The tasks tested needle passage through rings (1), an oblique running suture model (2), a urethrovesical anastomosis model (3) and a model simulating renal parenchymal reconstruction following partial nephrectomy (4). RESULTS Tasks 1 and 3 were completed significantly more quickly by those using the conventional instruments (P < 0.05), but there was no statistically significant difference for task 2 and 4 (P > 0.05). Those using conventional instruments were significantly more accurate in all of the tasks than those using the articulated instruments (P < 0.05). CONCLUSIONS The conventional laparoscopic needle-driver allowed laparoscopy-naive medical students to complete a series of standardized suturing tasks more rapidly and accurately than with the novel articulating needle-driver. Laparoscopic suturing with first-generation articulating needle-drivers might be more difficult to learn, secondary to the complexity of physical manoeuvres required for their use.
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Affiliation(s)
- Altug Tuncel
- Department of Urology, University of Texas South-western Medical Center, Dallas, Texas 75390-9110, USA
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16
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Cunningham MJ, Lin DT, Curry WT, Ebb DH, Yock TI, Curtin HD, Faquin WC. Case records of the Massachusetts General Hospital. Case 20-2007. An 11-year-old boy with a calcified mass in the nose. N Engl J Med 2007; 356:2721-30. [PMID: 17596608 DOI: 10.1056/nejmcpc079014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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17
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Carlsson S, Nilsson A, Wiklund PN. Postoperative urinary continence after robot-assisted laparoscopic radical prostatectomy. ACTA ACUST UNITED AC 2006; 40:103-7. [PMID: 16608806 DOI: 10.1080/00365590500368120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Laparoscopic radical prostatectomy has shown excellent results concerning patient morbidity, with less blood loss compared to conventional surgery. Robot-assisted laparoscopy offers several additional important technical improvements and therefore it might be suggested that robotic radical prostatectomy would also offer surgical advantages. The objective of this study was to evaluate urinary continence for the first 72 cases of robot-assisted radical prostatectomy performed by a single surgical team. MATERIAL AND METHODS We analysed the outcomes of the first 72 consecutive patients to undergo robot-assisted prostatectomy for localized prostate cancer at our hospital between January 2002 and May 2004. A self-administered questionnaire concerning urinary status was mailed to the patients 3 and 6 months after surgery. Pre- and peroperative characteristics were obtained from patient medical records. The mean age was 61.2 years (range 36-71 years) and the mean preoperative prostate-specific antigen level was 6.3 ng/ml (range 2.3-10.7 ng/ml). The preoperative clinical stage was T1c, 67%, T2, 28% and T3, 5% and the mean Gleason sum was 6 (range 5-9). RESULTS Sixty-one of the 68 patients (90%) reported no use of pads and 6 (9%) used a maximum of 1 pad/day 3-6 months after surgery. One patient reported use of >1 pad/day 6 months after surgery. Three significant complications were noted: ureter injury, haemorrhage and femoral nerve injury. CONCLUSIONS In this series, which represents the learning curve for one surgical team, only a tenth of the patients still required pads 3-6 months after surgery. Considering the short follow-up period, the results in this series will probably improve over time.
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Affiliation(s)
- Stefan Carlsson
- Department of Urology, Division of Surgery, Karolinska Hospital, Stockholm, Sweden.
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18
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|