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Wu Z, Chen D, Pan C, Zhang G, Chen S, Shi J, Meng C, Zhao X, Tao B, Chen D, Liu W, Ding H, Tang Z. Surgical Robotics for Intracerebral Hemorrhage Treatment: State of the Art and Future Directions. Ann Biomed Eng 2023; 51:1933-1941. [PMID: 37405558 PMCID: PMC10409846 DOI: 10.1007/s10439-023-03295-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/17/2023] [Indexed: 07/06/2023]
Abstract
Intracerebral hemorrhage (ICH) is a stroke subtype with high mortality and disability, and there are no proven medical treatments that can improve the functional outcome of ICH patients. Robot-assisted neurosurgery is a significant advancement in the development of minimally invasive surgery for ICH. This review encompasses the latest advances and future directions of surgical robots for ICH. First, three robotic systems for neurosurgery applied to ICH are illustrated. Second, the key technologies of robot-assisted surgery for ICH are introduced in aspects of stereotactic technique and navigation, the puncture instrument, and hematoma evacuation. Finally, the limitations of current surgical robots are summarized, and the possible development direction is discussed, which is named "multisensor fusion and intelligent aspiration control of minimally invasive surgical robot for ICH". It is expected that the new generation of surgical robots for ICH will facilitate quantitative, precise, individualized, standardized treatment strategies for ICH.
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Affiliation(s)
- Zhuojin Wu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Danyang Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chao Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ge Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shiling Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jian Shi
- School of Mechanical Science & Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Cai Meng
- School of Mechanical Engineering & Automation-BUAA, Beihang University, Beijing, 100083, China
| | - Xingwei Zhao
- School of Mechanical Science & Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Bo Tao
- School of Mechanical Science & Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Diansheng Chen
- School of Mechanical Engineering & Automation-BUAA, Beihang University, Beijing, 100083, China
| | - Wenjie Liu
- Beijing WanTeFu Medical Instrument Co., Ltd, Beijing, 102299, China
| | - Han Ding
- School of Mechanical Science & Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China.
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Jin R, Zhang Z, Zheng Y, Niu Z, Sun S, Cao Y, Zhang Y, Abbas AE, Lerut T, Lin J, Li H. Health-Related Quality of Life Following Robotic-Assisted or Video-Assisted Lobectomy in Patients With Non-Small Cell Lung Cancer: Results From the RVlob Randomized Clinical Trial. Chest 2023; 163:1576-1588. [PMID: 36621757 DOI: 10.1016/j.chest.2022.12.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/05/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Robot-assisted lobectomy (RAL) is increasingly used as an alternative to video-assisted lobectomy (VAL) for resectable non-small cell lung cancer (NSCLC). However, there is little evidence of any difference in postoperative health-related quality of life (HRQoL) between these two approaches. RESEARCH QUESTION Is RAL superior to VAL in improving quality of life in patients with resectable NSCLC? STUDY DESIGN AND METHODS We performed a single-center, open-label randomized clinical trial from May 2017 to May 2020 with 320 enrolled patients undergoing RAL or VAL for resectable NSCLC (RVlob trial; NCT03134534). Postoperative pain was evaluated by visual analog score or numeric rating score on postoperative day 1 and at weeks 4, 24, and 48. The European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30), EORTC Quality of Life Questionnaire in Lung Cancer (QLQ-LC13), and the European Quality of Life 5 Dimensions (EQ-5D) questionnaire were also administered at weeks 4, 24, and 48 after surgery. RESULTS One hundred and fifty-seven patients underwent RAL and 163 underwent VAL. The mean pain score of patients after RAL was significantly lower at week 4 (2.097 ± 0.111 vs 2.431 ± 0.108; P = .032). QLQ-C30 and QLQ-LC13 summary scores (P > .05) were similar for both RAL and VAL during the first 48 weeks of follow-up. HRQoL scores assessed with the EQ-5D questionnaire were also comparable between the two groups (P > .05) during the whole study period. INTERPRETATION Both RAL and VAL showed satisfactory and comparable HRQoL and postoperative pain up to 48 weeks after surgery, despite some minor statistical differences at week 4. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT03134534; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Runsen Jin
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhengyuan Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuyan Zheng
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhenyi Niu
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Siying Sun
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuqin Cao
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yajie Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Abbas E Abbas
