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Gonzalez MR, Lim PL, Chen AF, Melnic CM, Bedair HS. Comparing Rates of Minimal Clinically Important Difference Between Manual and Robotic-Assisted Total Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00883-0. [PMID: 39218238 DOI: 10.1016/j.arth.2024.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Differences in patient-reported outcome measures (PROMs) between manual total knee arthroplasty (mTKA) and robotic-assisted TKA (rTKA) have not been adequately assessed. We compared the minimal clinically important difference for improvement (MCID-I) and Worsening (MCID-W) between mTKA and rTKA patients. METHODS Patients who underwent primary TKA (874 mTKA, 439 rTKA) with complete pre-operative and one-year post-operative PROMs were retrospectively identified using a multi-hospital joint arthroplasty registry. Patient-Reported Outcomes Measurement Information System Physical Function Short Form 10a (PROMIS PF-10a), PROMIS Global - Physical, or Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) were collected. The MCID-I, MCID-W, and "no significant change" rates were calculated using distribution-based methods. Propensity-score matching was performed to control for confounding. RESULTS Similar 90-day pulmonary embolism (P = 0.26), deep venous thrombosis (P = 0.67), and emergency department visit (P = 0.35) rates were found. The 90-day readmission rate for mTKA was 1.7 and 3.4% for rTKA (P = 0.08), and overall revision rates were 2.2% for mTKA and 0.7% for rTKA (P = 0.07). Revision-free survival was 99% at one and two years for both groups (P = 0.65 and P = 0.43, respectively). There were no differences in the proportion of patients achieving MCID-I or MCID-W for PROMIS PF-10a, PROMIS Global - Physical, or KOOS-PS. The MCID-I for PROMIS PF-10a was achieved in 65.5 and 62.2% of patients who had mTKA and rTKA, respectively (P = 0.32). CONCLUSION Our study demonstrated similar complication rates, and MCID-I and MCID-W attainment rates between mTKA and rTKA patients. Future studies should assess MCID attainment rates in the long term and in larger cohorts, comparing mTKA and rTKA.
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Affiliation(s)
- Marcos R Gonzalez
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Perry L Lim
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA.
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郝 定. [Brief history and application prospect of robotic spine surgery]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:899-903. [PMID: 39175308 PMCID: PMC11335596 DOI: 10.7507/1002-1892.202406089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/24/2024]
Abstract
Spinal robotics has rounded out twenty years in clinical, is mainly used for pedicle screw placement at present, can significantly increase the accuracy of screw placement and reduce radiation exposure to the patient and the surgeon. In the future, haptic feedback, automatic collision avoidance, and other technologies will further expand its application to complete precise operations such as decompression and correction, providing safety guarantee for the implementation of complex spinal surgery.
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Affiliation(s)
- 定均 郝
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spine Surgery, Xi’an Jiaotong University Affiliated Honghui Hospital, Xi’an Shaanxi, 710054, P. R. China
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Farooq M, Zahra SG. Robotics and Artificial Intelligence in Minimally Invasive Spine Surgery: A Bibliometric and Visualization Analysis. World Neurosurg 2024; 190:240-254. [PMID: 39002779 DOI: 10.1016/j.wneu.2024.07.067] [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: 02/10/2024] [Revised: 07/07/2024] [Accepted: 07/08/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE This study aims to highlight the trends in the minimally invasive spine surgery (MISS) research field from the bibliometrics perspective. METHODS The articles and reviews from 2002 to 2022 were manually retrieved from Scopus based on predefined inclusion criteria. A total of 296 articles for robotics and 13 articles for AI were included in the final analysis. All publication records were imported and analyzed in Microsoft Excel and VOSviewer. RESULTS An increase in the number of publications per year was observed in the last five years. For robotics, the United States published the largest number of articles (161), but the Netherlands had the highest total citations (1216). Beijing Jishuitan Hospital, China, was the most prolific institution. For journals, World Neurosurgery had the most publications (31), while Spine journal was the most impactful (average citation index = 86.6). Wang T.Y was the author with the most published articles (5). For AI, the United States had the greatest number of publications (10) and the highest citations (229). Global Spine Journal had the most publications (3), while Spine had the most citations (112). Kim J.S. was the most cited author (102). Recent keywords mainly focused on techniques and prognoses using these modalities in MISS. There were relatively fewer collaborations among countries. CONCLUSIONS An increasing trend in publications regarding robotics and AI use reflects the recent MISS technique advancements. Our findings can provide useful information to identify potential research fronts in the coming years. Enhanced collaboration on an international level should be pursued.
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Affiliation(s)
- Minaam Farooq
- Mayo Hospital Lahore, King Edward Medical University, Lahore, Pakistan.
| | - Shah Gul Zahra
- Mayo Hospital Lahore, King Edward Medical University, Lahore, Pakistan
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Łajczak PM, Jóźwik K. Beyond the Band-Aid: Robot-Assisted Laparoscopy for Splenic Aneurysms. A Systematic Review. Ann Vasc Surg 2024:S0890-5096(24)00409-6. [PMID: 39009124 DOI: 10.1016/j.avsg.2024.05.026] [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: 04/12/2024] [Revised: 05/15/2024] [Accepted: 05/31/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION Splenic artery aneurysm (SAA) is characterized by a weakening and bulging of splenic artery. Robot-assisted laparoscopic surgery is a minimally invasive surgical technique. This systematic review aimed to assess the use of robot-assisted laparoscopic surgery to manage SAA. METHODOLOGY Five medical databases were used to identify studies that investigated the use of robotic devices in laparoscopic SAA management in humans. Original, peer-reviewed articles were included. Two authors independently screened articles and extracted data on factors including patient demographics, surgical procedures, and outcomes. RESULTS The PRISMA search identified seven studies with a total of 28 patients who underwent robot-assisted laparoscopic surgery for SAA. The studies reported successful surgeries using various techniques, including end-to-end anastomosis, ligation, and graft placement. 3D printed models were used in one study as an aid for pre-operative surgery planning. Mean operation time was 210 minutes, and three complications were reported (robotic arm failure during surgery and two conversions to open surgery). DISCUSSION AND FUTURE DIRECTIONS Robot-assisted laparoscopic surgery offers several advantages over traditional open surgery for SAA management. However, more research is needed to confirm these potential benefits and establish robot-assisted laparoscopic surgery as a standard treatment option for SAA. Future studies should involve larger patient groups, compare this method to traditional techniques, and evaluate its cost-effectiveness. Additionally, incorporating advancements like mixed reality for pre-operative planning and 3D printing to improve surgical planning and patient communication.
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Affiliation(s)
- Paweł Marek Łajczak
- Prof. Zbigniew Religa Student Scientific Club at Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, 40-043 Zabrze.
| | - Kamil Jóźwik
- Prof. Zbigniew Religa Student Scientific Club at Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, 40-043 Zabrze
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Czako L, Sufliarsky B, Simko K, Sovis M, Vidova I, Farska J, Lifková M, Hamar T, Galis B. Exploring the Practical Applications of Artificial Intelligence, Deep Learning, and Machine Learning in Maxillofacial Surgery: A Comprehensive Analysis of Published Works. Bioengineering (Basel) 2024; 11:679. [PMID: 39061761 PMCID: PMC11274331 DOI: 10.3390/bioengineering11070679] [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: 04/21/2024] [Revised: 05/29/2024] [Accepted: 06/13/2024] [Indexed: 07/28/2024] Open
Abstract
Artificial intelligence (AI), deep learning (DL), and machine learning (ML) are computer, machine, and engineering systems that mimic human intelligence to devise procedures. These technologies also provide opportunities to advance diagnostics and planning in human medicine and dentistry. The purpose of this literature review was to ascertain the applicability and significance of AI and to highlight its uses in maxillofacial surgery. Our primary inclusion criterion was an original paper written in English focusing on the use of AI, DL, or ML in maxillofacial surgery. The sources were PubMed, Scopus, and Web of Science, and the queries were made on the 31 December 2023. The search strings used were "artificial intelligence maxillofacial surgery", "machine learning maxillofacial surgery", and "deep learning maxillofacial surgery". Following the removal of duplicates, the remaining search results were screened by three independent operators to minimize the risk of bias. A total of 324 publications from 1992 to 2023 were finally selected. These were calculated according to the year of publication with a continuous increase (excluding 2012 and 2013) and R2 = 0.9295. Generally, in orthognathic dentistry and maxillofacial surgery, AI and ML have gained popularity over the past few decades. When we included the keywords "planning in maxillofacial surgery" and "planning in orthognathic surgery", the number significantly increased to 7535 publications. The first publication appeared in 1965, with an increasing trend (excluding 2014-2018), with an R2 value of 0.8642. These technologies have been found to be useful in diagnosis and treatment planning in head and neck surgical oncology, cosmetic and aesthetic surgery, and oral pathology. In orthognathic surgery, they have been utilized for diagnosis, treatment planning, assessment of treatment needs, and cephalometric analyses, among other applications. This review confirms that the current use of AI and ML in maxillofacial surgery is focused mainly on evaluating digital diagnostic methods, especially radiology, treatment plans, and postoperative results. However, as these technologies become integrated into maxillofacial surgery and robotic surgery in the head and neck region, it is expected that they will be gradually utilized to plan and comprehensively evaluate the success of maxillofacial surgeries.
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Affiliation(s)
- Ladislav Czako
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Ruzinovska 6, 826 06 Bratislava, Slovakia; (L.C.); (K.S.); (M.S.); (I.V.); (J.F.); (B.G.)
| | - Barbora Sufliarsky
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Ruzinovska 6, 826 06 Bratislava, Slovakia; (L.C.); (K.S.); (M.S.); (I.V.); (J.F.); (B.G.)
| | - Kristian Simko
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Ruzinovska 6, 826 06 Bratislava, Slovakia; (L.C.); (K.S.); (M.S.); (I.V.); (J.F.); (B.G.)
| | - Marek Sovis
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Ruzinovska 6, 826 06 Bratislava, Slovakia; (L.C.); (K.S.); (M.S.); (I.V.); (J.F.); (B.G.)
| | - Ivana Vidova
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Ruzinovska 6, 826 06 Bratislava, Slovakia; (L.C.); (K.S.); (M.S.); (I.V.); (J.F.); (B.G.)
| | - Julia Farska
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Ruzinovska 6, 826 06 Bratislava, Slovakia; (L.C.); (K.S.); (M.S.); (I.V.); (J.F.); (B.G.)
| | - Michaela Lifková
- Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava, St. Elisabeth Hospital Bratislava, Heydukova 10, 812 50 Bratislava, Slovakia;
| | - Tomas Hamar
- Institute of Medical Terminology and Foreign Languages, Faculty of Medicine, Comenius University in Bratislava, Moskovska 2, 811 08 Bratislava, Slovakia;
| | - Branislav Galis
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Ruzinovska 6, 826 06 Bratislava, Slovakia; (L.C.); (K.S.); (M.S.); (I.V.); (J.F.); (B.G.)
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Alrayes MM, Sukeik M. Robotics in total knee replacement: Current use and future implications. World J Orthop 2024; 15:489-494. [PMID: 38947269 PMCID: PMC11212528 DOI: 10.5312/wjo.v15.i6.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/29/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024] Open
Abstract
Robotic total knee replacement (TKR) surgery has evolved over the years with the aim of improving the overall 80% satisfaction rate associated with TKR surgery. Proponents claim higher precision in executing the pre-operative plan which results in improved alignment and possibly better clinical outcomes. Opponents suggest longer operative times with potentially higher complications and no superiority in clinical outcomes alongside increased costs. This editorial will summarize where we currently stand and the future implications of using robotics in knee replacement surgery.
