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Araújo Silva D, Szutan LA, Zandonai AP. Assessment of the evolution of psychomotor skills in the robotic surgery simulation process. J Robot Surg 2024; 18:317. [PMID: 39123078 DOI: 10.1007/s11701-024-02069-4] [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: 07/07/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
Robotic surgery is a rapidly expanding field, given the wide variety of new robotic platforms emerging. Looking at the training of surgeons in robotic surgery is of extreme necessity and urgency, considering the ongoing technological advancements. In this research, the performance during the virtual reality simulation phase of training for robotic surgery was analyzed. It was observed that, in addition to the lack of consensus among societies regarding the required simulation hours, there is no guidance on the best curriculum to be adopted. From the data in this study, it can be inferred that the more advanced skills have fewer proficient individuals, meaning that fewer surgeons in training have reached proficiency in all skill exercises. Even with differences in the number of exercises performed proficiently between groups that underwent varying amounts of simulation time, there is no statistically significant difference in the proportion between them.
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Affiliation(s)
- Danilo Araújo Silva
- Postgraduate, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), Doutor Cesário Motta Junior Street, 61, São Paulo, São Paulo, 01221-020, Brazil.
| | - Luiz Arnaldo Szutan
- Digestive System Surgery, Hospital da Santa Casa de Misericórdia de São Paulo, Doutor Cesário Motta Junior Street, 112, São Paulo, São Paulo, 01221-020, Brazil
| | - Alexandra Paola Zandonai
- Postgraduate, Universidade de São Paulo (USP), Da Reitoria,374, São Paulo, São Paulo, 05508-220, Brazil
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张 晴, 谢 妍, 梁 法, 冯 玉, 杜 正. [Past and present of endoscopic surgery and robotic surgery in treatment of breast diseases]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:769-775. [PMID: 39013810 PMCID: PMC11252677 DOI: 10.7507/1002-1892.202404034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 07/18/2024]
Abstract
Objective To review the research progress related to endoscopic surgery and robotic surgery for breast diseases, aiming to provide references for clinical practice. Methods The recent domestic and international literature on endoscopic surgery and robotic surgery for breast diseases was reviewed, then the challenges in their development, the innovative evolution of endoscopic surgery combined with clinical practice by our team, and its clinical applications were summarized. Results Traditional endoscopic surgery, despite its advantages such as minimal invasiveness, good cosmetic outcomes, and high patient's satisfaction, has been limited in its development due to specific difficulties in establishing the operative field. Our team innovatively proposed the "reverse sequence method" and the Huaxi Hole 1 theory and methods, cleverly altering the surgical procedure sequence, adding small operative orifices to transform single-port operations into multi-port ones, effectively overcoming the challenges restricting the advancement of endoscopic surgery in the field of breast diseases, thereby enabling further proliferation of endoscopic procedures. In terms of breast endoscopic reconstruction surgery, the parachute patch technique has broadened the indications for reconstruction surgery, benefiting patients with a certain degree of breast ptosis; and the postoperative adjustment concept, through early intervention in the post-reconstruction breast shape, has further refined the reconstruction procedure. Robot-assisted surgery derived from endoscopic surgery theory has further enhanced the precision and stability of surgeries, reducing surgical risks; however, excessive time and economic costs are urgent issues that must be addressed. Conclusion Through theoretical innovations, endoscopic surgery has been applied in the excision and reconstruction of breast lesions, while robotic surgery shows promising applications in autologous breast reconstruction, especially in the latissimus dorsi reconstruction field. Nevertheless, the lack of high-level large-sample, multi-center randomized controlled clinical trials to confirm its surgical safety, oncological safety, and postoperative cosmetic outcomes is an important direction for future research.
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Affiliation(s)
- 晴 张
- 四川大学华西医院普通外科(成都 610041)Department of General Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
- 四川大学华西医院乳腺疾病中心(成都 610041)Breast Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - 妍妍 谢
- 四川大学华西医院普通外科(成都 610041)Department of General Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
- 四川大学华西医院乳腺疾病中心(成都 610041)Breast Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - 法清 梁
- 四川大学华西医院普通外科(成都 610041)Department of General Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
- 四川大学华西医院乳腺疾病中心(成都 610041)Breast Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - 玉 冯
- 四川大学华西医院普通外科(成都 610041)Department of General Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - 正贵 杜
- 四川大学华西医院普通外科(成都 610041)Department of General Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
- 四川大学华西医院乳腺疾病中心(成都 610041)Breast Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
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Nișcoveanu C, Refi D, Obada B, Dragosloveanu S, Scheau C, Baz RO. Beyond the Bony Fragment: A Review of Limbus Vertebra. Cureus 2024; 16:e60065. [PMID: 38746486 PMCID: PMC11093693 DOI: 10.7759/cureus.60065] [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: 05/09/2024] [Indexed: 05/16/2024] Open
Abstract
Vertebral limbus is a condition characterized by the intraspongious herniation of a portion of the nucleus pulposus. It is often asymptomatic, but it can sometimes cause nonspecific symptoms such as local pain and muscle spasm, or, in rare cases, radiculopathies, which is why it can be confused with vertebral fractures, spondyloarthropathies, infectious or tumoral processes. Early recognition of this pathology is preferable for a correct diagnosis and adequate treatment, the latter ranging from conservative approaches (such as personalized exercise programs and physical therapy) to surgical interventions reserved for severe cases with nerve compression.
