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Okazaki M, Suzawa K, Shien K, Hashimoto K, Tanaka S, Miyoshi K, Yamamoto H, Sugimoto S, Toyooka S. Effective division of the intersegmental plane using a robotic stapler in robotic pulmonary segmentectomy. Surg Today 2024:10.1007/s00595-024-02840-y. [PMID: 38635055 DOI: 10.1007/s00595-024-02840-y] [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: 12/06/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024]
Abstract
PURPOSES Robot-assisted thoracoscopic (RATS) segmentectomy is becoming increasingly common because of the expanded indications for segmentectomy and the widespread adoption of robotic surgery. The precise division of the intersegmental plane is necessary to ensure oncologic margins from the tumor and to preserve the lung function. In this study, we present a strategy for accurately dividing the intersegmental plane using a robotic stapler and review the surgical outcomes. METHODS RATS portal segmentectomy was performed using the Da Vinci Xi system and the intersegmental plane was dissected using a robotic stapler. We evaluated the perioperative outcomes in 92 patients who underwent RATS portal segmentectomy between May 2020 and January 2023. These results were compared with those of 82 patients who underwent complete video-assisted thoracoscopic surgery (CVATS) during the same period. RESULTS The operative and console times were 162 and 97 min, respectively. No intraoperative complications occurred, and postoperative complications were observed in four cases (4.3%). The operative time, blood loss, postoperative complications, and maximum incision size were significantly lower in the RATS group than in the CVATS group. However, RATS requires a significantly higher number of staplers than CVATS. CONCLUSIONS The division of the intersegmental plane using a robotic stapler in RATS portal segmentectomy was, therefore, found to be safe and effective.
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Affiliation(s)
- Mikio Okazaki
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Ken Suzawa
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kazuhiko Shien
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kohei Hashimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shin Tanaka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kentaroh Miyoshi
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiromasa Yamamoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Seiichiro Sugimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Petropoulou T, Theodoraki K, Kitsanta P, Amin S. Efficiency of the Robotic Platform in Improving the Rate of Sphincter Preservation in Patients With Mid and Low Rectal Cancer. World J Oncol 2023; 14:499-504. [PMID: 38022401 PMCID: PMC10681784 DOI: 10.14740/wjon1581] [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: 03/03/2023] [Accepted: 06/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background The aim of this study was to investigate whether the robotic platform can have a positive impact on the rate of sphincter preservation in patients with rectal tumors, undergoing robotic total mesorectal excision (TME), in comparison with laparoscopic or open TME. We also analyzed and compared short-term outcomes. Methods A prospectively collected robotic database was reviewed and compared with the trust and national data. Three groups were designed according to the surgical technique: open, laparoscopic and robotic. This includes all resections for mid and low rectal cancer which were performed with the robotic platform, over a period of 4 years, versus the trust data for the same period. Results Two hundred ninety-seven patients with mid and low rectal cancers were analyzed. Demographics for the groups (gender, age, and body mass index) were similar but distance from anal verge was shorter in the robotic group (7 vs. 8.5 cm, P < 0.001). The percentage of abdominoperineal resection (APR) rate was significantly lower in the robotic group (13.5% vs. 39.6% vs. 52.4% for the open group, P < 0.001). Median length of stay, complication rate, and positive circumferential resection margin (CRM) rate for the robotic group were also statistically significantly lower than those for both laparoscopic and open groups. Conclusion Robotic surgery for mid and low rectal cancer is safe and feasible, and could help surgeons perform ultra-low anterior resections, rather than APRs and save patients' sphincters. Positive CRM is low, which could lead to improved oncological outcomes.