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Affiliation(s)
- Majd M Alrayes
- Department of Trauma and Orthopedics, Orthopedic Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia
| | - Mohamed Sukeik
- Department of Trauma and Orthopaedics, Dr. Sulaiman Al-Habib Hospital, Khobar 34423, Saudi Arabia
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7
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Handa A, Gaidhane A, Choudhari SG. Role of Robotic-Assisted Surgery in Public Health: Its Advantages and Challenges. Cureus 2024; 16:e62958. [PMID: 39050344 PMCID: PMC11265954 DOI: 10.7759/cureus.62958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/23/2024] [Indexed: 07/27/2024] Open
Abstract
The modern hospital setting is closely related to engineering and technology. In a hospital, modern equipment is abundant in every department, including the operating room, intensive care unit, and laboratories. Thus, the quality of treatment provided in hospitals and technology advancements are closely tied. Robotic systems are used to support and improve the accuracy and agility of human surgeons during medical procedures. This surgical approach is commonly referred to as robotic surgery or robotic-assisted surgery (RAS). These systems are not entirely autonomous; they are managed by skilled surgeons who carry out procedures with improved accuracy and minimized invasiveness using a console and specialized instruments. Because RAS offers increased surgical precision, less discomfort after surgery, shorter hospital stays, and faster recovery time, all of which improve patient outcomes and lessen the strain on healthcare resources, it plays a critical role in public health. Its minimally invasive technique benefits patients and the healthcare system by lowering problems, reducing the requirement for blood transfusions, and reducing the danger of infections related to medical care. Furthermore, the possibility of remote surgery via robotic systems can increase access to specialized care, reducing regional differences and advancing fairness in public health. In this review article, we will be covering how RAS has its role in public health.
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Affiliation(s)
- Alisha Handa
- Community Medicine, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhay Gaidhane
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sonali G Choudhari
- School of Epidemiology and Public Health, Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Sosa BR, Cung M, Suhardi VJ, Morse K, Thomson A, Yang HS, Iyer S, Greenblatt MB. Capacity for large language model chatbots to aid in orthopedic management, research, and patient queries. J Orthop Res 2024; 42:1276-1282. [PMID: 38245845 DOI: 10.1002/jor.25782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/18/2023] [Accepted: 12/24/2023] [Indexed: 01/22/2024]
Abstract
Large language model (LLM) chatbots possess a remarkable capacity to synthesize complex information into concise, digestible summaries across a wide range of orthopedic subject matter. As LLM chatbots become widely available they will serve as a powerful, accessible resource that patients, clinicians, and researchers may reference to obtain information about orthopedic science and clinical management. Here, we examined the performance of three well-known and easily accessible chatbots-ChatGPT, Bard, and Bing AI-in responding to inquiries relating to clinical management and orthopedic concepts. Although all three chatbots were found to be capable of generating relevant responses, ChatGPT outperformed Bard and BingAI in each category due to its ability to provide accurate and complete responses to orthopedic queries. Despite their promising applications in clinical management, shortcomings observed included incomplete responses, lack of context, and outdated information. Nonetheless, the ability for these LLM chatbots to address these inquires has largely yet to be evaluated and will be critical for understanding the risks and opportunities of LLM chatbots in orthopedics.
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Affiliation(s)
- Branden R Sosa
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Michelle Cung
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Vincentius J Suhardi
- Research Division and Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Kyle Morse
- Department of Spine Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andrew Thomson
- Research Division and Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - He S Yang
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Matthew B Greenblatt
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
- Research Division and Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Myla K, Bou-Ayash N, Kim WC, Bugaev N, Bawazeer M. Is implementation of robotic-assisted procedures in acute care general surgery cost-effective? J Robot Surg 2024; 18:223. [PMID: 38801638 DOI: 10.1007/s11701-024-01912-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/16/2024] [Indexed: 05/29/2024]
Abstract
Over the past 2 decades, the use and importance of robotic surgery in minimally invasive surgery has increased. Across various surgical specialties, robotic technology has gained popularity through its use of 3D visualization, optimal ergonomic positioning, and precise instrument manipulation. This growing interest has also been seen in acute care surgery, where laparoscopic procedures are used more frequently. Despite the growing popularity of robotic surgery in the acute care surgical realm, there is very little research on the utility of robotics regarding its effects on health outcomes and cost-effectiveness. The current literature indicates some value in utilizing robotic technology in specific urgent procedures, such as cholecystectomies and incarcerated hernia repairs; however, the high cost of robotic surgery was found to be a potential barrier to its widespread use in acute care surgery. This narrative literature review aims to determine the cost-effectiveness of robotic-assisted surgery (RAS) in surgical procedures that are often done in urgent settings: cholecystectomies, inguinal hernia repair, ventral hernia repair, and appendectomies.
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Affiliation(s)
- Kumudini Myla
- Tufts University School of Medicine, Boston, MA, USA
| | | | - Woon Cho Kim
- Tufts University School of Medicine, Boston, MA, USA
- Tufts Medical Center, Department of Surgery, Boston, MA, USA
| | - Nikolay Bugaev
- Tufts University School of Medicine, Boston, MA, USA
- Tufts Medical Center, Department of Surgery, Boston, MA, USA
| | - Mohammed Bawazeer
- Tufts University School of Medicine, Boston, MA, USA.
- Tufts Medical Center, Department of Surgery, Boston, MA, USA.
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Arishi AA, Hakami IA, Mashbari HN, Hobani AH, Al-Musawa HI, Abuhadi RI, Maslouf AH, Matari MH, Albrahim HT, Algarni MA, Iskander O, Alyahyawi K. Knowledge, attitude, and perception of robotic-assisted surgery among the general population in Saudi Arabia: a cross-sectional study. J Robot Surg 2024; 18:196. [PMID: 38703278 DOI: 10.1007/s11701-024-01892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/28/2024] [Indexed: 05/06/2024]
Abstract
Minimally invasive surgery (MIS) has revolutionized surgical practices, with robotic-assisted surgery (RAS) significantly advancing. However, the understanding and acceptance of RAS vary, impacting its widespread adoption. This study aims to assess Saudi Arabians' attitudes and comprehension of RAS, which is crucial for promoting its integration into surgical procedures. A cross-sectional study was conducted in various Saudi Arabian cities. A total of 1449 participants were included, while participants with cognitive issues were excluded. Demographic information, knowledge, technology experience, attitudes, and perceptions about RAS were collected using an online self-administered questionnaire. Data were analyzed using descriptive and inferential statistics. Of the participants, 51.1% demonstrated awareness of RAS, mainly through social media (36.9%). Factors influencing awareness included gender, education, income, occupation, computer literacy, and technology comfort. Gender disparities were evident in attitudes and perceptions toward RAS. Concerns about RAS included robot malfunction (62.0%), surgical errors (45.4%), and surgeon competency (44.7%). 36.4% of the participants believe RAS is faster, 29.9% believe RAS is less painful, and 25.3% believe RAS has fewer complications. Positive perceptions encompassed the belief that robot-using surgeons are more skilled (44.5%) and hospitals offering RAS are better (54.3%). Notably, 47.7% expressed willingness to consider RAS as a treatment option. The study underscores the significance of promoting awareness and informed decisions to ensure the successful integration of RAS in surgical practices. Addressing concerns and misconceptions and enhancing public comprehension are pivotal for facilitating informed decision-making and fostering RAS acceptance within Saudi Arabia's surgical landscape.
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Affiliation(s)
- Abdulaziz A Arishi
- General Surgery Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.
| | - Ibrahim A Hakami
- General Surgery Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Hassan N Mashbari
- General Surgery Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | | | - Rana I Abuhadi
- Faculty of Medicine, Jazan University, 45142, Jazan, Saudi Arabia
| | - Atheer H Maslouf
- Faculty of Medicine, Jazan University, 45142, Jazan, Saudi Arabia
| | | | | | - Maram A Algarni
- Faculty of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Othamn Iskander
- General Surgery Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Khalid Alyahyawi
- General Surgery Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
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11
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Erozkan K, Gorgun E. Robotic colorectal surgery and future directions. Am J Surg 2024; 230:91-98. [PMID: 37953126 DOI: 10.1016/j.amjsurg.2023.10.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/22/2023] [Indexed: 11/14/2023]
Abstract
As the adoption of robotic-assisted procedures expands across various surgical specialties, colorectal surgery stands out as a prominent beneficiary. This rise in usage can be traced back to the increased accessibility of robotic platforms and a growing institutional shift towards cutting-edge surgical methods. When compared with traditional laparoscopic methods, robotic techniques offer distinct advantages. Their true potential shines in surgeries involving complex anatomical regions, where the robot's enhanced dexterity and range of motion prove invaluable. The three-dimensional, magnified view provided by robotic systems further boosts surgical precision and clarity. These advantages render robotic assistance especially suitable for colorectal surgeries, notably in intricate areas such as the rectum and endoluminal spaces. As the medical world emphasizes minimally invasive surgical methods, there's a pressing need to evolve and optimize robotic techniques in colorectal surgery. This article traces the evolution of robotic interventions in colorectal surgeries, highlighting both its historical milestones and anticipated future trends. We'll also explore emerging robotic tools and systems set to reshape the colorectal surgical arena.
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Affiliation(s)
- Kamil Erozkan
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
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Strübing F, Böcker A, Bigdeli AK, Gazyakan E, Vogelpohl J, Weigel J, Kneser U, Vollbach FH. [Robot-assisted Microsurgery in Lower Extremity Reconstruction]. HANDCHIR MIKROCHIR P 2024; 56:128-134. [PMID: 38519043 DOI: 10.1055/a-2264-6866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND In recent years, various robotic systems specifically designed for microsurgical tasks have been developed and approved. There is not much evidence for these systems to date. In our study, we examined the use of robot-assisted microsurgery in the reconstruction of the lower extremity. PATIENTS/MATERIAL AND METHODS Data was prospectively collected between February and November 2023. The Symani robotic system was used in 42 robot-assisted microsurgical procedures on the lower extremity, and the results were evaluated and documented. RESULTS The average age of the patients was 57±18 years. A total of 39 free flap reconstructions (95%), one lymphatic surgical procedure (3%) and two nerve transfers (5%) were performed. In total, 46 anastomoses and coaptations were carried out. This included six arterial end-to-end anastomoses (11%), seven arterial end-to-side anastomoses (13%), 36 venous end-to-end anastomoses (65%), two lymphovenous anastomoses (4%), and five epineural coaptations in the context of nerve transfers (9%). Arterial end-to-end anastomoses took an average of 26±12 minutes, and arterial end-to-side anastomoses took 42±21 minutes. The venous anastomoses took an average of 33±12 minutes. Epineural coaptations took an average of 24±13 minutes. In no procedure was there a need for a conversion to conventional hand suturing. There were two arterial thromboses (5%), one of which was successfully revised to save the flap. One total flap loss occurred, but there were no partial flap losses. CONCLUSION Using the Symani robotic system for microsurgical reconstruction of the lower extremity, we were able to demonstrate results that are comparable to conventional microsurgery.