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Affiliation(s)
- Cosmin Nișcoveanu
- Department of Radiology, Sf. Apostol Andrei County Hospital, Constanta, ROU
- Department of Radiology and Medical Imaging, Faculty of Medicine, Ovidius University, Constanta, ROU
| | - Deria Refi
- Department of Radiology, Sf. Apostol Andrei County Hospital, Constanta, ROU
| | - Bogdan Obada
- Department of Orthopaedics and Traumatology, Sf. Apostol Andrei County Hospital, Constanta, ROU
| | - Serban Dragosloveanu
- Department of Orthopaedics, Foisor Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, Bucharest, ROU
- Department of Orthopaedics and Traumatology, The Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Cristian Scheau
- Department of Radiology and Medical Imaging, Foisor Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, Bucharest, ROU
- Department of Physiology, The Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Radu Octavian Baz
- Department of Radiology, Sf. Apostol Andrei County Hospital, Constanta, ROU
- Department of Radiology and Medical Imaging, Faculty of Medicine, Ovidius University, Constanta, ROU
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Salem SA, Marom G, Shein GS, Fishman Y, Helou B, Brodie R, Elazary R, Pikarsky AJ, Mintz Y. Robotic Heller's myotomy using the new Hugo™ RAS system: first worldwide report. Surg Endosc 2024; 38:1180-1190. [PMID: 38082007 DOI: 10.1007/s00464-023-10618-5] [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: 11/02/2023] [Accepted: 11/26/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Achalasia is a rare disorder of the esophagus characterized by motor dysfunction in the esophagus and relaxation failure of the lower esophageal sphincter (LES). Currently, surgical myotomy procedures are considered the standard of care. Robotic Heller's myotomy (RHM) with fundoplication has been gaining popularity due to documented advantages in the precision of myotomy as well as avoiding the potential reflux following per-oral endoscopic myotomy (POEM). To the best of our knowledge, RHM has thus far has been performed exclusively by the da Vinci surgical system. The new Hugo RAS™ system offers a unique modular design and an open console which offers better maneuverability and docking options. In this study, we present the first worldwide series of patients undergoing RHM using the new Hugo RAS™ platform. Our objective is to propose optimal operating configuration and setup to fully harness the advantages of the unique modular design of this system. METHODS Ten consecutive achalasia patients underwent Robotic Heller's myotomy (RHM) with the Hugo RAS™ system. We prospectively collected patient data, including demographics, comorbidities, ASA class, Eckardt scores, pre-operative manometric data, and EndoFlip parameters. Additionally, we recorded the docking and total operative times. RESULTS Between December 2022 and August 2023, 10 patients underwent RHM with the Hugo™ RAS system. Patients had a median age of 42.5 years, 60% were female, and mean BMI was 23.2. Fifty percent had achalasia type 2 and 50% type 1. The median pre-operative integrated relaxation pressure (IRP) was 24.9. Median docking time was 10 min and overall operative time was 129.5 min. All patients, except one with acute coronary syndrome, had an uneventful peri-operative course and were discharged on post-operative day 2. CONCLUSION The Hugo™ RAS system is well designed for robotic Heller myotomy. The operative and clinical results are similar to the currently used robotic system; however, the modular design of the system has some differences. These translate to better docking angles and maneuverability as well as console surgeon's ergonomics. Further experience is needed to explore the advantages of the system's modular design and function.
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Affiliation(s)
- Samer Abu Salem
- Department of General Surgery, Hadassah Hebrew- University Medical Center, Jerusalem, Israel
| | - Gad Marom
- Department of General Surgery, Hadassah Hebrew- University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gabriel Szydlo Shein
- Department of General Surgery, Hadassah Hebrew- University Medical Center, Jerusalem, Israel
| | - Yuri Fishman
- Department of General Surgery, Hadassah Hebrew- University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Brigitte Helou
- Department of General Surgery, Hadassah Hebrew- University Medical Center, Jerusalem, Israel
| | - Ronit Brodie
- Department of General Surgery, Hadassah Hebrew- University Medical Center, Jerusalem, Israel
| | - Ram Elazary
- Department of General Surgery, Hadassah Hebrew- University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alon J Pikarsky
- Department of General Surgery, Hadassah Hebrew- University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yoav Mintz
- Department of General Surgery, Hadassah Hebrew- University Medical Center, Jerusalem, Israel.
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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Maniaci A, Chiesa Estomba C, Fakhry N, Vaira LA, Remacle M, Cammaroto G, Barillari MR, Iannella G, Mayo-Yanez M, Saibene AM, Baudouin R, Maza-Solano J, Mendelsohn AH, Holsinger FC, Ceccon FP, Haddad L, Hans S, La Mantia I, Cocuzza S, Gulinello F, Ayad T, Lechien JR. Influence of Otolaryngological Subspecialties on Perception of Transoral Robotic Surgery: An International YO-IFOS Survey. J Pers Med 2023; 13:1717. [PMID: 38138944 PMCID: PMC10744671 DOI: 10.3390/jpm13121717] [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: 11/10/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND To investigate perception, adoption, and awareness on the part of otolaryngology and head and neck surgeons (OTO-HNS) of transoral robotic surgery (TORS). METHODS Several items assessed: awareness/perception; access to TORS; training; indications and advantages/hurdles to TORS practice. A subanalysis was performed to assess differences according to the identified otolaryngological subspecialties. RESULTS A total of 359 people completed the survey. Among subspecialties, while for otolaryngologists 30/359 (8.4%) and H&N surgeons 100/359 (27.9%) TORS plays an effective role in hospital stay, laryngologists frequently disagreed (54.3%). There was a lower incidence among rhinologists and otologists (1.9%). Pediatric surgeons (0.8%) reported a positive response regarding the adoption of robotic surgery, and head and neck specialists expressed an even greater response (14.2%). Low adherence was related to perceived cost-prohibitive TORS, by 50% of H&N surgeons. CONCLUSIONS Perception, adoption, and knowledge about TORS play a key role in the application of the robotic system, significantly varying across subspecialties.