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Affiliation(s)
- Thalia Petropoulou
- Department of Colon & Rectal Surgery, Sheffield Teaching Hospitals, Sheffield, UK
- Department of Robotic Colon & Rectal Surgery, Euroclinic, Athens, Greece
| | | | | | - Shwan Amin
- Department of Colon & Rectal Surgery, Sheffield Teaching Hospitals, Sheffield, UK
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Somashekhar SP, Saldanha E, Kumar R, Pandey K, Dahiya A, Ashwin KR. Prospective analysis of 164 fires of da Vinci SureForm SmartFire stapler in oncological cases: Indian cohort of 76 consecutive cases. J Minim Access Surg 2023; 19:384-389. [PMID: 37282421 PMCID: PMC10449046 DOI: 10.4103/jmas.jmas_154_22] [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: 05/26/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 03/19/2023] Open
Abstract
Background The application of robotic staplers in surgeries has increased in recent years. Robotic platform enhances ability of the surgeon to directly control and manoeuvre staplers to achieve required angulation and sealing within the confines of the thorax and pelvis. Hence, in this study, we intended to learn the effectiveness of the SureForm™ SmartFire™ technology stapling system in various oncological procedures. Patients and Methods Prospective study of 76 patients who underwent robotic-assisted total oesophagectomy, gastrectomies, hemicolectomies, low anterior resection/abdominoperineal resection and lobectomies/metastasectomy for respective malignancies for 16 months. Internal data log of the da Vinci surgical system for reload colour, reloads used, clamp attempts and staple fires used during each procedure along with patient's post-operative outcomes were recorded. Results One hundred and sixty-four firings have been made in 76 cases, with the majority being green reloads (76.8%) and average reloads for radical cystectomy 3.5, lobectomies/metastasectomy 3.44 and oesophagectomy 2.55. None of the cases had incomplete firings and required force-fire activation. In forty per cent of cases, the robotic stapler had to pause for sequential compression and seal. Seventy per cent of anterior resection procedures had at least one firing >45° beyond the laparoscopy limit. Collectively 52% SureForm stapler fires in anterior resection with >45° angle of fire. None of the cases had bleed or leak. Conclusion SureForm™ SmartFire™ robotic staplers can be used for various oncological surgeries with minimal peri-operative leak and bleeding and has better articulation in closed spaces. Further case-matched comparative studies with laparoscopic or handheld powered staplers would be required for useful operative decision-making and analyse the clinical outcomes.
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Affiliation(s)
- S. P. Somashekhar
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Elroy Saldanha
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Rohit Kumar
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Kalyan Pandey
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Akhil Dahiya
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - K. R. Ashwin
- Department of Surgical Oncology, Manipal Hospitals, Bengaluru, Karnataka, India
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Harji D, Rouanet P, Cotte E, Dubois A, Rullier E, Pezet D, Passot G, Taoum C, Denost Q. A multicentre, prospective cohort study of handsewn versus stapled intracorporeal anastomosis for robotic hemicolectomy. Colorectal Dis 2022; 24:862-867. [PMID: 35167182 DOI: 10.1111/codi.16096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 12/23/2022]
Abstract
AIM Robotic right hemicolectomy is gaining in popularity due to the recognized technical benefits associated with the robotic platform. However, there is a lack of standardization regarding the optimal anastomotic technique in this cohort of patients, namely stapled or handsewn intra- or extra-corporeal anastomosis. The ergonomic benefit associated with the robotic platform lends itself to intracorporeal anastomosis (ICA). The aim of this study was to compare the short-term clinical outcomes of stapled versus handsewn ICA. METHOD A multicentre prospective cohort study was undertaken across four high-volume robotic centres in France between September 2018 and December 2020. All adult patients undergoing an elective robotic right hemicolectomy with an ICA performed and a minimum postoperative follow-up of 30 days were included. The primary endpoint of our study was anastomotic leak within 30 days postoperatively. RESULTS A total of 144 patients underwent robotic right hemicolectomy: 92 (63.8%) had a stapled ICA and 52 (36.1%) a handsewn ICA. The operative indication was adenocarcinoma in 90% with a stapled ICA compared with 62% in the handsewn ICA group (p < 0.001). The overall operating time was longer in the handsewn ICA group compared with the stapled ICA group (219 min vs. 193 min; p = 0.001). The anastomotic leak rate was 3.3% in stapled ICA and 3.8% in handsewn ICA (p = 1.00). There was no difference in the rate or severity of postoperative morbidity. CONCLUSION ICA robotic hemicolectomy is technically safe and is associated with low rates of anastomotic leak overall and equivalent clinical outcomes between the two techniques.