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Affiliation(s)
- Felix Strübing
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg, BG Unfallklinik Ludwigshafen, Ludwigshafen, Germany
| | - Arne Böcker
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg, BG Unfallklinik Ludwigshafen, Ludwigshafen, Germany
| | - Amir K Bigdeli
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg, BG Unfallklinik Ludwigshafen, Ludwigshafen, Germany
| | - Emre Gazyakan
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg, BG Unfallklinik Ludwigshafen, Ludwigshafen, Germany
| | - Julian Vogelpohl
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg, BG Unfallklinik Ludwigshafen, Ludwigshafen, Germany
| | - Jonathan Weigel
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg, BG Unfallklinik Ludwigshafen, Ludwigshafen, Germany
| | - Ulrich Kneser
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg, BG Unfallklinik Ludwigshafen, Ludwigshafen, Germany
| | - Felix H Vollbach
- Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg, BG Unfallklinik Ludwigshafen, Ludwigshafen, Germany
- Abteilung für Handchirurgie, Plastische Chirurgie Ästhetische Chirurgie, Klinikum der Ludwig-Maximilians-Universität, München, Deutschland
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Yamasaki Y, Tokunaga M, Sakai Y, Kayasuga H, Nishihara T, Tadano K, Kawashima K, Haruki S, Kinugasa Y. Effects of a force feedback function in a surgical robot on the suturing procedure. Surg Endosc 2024; 38:1222-1229. [PMID: 38092971 DOI: 10.1007/s00464-023-10617-6] [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: 10/01/2023] [Accepted: 11/26/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Currently, widely used robotic surgical systems do not provide force feedback. This study aimed to evaluate the impact and benefits of a force feedback function on the suturing procedure. METHODS Twenty surgeons were recruited and divided into young (Y-group, n = 11) and senior (S-group, n = 9) groups, based on their years of surgical experience. The effect of the force feedback function on suturing quality was evaluated using an objective assessment system (A-LAP mini, Kyoto Kagaku Co., Ltd., Kyoto, Japan). Each participant completed the suturing task on intestinal model sheets with the robotic contact force feedback on and off. The task accomplishment time (s), maximal force (Newton, N) applied to the robotic forceps, and quality of suturing (assessed by A-LAP mini) were recorded as performance parameters. RESULTS In total, the maximal force applied to the robotic forceps was significantly decreased with the robotic force feedback switched on (median [interquartile range]: 2.8 N (2.3-3.2)) as compared with when the feedback was switched off (3.4 N (2.7-4.0), P < 0.001). The contact force feedback function did not affect the objectively assessed suturing score (18 points (17.7-19.0) versus 18 points (17.0-19.0), P = 0.421). The contact force feedback function slightly shortened the task accomplishment time in the Y-group (552.5 s (466.5-832) versus 605.5 s (476.2-689.7), P = 0.851) but not in the S-group (566 s (440.2-703.5) versus 470.5 s (419.7-560.2), P = 0.164). CONCLUSIONS With the contact force feedback function, the suturing task was completed with a smaller maximal force, while maintaining the quality of suturing. Because the benefits are more apparent in young surgeons, robots with the contact force feedback function will facilitate the educational process in novice surgeons.
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Affiliation(s)
- Yoshimi Yamasaki
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Yoshihiro Sakai
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | | | | | | | | | - Shigeo Haruki
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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14
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Chand G, Singh S, Dhiraaj S, Kumar B, Shetty A, Halemani K, Ghatak T. Perception of robotic-assisted surgery (RAS) among medical students: a systematic review and meta-analysis. J Robot Surg 2024; 18:95. [PMID: 38413513 DOI: 10.1007/s11701-024-01847-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/24/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Robotic surgery, also known as robotic-assisted surgery (RAS), involves a camera and a small surgical instrument attached to a robotic arm. A trained surgeon operates the robot from a viewing screen while being in the same room. METHODOLOGY This review was prepared following Cochrane collaboration guidelines and reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. Two authors independently searched and appraised the studies published in PubMed, cumulative index to nursing and allied health literature (CINAHL), Embase, Clinical Key, and Google Scholar. Pooled data analyzed and reported in RevMan software version-5.4. RESULTS This systematic review and meta-analysis comprised 1400 medical students, from 8 studies. The participants' age ranged from 23 to 49 years. Similarly, the sample size ranged from 25 and 300. The pooled prevalence of the existing studies revealed that 29.8% of medical students, were favorable towards RAS. Effect size (ES), 95% confidence intervals (CI) and heterogeneity (I2) [ES = 29.8, 95% CI 16.4-43.2, I2 = 95.1%, P < 0.00]. About 40% of Australian medical students' positive opinion on RAS [ES = 40.4, 95% CI 25.7-55.2]. Similarly, 34.2% of students from Saudi Arabia [ES = 29.8, 95% CI 22.4-90.8, I2 = 99.3%, P < 0.00], 27.8% students from Canada [ES = 27.8, 95% CI 15.9-39.6], 24.8% from USA [ES = 24.8, 95% CI 6.9-42.7, I2 = 77.3%, P < 0.00] and 24% [ES = 24, 95% CI 18-30] from India favorable towards RAS. DISCUSSION Medical students from developed nations display favorable attitudes towards RAS. However, implementing of revised curriculum at the beginning of the graduation level sparks medical students' attitude towards robotic surgery.
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Affiliation(s)
- Gyan Chand
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Suyash Singh
- All India Institute of Medical Sciences, Raebareli, India
| | - Sanjay Dhiraaj
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Basant Kumar
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Asha Shetty
- All India Institute of Medical Scieces, Bhubaneswar, India
| | | | - Tanmoy Ghatak
- All India Institute of Medical Sciences, Raebareli, India
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15
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Chatterjee S, Das S, Ganguly K, Mandal D. Advancements in robotic surgery: innovations, challenges and future prospects. J Robot Surg 2024; 18:28. [PMID: 38231455 DOI: 10.1007/s11701-023-01801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/16/2023] [Indexed: 01/18/2024]
Abstract
The use of robots has revolutionized healthcare, wherein further innovations have led to improved precision and accuracy. Conceived in the late 1960s, robot-assisted surgeries have evolved to become an integral part of various surgical specialties. Modern robotic surgical systems are equipped with highly dexterous arms and miniaturized instruments that reduce tremors and enable delicate maneuvers. Implementation of advanced materials and designs along with the integration of imaging and visualization technologies have enhanced surgical accuracy and made robots safer and more adaptable to various procedures. Further, the haptic feedback system allows surgeons to determine the consistency of the tissues they are operating upon, without physical contact, thereby preventing injuries due to the application of excess force. With the implementation of teleoperation, surgeons can now overcome geographical limitations and provide specialized healthcare remotely. The use of artificial intelligence (AI) and machine learning (ML) aids in surgical decision-making by improving the recognition of minute and complex anatomical structures. All these advancements have led to faster recovery and fewer complications in patients. However, the substantial cost of robotic systems, their maintenance, the size of the systems and proper surgeon training pose major challenges. Nevertheless, with future advancements such as AI-driven automation, nanorobots, microscopic incision surgeries, semi-automated telerobotic systems, and the impact of 5G connectivity on remote surgery, the growth curve of robotic surgery points to innovation and stands as a testament to the persistent pursuit of progress in healthcare.
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Affiliation(s)
- Swastika Chatterjee
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India
| | | | - Karabi Ganguly
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India
| | - Dibyendu Mandal
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India.
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16
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Li A, Stanislaus CT, Steffens D, McBride KE, Leslie S, Thanigasalam R, Cunich M. Prospective cohort study investigating quality of life outcomes following multi-speciality robotic-assisted surgery. J Minim Access Surg 2024; 20:37-46. [PMID: 37148106 PMCID: PMC10898637 DOI: 10.4103/jmas.jmas_253_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 05/07/2023] Open
Abstract
INTRODUCTION Despite recent evidence on the surgical outcomes of robotic-assisted surgery (RAS), other patient centre outcomes, including quality of life (QOL), are lacking. This study aims to examine changes in QoL trajectories following RAS across different surgical specialities. PATIENTS AND METHODS A prospective cohort study was conducted for patients undergoing urologic, cardiothoracic, colorectal or benign gynaecological RAS, between June 2016 and January 2020 at a tertiary referral hospital in Australia. QoL was measured using the 36-item Short-Form Health Survey at pre-operative, 6 weeks and 6 months postoperatively. Physical and mental summary scores and utility index were primary outcomes, and sub-domains were secondary outcomes. STATISTICAL ANALYSIS USED Mixed-effects linear regressions were used to determine changes in QoL trajectories. RESULTS Of the 254 patients undergoing RAS, 154 underwent urologic, 36 cardiothoracic, 24 colorectal and 40 benign gynaecological surgery. Overall, the average age was 58.8 years and most patients were male (75.1%). Physical summary scores significantly decreased from pre-operative to 6 weeks' post-operative in urologic and colorectal RAS; with all surgical specialities at least returning to pre-operative levels within 6 months postoperatively. Mental summary scores consistently increased from pre-operative to 6 months postoperatively for colorectal and gynaecological RAS. CONCLUSIONS RAS contributed to positive changes in QoL, with physical health returning to the pre-operative level and mental health improvements across specialities, in the short term. While degrees of post-operative changes varied amongst specialities, significant improvements demonstrate benefits in RAS.
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Affiliation(s)
- Ang Li
- Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vitoria, Australia
| | - Christina T Stanislaus
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kate E McBride
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Scott Leslie
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ruban Thanigasalam
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Michelle Cunich
- Boden Initiative, Charles Perkins Centre, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Implementation and Policy, Cardiovascular Initiative, The University of Sydney, Camperdown, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, New South Wales, Australia
- The ANZAC Research Institute, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, New South Wales, Australia
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17
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Porterfield JR, Podolsky D, Ballecer C, Coker AM, Kudsi OY, Duffy AJ, Meara MP, Novitsky YW. Structured Resident Training in Robotic Surgery: Recommendations of the Robotic Surgery Education Working Group. JOURNAL OF SURGICAL EDUCATION 2024; 81:9-16. [PMID: 37827925 DOI: 10.1016/j.jsurg.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/10/2023] [Accepted: 09/10/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE A universal resident robotic surgery training pathway that maximizes proficiency and safety has not been defined by a consensus of surgical educators or by surgical societies. The objective of the Robotic Surgery Education Working Group was to develop a universal curriculum pathway and leverage digital tools to support resident education. DESIGN The two lead authors (JP and YN) contacted potential members of the Working Group. Members were selected based on their authorship of peer-review publications, their experience as minimally invasive and robotic surgeons, their reputations, and their ability to commit the time involved to work collaboratively and efficiently to reach consensus regarding best practices in robotic surgery education. The Group's approach was to reach 100% consensus to provide a transferable curriculum that could be applied to the vast majority of resident programs. SETTING Virtual and in-person meetings in the United States. PARTICIPANTS Eight surgeons (2 females and 6 males) from five academic medical institutions (700-1541 beds) and three community teaching hospitals (231-607 beds) in geographically diverse locations comprised the Working Group. They represented highly specialized general surgeons and educators in their mid-to-late careers. All members were experienced minimally invasive surgeons and had national reputations as robotic surgery educators. RESULTS The surgeons initially developed and agreed upon questions for each member to consider and respond to individually via email. Responses were collated and consolidated to present on an anonymized basis to the Group during an in-person day-long meeting. The surgeons self-facilitated and honed the agreed upon responses of the Group into a 5-level Robotic Surgery Curriculum Pathway, which each member agreed was relevant and expressed their convictions and experience. CONCLUSIONS The current needs for a universal robotic surgery training curriculum are validated objective and subjective measures of proficiency, access to simulation, and a digital platform that follows a resident from their first day of residency through training and their entire career. Refinement of current digital solutions and continued innovation guided by surgical educators is essential to build and maintain a scalable, multi-institutional supported curriculum.