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Affiliation(s)
- Antonino Maniaci
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Faculty of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, 13005 Marseille, France
| | - Carlos Chiesa Estomba
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, 20003 San Sebastian, Spain
| | - Nicolas Fakhry
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, La Conception University Hospital, AP-HM, Aix Marseille Univ, 13005 Marseille, France
| | - Luigi Angelo Vaira
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Maxillofacial Surgery Unit, University Hospital of Sassari, 07025 Sassari, Italy
| | - Marc Remacle
- Department of Otorhinolaryngology-Head and Neck Surgery, CHL-Eich, Rue d’Eich 78, 1111 Luxembourg, Luxembourg;
| | - Giovanni Cammaroto
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Head-Neck, and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Pierantoni Hospital, 47121 Forlì, Italy
| | - Maria Rosaria Barillari
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Mental and Physical Health and Preventive Medicine, “L. Vanvitelli” University, 80121 Naples, Italy
| | - Giannicola Iannella
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Organi di Senso Department, Sapienza University of Rome, Viale del Policlinico 151, 00161 Rome, Italy
| | - Miguel Mayo-Yanez
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, 15001 Galicia, Spain
| | - Alberto Maria Saibene
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, 20121 Milan, Italy
| | - Robin Baudouin
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 75000 Paris, France;
| | - Juan Maza-Solano
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Service of Otolaryngology, ENT Deparment, Virgen de la Macarena University Hospital,41000 Seville, Spain
| | - Abie H. Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 94305, USA;
| | - Floyd Christopher Holsinger
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Fabio P. Ceccon
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo (UNIFESP), 06000 São Paulo, Brazil; (F.P.C.); (L.H.)
| | - Leonardo Haddad
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo (UNIFESP), 06000 São Paulo, Brazil; (F.P.C.); (L.H.)
| | - Stephane Hans
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 75000 Paris, France;
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (I.L.M.); (S.C.); (F.G.)
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (I.L.M.); (S.C.); (F.G.)
| | - Federica Gulinello
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (I.L.M.); (S.C.); (F.G.)
| | - Tareck Ayad
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Division of Otolaryngology-Head and Neck Surgery, Center Hospitalier de l’Université de Montréal, Head and Neck Deparment, Montreal, QC 54550, Canada
| | - Jerome R. Lechien
- Robotics Study Group of Young Otolaryngologists, International Federation of Oto-Rhino-Laryngological Societies, 75000 Paris, France; (C.C.E.); (N.F.); (L.A.V.); (G.C.); (M.R.B.); (G.I.); (M.M.-Y.); (A.M.S.); (R.B.); (J.M.-S.); (T.A.); (J.R.L.)
- Department of Otolaryngology and Head and Neck Surgery, Foch Hospital, Paris Saclay University, 75000 Paris, France
- Department of Otolaryngology and Head and Neck Surgery, Division of Broncho-Esophagology, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7031 Mons, Belgium
- Department of Otolaryngology and Head and Neck Surgery, Elsan Polyclinic of Poitiers, 86000 Poitiers, France
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Sadri H, Fung-Kee-Fung M, Shayegan B, Garneau PY, Pezeshki P. A systematic review of full economic evaluations of robotic-assisted surgery in thoracic and abdominopelvic procedures. J Robot Surg 2023; 17:2671-2685. [PMID: 37843673 PMCID: PMC10678817 DOI: 10.1007/s11701-023-01731-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/24/2023] [Indexed: 10/17/2023]
Abstract
This study aims to conduct a systematic review of full economic analyses of robotic-assisted surgery (RAS) in adults' thoracic and abdominopelvic indications. Authors used Medline, EMBASE, and PubMed to conduct a systematic review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. Fully published economic articles in English were included. Methodology and reporting quality were assessed using standardized tools. Majority of studies (28/33) were on oncology procedures. Radical prostatectomy was the most reported procedure (16/33). Twenty-eight studies used quality-adjusted life years, and five used complication rates as outcomes. Nine used primary and 24 studies used secondary data. All studies used modeling. In 81% of studies (27/33), RAS was cost-effective or potentially cost-effective compared to comparator procedures, including radical prostatectomy, nephrectomy, and cystectomy. Societal perspective, longer-term time-horizon, and larger volumes favored RAS. Cost-drivers were length of stay and equipment cost. From societal and payer perspectives, robotic-assisted surgery is a cost-effective strategy for thoracic and abdominopelvic procedures.Clinical trial registration This study is a systematic review with no intervention, not a clinical trial.
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Affiliation(s)
- Hamid Sadri
- Department of Health Economic and Outcomes Research, Medtronic ULC, 99 Hereford St., Brampton, ON, L6Y 0R3, Canada.