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Affiliation(s)
- Deena Harji
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Philippe Rouanet
- Department of Colorectal Surgery, Institut du Cancer de Montpellier, Montpellier, France
| | - Eddy Cotte
- Department of Digestive and Oncological Surgery, Lyon University Hospital, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Anne Dubois
- Department of Colorectal Surgery, Chu Estaing, Clermont-Ferrand, France
| | - Eric Rullier
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Denis Pezet
- Department of Colorectal Surgery, Chu Estaing, Clermont-Ferrand, France
| | - Guillaume Passot
- Department of Digestive and Oncological Surgery, Lyon University Hospital, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Christophe Taoum
- Department of Colorectal Surgery, Institut du Cancer de Montpellier, Montpellier, France
| | - Quentin Denost
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
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Kingo PS, Wrist Lam G, Jensen JB. Can maneuverability in the robot assisted laparoscopic stapler during ileoileal anastomosis compensate for shorter stapler length? - A randomized experimental porcine study. Scand J Urol 2021; 55:474-479. [PMID: 34553676 DOI: 10.1080/21681805.2021.1977846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Ileal anastomosis is imperative in patients given a urinary diversion during radical cystectomy. Proper handling and staplers with a certain length are important to prevent stenosis of the bowel. The study aim was to compare the circumference and diameter of ileoileal anastomoses using the Endo GIA tri-stapler 45 mm and 60 mm iDrive systems compared to the RAL Endowrist DaVinci 45 mm. This was to investigate if the better maneuverability of the robotic stapler would compensate for the shorter stapler length in the RAL Endowrist DaVinci 45. MATERIALS AND METHODS Twenty ileoileal anastomoses were performed in a total of three pigs after randomization according to the type of anastomosis technique used (depending on stapler and robotic system) allocated to four groups (each with five anastomoses): (1) iDrive 45 mm, (2) iDrive 60 mm, (3) RAL DaVinci 45 mm (Si-system), and (4) RAL DaVinci 45 mm (Xi-system). Diameter (mm) and circumference (mm) were measured and compared. RESULTS Diameters and circumferences in Group 1 were significantly smaller compared to all the other groups, which did not differ from each other, except in Group 2 where anastomoses had a significantly higher circumference than Group 4. CONCLUSION The iDrive 60 mm makes the anastomoses with the widest diameter and highest circumference compared to the iDrive 45 mm. With the RAL DaVinci 45 mm, the diameter and circumference were comparable to the iDrive 60 mm and significantly better than the iDrive 45 mm. An explanation may be the better maneuverability and surgeon control of the RAL DaVinci stapler.
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Affiliation(s)
- Pernille Skjold Kingo
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Gitte Wrist Lam
- Department of Urology, Herlev University Hospital, Herlev, Denmark
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Zervos M, Song A, Li Y, Lee SH, Oh DS. Clinical and Economic Outcomes of Using Robotic Versus Hand-Held Staplers During Robotic Lobectomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:470-476. [PMID: 34488486 DOI: 10.1177/15569845211040814] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE During robotic lobectomy (RL), the surgeon can elect to use either robotic staplers or hand-held laparoscopic staplers. It is assumed that either will result in similar outcomes, while robotic staplers increase cost. We sought to compare perioperative outcomes and costs between RL cases that utilized robotic staplers versus hand-held staplers in real-world clinical practice. METHODS Patients who underwent an elective RL between October 2015 and December 2017 were identified in the Premier Hospital Perspective Database. Propensity score matching (PSM) analysis was performed to compare perioperative outcomes, healthcare resource utilization, and costs between cases using robotic staplers and hand-held staplers during RL. RESULTS In the PSM analysis, RL cases that fully utilized robotic staplers compared to hand-held staplers were associated with significantly lower risks of developing bleeding (5.6% vs 9.8%, P = 0.03) and conversion to open surgery (0.3% vs 5.9%, P = 0.004). Additionally, in a multivariable regression analysis, robotic stapler was associated with reduced risk for air leak (OR 0.70, 95% CI 0.50-0.98) and overall complications (OR 0.76, 95% CI 0.58-0.99). The total index hospitalization costs were comparable between the 2 groups (median [IQR], $21,667 [$16,860-$29,033] in robotic stapler vs $21,398 [$17,258-$29,406] in hand-held stapler, P = 0.22). CONCLUSIONS Among RL cases, utilization of robotic staplers was associated with significantly lower risks of perioperative bleeding, conversion, and possibly air leak and overall complications compared to RL cases utilizing hand-held staplers. The choice of stapler may have an impact on outcomes and robotic staplers do not increase total costs.