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Affiliation(s)
- John R Porterfield
- Department of Surgery, University of Alabama Birmingham, Birmingham, Alabama.
| | - Dina Podolsky
- Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Conrad Ballecer
- Center for Minimally Invasive and Robotic Surgery, Dignity Health, St. Joseph Medical Center, Phoenix, Arizona
| | - Alisa M Coker
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Omar Yusef Kudsi
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts
| | - Andrew J Duffy
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Michael P Meara
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Yuri W Novitsky
- Department of Surgery, Columbia University Irving Medical Center, New York, New York
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Jain Y, Lanjewar R, Shinde RK. Revolutionising Breast Surgery: A Comprehensive Review of Robotic Innovations in Breast Surgery and Reconstruction. Cureus 2024; 16:e52695. [PMID: 38384645 PMCID: PMC10879655 DOI: 10.7759/cureus.52695] [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: 10/13/2023] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
Robotic innovations in breast surgery have ushered in a new era of precision, safety, and patient-centred care. This comprehensive review explores the multifaceted realm of robotic breast surgery, from preoperative planning to postoperative outcomes, learning curves for surgeons, and the implications for healthcare policies. We examine the ethical considerations, cost-effectiveness, and future directions, including integrating artificial intelligence and telesurgery. Key findings reveal that robotic systems provide improved surgical precision, reduced complications, and enhanced patient satisfaction. Ethical concerns encompass informed consent, resource allocation, and equitable access. The future of breast surgery lies in continued research and development, ensuring that robotics becomes a standard of care accessible to all patients. This technology is reshaping breast surgery and offering new possibilities for minimally invasive, patient-centred care, ultimately redefining the standards of care in this critical field of medicine.
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Affiliation(s)
- Yashraj Jain
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ranjana Lanjewar
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Rivero-Moreno Y, Rodriguez M, Losada-Muñoz P, Redden S, Lopez-Lezama S, Vidal-Gallardo A, Machado-Paled D, Cordova Guilarte J, Teran-Quintero S. Autonomous Robotic Surgery: Has the Future Arrived? Cureus 2024; 16:e52243. [PMID: 38352080 PMCID: PMC10862530 DOI: 10.7759/cureus.52243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 02/16/2024] Open
Abstract
Autonomous robotic surgery represents a pioneering field dedicated to the integration of robotic systems with varying degrees of autonomy for the execution of surgical procedures. This paradigm shift is made possible by the progressive integration of artificial intelligence (AI) and machine learning (ML) into the realm of surgical interventions. While the majority of autonomous robotic systems remain in the experimental phase, a notable subset has successfully transitioned into clinical applications. Noteworthy procedures, such as venipuncture, hair implantations, intestinal anastomosis, total knee replacement, cochlear implant, radiosurgery, and knot tying, among others, exemplify the current capabilities of autonomous surgical systems. This review endeavors to comprehensively address facets of autonomous robotic surgery, commencing with a concise elucidation of fundamental concepts and traversing the pivotal milestones in the historical evolution of robotic surgery. This historical trajectory underscores the incremental assimilation of autonomous systems into surgical practices. This review aims to address topics related to autonomous robotic surgery, starting with a description of fundamental concepts and going through the milestones in robotic surgery history that also show the gradual incorporations of autonomous systems. It also includes a discussion of the key benefits and risks of this technology, the degrees of autonomy in surgical robots, their limitations, the current legal regulations governing their usage, and the main ethical concerns inherent to their nature.
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Affiliation(s)
| | | | | | - Samantha Redden
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, USA
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20
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Peng Y, Liu Y, Lai S, Li Y, Lin Z, Hao L, Dong J, Li X, Huang K. Global trends and prospects in health economics of robotic surgery: a bibliometric analysis. Int J Surg 2023; 109:3896-3904. [PMID: 37720937 PMCID: PMC10720792 DOI: 10.1097/js9.0000000000000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/20/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Over 10 million robotic surgeries have been performed. However, the cost and benefit of robotic surgery need to be evaluated to help hospitals, surgeons, patients, and payers make proper choices, making a health economic analysis necessary. The authors revealed the bibliometric profile in the field of health economics of robotic surgery to prompt research development and guide future studies. MATERIALS AND METHODS The Web of Science Core Collection scientific database was searched for documents indexed from 2003 to 31 December 2022. Document types, years, authors, countries, institutions, journal sources, references, and keywords were analyzed and visualized using the Bibliometrix package, WPS Office software, Microsoft PowerPoint 2019, VOSviewer software (version 1.6.18), ggplot2, and Scimago Graphica. RESULTS The development of the health economics of robotic surgery can be divided into three phases: slow-growing (2003-2009), developing (2010-2018), and fast-developing (2019-2022). J.C.H. and S.L.C. were the most active and influential authors, respectively. The USA produced the most documents, followed by China, and Italy. Korea had the highest number of citations per document. Surgical Endoscopy and Other Interventional Techniques accepted most documents, whereas Annals of Surgery, European Urology, and Journal of Minimally Invasive Gynecology had the highest number of citations per document. The Journal of Robotic Surgery is promising. The most-cited document in this field is New Technology and Health Care Costs - The Case of Robot-Assisted Surgery in 2010. The proportion of documents on urology is decreasing, while documents in the field of arthrology are emerging and flourishing. CONCLUSION Research on the health economics of robotic surgery has been unbalanced. Areas awaiting exploration have been identified. Collaboration between scholars and coverage with provisions for evidence development by the government is needed to learn more comprehensively about the health economics of robotic surgery.
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Affiliation(s)
- Yihao Peng
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Yuancheng Liu
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Sicen Lai
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Yixin Li
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Zexu Lin
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Lingjia Hao
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Jingyi Dong
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Xu Li
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- XiangYa School of Medicine, Central South University
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
| | - Kai Huang
- Department of Dermatology, Xiangya Hospital Central South University
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology
- Furong Laboratory, Hunan, China
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Suarez-Ahedo C, Lopez-Reyes A, Martinez-Armenta C, Martinez-Gomez LE, Martinez-Nava GA, Pineda C, Vanegas-Contla DR, Domb B. Revolutionizing orthopedics: a comprehensive review of robot-assisted surgery, clinical outcomes, and the future of patient care. J Robot Surg 2023; 17:2575-2581. [PMID: 37639163 DOI: 10.1007/s11701-023-01697-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
Robotic-assisted orthopedic surgery (RAOS) is revolutionizing the field, offering the potential for increased accuracy and precision and improved patient outcomes. This comprehensive review explores the historical perspective, current robotic systems, advantages and limitations, clinical outcomes, patient satisfaction, future developments, and innovation in RAOS. Based on systematic reviews, meta-analyses, and recent studies, this article highlights the most significant findings and compares RAOS to conventional techniques. As robotic-assisted surgery continues to evolve, clinicians and researchers must stay informed and adapt their practices to provide optimal patient care. Evidence from published studies corroborates these claims, highlighting superior component positioning, decreased incidence of complications, and heightened patient satisfaction. However, challenges such as costs, learning curves, and technical issues must be resolved to fully capitalize on these advantages.
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Affiliation(s)
- Carlos Suarez-Ahedo
- Instituto Nacional de Rehabilitación, Mexico City, Mexico.
- American Hip Institute, Des Plaines, IL, USA.
| | | | | | | | | | - Carlos Pineda
- Instituto Nacional de Rehabilitación, Mexico City, Mexico
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Reddy K, Gharde P, Tayade H, Patil M, Reddy LS, Surya D. Advancements in Robotic Surgery: A Comprehensive Overview of Current Utilizations and Upcoming Frontiers. Cureus 2023; 15:e50415. [PMID: 38222213 PMCID: PMC10784205 DOI: 10.7759/cureus.50415] [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: 09/10/2023] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
Robotic surgery, a groundbreaking advancement in medical technology, has redefined the landscape of surgical procedures. This comprehensive overview explores the multifaceted world of robotic surgery, encompassing its definition, historical development, current applications, clinical outcomes, benefits, emerging frontiers, challenges, and future implications. We delve into the fundamentals of robotic surgical systems, examining their components and advantages. From general and gynecological surgery to urology, cardiac surgery, orthopedics, and beyond, we highlight the diverse specialties where robotic surgery is making a significant impact. The many benefits discussed include improved patient outcomes, reduced complications, faster recovery times, cost-effectiveness, and enhanced surgeon experiences. The outlook reveals a healthcare landscape where robotic surgery is increasingly vital, enabling personalized medicine, bridging healthcare disparities, and advancing surgical precision. However, challenges such as cost, surgeon training, technical issues, ethical considerations, and patient acceptance remain relevant. In conclusion, robotic surgery is poised to continue shaping the future of health care, offering transformative possibilities while emphasizing the importance of collaboration, innovation, and ethical governance.
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Affiliation(s)
- Kavyanjali Reddy
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Gharde
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshal Tayade
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mihir Patil
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Lucky Srivani Reddy
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dheeraj Surya
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Weerarathna IN, Raymond D, Luharia A. Human-Robot Collaboration for Healthcare: A Narrative Review. Cureus 2023; 15:e49210. [PMID: 38143700 PMCID: PMC10739095 DOI: 10.7759/cureus.49210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
Robotic applications have often quickly transitioned from industrial to social. Because of this, robots can now engage with people in a natural way and blend in with their surroundings. Due to the lack of medical professionals, growing healthcare costs, and the exponential rise in the population of vulnerable groups like the ill, elderly, and children with developmental disabilities, the use of social robots in the healthcare system is expanding. As a result, social robots are employed in the medical field to entertain and educate hospitalized patients about health issues, as well as to assist the elderly and sick. They are also employed in the dispensing of medications, rehabilitation, and emotional and geriatric care. Thus, social robots raise the standard and effectiveness of medical care. This article explains how patients and healthcare professionals collaborate with robots in the healthcare industry. The objectives of this collaboration are to resolve moral and legal concerns, improve patient outcomes, and improve healthcare delivery. It has a broad range of uses, including telemedicine, rehabilitation, and robotic surgical support. Human-robot interaction is the term used to describe interactions between social robots and people. Many obstacles stand in the way of human-robot interaction in healthcare, including safety concerns, acceptability issues, appropriateness, usefulness, and the worry that robots may replace human carers. In the end, these difficulties result in a poor adoption rate for robotic technology. As a result, the applications and difficulties of human-robot interaction in healthcare are thoroughly evaluated in this research. This study also reviews future safety prospects from human-robot interaction in healthcare, as well as ethical and usability issues including privacy, trust, and safety, and our aims to provide a comprehensive overview of the use of robots in healthcare, including their applications, benefits, challenges, and prospects, to facilitate a deeper understanding of this evolving field.
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Affiliation(s)
- Induni N Weerarathna
- Biomedical Sciences, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - David Raymond
- Computer Science and Medical Engineering, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anurag Luharia
- Radiotherapy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Yelne S, Chaudhary M, Dod K, Sayyad A, Sharma R. Harnessing the Power of AI: A Comprehensive Review of Its Impact and Challenges in Nursing Science and Healthcare. Cureus 2023; 15:e49252. [PMID: 38143615 PMCID: PMC10744168 DOI: 10.7759/cureus.49252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
This comprehensive review delves into the impact and challenges of Artificial Intelligence (AI) in nursing science and healthcare. AI has already demonstrated its transformative potential in these fields, with applications spanning from personalized care and diagnostic accuracy to predictive analytics and telemedicine. However, the integration of AI has its complexities, including concerns related to data privacy, ethical considerations, and biases in algorithms and datasets. The future of healthcare appears promising, with AI poised to advance diagnostics, treatment, and healthcare practices. Nevertheless, it is crucial to remember that AI should complement, not replace, healthcare professionals, preserving the essential human element of care. To maximize AI's potential in healthcare, interdisciplinary collaboration, ethical guidelines, and the protection of patient rights are essential. This review concludes with a call to action, emphasizing the need for ongoing research and collective efforts to ensure that AI contributes to improved healthcare outcomes while upholding the highest standards of ethics and patient-centered care.