| | - Michael Fung-Kee-Fung
- Champlain Regional Cancer Program Depts OB/GYN, Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, 50 Charlton Ave., Hamilton, ON, L8N 4A6, Canada
| | - Pierre Y Garneau
- Surgical Department, Hôpital du Sacré-Coeur de Montréal, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
| | - Padina Pezeshki
- Department of Clinical Research, Medtronic ULC, 99 Hereford St., Brampton, ON, L6Y 0R3, Canada
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7
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Huang J, Huang Z, Mei H, Rong L, Zhou Y, Guo J, Wan L, Xu Y, Tang S. Cost-effectiveness analysis of robot-assisted laparoscopic surgery for complex pediatric surgical conditions. Surg Endosc 2023; 37:8404-8420. [PMID: 37721590 DOI: 10.1007/s00464-023-10399-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 08/14/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Robotics has been used safely and successfully in a variety of adult surgeries and is gradually gaining ground in pediatrics. While the benefits of robotic-assisted surgery in disease treatment are well recognized, its high cost has led to questions. To investigate whether robotic-assisted laparoscopic surgery (RALS) is cost-effective compared to conventional laparoscopic surgery (LS) in pediatric surgery, we attempted to construct a model to perform an analysis of these two surgical approaches using Python statistical analysis software. METHODS We selected four common complex pediatric surgical conditions (choledochal cyst, Hirschsprung's disease, vesicoureteral reflux, and congenital hydronephrosis) from three systems (pediatric hepatobiliary, gastroenterology, and urology). Models were constructed using Python statistical software to compare hospital costs and surgical outcomes for RALS and LS. In addition, we performed a preferred strategy analysis for both surgical modalities while assessing model uncertainty using one-way sensitivity analysis. RESULTS For the four diseases, the operative time decreased sequentially. The total inpatient costs of RALS were 10,816.72, 9145.44, 8414.29, 7973.58 dollars, respectively, yielding 1.789, 1.712, 1.749, 1.792 quality adjustment life years (QALYs) over two years post-operatively. The incremental cost of RALS relative to LS for each disease was 3523.44, 3200.20, 3049.79, 3043.66 dollars, respectively, with an incremental utility of 0.060, 0.054, 0.051, 0.050 QALYs. The incremental cost-effectiveness ratios (ICERs) for RALS for each of the four diseases were 58,724.01, 59,262.95, 59,799.79, 60,873.20 dollars/QALY, all less than 100,000 dollars/QALY. The cost of robot consumables was the main incremental cost of RALS and had the most significant impact on the model. CONCLUSION For the four pediatric surgical conditions described above, RALS has higher inpatient costs than LS, but it has better postoperative outcomes, and all four RALS treatments are cost-effective. Children with complex diseases and long operative times appear to benefit more from RALS.
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Affiliation(s)
- Jiangrui Huang
- Department of Pediatric Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhong Huang
- Department of Computer Science, University of Science and Technology of China, Hefei, China
| | - Hong Mei
- Department of Pediatric Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Liying Rong
- Department of Pediatric Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Zhou
- Department of Pediatric Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jialing Guo
- Department of Pediatric Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Li Wan
- Department of Pediatric Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yinhui Xu
- Department of Pediatric Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shaotao Tang
- Department of Pediatric Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
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Lu J, Huang Z, Zhuang B, Cheng Z, Guo J, Lou H. Development and evaluation of a robotic system for lumbar puncture and epidural steroid injection. Front Neurorobot 2023; 17:1253761. [PMID: 37881516 PMCID: PMC10595035 DOI: 10.3389/fnbot.2023.1253761] [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: 07/06/2023] [Accepted: 08/11/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction Lumbar puncture is an important medical procedure for various diagnostics and therapies, but it can be hazardous due to individual variances in subcutaneous soft tissue, especially in the elderly and obese. Our research describes a novel robot-assisted puncture system that automatically controls and maintains the probe at the target tissue layer through a process of tissue recognition. Methods The system comprises a robotic system and a master computer. The robotic system is constructed based on a probe consisting of a pair of concentric electrodes. From the probe, impedance spectroscopy measures bio-impedance signals and transforms them into spectra that are communicated to the master computer. The master computer uses a Bayesian neural network to classify the bio-impedance spectra as corresponding to different soft tissues. By feeding the bio-impedance spectra of unknown tissues into the Bayesian neural network, we can determine their categories. Based on the recognition results, the master computer controls the motion of the robotic system. Results The proposed system is demonstrated on a realistic phantom made of ex vivo tissues to simulate the spinal environment. The findings indicate that the technology has the potential to increase the precision and security of lumbar punctures and associated procedures. Discussion In addition to lumbar puncture, the robotic system is suitable for related puncture operations such as discography, radiofrequency ablation, facet joint injection, and epidural steroid injection, as long as the required tissue recognition features are available. These operations can only be carried out once the puncture needle and additional instruments reach the target tissue layer, despite their ensuing processes being distinct.
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Affiliation(s)
- Jiaxin Lu
- School of Automation, Guangdong University of Technology, Guangzhou, China
| | - Zekai Huang
- School of Automation, Guangdong University of Technology, Guangzhou, China
| | - Baiyang Zhuang
- School of Automation, Guangdong University of Technology, Guangzhou, China
| | - Zhuoqi Cheng
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Jing Guo
- School of Automation, Guangdong University of Technology, Guangzhou, China
| | - Haifang Lou
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
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Gaitán-Duarte H. The use of artificial intelligence and scientific papers published in the Colombian Journal of Obstetrics and Gynecology. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2023; 74:196-201. [PMID: 37937906 PMCID: PMC10652773 DOI: 10.18597/rcog.4139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Indexed: 11/09/2023]
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10
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Brassetti A, Ragusa A, Tedesco F, Prata F, Cacciatore L, Iannuzzi A, Bove AM, Anceschi U, Proietti F, D’Annunzio S, Flammia RS, Chiacchio G, Ferriero M, Guaglianone S, Mastroianni R, Misuraca L, Tuderti G, Simone G. Robotic Surgery in Urology: History from PROBOT ® to HUGO TM. SENSORS (BASEL, SWITZERLAND) 2023; 23:7104. [PMID: 37631641 PMCID: PMC10458477 DOI: 10.3390/s23167104] [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: 06/27/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
The advent of robotic surgical systems had a significant impact on every surgical area, especially urology, gynecology, and general and cardiac surgery. The aim of this article is to delineate robotic surgery, particularly focusing on its historical background, its evolution, its present status, and its future perspectives. A comprehensive literature review was conducted upon PubMed/MEDLINE, using the keywords "robotic surgical system", "robotic surgical device", "robotics AND urology". Additionally, the retrieved articles' reference lists were investigated. Analysis concentrated on urological surgical systems for laparoscopic surgery that have been given regulatory approval for use on humans. From the late 1980s, before daVinci® Era in 2000s, ancestor platform as Probot® and PUMA 560 were described to outline historical perspective. Thus, new robotic competitors of Intuitive Surgical such as Senhance®, Revo-I®, Versius®, Avatera®, Hinotori®, and HugoTM RAS were illustrated. Although daVinci® had high level competitiveness, and for many years represented the most plausible option for robotic procedures, several modern platforms are emerging in the surgical market. Growing competition through unique features of the new robotic technologies might extend applications fields, improve diffusion, and increase cost-effectiveness procedures. More experiences are needed to identify the role of these new advancements in surgical branches and in healthcare systems.