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Affiliation(s)
- Michael Zervos
- 12296 Division of Thoracic Surgery, Department of Surgery, New York University School of Medicine, NY, USA
| | - Alfred Song
- 10624 Department of Surgery, Stanford School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Yanli Li
- 19727 Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, CA, USA
| | - Shih Hao Lee
- 19727 Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, CA, USA
| | - Daniel S Oh
- 5116 Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Giffen Z, Ezzone A, Ekwenna O. Robotic stapler use: Is it safe?-FDA database analysis across multiple surgical specialties. PLoS One 2021; 16:e0253548. [PMID: 34166443 PMCID: PMC8224848 DOI: 10.1371/journal.pone.0253548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/07/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Robotic-assisted techniques are common across many surgical subspecialties. While robotic stapling offers increased surgeon control, there is limited information on surgical complications related to robotic stapler use. Methods We reviewed the FDA’s MAUDE database for adverse events related to robotic stapler use. Results Upon review of the FDA database, the most frequently reported robotic stapler complications were malfunction, failure to form staple line, device fragmentation, and misfire. 31 Clavien-Dindo grade II or higher complications were attributed to stapler use since 2014. Conclusions Further research on prevalence of robotic stapler use is needed to quantity the associated complication rate.
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Affiliation(s)
- Zane Giffen
- Department of Urology and Renal Transplantation, University of Toledo, Toledo, OH, United States of America
- * E-mail:
| | - Austin Ezzone
- Department of Urology and Renal Transplantation, University of Toledo, Toledo, OH, United States of America
| | - Obi Ekwenna
- Department of Urology and Renal Transplantation, University of Toledo, Toledo, OH, United States of America
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Efficacy of a robotic stapler on symptomatic anastomotic leakage in robotic low anterior resection for rectal cancer. Surg Today 2021; 52:120-128. [PMID: 34110488 DOI: 10.1007/s00595-021-02313-6] [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: 12/10/2020] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Clinical evidence demonstrating risk factors for anastomotic leakage including robotic staplers has remained limited, even though the use of robotic surgery has increased substantially. The purpose of this study was to evaluate the effects of robotic staplers on symptomatic anastomotic leakage in robotic low anterior resection for rectal cancer. METHODS A total of 427 consecutive patients with primary rectal cancer who underwent robotic low anterior resection without diverting stoma were investigated retrospectively. Symptomatic anastomotic leakage was defined as anastomotic leakage of Clavien-Dindo Grade ≥ II. We compared the symptomatic anastomotic leakage rates between manual and robotic staplers using propensity score matching and investigated the risk factors for symptomatic anastomotic leakage. RESULTS After propensity score matching, 168 pairs of manual and robotic stapler cases were selected. The symptomatic anastomotic leakage rate was significantly higher for manual staplers (6.5%) than for robotic staplers (1.2%, p = 0.02). In a multivariate analysis, the use of a manual stapler (p = 0.04, OR 4.86, 95% CI 1.08-21.8) and anastomosis < 4 cm from the anal verge (p < 0.01, OR 4.36, 95% CI 1.48-12.9) were identified as independent risk factors for symptomatic anastomotic leakage. CONCLUSIONS Robotic stapler use was associated with a significantly decreased rate of anastomotic leakage in robotic low anterior resection without diverting stoma for rectal cancer.