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Affiliation(s)
- Seema Yelne
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Minakshi Chaudhary
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Karishma Dod
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akhtaribano Sayyad
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ranjana Sharma
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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25
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Aramini B, Masciale V, van Vugt JLA. Editorial: Innovations in surgical oncology. Front Oncol 2023; 13:1257762. [PMID: 37621685 PMCID: PMC10446962 DOI: 10.3389/fonc.2023.1257762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Affiliation(s)
- Beatrice Aramini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences (DIMEC) of the Alma Mater Studiorum, University of Bologna, Giovanni Battista Morgagni—Luigi Pierantoni Hospital, Forlì, Italy
| | - Valentina Masciale
- Division of Oncology, Laboratory of Cellular Therapy, Department of Medical and Surgical Sciences for Children & Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Jeroen L. A. van Vugt
- Department of Surgery, Erasmus Medical Center (MC) University Medical Center, Rotterdam, Netherlands
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26
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Smith C, Fowler J, Ferreira L, Moore C. Robot-Assisted Nasal Reconstruction: A Cadaveric Study. J Craniofac Surg 2023; 34:1343-1346. [PMID: 36913619 DOI: 10.1097/scs.0000000000009272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/11/2022] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE Manual contouring of cartilage for nasal reconstruction is tedious and time-consuming. The use of a robot could improve the speed and precision of the contouring process. This cadaveric study evaluates the efficiency and accuracy of a robot methodology for contouring the lower lateral cartilage of the nasal tip. METHODS An augmented robot with a spherical burring tool attached was utilized to carve 11 cadaveric rib cartilage specimens. In phase 1, the right lower lateral cartilage was harvested from a cadaveric specimen and used to define a carving path for each rib specimen. In phase 2, the cartilage remained in situ during the scanning and 3-dimensional modeling. The final carved specimens were compared with the preoperative plans through topographical accuracy analysis. The contouring times of the specimens were compared with 14 retrospectively reviewed cases (2017-2020) by an experienced surgeon. RESULTS Phase 1 root mean square error of 0.40±0.15 mm and mean absolute deviation of 0.33±0.13 mm. Phase 2 root mean square error of 0.43 mm and mean absolute deviation of 0.28 mm. The average carving time for the robot specimens was 14±3 minutes and 16 minutes for Phase 1 and Phase 2, respectively. The average manual carving by an experienced surgeon was 22±4 minutes. CONCLUSIONS Robot-assisted nasal reconstruction is very precise and more efficient than manual contouring. This technique represents an exciting and innovative alternative for complex nasal reconstruction.
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Affiliation(s)
- Corey Smith
- Department of Mechanical and Materials Engineering, The University of Western Ontario
| | - James Fowler
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Louis Ferreira
- Department of Mechanical and Materials Engineering, The University of Western Ontario
| | - Corey Moore
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
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Ng AP, Sanaiha Y, Bakhtiyar SS, Ebrahimian S, Branche C, Benharash P. National analysis of cost disparities in robotic-assisted versus laparoscopic abdominal operations. Surgery 2023; 173:1340-1345. [PMID: 36959072 DOI: 10.1016/j.surg.2023.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 02/11/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Although the use of robotic-assisted surgery continues to expand, the cost-effectiveness of this platform remains unclear. The present study aimed to compare hospitalization costs and clinical outcomes between robotic-assisted surgery and laparoscopic approaches for major abdominal operations. METHODS All adults receiving minimally invasive gastrectomy, cholecystectomy, colectomy (right, left, transverse, sigmoid), ventral hernia repair, hysterectomy, and abdominoperineal resection were identified in the 2012 to 2019 National Inpatient Sample. Records with concurrent operations were excluded. Multivariable linear and logistic regressions were developed to examine the association of the operative approach with costs, length of stay, and complications. An interaction term between the year and operative approach was used to analyze cost differences over time. RESULTS Of an estimated 1,124,450 patients, 75.8% had laparoscopic surgery, and 24.2% had robotic-assisted surgery. Compared to laparoscopic, patients with robotic-assisted operations were younger and more commonly privately insured. The average hospitalization cost for laparoscopic cases was $16,000 ± 14,800 and robotic-assisted cases was $18,300 ± 13,900 (P < .001). Regardless of procedure type, all robotic-assisted operations had higher costs compared to laparoscopic operations. Risk-adjusted trend analysis revealed that the discrepancy in costs between laparoscopic and robotic-assisted surgery persisted and widened over time from $1,600 in 2012 to $2,600 in 2019. Compared to laparoscopic procedures, robotic procedures had a 2.2% reduction in complications (9.4 vs 11.6%, P < .001) and a 0.7-day decrement in the length of stay (95% confidence interval -0.8 to -0.7). CONCLUSION Disparities in costs between robotic and laparoscopic abdominal operations have persisted over time. Given the modest decrement in adverse outcomes, further investigation into the clinical benefits of robotic surgery is warranted to justify its greater costs.
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Affiliation(s)
- Ayesha P Ng
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California-Las Angeles, CA. http://www.twitter.com/Ng_Ayesha
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California-Las Angeles, CA; Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at University of California-Las Angeles, CA
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California-Las Angeles, CA; Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at University of California-Las Angeles, CA; Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Shayan Ebrahimian
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California-Las Angeles, CA
| | - Corynn Branche
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California-Las Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California-Las Angeles, CA; Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at University of California-Las Angeles, CA.
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Gkeka K, Tsaturyan A, Faitatziadis S, Peteinaris A, Anaplioti E, Pagonis K, Vagionis A, Tatanis V, Vrettos T, Kallidonis P, Liatsikos E. Robot-Assisted Radical Nephrectomy Using the Novel Avatera Robotic Surgical System: A Feasibility Study in a Porcine Model. J Endourol 2023; 37:273-278. [PMID: 36274228 DOI: 10.1089/end.2022.0596] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: To evaluate the feasibility and intraoperative technical parameters of the new robot-assisted surgical system Avatera by performing bilateral nephrectomy in a live porcine model. Materials and Methods: Six pigs underwent bilateral robot-assisted radical nephrectomy using the Avatera robotic system (RS). The operations were performed by experienced open (Group 1) and laparoscopic (Group 2) surgeons. The operating time, docking time, set-up time, and console time were evaluated. Data regarding intraoperative complications (major or not), injury of adjacent organs, and technical difficulties during the operation were also recorded. Results: Robot-assisted bilateral nephrectomy was completed effectively in all sample pigs. The docking time and set-up time were similar among the two groups, whereas the console time and operating time were significantly longer for the open surgeon group. Two intraoperative minor complications occurred in the open surgeon's group. An inadvertent damage of the renal vein occurred in two cases and the bleeding was controlled effectively. Other than the initial two cases, the estimated blood loss was <50 mL in both groups. Injury of the adjacent organs was not noticed. Conclusions: The study demonstrated that radical nephrectomy using the Avatera robotic surgical system is technically feasible, safe, and valid in pigs. Our results warrant the application of the Avatera RS in other urologic procedures, collecting data for further clinical trials.
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Affiliation(s)
- Kristiana Gkeka
- Department of Urology and University of Patras, Patras, Greece
| | - Arman Tsaturyan
- Department of Urology and University of Patras, Patras, Greece
| | | | | | | | | | | | | | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | | | - Evangelos Liatsikos
- Department of Urology and University of Patras, Patras, Greece.,Department of Urology, Medical University of Vienna, Vienna, Austria
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29
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Trela KC, Dhawan R. Intrathecal Morphine for Analgesia in Robotic Totally Endoscopic Coronary Artery Bypass and Myocardial Bridge Unroofing. J Cardiothorac Vasc Anesth 2023; 37:316-321. [PMID: 36379834 DOI: 10.1053/j.jvca.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Kristin C Trela
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Richa Dhawan
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
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30
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Myneni AA, Brophy T, Harmon B, Boccardo JD, Burstein MD, Schwaitzberg SD, Noyes K, Hoffman AB. The impact of disclosure of conflicts of interest in studies comparing robot-assisted and laparoscopic cholecystectomies-a persistent problem. Surg Endosc 2023; 37:1515-1527. [PMID: 35851821 DOI: 10.1007/s00464-022-09440-2] [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: 03/19/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Accurate disclosure of conflicts of interest (COI) is critical to interpretation of study results, especially when industry interests are involved. We reviewed published manuscripts comparing robot-assisted cholecystectomy (RAC) and laparoscopic cholecystectomy (LC) to evaluate the relationship between COI disclosures and conclusions drawn on the procedure benefits and safety profile. METHODS Searching Pubmed and Embase using key words "cholecystectomy", laparoscopic" and "robotic"/"robot-assisted" retrieved 345 publications. Manuscripts that compared benefits and safety of RAC over LC, had at least one US author and were published between 2014 and 2020 enabling verification of disclosures with reported industry payments in CMS's Open Payments database (OPD) (up to 1 calendar year prior to publication) were included in the analysis (n = 37). RESULTS Overall, 26 (70%) manuscripts concluded that RAC was equivalent or better than LC (RAC +) and 11 (30%) concluded that RAC was inferior to LC (RAC-). Six manuscripts (5 RAC + and 1 RAC-) did not have clearly stated COI disclosures. Among those that had disclosure statements, authors' disclosures matched OPD records among 17 (81%) of RAC + and 9 (90%) RAC- papers. All 11 RAC- and 17 RAC + (65%) manuscripts were based on retrospective cohort studies. The remaining RAC + papers were based on case studies/series (n = 4), literature review (n = 4) and clinical trial (n = 1). A higher proportion of RAC + (85% vs 45% RAC-) manuscripts used data from a single institution. Authors on RAC + papers received higher amounts of industry payments on average compared to RAC- papers. CONCLUSIONS It is imperative for authors to understand and accurately disclose their COI while disseminating scientific output. Journals have the responsibility to use a publicly available resource like the OPD to verify authors' disclosures prior to publication to protect the process of scientific authorship which is the foundation of modern surgical care.
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Affiliation(s)
- Ajay A Myneni
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA
| | - Taylor Brophy
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Brooks Harmon
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Joseph D Boccardo
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Matthew D Burstein
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA.,Department of Surgery, University Hospitals, Cleveland, OH, USA
| | - Steven D Schwaitzberg
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA
| | - Katia Noyes
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA.,Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Aaron B Hoffman
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA.
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Bauerle WB, Mody P, Estep A, Stoltzfus J, El Chaar M. Current Trends in the Utilization of a Robotic Approach in the Field of Bariatric Surgery. Obes Surg 2023; 33:482-491. [PMID: 36572836 PMCID: PMC9792156 DOI: 10.1007/s11695-022-06378-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE The utilization rate of robotic surgery for bariatric procedures is not well-described. Our study identified the proportion of metabolic and bariatric surgery (MBS) procedures in the United States between 2015 and 2020 performed using a robotic (R-) or laparoscopic (L-) approach. MATERIALS AND METHODS A descriptive analysis of the 2015-2020 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant User Data File (PUF) datasets was performed. The primary outcome was (1) surgical cases performed annually and (2) proportion of cases performed using a R- or L- approach. Analysis was done separately for sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), and revisional bariatric surgery (RBS). Statistical analysis consisted of means and proportions, fold difference, annual slope, and Student's t tests or chi-square tests as appropriate, with statistical significance set to p < .05. RESULTS A total of 1,135, 214 procedures were captured between 2015 and 2020. R-RYGB increased from 2554 to 6198 (6.8% to 16.7%), R-SG increased from 5229 to 17,063 (6.0% to 17.2%), R-RBS increased from 993 to 3386 (4.7% to 17.4%), and R-BPD-DS increased from 221 to 393 (22.0% to 28.4%). The greatest annual increase was observed among R-RBS and R-SG (3.70-fold difference; slope 2.4% per year and 2.87-fold difference; slope 2.2% per year, respectively). CONCLUSION There is a nationwide increase in the utilization of a R- approach in bariatric surgery. There are concerns related to the potential increase in healthcare expenditures related to robotics. Further studies are needed to establish key performance indicators along with guidelines for training, adoption and utilization of a R- approach.