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Affiliation(s)
| | - Alberto Ragusa
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (A.B.); (F.T.); (F.P.); (L.C.); (A.I.); (A.M.B.); (U.A.); (F.P.); (S.D.); (R.S.F.); (G.C.); (M.F.); (S.G.); (R.M.); (L.M.); (G.T.); (G.S.)
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Rivero-Moreno Y, Echevarria S, Vidal-Valderrama C, Pianetti L, Cordova-Guilarte J, Navarro-Gonzalez J, Acevedo-Rodríguez J, Dorado-Avila G, Osorio-Romero L, Chavez-Campos C, Acero-Alvarracín K. Robotic Surgery: A Comprehensive Review of the Literature and Current Trends. Cureus 2023; 15:e42370. [PMID: 37621804 PMCID: PMC10445506 DOI: 10.7759/cureus.42370] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
Robotic surgery (RS) is an evolution of minimally invasive surgery that combines medical science, robotics, and engineering. The first robots approved by the Food and Drug Administration (FDA) were the Da Vinci Surgical System and the ZEUS Robotic Surgical System, which have been improving over time. Through the decades, the equipment applied to RS had undergone a wide transformation as a response to the development of new techniques and facilities for the assembly and implementation of the own. RS has revolutionized the field of urology, enabling surgeons to perform complex procedures with greater precision and accuracy, and many other surgical specialties such as gynecology, general surgery, otolaryngology, cardiothoracic surgery, and neurosurgery. Several benefits, such as a better approach to the surgical site, a three-dimensional image that improves depth perception, and smaller scars, enhance range of motion, allowing the surgeon to conduct more complicated surgical operations, and reduced postoperative complications have made robotic-assisted surgery an increasingly popular approach. However, some points like the cost of surgical procedures, equipment-instrument, and maintenance are important aspects to consider. Machine learning will likely have a role to play in surgical training shortly through "automated performance metrics," where algorithms observe and "learn" individual surgeons' techniques, assess performance, and anticipate surgical outcomes with the potential to individualize surgical training and aid decision-making in real time.
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Affiliation(s)
| | | | | | - Luigi Pianetti
- General Surgery, Universidad Nacional del Litoral, Argentina, ARG
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12
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Comparison of robot-assisted sleeve gastrectomy outcomes in multiple staple line treatment modalities from 2015 to 2019: a 5-year propensity score-adjusted MBSAQIP® analysis. Surg Endosc 2023; 37:1401-1411. [PMID: 35701675 DOI: 10.1007/s00464-022-09366-9] [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: 03/28/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Robot-assisted sleeve gastrectomy (RSG) is an increasingly common approach to sleeve gastrectomy (SG). Staple line reinforcement (SLR) is well-discussed in laparoscopic SG literature, but not RSG- likely due to the absence of dedicated robotic SLR devices. However, most RSG cases report SLR. This retrospective analysis compares outcomes in RSG cases reporting (1) any staple line treatment (SLT) vs none and (2) SLR vs oversewing. METHODS MBSAQIP was queried for adults who underwent RSG from 2015 to 2019. Open procedures, Natural Orifice Transluminal Endoscopic Surgery, hand-assisted, single-incision, concurrent procedures, and illogical BMIs were excluded (n = 3444). Final sample included 52,354 patients. Two comparisons were made: SLT (n = 34,886) vs none (n = 17,468) and SLR (n = 22,217) vs oversew (n = 5620). We fitted multivariable regression models to estimate risk ratios (RR) and 95% confidence intervals (CI) and performed propensity score analysis with inverse probability of treatment weight based on patient factors. RESULTS Most RSG cases utilized SLT (66.6%). Cases with SLT had a reduced risk of organ space SSI (RR 0.68 [0.49, 0.94]), 30-day reoperation (RR 0.77 [0.64, 0.93]), 30-day re-intervention (RR 0.80 [0.67, 0.96]), sepsis (RR 0.58 [0.35, 0.96]), unplanned intubation (RR 0.59 [0.37, 0.93]), extended ventilator use (RR 0.46 [0.23, 0.91]), and renal failure (RR 0.40 [0.19, 0.82]) compared to no-treatment cases. In single-treatment cases (n = 27,837), most utilized SLR (79.8%). Cases with oversew had a higher risk of any SSI (RR 1.70 [1.19, 2.42]), superficial incisional SSI (RR 1.71 [1.06, 2.76]), septic shock (RR 6.47 [2.11, 19.87]), unplanned intubation (RR 2.18 [1.06, 4.47]), and extended ventilator use (> 48 h) (RR 4.55 [1.63, 12.71]) than SLR. CONCLUSIONS Our data suggest SLT in RSG is associated with reduced risk of some adverse outcomes vs no-treatment. Among SLT, SLR demonstrated lower risk than oversewing. However, risk of all-cause mortality, cardiac arrest, and unplanned ICU admission were not significant.