- Department of Thoracic Surgery, Brown Surgical Associates and Lifespan Hospitals, Warren Alpert Medical School of Brown University, Providence, RI
| | - Toni Lerut
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - Jules Lin
- Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, MI
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Habibnejad-Korayem M, Nabiei O, Gharibshah S, Nouhi-Hefzabad R. Atomistic Assessment of Cystine Kidney Stone Behavior in a Mechanical Breakdown Process by Nanobiorobots through Classical Molecular Dynamics Simulations. J Phys Chem B 2021; 125:10344-10354. [PMID: 34463504 DOI: 10.1021/acs.jpcb.1c04682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Because cystine kidney stones are a more serious challenge for health-related quality of life than other types of kidney stones, the search for a new treatment for cystinuria is considered the main goal of this study. To achieve the defined goal, classical molecular dynamics simulations and quantum mechanics calculations were implemented in this study. Three nanodrills with different stiffnesses (i.e., silicon, silica, and silicon carbide) were selected to find the efficient nanodrill to break the kidney stones into smaller pieces. The related nanodrills under various forces from 20 to 100 eV/Å inclusive were exerted on the cystine kidney stones to determine the effect of the force magnitude on the rate of destruction. The exerted forces were modeled via a hypothetical spring force. To bring this investigation closer to reality, the urinary tract and the bulk of cystine kidney stones were modeled by simulation of the real blockage of the kidney stones. The obtained results from quantum mechanics calculations reveal the strong interaction (chemisorption) between the cystine stone components. Moreover, the molecular dynamics simulations show that an increase in force does not necessarily lead to more destruction of cystine kidney stones. The maximum rate of cystine kidney stone destruction occurs under forces of 80, 70, and 60 eV/Å for SiO2, Si, and SiC nanodrills, which is about 19, 13, and 11%, respectively. In addition, the SiO2 nanodrill has more crossing time and z-direction deformation than other nanodrills due to the attractive interaction between SiO2 and stones, it shows less deformation during the process of kidney stone breaking because of repulsive interactions between the nanodrill and the kidney stone.
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Affiliation(s)
- Moharram Habibnejad-Korayem
- Robotic Research Laboratory, Centre of Excellence in Experimental Solid Mechanics and Dynamics, School of Mechanical Engineering, Iran University of Science and Technology, Tehran 1684613114, Iran
| | - Omid Nabiei
- Robotic Research Laboratory, Centre of Excellence in Experimental Solid Mechanics and Dynamics, School of Mechanical Engineering, Iran University of Science and Technology, Tehran 1684613114, Iran
| | - Sima Gharibshah
- Semnan University of Medical Sciences, P.O. Box: 16846-13114, Semnan 3513119111, Iran
| | - Rouzbeh Nouhi-Hefzabad
- Robotic Research Laboratory, Centre of Excellence in Experimental Solid Mechanics and Dynamics, School of Mechanical Engineering, Iran University of Science and Technology, Tehran 1684613114, Iran
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Robotic-Assisted versus Video-Assisted Thoracoscopic Lobectomy: Short-Term Results of a Randomized Clinical Trial (RVlob Trial). Ann Surg 2021; 275:295-302. [PMID: 33938492 DOI: 10.1097/sla.0000000000004922] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether robotic-assisted lobectomy (RAL) affects perioperative outcomes and long-term efficacy in non-small cell lung cancer (NSCLC) patients, compared with traditional video-assisted lobectomy (VAL). SUMMARY BACKGROUND DATA RAL is a promising treatment for NSCLC. However, its efficacy has not been fully evaluated. METHODS A single-center, open-labeled prospective randomized clinical trial was launched in May 2017 to compare the efficacy of RAL and VAL. By May 2020, 320 patients were enrolled. The perioperative results of RAL and VAL were compared. RESULTS The 320 enrolled patients were randomly assigned to the RAL group (n = 157) and the VAL group (n = 163). Perioperative outcomes were comparable between the two groups, including the length of hospital stay (P = 0.76) and the rate of postoperative complications (P = 0.45). No perioperative mortality occurred in either group. The total amount of chest tube drainage (830 ml [IQR, 550-1130 ml] vs. 685 ml [IQR, 367.5-1160 ml], P = 0.007) and hospitalization costs ($12821 [IQR, $12145-$13924] vs. $8009 [IQR, $7014-$9003], P < 0.001) were significantly higher in the RAL group. RAL group had a significantly higher number of lymph nodes (LNs) harvested (11 [IQR, 8-15] vs. 10 [IQR, 8-13], P = 0.02), higher number of N1 LNs (6 [IQR, 4-8] vs. 5 [IQR, 3-7], P = 0.005), and more LN stations examined (6 [IQR, 5-7] vs. 5 [IQR, 4-6], P < 0.001). CONCLUSIONS Both RAL and VAL are safe and feasible for the treatment of NSCLC. RAL achieved similar perioperative outcomes, together with higher LN yield. Further follow-up investigations are required to evaluate the long-term efficacy of RAL. (ClinicalTrials.gov identifier: NCT03134534).