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Trafeli M, Foppa C, Montanelli P, Nelli T, Staderini F, Badii B, Skalamera I, Cianchi F, Coratti F. Robotic colorectal surgery checkpoint: a review of cited articles during the last year. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.19.04963-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tejedor P, Sagias F, Flashman K, Kandala NL, Khan J. The use of robotic or laparoscopic stapler in rectal cancer surgery: a systematic review and meta-analysis. J Robot Surg 2020; 14:829-833. [PMID: 32691353 DOI: 10.1007/s11701-020-01126-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/13/2020] [Indexed: 01/18/2023]
Abstract
Minimally invasive surgery for total mesorectal excision (TME) remains technically challenging due to poor maneuverability within the pelvis, which makes extremely difficult to introduce a laparoscopic stapler (LS) for the rectal transection. We aim to perform a systematic review and meta-analysis on robotic TME after the use of robotic stapler (RS) or LS after robotic TME. A systematic literature search was performed using PubMed, MEDLINE, and Cochrane Database. Participants who underwent robotic anterior resection were considered following these criteria: (1) studies comparing RS and LS; (2) studies reporting the rate of anastomotic leakage (AL). The primary outcome was the risk of AL. Secondary outcomes included the number of firings of stapler needed. A meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement was performed. A total of 4 studies including 391 patients (LS = 251, RS = 140) were included for analysis. Regarding the number of firings, overall results suggest that the rectal stapling was achieved with less firings in the RS group, but the difference is not significant [risk difference, (95% CI) 0.42 (- 0.13, 0.97)]. There was a 56% increased odds of AL for LS compared with RS; however, this was not statistically significant (OR: 1.56; 95% CI 0.59, 4.14). With the current literature evidence, the present study could not demonstrate a clear benefit of the RS over the LS. Although the development of an AL is multifactorial and unpredictable, our data may suggest that the use of the RS could help reducing the risk of AL. There is a need of future randomized clinical trial to assess the possible benefits of the RS.
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Affiliation(s)
- Patricia Tejedor
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - Filippos Sagias
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - Karen Flashman
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - Ngianga Li Kandala
- Faculty of Sciences, School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
| | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK.
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Tejedor P, Sagias F, Khan JS. The Use of Enhanced Technologies in Robotic Surgery and Its Impact on Outcomes in Rectal Cancer: A Systematic Review. Surg Innov 2020; 27:384-391. [PMID: 32484427 DOI: 10.1177/1553350620928277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The main advantage of the robotic approach is the surgical precision that the technology offers. It is particularly useful in rectal cancer as this is a technically challenging procedure. The technological advantage of the robot leads to better postoperative outcomes. Apart from the 3D vision and endowrist instrumentation in comparison to laparoscopy, the options of using fluorescence imaging, endowrist stapler, and table motion have revolutionised the way of performing an anterior resection. Thus, the true benefit of these advances will be the quality of the surgery, which leads to better postoperative outcomes. This article focuses on the current status of applications of new modalities and technology development in robotic rectal surgery. A systematic literature search was performed using PubMed, MEDLINE, and cochrane database. The studies included were considered based on the following (1) articles written in English, (2) full text is available, (3) whether the topic is related to the use of novel technologies during robotic rectal surgery, and (4) sample: adult patients and malignant rectal disease. The primary end point was to analyse the current use of technological advances in robotic rectal surgery. Only a few studies are currently available on the use of these different technologies in robotic colorectal surgery. Many of these reports describe promising results, although with short-term outcomes. The use of technologies in robotic colorectal surgery is safe and feasible and can be used together to improve short-term outcomes. Intraoperative fluorescence angiography has demonstrated to reduce the rate of anastomotic leak, whereas the robotic stapler and the table motion simplify anatomic resection.
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Affiliation(s)
- Patricia Tejedor
- Department of Colorectal Surgery, 112006Queen Alexandra Hospital, UK
| | - Filippos Sagias
- Department of Colorectal Surgery, 112006Queen Alexandra Hospital, UK
| | - Jim S Khan
- Department of Colorectal Surgery, 112006Queen Alexandra Hospital, UK
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12
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Laparoscopic Billroth I Gastroduodenostomy in Robotic Distal Gastrectomy for Gastric Cancers: Fusion Surgery. Surg Laparosc Endosc Percutan Tech 2019; 29:520-523. [PMID: 31517746 DOI: 10.1097/sle.0000000000000720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The authors outline their stapling technique and retrospectively compare outcomes of laparoscopic staplers versus robotic staplers in patients undergoing robotic distal gastrectomy (RDG) with Billroth I gastroduodenostomy for gastric cancers. MATERIALS AND METHODS Of our 28 consecutive patients who underwent RDG, 18 underwent Billroth I gastroduodenostomy using laparoscopic staplers (fusion group); robotic staplers were used in the remaining 10 patients (robot group). All RDG procedures were performed using the da Vinci Surgical System. RESULTS The duration of reconstruction was significantly longer for the robot group than for the fusion group. There were no conversions to conventional laparoscopy or open surgery in the fusion group, but 1 patient in the robot group required conversion to laparoscopic reconstruction for duodenal injury during anastomosis. No postoperative complications developed in the fusion group. CONCLUSION Regarding short-term surgical outcomes, robotic-assisted laparoscopic stapling techniques for reconstruction after RDG are both feasible and safe for gastric cancers.