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Jacobson JC, Pandya SR. Pediatric robotic surgery: An overview. Semin Pediatr Surg 2023; 32:151255. [PMID: 36736161 DOI: 10.1016/j.sempedsurg.2023.151255] [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: 01/27/2023]
Abstract
Pediatric robotic surgery offers children a minimally invasive approach with numerous advantages over open or thoracoscopic and laparoscopic surgery. However, despite its widespread adoption for adult patients, the utilization of robotic surgery within pediatrics has been relatively slower to progress. This paper provides an overview of pediatric robotic surgery and discusses benefits, limitations, and strategies for successful implementation of robotics within pediatric surgical practice.
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Affiliation(s)
- Jillian C Jacobson
- Division of Pediatric Surgery, Children's Medical Center & Department of Surgery, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Suite D2000, Dallas, TX 75235, USA
| | - Samir R Pandya
- Division of Pediatric Surgery, Children's Medical Center & Department of Surgery, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Suite D2000, Dallas, TX 75235, USA.
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COSTA TN, TUSTUMI F, FERROS LSM, COLONNO BB, ABDALLA RZ, RIBEIRO-JUNIOR U, CECCONELLO I. ROBOTIC-ASSISTED VERSUS LAPAROSCOPIC INCISIONAL HERNIA REPAIR: DIFFERENCES IN DIRECT COSTS FROM A BRAZILIAN PUBLIC INSTITUTE PERSPECTIVE. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 35:e1714. [PMID: 36629691 PMCID: PMC9831626 DOI: 10.1590/0102-672020220002e1714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Robotic-assisted surgery research has grown dramatically in the past two decades and the advantages over traditional videolaparoscopy have been extensively debated. For hernias, the robotic system can increase intraoperative strategies, especially in complex hernias or incisional hernias. AIMS This study aimed to compare the direct cost differences between robotic and laparoscopic hernia repair and determine each source of expenditure that may be related to the increased costs in a robotic program from the perspective of a Brazilian public institution. METHODS This study investigated the differences in direct costs from the data generated from a trial protocol (ReBEC: RBR-5s6mnrf). Patients with incisional hernia were randomly assigned to receive laparoscopic ventral incisional hernia repair (LVIHR) or robotic ventral incisional hernia repair (RVIHR). The direct medical costs of hernia treatment were described in the Brazilian currency (R$). RESULTS A total of 19 patients submitted to LVIHR were compared with 18 submitted to RVIHR. The amount spent on operation room time (RVIHR: 2,447.91±644.79; LVIHR: 1,989.67±763.00; p=0.030), inhaled medical gases in operating room (RVIHR: 270.57±211.51; LVIHR: 84.55±252.34; p=0.023), human resources in operating room (RVIHR: 3,164.43±894.97; LVIHR: 2,120.16±663.78; p<0.001), material resources (RVIHR: 3,204.32±351.55; LVIHR: 736.51±972.32; p<0.001), and medications (RVIHR: 823.40±175.47; LVIHR: 288.50±352.55; p<0.001) for RVIHR was higher than that for LVIHR, implying a higher total cost to RVIHR (RVIHR: 14,712.24±3,520.82; LVIHR: 10,295.95±3,453.59; p<0.001). No significant difference was noted in costs related to the hospital stay, human resources in intensive care unit and ward, diagnostic tests, and meshes. CONCLUSION Robotic system adds a significant overall cost to traditional laparoscopic hernia repair. The cost of the medical and robotic devices and longer operative times are the main factors driving the difference in costs.
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Affiliation(s)
| | - Francisco TUSTUMI
- Universidade de São Paulo, Department of Gastroenterology – São
Paulo (SP), Brazil
| | | | | | | | | | - Ivan CECCONELLO
- Universidade de São Paulo, Department of Gastroenterology – São
Paulo (SP), Brazil
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15
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Auswirkungen der COVID-19-Pandemie auf die robotische Viszeralchirurgie in Deutschland. DIE CHIRURGIE 2022; 93:765-777. [PMID: 35821304 PMCID: PMC9343279 DOI: 10.1007/s00104-022-01684-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/15/2022]
Abstract
Einleitung Der Einsatz roboterassistierter Operationen verzeichnet in der Viszeralchirurgie gegenwärtig einen stetigen Zuwachs. Im Jahr 2020 hat die COVID-19-Pandemie den klinischen und chirurgischen Alltag unerwartet wesentlich verändert. Wir haben in einer Umfrage den Status der roboterassistierten Viszeralchirurgie in Deutschland sowie die gegenwärtigen Ausbildungskonzepte evaluiert und deren Veränderungen unter dem Einfluss der COVID-19-Pandemie untersucht. Material und Methoden In einer umfangreichen Recherche wurden 89 Kliniken identifiziert, welche ein Robotersystem für die Viszeralchirurgie 2020 einsetzten. Diese Kliniken wurden über eine webbasierte anonyme Umfrage mit 35 Fragen dreimal kontaktiert. Die Fragen bezogen sich auf die Einsatzgebiete eines Operationsroboters in der Viszeralchirurgie, die dazugehörige klinische Ausbildung und den Einfluss der COVID-19-Pandemie auf das bestehende Programm. Ergebnisse Von den angeschriebenen Kliniken haben 22 (24,7%) eine Rückmeldung gegeben. Hiervon waren 17 (19,1%) Fragebögen auswertbar. Es beteiligten sich 58,8% Universitätsklinika, 17,6% Maximalversorger und 23,5% Schwerpunktkrankenhäuser an der Studie. Der Operationsroboter wurde am oberen Gastrointestinaltrakt (OGIT; 88,2%), am hepatopankreatikobiliären System (HPB; 82,4%) und im kolorektalen Bereich (KRK; 94,1%) sowie bei der Hernienversorgung (35,3%) eingesetzt. Der relative Anteil robotischer Eingriffe am operierten Gesamtkollektiv lag dabei zwischen 0,3% und 15,4%. Die Konversionsraten für 2020 lag im Mittel bei 4,6 ± 3,2%. Die Operationsroboter wurden zum Großteil im interdisziplinären Setting wechselweise