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Affiliation(s)
- Wayne B Bauerle
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Pooja Mody
- Division of Bariatric Surgery, Department of Surgery, St. Luke's University Hospital and Network, Bethlehem, PA, USA
| | - Allison Estep
- Division of Bariatric Surgery, Department of Surgery, St. Luke's University Hospital and Network, Bethlehem, PA, USA
| | - Jill Stoltzfus
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Maher El Chaar
- Division of Bariatric Surgery, Department of Surgery, St. Luke's University Hospital and Network, Bethlehem, PA, USA.
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Guerrero DT, Asaad M, Rajesh A, Hassan A, Butler CE. Advancing Surgical Education: The Use of Artificial Intelligence in Surgical Training. Am Surg 2023; 89:49-54. [PMID: 35570822 DOI: 10.1177/00031348221101503] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The technology of artificial intelligence (AI) has made significant in-roads into the field of medicine over the last decade. With surgery being a discipline where repetition is the key to mastery, the scope of AI presents enormous potential for resident education through the analysis of technique and delivery of structured feedback for performance improvement. In an era marred by a raging pandemic that has decreased exposure and opportunity, AI offers an attractive solution towards improving operating room efficiency, safe patient care in the hands of supervised residents and can ultimately culminate in reduced health care costs. Through this article, we elucidate the current adoption of the artificial intelligence technology and its prospects for advancing surgical education.
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Affiliation(s)
- David T Guerrero
- 12317University of Pittsburgh Medical School, Pittsburgh, PA, USA
| | - Malke Asaad
- Department of Plastic Surgery, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Aashish Rajesh
- 14742University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Abbas Hassan
- Department of Plastic Surgery, 571198The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles E Butler
- Department of Plastic Surgery, 571198The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Cost-Effectiveness of Totally Robotic and Conventional Laparoscopic Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2022.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Han H, Kim J, Moon YJ, Jung HD, Cheon B, Han J, Cho SY, Kwon DS, Lee JY. Feasibility of Laser Lithotripsy for Midsize Stones Using Robotic Retrograde Intrarenal Surgery System easyUretero in a Porcine Model. J Endourol 2022; 36:1586-1592. [PMID: 35850514 DOI: 10.1089/end.2022.0272] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: To test the safety and feasibility of laser lithotripsy for midsize renal stones using a newly developed robotic retrograde intrarenal surgery (RIRS) system (easyUretero) in a porcine model. Materials and Methods: Three urologic surgeons representing three different RIRS experience levels (beginner, intermediate, and expert) participated. Four female pigs (aged 6 months) underwent manual or robotic RIRS. Under general anesthesia, a nephrostomy tract was created ventrally, and calcium stones (diameter, 1.0-1.5 cm) were inserted at renal calices. For manual RIRS, surgeons operated a flexible ureteroscope. For robotic RIRS, the ureteroscope was attached to the robotic slave device. The Auriga XL™ Holmium laser was used for lithotripsy. Lasering and stone retrieval time were measured. Kidneys and ureters were inspected for injury at the end of each session. Results: For the expert, both lasering and stone retrieval by manual RIRS were quicker than by robotic RIRS (22.8 ± 11.0 s/stone vs 234.5 ± 102.5 s/stone, p = 0.02; 41.5 ± 0.5 s/stone vs 79.3 ± 8.1 s/stone, p = 0.02). For the intermediate and beginner, lasering and stone retrieval times were not significantly different between manual and robotic procedures (127.8 ± 93.2 s/stone vs 284.8 ± 112.3 s/stone, p = 0.08; 86.0 ± 30.5 s/stone vs 84.1 ± 21.4 s/stone, p = 0.92). All stones were removed. Grade 1 ureteral and renal injuries occurred in both manual RIRS and robotic RIRS. Conclusions: The laser lithotripsy using the easyUretero robotic system is safe and feasible in a porcine model, even for less-experienced surgeons.
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Affiliation(s)
- Hyunho Han
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | | | - Young Joon Moon
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hae Do Jung
- Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Byungsik Cheon
- ROEN Surgical, Inc., Daejeon, Korea
- Robotics Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Jungmin Han
- ROEN Surgical, Inc., Daejeon, Korea
- Robotics Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Soo Kwon
- ROEN Surgical, Inc., Daejeon, Korea
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea
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Porras Rodriguez P, Kapadia S, Moazzez A, Singer G, Neville A, Yetasook A, Dauphine C. Should Robotic Surgery Training Become a General Surgery Residency Requirement? A National Survey of Program Directors in Surgery. JOURNAL OF SURGICAL EDUCATION 2022; 79:e242-e247. [PMID: 35831236 DOI: 10.1016/j.jsurg.2022.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Robotic-assisted surgery (RAS) accounts for 15% of general surgery (GS) operations performed and is set to grow in prevalence. Currently, there are no training requirements or standard robotic curricula for GS residents. This study aimed to query GS program directors (PDs) on the necessity, extent, and potential impact of including RAS as a required component of residency training. DESIGN Analysis of responses to a 14-question web-based survey. SETTING Survey was distributed to PDs via the Association of Program Directors in Surgery listserv in April and May 2021. PARTICIPANTS General surgery program directors RESULTS: Among 140 respondents, 110 (78.6%) agreed that operating at the robotic console should be a GS residency requirement, yet 93 (66.4%) indicated that RAS exposure negatively impacts the acquisition of other necessary skills. Still, 116 (82.9%) agreed that RAS training provided a net benefit to GS residents, PDs at academic programs were more supportive than those at independent programs of RAS console training requirements (68.2% versus 46.7%, p = 0.048). The median response to the ideal proportion of abdominopelvic cases performed by graduation was 20% robotic, 40% laparoscopic, and 35% open. The suggested minimum number of robotic cases that should be performed by graduation was indicated to be 30 cases by 26% of respondents, 20 by 23%, 10 by 12%, 5 by 4%, and "no minimum" by 36%. CONCLUSIONS There is strong interest among PDs to institute RAS training requirements for GS residents. This study provides PD perspectives to help inform national conversations on whether and to what extent RAS requirements should be included in GS residency training.
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Affiliation(s)
| | - Sonam Kapadia
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Ashkan Moazzez
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - George Singer
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Angela Neville
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Amy Yetasook
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Christine Dauphine
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
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Kuris EO, Anderson GM, Osorio C, Basques B, Alsoof D, Daniels AH. Development of a Robotic Spine Surgery Program: Rationale, Strategy, Challenges, and Monitoring of Outcomes After Implementation. J Bone Joint Surg Am 2022; 104:e83. [PMID: 36197328 DOI: 10.2106/jbjs.22.00022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Surgical robots were invented in the 1980s, and since then, robotic-assisted surgery has become commonplace. In the field of spine surgery, robotic assistance is utilized mainly to place pedicle screws, and multiple studies have demonstrated that robots can increase the accuracy of screw placement and reduce radiation exposure to the patient and the surgeon. However, this may be at the cost of longer operative times, complications, and the risk of errors in mapping the patient's anatomy.
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Affiliation(s)
- Eren O Kuris
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - George M Anderson
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Camilo Osorio
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bryce Basques
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Mahmud KA, Ghazali FNF, Zahari MNI, Halim HA, Khalid AK, Toh ST, Yunus MRM. Practising transoral robotic surgery in a middle-income country: surgical outcomes and early challenges. J Robot Surg 2022; 17:613-618. [PMID: 36183030 DOI: 10.1007/s11701-022-01456-z] [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: 01/29/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022]
Abstract
Transoral robotic surgery is a minimally invasive surgical technique that recently debuted in Malaysia. However, there are concerns over its cost, practicality, and feasibility in local settings. Our study aims to evaluate the surgical outcomes of transoral robotic surgery and discuss its learning curves. The clinical records of all patients who underwent transoral robotic surgery in a university hospital were reviewed. 25 patients were identified with a mean age of 43.9 years. The commonest indication was obstructive sleep apnoea (OSA) (76%), followed by base of tongue carcinoma (16%), recurrent tonsilitis and Wharton's duct cyst (4% each). For excision of tongue base in obstructive sleep apnoea without epiglottectomy, the mean operating time was 2.3(±0.9) hours with an average of 2.8(±0.4) days of hospital stay. The success rate for OSA surgery was seen in 78.9% of cases. The mean operating time for transoral excision of tongue base carcinoma was 4.3(±2.5) hours, whereas the mean hospital stay was 9(±3.6) days. All surgical margins were cleared with no recurrence except for one patient. The recurrent tumour was successfully excised via transoral robotic surgery, and he remained disease free after one year. The most frequent post-operative complaints were dysphagia, post-nasal drip, and hypogeusia. Transoral robotic surgery in Malaysia is in the commencement phase, where some pitfalls are expected. Opportunities should be given for more surgeons to acquire this technique so that minimally invasive surgery for head and neck diseases is readily available for patients in middle-income countries.
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Affiliation(s)
- Khairil Afif Mahmud
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | | | - Haizlene Abd Halim
- Faculty of Medicine, Sungai Buloh Campus, UiTM Selangor Branch, Sungai Buloh, Selangor, Malaysia
| | - Ahmad Kusyairi Khalid
- Department of Otorhinolaryngology-Head and Neck Surgery, UiTM Private Specialist Centre, Jalan Hospital, 47000, Sg. Buloh, Selangor Darul Ehsan, Malaysia.
| | - Song Tar Toh
- Department of Otolaryngology and Head, Singhealth Duke-NUS Sleep Centre, Singapore, Singapore
| | - Mohd Razif Mohamad Yunus
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Evaluation of Surgical Morbidity After Hysterectomy During an Obesity Epidemic. Obstet Gynecol 2022; 139:589-596. [DOI: 10.1097/aog.0000000000004699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
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Pandav K, Te AG, Tomer N, Nair SS, Tewari AK. Leveraging 5G technology for robotic surgery and cancer care. Cancer Rep (Hoboken) 2022; 5:e1595. [PMID: 35266317 PMCID: PMC9351674 DOI: 10.1002/cnr2.1595] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/09/2021] [Accepted: 11/10/2021] [Indexed: 01/20/2023] Open
Abstract
Background The field of robotic surgery has seen significant advancements in the past few years and it has been adopted in many large hospitals in the United States and worldwide as a standard for various procedures in recent years. However, the location of many hospitals in urban areas and a lack of surgical expertise in the rural areas could lead to increased travel time and treatment delays for patients in need of robotic surgical management, including cancer patients. The fifth generation (5G) networks have been deployed by various telecom companies in multiple countries worldwide. Our aim is to update the readers about the novel technology and the current scenario of surgical procedures performed using 5G technology. In this article, we also discuss how the technology could aid cancer patients requiring surgical management, the future perspectives, the potential challenges, and the limitations, which would need to overcome prior to widespread real‐life use of the technology for cancer care. Recent findings The expansion of 5G technology has enabled some countries to conduct remote surgical procedures, tele‐mentored and real‐time interactive procedures on animal models, cadavers, and humans, demonstrating that 5G networks could offer a potential solution to previously experienced latency and reliability hurdles during the remote surgeries performed in the 2000s. Conclusion New technological advancements could serve as a ground for emerging novel therapeutic applications. While limitations and challenges related to the 5G infrastructure, cost, compatibility, and security exist; researching to overcome the limitations and comprehend the potential benefits of integrating the technology into practice would be imminent before widespread clinical use. Remote and tele‐mentored 5G‐powered procedures could offer a new tool in improving the care of patients requiring robotic surgical management such as prostate cancer patients.