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Tejedor P, Sagias F, Nock D, Flashman K, Naqvi S, Kandala NL, Khan JS. Advantages of using a robotic stapler in rectal cancer surgery. J Robot Surg 2019. [PMID: 31290074 DOI: 10.1007/s11701‐019‐00993‐4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To compare short-term postoperative outcomes in patients undergoing robotic total mesorectal excision (TME) after the use of robotic and laparoscopic staplers. Over a 5-year period, 196 patients were divided into 2 groups according to the use of laparoscopic (LS) or robotic stapler (RS). Patient demographics and postoperative complications were compared. A total of 145 (74%) robotic TME were performed using the LS and 51 (26%) the RS. No conversions to laparoscopy or laparotomy were observed, in either group. Transection of the rectum using one or two firings was achieved in a higher proportion of RS cases (91%) compared with LS cases (60%; p < 0.001). The anastomotic leakage (AL) rate was 4% in the RS group vs. 7% in the LS group (p > 0.05). However, when three or more firings were needed for the rectal transection, the risk of AL increased (3.4% with ≤ 2 firings vs. 10.7% with ≥ 3 firings, p = 0.006). Our data confirm that multiple stapler firings for rectal transection have a major impact on AL. The robotic stapler simplifies the transaction, so that rectal division requires fewer stapler firings, with a potential reduction in the incidence of AL.
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Affiliation(s)
- P Tejedor
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road Cosham, Portsmouth, PO6 3LY, UK
| | - F Sagias
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road Cosham, Portsmouth, PO6 3LY, UK
| | - D Nock
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road Cosham, Portsmouth, PO6 3LY, UK
| | - K Flashman
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road Cosham, Portsmouth, PO6 3LY, UK
| | - S Naqvi
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road Cosham, Portsmouth, PO6 3LY, UK
| | - N Li Kandala
- Faculty of Sciences, School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
| | - Jim S Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road Cosham, Portsmouth, PO6 3LY, UK. .,School of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK.
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14
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Tejedor P, Sagias F, Nock D, Flashman K, Naqvi S, Kandala NL, Khan JS. Advantages of using a robotic stapler in rectal cancer surgery. J Robot Surg 2019; 14:365-370. [DOI: 10.1007/s11701-019-00993-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 06/20/2019] [Indexed: 02/06/2023]
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15
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Robotic-assisted surgery for complicated and non-complicated diverticulitis: a single-surgeon case series. J Robot Surg 2019; 13:765-772. [DOI: 10.1007/s11701-018-00914-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022]
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16
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Does Robot Overcome Obesity-related Limitations of Minimally Invasive Rectal Surgery for Cancer? Surg Laparosc Endosc Percutan Tech 2018; 28:e8-e11. [PMID: 29252933 DOI: 10.1097/sle.0000000000000500] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Adoption of laparoscopic surgery for cancers requiring partial or total proctectomy has been slow due to difficulty of achieving oncologically adequate resection. Obesity is a factor complicating use and outcomes of laparoscopic technique for rectal surgery. Impact of obesity on the outcomes of robotic rectal surgery for cancer is not well defined. This study is designed to assess whether if the robotic technique has potential to overcome the limitations of obesity and to improve outcomes of minimally invasive rectal surgery for cancer. PATIENTS AND METHODS Patients undergoing robotic sphincter-saving radical resection with da Vinci Xi System between December 2014 and December 2016 were included. Patients were divided into 2 groups as obese and nonobese. Patient demographics, perioperative outcomes and short-term results were compared between the groups. RESULTS The study included 101 patients (30 were obese). Sex (female: 35 vs. 37%, P=0.89), American Society of Anesthesiologists score (2 vs. 2, P=0.41), number of patients undergoing neoadjuvant chemoradiation (39% vs. 23%, P=0.12) and history of prior abdominal surgery (28% vs. 23%, P=0.62) were comparable between the groups. Operative time was longer in the obese group (311 vs. 332 min. P=0.01). Overall complication rates (27% vs. 23%, P=0.72), length of hospital stay (6 vs. 7, P=0.10) and pathologic outcomes were similar between the groups. Conversion to laparoscopy was not required in any operation. Two nonobese patients required conversion to open surgery. CONCLUSION Robotic rectal surgery for cancer in obese patients is equally safe and effective as in nonobese patients. The new robotic platform can facilitate to overcome obesity-related limitations of rectal surgery.