mit anderen chirurgischen Disziplinen (82,4%) genutzt. Zu Lehrzwecken stand in sieben Kliniken (41,2%) eine zweite Konsole zur Verfügung. Die Ausbildungsstrukturen waren sehr heterogen und nur 13,2 ± 6,5% der Chirurg*innen pro Klinik waren in das Roboterprogramm involviert. In 82,4% existierten feste Teams, die sich aus Ober‑, Fach- und Assistenzärzt*innen zusammensetzen und in 76,5% wurden Ärzt*innen und Pflegepersonal über klinikinterne Ausbildungsprogramme geschult. Die COVID-19-Pandemie hatte einen Fallzahlrückgang robotischer Eingriffe im Vergleich zu 2019 bei 70% der Kliniken vor allem im zweiten Jahresquartal 2020 (64,7%) zur Folge. Dies wurde auf Personalmangel nichtchirurgischer Disziplinen (Anästhesie 35,3%, OP-Pflege 35,3%, Intensivmedizin 17,6%), interne Regularien (58,8%) und begrenzte Intensiv- oder Überwachungskapazitäten (47,1%) zurückgeführt. Die COVID-19-Pandemie führte in der robotischen Ausbildung teilweise bei der Assistenz am OP-Tisch (23,5%) und der Assistenz an der zweiten Konsole (42,9%) zu einem kompletten Ausbildungsstopp. Ausschlaggebend für diese Entwicklung war überwiegend der Rückgang der Operationszahlen. Schlussfolgerung Die Robotik wird mittlerweile in einem breiten Spektrum der Viszeralchirurgie an Kliniken mit unterschiedlichen Versorgungsschwerpunkten in Deutschland eingesetzt. Der relative Anteil der Eingriffe am Gesamtspektrum ist allerdings noch gering. Roboterassistierte Eingriffe sind expertenfokussiert und es bestehen sehr heterogene Ausbildungskonzepte. Ein Lernerfolg mit konstanten und niedrigen Konversionsraten ist nach wenigen Jahren mit zunehmender Erfahrung zu erkennen. Die COVID-19-Pandemie hatte insgesamt einen negativen Einfluss auf die robotischen OP-Fallzahlen und die damit verbundenen Ausbildungsmöglichkeiten bei freien chirurgischen Personalressourcen. Hier ist eine kreative Gestaltung optimierter Ausbildungsmodalitäten erforderlich.
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Pérez de la Torre RA, Ramanathan S, Williams AL, Perez-Cruet M. Minimally-Invasive Assisted Robotic Spine Surgery (MARSS). Front Surg 2022; 9:884247. [PMID: 35903260 PMCID: PMC9316616 DOI: 10.3389/fsurg.2022.884247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Minimally-Invasive robotic spine surgery (MARSS) has expanded the surgeons armamentarium to treat a variety of spinal disorders. In the last decade, robotic developments in spine surgery have improved the safety, accuracy and efficacy of instrumentation placement. Additionally, robotic instruments have been applied to remove tumors in difficult locations while maintaining minimally invasive access. Gross movements by the surgeon are translated into fine, precise movements by the robot. This is exemplified in this chapter with the use of the da Vinci robot to remove apical thoracic tumors. In this chapter, we will review the development, technological advancements, and cases that have been conducted using MARSS to treat spine pathology in a minimally invasive fashion.
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Affiliation(s)
| | - Siddharth Ramanathan
- Department of Neurosurgery, Oakland University William Beaumont, School of Medicine, Royal Oak, MI, United States
| | - Ashley L. Williams
- Department of Neurosurgery, Oakland University William Beaumont, School of Medicine, Royal Oak, MI, United States
| | - Mick J. Perez-Cruet
- Department of Neurosurgery, Oakland University William Beaumont, School of Medicine, Royal Oak, MI, United States
- Michigan Head and Spine Institute, Southfield, MI, United States
- Correspondence: Mick Perez-Cruet
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Sony M, Antony J, McDermott O. The impact of medical cyber–physical systems on healthcare service delivery. TQM JOURNAL 2022. [DOI: 10.1108/tqm-01-2022-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe pandemic has reinforced the need for revamping the healthcare service delivery systems around the world to meet the increased challenges of modern-day illnesses. The use of medical cyber–physical system (MCPS) in the healthcare is one of the means of transforming the landscape of the traditional healthcare service delivery system. The purpose of this study is to critically examine the impact of MCPS on the quality of healthcare service delivery.Design/methodology/approachThis paper uses an evidence-based approach, the authors have conducted a systematic literature review to study the impact of MCPS on healthcare service delivery. Fifty-four articles were thematically examined to study the impact of MCPS on eight characteristics of the healthcare service delivery proposed by the world health organisation.FindingsThe study proposes support that MCPS will positively impact (1) comprehensiveness, (2) accessibility, (3) coverage, (4) continuity, (5) quality, (6) person-centredness, (7) coordination, (8) accountability and (9) efficiency dimension of the healthcare service delivery. The study further draws nine propositions to support the impact of MCPS on the healthcare service delivery.Practical implicationsThis study can be used by stakeholders as a guide point while using MCPS in healthcare service delivery systems. Besides, healthcare managers can use this study to understand the performance of their healthcare system. This study can further be used for designing effective strategies for deploying MCPS to be effective and efficient in each of the dimensions of healthcare service delivery.Originality/valueThe previous studies have focussed on technology aspects of MCPS and none of them critically analysed the impact on healthcare service delivery. This is the first literature review carried out to understand the impact of MCPS on the nine dimensions of healthcare service delivery proposed by WHO. This study provides improved thematic awareness of the resulting body of knowledge, allowing the field of MCPS and healthcare service delivery to progress in a more informed and multidisciplinary manner.