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Affiliation(s)
- Krunal Pandav
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Austen G Te
- Laboratory of Biochemical Genetics and Metabolism, The Rockefeller University, New York, NY, USA
| | - Nir Tomer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sujit S Nair
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Potapov PA, Timoshenko DS, Armashov VP, Matveev NL, Belousov AM. [Robotic-assisted surgery: yesterday, today, tomorrow]. Khirurgiia (Mosk) 2022:29-35. [PMID: 36398952 DOI: 10.17116/hirurgia202211129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Analysis of development of «robotic surgery» on the basis of historical prerequisites, review of the possibilities of the new Senhance robotic surgical system and determination of further perspective. MATERIAL AND METHODS A prospective group of 51 patients with surgical pathology who underwent surgical interventions using the new Senhance robotic system was analyzed. The study included 51 patients. Robot-assisted cholecystectomy was performed in 20 patients, 31 patients underwent robotic transabdominal preperitoneal plastic surgery. RESULTS A short-term analysis of intraoperative and early postoperative data showed the safety of using the Senhance robotic complex for the patient. The ergonomics of this system contributes to significantly less fatigue of the surgeon during the operation, increasing its efficiency and safety. CONCLUSION The emergence of competitive robotic systems contributes to the dynamic development of robotic surgery, which in turn will lead to a reduction in the cost of these technologies in the future. Innovative solutions used in modern robotic complexes are based on the principles of machine learning, which in due time will make the «robot surgeon» not just a tool, but a full-fledged member of the operating team.
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Affiliation(s)
- P A Potapov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - D S Timoshenko
- Loginov Moscow Clinical Scientific Center Department of Healthcare, Moscow, Russia
| | - V P Armashov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - N L Matveev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A M Belousov
- Loginov Moscow Clinical Scientific Center Department of Healthcare, Moscow, Russia
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Abstract
In recent decades, healthcare organizations around the world have increasingly appreciated the value of information technologies for a variety of applications. Three of the new technological advancements that are impacting smart health are metaverse, artificial intelligence (AI), and data science. The metaverse is the intersection of three major technologies — AI, augmented reality (AR), and virtual reality (VR). Metaverse provides new possibilities and potential that are still emerging. The increased work efficiency enabled by artificial intelligence and data science in hospitals not only improves patient care but also cuts costs and workload for healthcare providers. Artificial intelligence, coupled with machine learning, is transforming the healthcare industry. The availability of big data enables data scientists to use the data for descriptive, predictive, and prescriptive analytics. This article reviews multiple case studies and the literature on AI and data science applications in hospital administration. The article also presents unresolved research questions and challenges in the applications of the metaverse, AI, and data science in the smart health context. For researchers, in addition to providing a good synopsis of the development and applications of the metaverse, AI, and data science in the healthcare area, this article identifies possible future research directions and discusses the possibilities of the metaverse, artificial intelligence, and data science in smart health. For practitioners, this article provides both hospital decision-makers and healthcare workers with practical guidelines and a smart health management model.
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Affiliation(s)
- Yin Yang
- West China Hospital, Sichuan University, China
| | | | - Wen Xie
- West China Hospital, Sichuan University, China
| | - Yan Sun
- Nanyang Technological University, Singapore
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42
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Geldmaker LE, Hasse CH, Baird B, Haehn DA, Anyane-Yeboah AN, Wieczorek MA, Thomas Ball CS, Dora C, Lyon TD, Thiel DD. Analysis of Operating Room (OR) Efficiency During Robotic-Assisted Urologic Surgeries Utilizing Fixed (Nonprocedural) Operative Times. J Endourol 2021; 36:654-660. [PMID: 34937418 DOI: 10.1089/end.2021.0673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To analyze operating room (OR) efficiency by evaluating fixed OR times for three common urologic robotic-assisted procedures. Methods: Over a 24-month period, we prospectively collected intraoperative data for 635-consecutive robotic-assisted surgeries. Fixed (nonprocedural) OR times were evaluated for robotic-assisted partial nephrectomy (RAPN) (n=146), robotic-assisted radical cystectomy (RARC) (n=77), and robotic-assisted radical prostatectomy (RARP) (n=412). Fixed OR times were defined as nonprocedural time in the OR, including: in room time to anesthesia release time (IRAT), anesthesia release to cut time (ARCT), in room time to cut time (IRCT; IRAT + ARCT), and close time to wheels out time (CTWO). The effects of surgery time of day and the number of anesthesia personnel (AP) present in surgery on fixed OR times were also analyzed. Results: Fixed OR times occupied 15.1% (IQR: 12.9%-17.1%) (RARC), 26.6% (22.9%-30.8%) (RAPN), and 20.1% (17.4%-23.1%) (RARP) of total OR time. Time of day did not have a negative effect on fixed OR times for robotic urologic surgeries. Median AP count was highest for RARC (median: 3, range: 1-7). We did not find any association between AP count and fixed OR times for any of the procedures (P≥0.19). Conclusions: Fixed OR times made up a significant percentage of total OR time for robotic-assisted procedures and should be incorporated into OR efficiency analyses. The number of AP per case and time of day of surgery did not negatively impact fixed OR times in urologic robotic surgeries.
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Affiliation(s)
- Laura E Geldmaker
- Mayo Clinic Jacksonville, Department of Urology, Jacksonville, Florida, United States;
| | - Christopher H Hasse
- Mayo Clinic Jacksonville, Department of Administration, Jacksonville, Florida, United States;
| | - Bryce Baird
- Mayo Clinic Florida, 23389, Urology, Jacksonville, Florida, United States;
| | - Daniela A Haehn
- Mayo Clinic Florida, 23389, Urology, 4500 San Pablo Rd S, Jacksonville, Florida, United States, 32224;
| | - Abena N Anyane-Yeboah
- Mayo Clinic Jacksonville, Department of Administration, Jacksonville, Florida, United States;
| | - Mikolaj A Wieczorek
- Mayo Clinic Jacksonville, Department of Biomedical Statistics and Informatics, Jacksonville, Florida, United States;
| | - Colleen S Thomas Ball
- Mayo Clinic, Biomedical Statistics and Informatics, Jacksonville, Florida, United States;
| | - Chandler Dora
- Mayo Clinic Florida, 23389, 4500 San Pablo Road, Department of Urology, Jacksonville, Jacksonville, Florida, United States, 32224-1865;
| | - Timothy D Lyon
- Mayo Clinic Hospital Jacksonville, 156400, Urology, Jacksonville, Florida, United States;
| | - David D Thiel
- Mayo Clinic Jacksonville, Department of Urology, 4500 San Pablo Road, Jacksonville, Florida, United States, 32224.,University of Iowa, Department of Urology, 200 Hawkins Drive, Iowa City, Iowa, United States, 52242;
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Jumaa MA, Salahuddin H, Burgess R. The Future of Endovascular Therapy. Neurology 2021; 97:S185-S193. [PMID: 34785617 DOI: 10.1212/wnl.0000000000012807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 04/13/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE REVIEW This article summarizes a broad range of the most recent advances and future directions in stroke diagnostics, endovascular robotics, and neuromodulation. RECENT FINDINGS In the past 5 years, the field of interventional neurology has seen major technological advances for the diagnosis and treatment of cerebrovascular diseases. Several new technologies became available to aid in complex prehospital stroke triage, stroke diagnosis, and interpretation of radiologic findings. Robotics and neuromodulation promise to expand access to established treatments and broaden neuroendovascular indications. SUMMARY Mobile applications offer a solution to simplify prehospital diagnostic and transfer decisions. Several prehospital devices are also under development to improve the accuracy of detection of large vessel occlusion (LVO). Artificial intelligence is now routinely used in early diagnosis of LVO and for detecting salvageability of the affected brain parenchyma. Technological advances have also paved the way to incorporate endovascular robotics and neuromodulation into practice. This may expand the deliverability of established treatments and facilitate the development of cutting-edge treatments for other complex neurologic diseases.
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Affiliation(s)
- Mouhammad A Jumaa
- From the Department of Neurology, ProMedica Neurosciences Institute; and Department of Neurology, University of Toledo College of Medicine, OH.
| | - Hisham Salahuddin
- From the Department of Neurology, ProMedica Neurosciences Institute; and Department of Neurology, University of Toledo College of Medicine, OH
| | - Richard Burgess
- From the Department of Neurology, ProMedica Neurosciences Institute; and Department of Neurology, University of Toledo College of Medicine, OH
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Cawich SO, Kluger MD, Francis W, Deshpande RR, Mohammed F, Bonadie KO, Thomas DA, Pearce NW, Schrope BA. Review of minimally invasive pancreas surgery and opinion on its incorporation into low volume and resource poor centres. World J Gastrointest Surg 2021; 13:1122-1135. [PMID: 34754382 PMCID: PMC8554718 DOI: 10.4240/wjgs.v13.i10.1122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/19/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Pancreatic surgery has been one of the last areas for the application of minimally invasive surgery (MIS) because there are many factors that make laparoscopic pancreas resections difficult. The concept of service centralization has also limited expertise to a small cadre of high-volume centres in resource rich countries. However, this is not the environment that many surgeons in developing countries work in. These patients often do not have the opportunity to travel to high volume centres for care. Therefore, we sought to review the existing data on MIS for the pancreas and to discuss. In this paper, we review the evolution of MIS on the pancreas and discuss the incorporation of this service into low-volume and resource-poor countries, such as those in the Caribbean. This paper has two parts. First, we performed a literature review evaluating all studies published on laparoscopic and robotic surgery of the pancreas. The data in the Caribbean is examined and we discuss tips for incorporating this operation into resource poor hospital practice. Low pancreatic case volume in the Caribbean, and financial barriers to MIS in general, laparoscopic distal pancreatectomy, enucleation and cystogastrostomy are feasible operations to integrate in to a resource-limited healthcare environment. This is because they can be performed with minimal to no consumables and require an intermediate MIS skillset to complement an open pancreatic surgeon’s peri-operative experience.
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Affiliation(s)
- Shamir O Cawich
- Clinical Surgical Sciences, University of the West Indies, Tunapuna 331333, Trinidad and Tobago
| | - Michael D Kluger
- Department of Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY 10032, United States
| | - Wesley Francis
- Department of Surgery, University of the West Indies, Nassau N-1184, Bahamas
| | - Rahul R Deshpande
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Fawwaz Mohammed
- Department of Clinical Surgical Sciences, University of the West Indies, Tunapuna 331333, Trinidad and Tobago
| | - Kimon O Bonadie
- Department of Surgery, Health Service Authority, Georgetown 915 GT, Cayman Islands
| | - Dexter A Thomas
- Department of Clinical Surgical Sciences, University of the West Indies, Tunapuna 331333, Trinidad and Tobago
| | - Neil W Pearce
- Department of Surgery, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
| | - Beth A Schrope
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY 10032, United States
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Nik Ramli NN, Asokan A, Mayakrishnan D, Annamalai H. Exploring Stroke Rehabilitation in Malaysia: Are Robots Better than Humans for Stroke Recuperation? Malays J Med Sci 2021; 28:14-23. [PMID: 34512127 PMCID: PMC8407787 DOI: 10.21315/mjms2021.28.4.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/16/2020] [Indexed: 11/13/2022] Open
Abstract
Ranked as the second leading cause of death and the primary factor to adult disability worldwide, stroke has become a global epidemic problem and burden. As a developing country, Malaysia still faces challenges in providing ideal rehabilitation services to individuals with physical disabilities including stroke survivors. Conventional post-stroke care is often delivered in a team-based approach and involves several disciplines, such as physical therapy, occupational therapy, speech and language therapy, depending on the nature and severity of the deficits. Robots are potential tools for stroke rehabilitation as they can enhance existing conventional therapy by delivering a precise and consistent therapy of highly repetitive movements. In addition, robot-assisted physiotherapy could facilitate the effectiveness of unsupervised rehabilitation and thus, may reduce the cost and duration of therapist-assisted rehabilitation. Research on robot-assisted physiotherapy for stroke in Malaysia is slowly coming into the limelight in the past two decades. This review explores the effectiveness of robot-assisted physiotherapy particularly in improving motor functions of stroke survivors in Malaysia.