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17
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Guadagni S, Di Franco G, Gianardi D, Palmeri M, Ceccarelli C, Bianchini M, Furbetta N, Caprili G, D'Isidoro C, Moglia A, Melfi F, Buccianti P, Mosca F, Morelli L. Control Comparison of the New EndoWrist and Traditional Laparoscopic Staplers for Anterior Rectal Resection with the Da Vinci Xi: A Case Study. J Laparoendosc Adv Surg Tech A 2018; 28:1422-1427. [PMID: 29920142 DOI: 10.1089/lap.2018.0218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: A new robotic stapler for the da Vinci Xi® is directly controlled by the surgeon at the console and equipped with EndoWrist® technology. We evaluated operative and short-term results of the first patients who underwent anterior rectal resection for cancer with the da Vinci Xi and new staplers, and compared the results with those of a comparable group treated with traditional laparoscopic staplers. Methods: From December 2015 to December 2017, 25 patients underwent anterior rectal resection for cancer with robotic EndoWrist staplers (EndoWrist group). Using a case-control method, we compared the results with those of a similar group of patients treated with the same system and a traditional laparoscopic endostapler, controlled by a bedside assistant (Control group). Results: No conversions to laparoscopy or laparotomy were observed, in either group. The mean number of charges was 2.1 ± 0.2 in the EndoWrist group versus 2.7 ± 0.7 in the Control group (P = .0004). The other perioperative results were comparable. During follow-up, the incidence of anastomotic fistula in a contrast enema study was higher in the Control group, although the difference was not statistically significant (two leaks versus two leaks in EndoWrist group; P = .8). The interval between rectal resection and stoma closure was shorter in the EndoWrist group (3.4 ± 2.5 versus 4.2 ± 2.9 months in the Control group; P = .2), although the difference was not significant. Conclusions: Our experience suggests that the new robotic staplers simplify transection, which could reduce the average number of stapler firings used during rectal resection and could decrease the incidence of anastomotic leakage. These findings require confirmation in larger studies.
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Affiliation(s)
- Simone Guadagni
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Gregorio Di Franco
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Desirée Gianardi
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Matteo Palmeri
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Cristina Ceccarelli
- 2 General Surgery Unit, Department of Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,3 Multidisciplinary Robotic Center, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Matteo Bianchini
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Niccolò Furbetta
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Giovanni Caprili
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Cristiano D'Isidoro
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy
| | - Andrea Moglia
- 4 EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Franca Melfi
- 3 Multidisciplinary Robotic Center, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Piero Buccianti
- 2 General Surgery Unit, Department of Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,3 Multidisciplinary Robotic Center, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Franco Mosca
- 4 EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Luca Morelli
- 1 General Surgery Unit, Department of Surgery, University of Pisa, Pisa, Italy.,3 Multidisciplinary Robotic Center, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,4 EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
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18
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Johnson CS, Kassir A, Marx DS, Soliman MK. Performance of da Vinci Stapler during robotic-assisted right colectomy with intracorporeal anastomosis. J Robot Surg 2018; 13:115-119. [DOI: 10.1007/s11701-018-0828-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/16/2018] [Indexed: 01/18/2023]
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19
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Gutierrez M, Ditto R, Roy S. Systematic review of operative outcomes of robotic surgical procedures performed with endoscopic linear staplers or robotic staplers. J Robot Surg 2018; 13:9-21. [PMID: 29744808 PMCID: PMC6397135 DOI: 10.1007/s11701-018-0822-5] [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] [Received: 02/26/2018] [Accepted: 04/30/2018] [Indexed: 02/08/2023]
Abstract
A comprehensive review of operative outcomes of robotic surgical procedures performed with the da Vinci robotic system using either endoscopic linear staplers (ELS) or robotic staplers is not available in the published literature. We conducted a literature search to identify publications of robotic surgical procedures in all specialties performed with either ELS or robotic staplers. Twenty-nine manuscripts and six abstracts with relevant information on operative outcomes published from January 2011 to September 2017 were identified. Given the relatively recent market release of robotic staplers in 2014, comparative perioperative clinical outcomes data on the performance of ELS vs. robotic staplers in robotic surgery is very sparse in the published literature. Only three comparative studies of surgeries with the da Vinci robotic system plus ELS vs. da Vinci plus robotic staplers were identified; two in robotic colorectal surgery and the other in robotic gastric bypass surgery. These comparative studies illustrate some nuances in device design and usability, which may impact outcomes and cost, and therefore may be important to consider when selecting the appropriate stapling technologies/technique for different robotic surgeries. Comparative perioperative data on the use of ELS vs. robotic staplers in robotic surgery is scarce (three studies), and current literature identifies both types of devices as safe and effective. Given the longer clinical history of ELS and its relatively more robust evidence base, there may be trade-offs to consider before switching to robotic staplers in certain robotic procedures. However, this literature review may serve as an initial reference for future research.