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Dunn D. Robotic-Assisted Surgery: A Brief History to Understand Today's Practices. AORN J 2022; 115:217-221. [PMID: 35213044 DOI: 10.1002/aorn.13629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 11/11/2022]
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Darwich I, Abuassi M, Aliyev R, Scheidt M, Alkadri MA, Hees A, Demirel-Darwich S, Chand M, Willeke F. Early experience with the ARTISENTIAL ® articulated instruments in laparoscopic low anterior resection with TME. Tech Coloproctol 2022; 26:373-386. [PMID: 35141794 PMCID: PMC9018813 DOI: 10.1007/s10151-022-02588-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/23/2022] [Indexed: 11/10/2022]
Abstract
Background The notion of articulation in surgery has been largely synonymous with robotics. The ARTISENTIAL® instruments aim at bringing advanced articulation to laparoscopy to overcome challenges in narrow anatomical spaces. In this paper, we present first single-center results of a series of low anterior resections, performed with ARTISENTIAL®. Methods Between September 2020 and August 2021, at the Department of Surgery, St. Marienkrankenhaus Siegen, Siegen, Germany, patients with cancer of the mid- and low rectum were prospectively enrolled in a pilot feasibility study to evaluate the ARTISENTIAL® articulated instruments in performing a laparoscopic low anterior resection. Perioperative and short-term postoperative data were analyzed. Results Seventeen patients (10 males/7 females) were enrolled in this study. The patients had a median age of 66 years (range 47–80 years) and a median body mass index of 28 kg/m2 (range 23–33 kg/m2). The median time to rectal transection was 155 min (range 118–280 min) and the median total operative time was 276 min (range 192–458 min). The median estimated blood loss was 30 ml (range 5–70 ml) and there were no conversions to laparotomy. The median number of harvested lymph nodes was 15 (range 12–28). Total mesorectal excision (TME) quality was ‘good’ in all patients with no cases of circumferential resection margin involvement (R0 = 100%). The median length of stay was 9 days (range 7–14 days). There were no anastomotic leaks and the overall complication rate was 17.6%. There was one unrelated readmission with no mortality. Conclusions Low anterior resection with ARTISENTIAL® is feasible and safe. All patients had a successful TME procedure with a good oncological outcome. We will now seek to evaluate the benefits of ARTISENTIAL® in comparison with standard laparoscopic instruments through a larger study. Supplementary Information The online version contains supplementary material available at 10.1007/s10151-022-02588-y.
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Affiliation(s)
- I Darwich
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany.
| | - M Abuassi
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany
| | - R Aliyev
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany
| | - M Scheidt
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany
| | - M A Alkadri
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany
| | - A Hees
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany
| | - S Demirel-Darwich
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany
| | - M Chand
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, 43-45 Foley Street, London, W1W 7JN, UK
| | - F Willeke
- Department of Surgery, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Germany
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Guimarães EMR, Barbosa IV, Carmo TGD, Probo DRG, Rolim KMC. Construção e validação de vídeo educativo para pacientes no perioperatório de cirurgia robótica. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0952pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivos: construir e validar tecnologia educacional, do tipo vídeo, direcionada para o ensino acerca do perioperatório de cirurgia robótica. Métodos: estudo de desenvolvimento metodológico, seguindo as fases de revisão integrativa: pré-produção, produção, pós-produção e validação. O vídeo foi avaliado quanto ao conteúdo e aparência por 14 juízes. Calcularam-se os índices de validade de conteúdo (IVC) e aparência (IVA), concordância (IC), e aplicou-se o teste exato de binomial, considerando p>0,05 e a proporção de 0,80 de concordância. Resultados: o vídeo contemplou 13 temáticas, com tempo de duração de sete minutos e 33 segundos. Os itens das três dimensões avaliadas apresentaram IVCs excelentes, variando entre 0,86 e 1,00 (p>0,05), com IVC total de 0,95, IVA de 0,94 e IC igual a 61,5%. Conclusões: construiu-se ferramenta tecnológica, do tipo vídeo educativo, para o ensino sobre o perioperatório de cirurgia robótica. O material foi fundamentado no conhecimento científico e considerado válido pelos juízes especialistas.
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Guimarães EMR, Barbosa IV, Carmo TGD, Probo DRG, Rolim KMC. Construction and validation of an educational video for patients in the perioperative period of robotic surgery. Rev Bras Enferm 2022; 75:e20210952. [DOI: 10.1590/0034-7167-2021-0952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/27/2022] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Objectives: to build and validate educational technology, of the video type, aimed at teaching about the perioperative period of robotic surgery. Methods: methodological development study, following the integrative review phases: pre-production, production, post-production, and validation. The video was evaluated for content and appearance by 14 judges. Content validity (CVI) and appearance (AVI) and agreement (CI) indices were calculated, and the exact binomial test was applied, considering p>0.05 and a proportion of 0.80 of agreement. Results: the video included 13 themes, with a duration of seven minutes and 33 seconds. The items of the three dimensions evaluated presented excellent CVI, ranging between 0.86 and 1.00 (p>0.05), with a total CVI of 0.95, VAT of 0.94 and CI equal to 61.5%. Conclusions: the video included 13 themes, with a duration of seven minutes and 33 seconds. The items of the three dimensions evaluated presented excellent CVI, ranging between 0.86 and 1.00 (p>0.05), with a total CVI of 0.95, VAT of 0.94 and CI equal to 61.5%.
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