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Khandelwal A, Kapoor I, Mahajan C, Sharma HB, Prabhakar H. Perioperative anesthetic management and factors affecting outcome in robotized stereotactic assisted (ROSA) intracranial procedures: A retrospective study. J Clin Anesth 2020; 62:109717. [PMID: 32045845 DOI: 10.1016/j.jclinane.2020.109717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/01/2019] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Affiliation(s)
| | - Indu Kapoor
- All India Institute of Medical Sciences, New Delhi, INDIA.
| | - Charu Mahajan
- All India Institute of Medical Sciences, New Delhi, INDIA
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Luck ES, Gillespie BM. Technological Advancements in the OR: Do We Need to Redefine Intraoperative Nursing Roles? AORN J 2019; 106:280-282. [PMID: 28958313 DOI: 10.1016/j.aorn.2017.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
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Mirnezami R, Ahmed A. Surgery 3.0, artificial intelligence and the next-generation surgeon. Br J Surg 2018; 105:463-465. [PMID: 29603133 DOI: 10.1002/bjs.10860] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/15/2018] [Indexed: 01/14/2023]
Abstract
The robots are coming
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Affiliation(s)
- R Mirnezami
- St Mark's Hospital and Academic Institute, Harrow, London, W2 1NY, UK.,Department of Surgery and Cancer, Imperial College London, St Mary's Campus, South Wharf Road, London, W2 1NY, UK
| | - A Ahmed
- St Mark's Hospital and Academic Institute, Harrow, London, W2 1NY, UK
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Dobbs TD, Cundy O, Samarendra H, Khan K, Whitaker IS. A Systematic Review of the Role of Robotics in Plastic and Reconstructive Surgery-From Inception to the Future. Front Surg 2017; 4:66. [PMID: 29188219 PMCID: PMC5694772 DOI: 10.3389/fsurg.2017.00066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/01/2017] [Indexed: 12/20/2022] Open
Abstract
Background The use of robots in surgery has become commonplace in many specialties. In this systematic review, we report on the current uses of robotics in plastic and reconstructive surgery and looks to future roles for robotics in this arena. Methods A systematic literature search of Medline, EMBASE, and Scopus was performed using appropriate search terms in order to identify all applications of robot-assistance in plastic and reconstructive surgery. All articles were reviewed by two authors and a qualitative synthesis performed of those articles that met the inclusion criteria. The systematic review and results were conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. Results A total of 7,904 articles were identified for title and abstract review. Sixty-eight studies met the inclusion criteria. Robotic assistance in plastic and reconstructive surgery is still in its infancy, with areas such as trans-oral robotic surgery and microvascular procedures the dominant areas of interest currently. A number of benefits have been shown over conventional open surgery, such as improved access and greater dexterity; however, these must be balanced against disadvantages such as the lack of haptic feedback and cost implications. Conclusion The feasibility of robotic plastic surgery has been demonstrated in several specific indications. As technology, knowledge, and skills in this area improve, these techniques have the potential to contribute positively to patient and provider experience and outcomes.
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Affiliation(s)
- Thomas D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Institute of Life Science, Swansea University Medical School, Swansea, United Kingdom.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Olivia Cundy
- Oxford University Medical School, Oxford, United Kingdom
| | | | - Khurram Khan
- Department of Plastic Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Iain Stuart Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Institute of Life Science, Swansea University Medical School, Swansea, United Kingdom.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
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Doulgeris JJ, Gonzalez-Blohm SA, Filis AK, Shea TM, Aghayev K, Vrionis FD. Robotics in Neurosurgery: Evolution, Current Challenges, and Compromises. Cancer Control 2016; 22:352-9. [PMID: 26351892 DOI: 10.1177/107327481502200314] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Advances in technology have pushed the boundaries of neurosurgery. Surgeons play a major role in the neurosurgical field, but robotic systems challenge the current status quo. Robotic-assisted surgery has revolutionized several surgical fields, yet robotic-assisted neurosurgery is limited by available technology. METHODS The literature on the current robotic systems in neurosurgery and the challenges and compromises of robotic design are reviewed and discussed. RESULTS Several robotic systems are currently in use, but the application of these systems is limited in the field of neurosurgery. Most robotic systems are suited to assist in stereotactic procedures. Current research and development teams focus on robotic-assisted microsurgery and minimally invasive surgery. The tasks of miniaturizing the current tools and maximizing control challenge manufacturers and hinder progress. Furthermore, loss of haptic feedback, proprioception, and visualization increase the time it takes for users to master robotic systems. CONCLUSIONS Robotic-assisted surgery is a promising field in neurosurgery, but improvements and breakthroughs in minimally invasive and endoscopic robotic-assisted surgical systems must occur before robotic assistance becomes commonplace in the neurosurgical field.