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20
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Atasoy D, Aytac E, Ozben V, Bayraktar O, Erenler Bayraktar I, Aghayeva A, Baca B, Hamzaoglu I, Karahasanoglu T. Robotic Versus Laparoscopic Stapler Use for Rectal Transection in Robotic Surgery for Cancer. J Laparoendosc Adv Surg Tech A 2018; 28:501-505. [DOI: 10.1089/lap.2017.0545] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Deniz Atasoy
- Department of General Surgery, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Erman Aytac
- Department of General Surgery, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Volkan Ozben
- Department of General Surgery, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Onur Bayraktar
- Department of General Surgery, School of Medicine, Acibadem University, Istanbul, Turkey
| | | | - Afag Aghayeva
- Department of General Surgery, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Bilgi Baca
- Department of General Surgery, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Ismail Hamzaoglu
- Department of General Surgery, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Tayfun Karahasanoglu
- Department of General Surgery, School of Medicine, Acibadem University, Istanbul, Turkey
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21
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He Z, Zeng L, Zhang C, Wang L, Wang Z, Rustam A, Du C, Lv W, Hu J. Initial experience of Da Vinci robotic thoracic surgery at the First Affiliated Hospital of Zhejiang University. J Vis Surg 2018; 3:153. [PMID: 29302429 DOI: 10.21037/jovs.2017.09.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/14/2017] [Indexed: 11/06/2022]
Abstract
Robot-assisted thoracic surgery (RATS) is a relatively new but rapidly adopted technique, pioneered by the urological and gynecological departments. The primary objective of this study is to present the current status, a series of improvement and innovation of Da Vinci robotic surgery in the Department of Thoracic Surgery at First Affiliated Hospital of Zhejiang University. In addition, we discuss the prospect of robotic surgical technology.
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Affiliation(s)
- Zhehao He
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Liping Zeng
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Chong Zhang
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Luming Wang
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Zhitian Wang
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Azmat Rustam
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Chengli Du
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
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22
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Criss CN, Ralls MW, Johnson KN, Awtar S, Jarboe MD, Geiger JD. A Novel Intuitively Controlled Articulating Instrument for Reoperative Foregut Surgery: A Case Report. J Laparoendosc Adv Surg Tech A 2017; 27:983-986. [PMID: 28727949 DOI: 10.1089/lap.2017.0107] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The field of laparoscopic surgery has continued to grow exponentially over the years, prompting new innovative technologies. Despite substantial advancements, standard laparoscopic tools have undergone little design changes and fail to optimize mobility in limited spaces. Advancements in robotics have attempted to address this, allowing for increasing degrees of freedom and articulation of instruments. Even so, this system has proven to be cumbersome with questionable cost-effectiveness. In this study, we present the first use of a solely mechanical intuitively controlled articulating laparoscopic needle driver. The ability to naturally articulate allowed for ease during suturing and knot tying during the critical portions of the operation. The FlexDex surgical instrument demonstrates promise in the field of foregut surgery in addition to other areas of minimally invasive specialties.
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Affiliation(s)
- Cory N Criss
- Section of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
| | - Matthew W Ralls
- Section of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
| | - Kevin N Johnson
- Section of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
| | - Shorya Awtar
- Section of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
| | - Marcus D Jarboe
- Section of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
| | - James D Geiger
- Section of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
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