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Affiliation(s)
- Nik Nasihah Nik Ramli
- International Medical School, Management & Science University, Shah Alam, Selangor, Malaysia
| | - Amhsavenii Asokan
- International Medical School, Management & Science University, Shah Alam, Selangor, Malaysia
| | - Daniel Mayakrishnan
- International Medical School, Management & Science University, Shah Alam, Selangor, Malaysia
| | - Hariharasudan Annamalai
- International Medical School, Management & Science University, Shah Alam, Selangor, Malaysia
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Bonatti J, Kiaii B, Alhan C, Cerny S, Torregrossa G, Bisleri G, Komlo C, Guy TS. The role of robotic technology in minimally invasive surgery for mitral valve disease. Expert Rev Med Devices 2021; 18:955-970. [PMID: 34325594 DOI: 10.1080/17434440.2021.1960506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Robotic mitral valve surgery has developed for more than 20 years. The main purpose of robotic assistance is to use multiwristed instruments for surgical endothoracic maneuvers on the mitral valve without opening the chest. The surgeon controls the instruments remotely from a console but is virtually immersed into the operative field. AREAS COVERED This review outlines indications and contraindication for the procedure. Intra- and postoperative results as available in the literature are reported. Further areas focus on the technological development, advances in surgical techniques, training methods, and learning curves. Finally we give an outlook on the potential future of this operation. EXPERT OPINION Robotic assistance allows for the surgically least invasive form of mitral valve operations. All variations of robotic mitral valve repair and replacement are feasible and indications have recently been broadened. Improved dexterity of instrumentation, 3D and HD vision, introduction of a robotic left atrial retractor, and adjunct technology enable most complex forms of minimally invasive mitral valve interventions through ports on the patient's right chest wall. Application of robotics results in significantly reduced surgical trauma while maintaining safety and outcome standards in mitral valve surgery.
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Affiliation(s)
- Johannes Bonatti
- UPMC Heart and Vascular Institute and Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bob Kiaii
- Department of Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Stepan Cerny
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Main Line Health - Lankenau Heart Institute, Wynnewood, PA, USA
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Caroline Komlo
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - T Sloane Guy
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Soliman MA, Khan A, O'Connor TE, Foley K, Pollina J. Accuracy and Efficiency of Fusion Robotics™ Versus Mazor-X™ in Single-Level Lumbar Pedicle Screw Placement. Cureus 2021; 13:e15939. [PMID: 34211815 PMCID: PMC8236238 DOI: 10.7759/cureus.15939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction There has been a surge in robot utilization in spine surgery over the past five years with the rapid development of new spine robotic platforms. This study aimed to compare a new robotic spine platform from Fusion RoboticsTM (Fusion Robotics, Helena, MT) with the widely used Mazor-XTM Stealth Edition robotic platform (Medtronic, Dublin, Ireland) in terms of workflow and lumbar pedicle screw placement accuracy. Methods A cadaver lab was conducted, which included four procedures with single-level lumbar pedicle screw placement using the Fusion RoboticsTM system. These four procedures were compared to four propensity-score matched cases with single-level lumbar pedicle screw placement using the Mazor-XTM Stealth Edition. A single surgeon performed all surgeries. The cases were matched in terms of demographics (age, sex, race, BMI) and comorbidities (Charlson Comorbidity Index score). The primary outcome measure was the operative workflow efficiency (duration as measured with a stopwatch by an independent observer). The secondary outcome measures were pedicle screw accuracy and accuracy to plan. Results After propensity-score matching, there were four cases in each group with no significant between-group differences in terms of sex, race, BMI, or surgical levels; however, there were significant differences in terms of age (p=0.01) and comorbidities (p<0.001). The workflow efficiency measurement showed that the Fusion RoboticsTM platform had a significantly shorter duration in terms of the system set-up time, planning to in-position time, and total procedure time (p<0.05). However, there was no significant difference between the robotic platforms in terms of creating a sterile barrier, scanning and importing images, creating a plan, screw placement, screw accuracy, and screw accuracy to plan. Conclusion Based on our findings, the Fusion RoboticsTM platform had a significantly shorter procedure workflow duration while maintaining the same accuracy as the most commonly used robotic platform (Mazor-XTM). This is the first study to directly compare different spine surgery robotic systems.
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Affiliation(s)
- Mohamed A Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, USA.,Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, EGY
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, USA
| | - Timothy E O'Connor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, USA
| | - Kevin Foley
- Department of Neurosurgery, Semmes-Murphey Clinic & University of Tennessee Health Science Center, Memphis, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, USA
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Rotim K, Splavski B, Vrban F. THE SAFETY AND EFFICACY OF ROBOT-ASSISTED STEREOTACTIC BIOPSY FOR BRAIN GLIOMA: EARLIEST INSTITUTIONAL EXPERIENCES AND EVALUATION OF LITERATURE. Acta Clin Croat 2021; 60:296-303. [PMID: 34744281 PMCID: PMC8564848 DOI: 10.20471/acc.2021.60.02.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/27/2021] [Indexed: 11/24/2022] Open
Abstract
Robot-assisted brain tumor biopsy is becoming one of the most important innovative technologies in neurosurgical practice. The idea behind its engagement is to advance the safety and efficacy of the biopsy procedure, which is much in demand when planning the management of endocranial tumor pathology. Herein, we provide our earliest institutional experiences in utilizing this mesmerizing technology. Cranial robotic device was employed for stereotactic robot-assisted brain glioma biopsy in three consecutive patients from our series: an anaplastic isocitrate dehydrogenase (IDH) negative astrocytoma (WHO grade III) located in the right trigone region of the periventricular white matter; a low grade diffuse astrocytoma (WHO grade II) of bilateral thalamic region spreading into the right mesencephalic area; and an IDH-wildtype glioblastoma (WHO grade IV) of the right frontal lobe producing a contralateral midline shifting. Robot-assisted tumor biopsy was successfully performed to get tissue samples for histopathologic and immunohistochemical analysis. The adjacent tissue iatrogenic damage of the eloquent cortical areas was minimal, while the immediate postoperative recovery was satisfactory in all patients. In conclusion, considering the preliminary results of our early experiences, robot-assisted tumor biopsy was proven to be a feasible and accurate procedure when surgery for brain glioma was not an option. It may increase safety and precision, without expanding surgical time, being similarly effective when compared to standard stereotactic and manual biopsy. Using this method to provide accurate sampling for histopathologic and immunohistochemical analysis is a safe and easy way to determine management strategies and outcome of different types of brain glioma.
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Affiliation(s)
| | - Bruno Splavski
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia
| | - Filip Vrban
- 1Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 3University of Applied Health Sciences, Zagreb, Croatia; 4Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health, Osijek, Croatia
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Viox D, Dhawan R, Balkhy HH, Cormican D, Bhatt H, Savadjian A, Chaney MA. Unilateral Pulmonary Edema After Robotically Assisted Mitral Valve Repair Requiring Veno-Venous Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2021; 36:321-331. [PMID: 33975792 DOI: 10.1053/j.jvca.2021.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/27/2021] [Indexed: 01/17/2023]
Abstract
Unilateral pulmonary edema (UPE) is an uncommon yet potentially life-threatening complication of minimally invasive cardiac surgery (MICS). Most frequently described after robotically assisted mitral valve (MV) repair, it is characterized by right lung edema, hypoxemia, hypercapnia, pulmonary hypertension, and hemodynamic instability beginning minutes-to-hours after separation from cardiopulmonary bypass (CPB). The authors describe a severe case with refractory hypoxemia requiring veno-venous (VV) extracorporeal membrane oxygenation (ECMO) after robotically assisted MV repair.
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Affiliation(s)
- Dan Viox
- Department of Anesthesiology, Emory University Hospital, Atlanta, GA
| | - Richa Dhawan
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Husam H Balkhy
- Robotic and Minimally Invasive Cardiac Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Daniel Cormican
- Cardiothoracic Anesthesiology, Allegheny General Hospital, Surgical Critical Care Medicine, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Himani Bhatt
- Division of Cardiac Anesthesiology, Mount Sinai Morningside Medical Center, New York, NY; Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andre Savadjian
- Division of Cardiac Anesthesiology, Mount Sinai Morningside Medical Center, New York, NY
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
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Rice MK, Hodges JC, Bellon J, Borrebach J, Al Abbas AI, Hamad A, Knab LM, Moser AJ, Zureikat AH, Zeh HJ, Hogg ME. Association of Mentorship and a Formal Robotic Proficiency Skills Curriculum With Subsequent Generations' Learning Curve and Safety for Robotic Pancreaticoduodenectomy. JAMA Surg 2021; 155:607-615. [PMID: 32432666 DOI: 10.1001/jamasurg.2020.1040] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Learning curves are unavoidable for practicing surgeons when adopting new technologies. However, patient outcomes are worse in the early stages of a learning curve vs after mastery. Therefore, it is critical to find a way to decrease these learning curves without compromising patient safety. Objective To evaluate the association of mentorship and a formal proficiency-based skills curriculum with the learning curves of 3 generations of surgeons and to determine the association with increased patient safety. Design, Setting, and Participants All consecutive robotic pancreaticoduodenectomies (RPDs) performed at the University of Pittsburgh Medical Center between 2008 and 2017 were included in this study. Surgeons were split into generations based on their access to mentorship and a proficiency-based skills curriculum. The generations are (1) no mentorship or curriculum, (2) mentorship but no curriculum, and (3) mentorship and curriculum. Univariable and multivariable analyses were used to create risk-adjusted learning curves by surgical generation and to analyze factors associated with operating room time, complications, and fellows completing the full resection. The participants include surgical oncology attending surgeons and fellows who participated in an RPD at University of Pittsburgh Medical Center between 2008 and 2017. Main Outcomes and Measures The primary outcome was operating room time (ORT). Secondary outcomes were postoperative pancreatic fistula and Clavien-Dindo classification higher than grade 2. Results We identified 514 RPDs completed between 2008 and 2017, of which 258 (50.2%) were completed by first-generation surgeons, 151 (29.3%) were completed by the second generation, and 82 (15.9%) were completed by the third generation. There was no statistically significant difference between groups with respect to age (66.3-67.3 years; P = .52) or female sex (n = 34 [41.5%] vs n = 121 [46.9%]; P = .60). There was a significant decrease in ORT (P < .001), from 450.8 minutes for the first-generation surgeons to 348.6 minutes for the third generation. Additionally, across generations, Clavien-Dindo classification higher than grade 2 (n = 74 [28.7%] vs n = 30 [9.9%] vs n = 12 [14.6%]; P = .01), conversion rates (n = 18 [7.0%] vs n = 7 [4.6%] vs n = 0; P = .006), and estimated blood loss (426 mL vs 288.6 mL vs 254.7 mL; P < .001) decreased significantly with subsequent generations. There were no significant differences in postoperative pancreatic fistula. Conclusions and Relevance In this study, ORT, conversion rates, and estimated blood loss decreased across generations without a concomitant rise in adverse patient outcomes. These findings suggest that a proficiency-based curriculum coupled with mentorship allows for the safe introduction of less experienced surgeons to RPD without compromising patient safety.
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Affiliation(s)
- MaryJoe K Rice
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Jacob C Hodges
- Wolff Center at University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Johanna Bellon
- Wolff Center at University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jeffrey Borrebach
- Wolff Center at University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amr I Al Abbas
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Ahmad Hamad
- Department of Surgery, Ohio State University Medical Center, Columbus
| | - L Mark Knab
- Department of Surgery, Loyola University Medical Center, Chicago, Illinois
| | - A James Moser
- Department of Surgery, Beth Israel Deaconess, Boston, Massachusetts
| | - Amer H Zureikat
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Herbert J Zeh
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Melissa E Hogg
- Department of Surgery, NorthShore University Health System, Chicago, Illinois
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