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Velez-Cubian FO, Ng EP, Fontaine JP, Toloza EM. Robotic-Assisted Videothoracoscopic Surgery of the Lung. Cancer Control 2015; 22:314-25. [DOI: 10.1177/107327481502200309] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Frank O. Velez-Cubian
- Departments of Surgery, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Emily P. Ng
- Morsani College of Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Jacques P. Fontaine
- Departments of Surgery, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Oncologic Sciences, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- University of South Florida, and the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Eric M. Toloza
- Departments of Surgery, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Oncologic Sciences, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- University of South Florida, and the Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Abstract
Osteoarthritis is a common disease that leads patients to seek total joint replacement (TJR). Component misalignment leads to failure of TJR. Computer navigation enhances the precision of component alignment, but the addition of robotic guidance can boost TJR to a higher level of accuracy. Some 29 English-language peer-reviewed articles from 2002 to 2013 and 1 Web site were reviewed. A conceptual framework was adapted to explain benefits and barriers of adoption of robotic TJR. A total of 10 studies were reviewed with focus on more precise alignment, outcomes, length of stay, and costs. Cost to obtain robotic surgical equipment was found to be about $1 million with maintenance costs approaching $350 000. Robotic techniques compared with conventional orthopedic surgery showed slight variances in favor of robotic procedures. Although hospitals have the potential to reduce costs and improve outcomes with robotic TJR, the expenditure and maintenance have not been proven a clear return on investment. As surgical robotic technology evolves in accuracy and accessibility, joint replacement surgery may benefit from improved precision and decreased health care costs. However, equipment purchase and upkeep costs and surgeon training may impede use to its full potential in orthopedic surgery in the United States.
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Diez Del Val I, Martinez Blazquez C, Loureiro Gonzalez C, Vitores Lopez JM, Sierra Esteban V, Barrenetxea Asua J, Del Hoyo Aretxabala I, Perez de Villarreal P, Bilbao Axpe JE, Mendez Martin JJ. Robot-assisted gastroesophageal surgery: usefulness and limitations. J Robot Surg 2013; 8:111-8. [PMID: 27637520 DOI: 10.1007/s11701-013-0435-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 08/27/2013] [Indexed: 12/17/2022]
Abstract
Robot-assisted surgery overcomes some of the limitations of traditional laparoscopic surgery. We present our experience and lessons learned in two surgical units dedicated to gastro-esophageal surgery. From June 2009 to January 2013, we performed 130 robot-assisted gastroesophageal procedures, including Nissen fundoplication (29), paraesophageal hernia repair (18), redo for failed antireflux surgery (11), esophagectomy (19), subtotal (5) or wedge (4) gastrectomy, Heller myotomy for achalasia (22), gastric bypass for morbid obesity (12), thoracoscopic leiomyomectomy (4), Morgagni hernia repair (3), lower-third esophageal diverticulectomy (1) and two diagnostic procedures. There were 80 men and 50 women with a median age of 54 years (interquartile range: 46-65). Ten patients (7.7 %) had severe postoperative complications: eight after esophagectomy (three leaks-two cervical and one thoracic-managed conservatively), one stapler failure, one chylothorax, one case of gastric migration to the thorax, one case of biliary peritonitis, and one patient with a transient ventricular dyskinesia. One redo procedure needed reoperation because of port-site bleeding, and one patient died of pulmonary complications after a giant paraesophageal hernia repair; 30-day mortality was, therefore, 0.8 %. There were six elective and one forced conversions (hemorrhage), so total conversion was 5.4 %. Median length of stay was 4 days (IQ range 3-7). Robot-assisted gastroesophageal surgery is feasible and safe, and may be applied to most common procedures. It seems of particular value for Heller myotomy, large paraesophageal hernias, redo antireflux surgery, transhiatal dissection, and hand-sewn intrathoracic anastomosis.
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Affiliation(s)
- Ismael Diez Del Val
- Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
| | - Cándido Martinez Blazquez
- Esophago-gastric Surgery Unit, Service of General and Digestive Surgery, Araba University Hospital, Jose Achotegui, s/n, 01009, Vitoria-Gasteiz, Spain
| | - Carlos Loureiro Gonzalez
- Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain
| | - Jose Maria Vitores Lopez
- Esophago-gastric Surgery Unit, Service of General and Digestive Surgery, Araba University Hospital, Jose Achotegui, s/n, 01009, Vitoria-Gasteiz, Spain
| | - Valentin Sierra Esteban
- Esophago-gastric Surgery Unit, Service of General and Digestive Surgery, Araba University Hospital, Jose Achotegui, s/n, 01009, Vitoria-Gasteiz, Spain
| | - Julen Barrenetxea Asua
- Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain
| | - Izaskun Del Hoyo Aretxabala
- Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain
| | - Patricia Perez de Villarreal
- Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain
| | - Jose Esteban Bilbao Axpe
- Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain
| | - Jaime Jesus Mendez Martin
- Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain
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