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Monek AC, Mitha R, Andrews E, Sarkaria IS, Agarwal N, Hamilton DK. Multidisciplinary Surgical Approach Using Augmented Reality Preplanning for Resection of Giant Thoracic Schwannoma With Robotic-Assisted Thoracoscopic Mobilization. Oper Neurosurg (Hagerstown) 2024; 27:500-503. [PMID: 38687027 DOI: 10.1227/ons.0000000000001174] [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: 11/07/2023] [Accepted: 02/24/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND IMPORTANCE In adults, primary spinal cord tumors account for 5% of all primary tumors of the central nervous system, with schwannomas making up about 74% of all nerve sheath tumors. Thoracic schwannomas can pose a threat to neurovasculature, presenting a significant challenge to safe and complete surgical resection. For patients presenting with complex pathologies including tumors, a dual surgeon approach may be used to optimize patient care and improve outcomes. CLINICAL PRESENTATION A 73-year-old female previously diagnosed with a nerve sheath tumor of the fourth thoracic vertebra presented with significant thoracic pain and a history of falls. Imaging showed that the tumor had doubled in size ranging from T3 to T5. Augmented reality volumetric rendering was used to clarify anatomic relationships of the mass for perioperative evaluation and decision-making. A dual surgeon approach was used for complete resection. First, a ventrolateral left video-assisted thoracoscopic surgery was performed with robotic assistance followed by a posterior tumor resection and thoracic restabilization. The patient did well postoperatively. CONCLUSION Although surgical treatment of large thoracic dumbbell tumors presents a myriad of risks, perioperative evaluation with augmented reality, new robotic surgical techniques, and a dual surgeon approach can be implemented to mitigate these risks.
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Affiliation(s)
- Adam C Monek
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Edward Andrews
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
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Davidar AD, Jiang K, Weber-Levine C, Bhimreddy M, Theodore N. Advancements in Robotic-Assisted Spine Surgery. Neurosurg Clin N Am 2024; 35:263-272. [PMID: 38423742 DOI: 10.1016/j.nec.2023.11.005] [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: 03/02/2024]
Abstract
Applications and workflows around spinal robotics have evolved since these systems were first introduced in 2004. Initially approved for lumbar pedicle screw placement, the scope of robotics has expanded to instrumentation across different regions. Additionally, precise navigation can aid in tumor resection or spinal lesion ablation. Robot-assisted surgery can improve accuracy while decreasing radiation exposure, length of hospital stay, complication, and revision rates. Disadvantages include increased operative time, dependence on preoperative imaging among others. The future of robotic spine surgery includes automated surgery, telerobotic surgery, and the inclusion of machine learning or artificial intelligence in preoperative planning.
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Affiliation(s)
- A Daniel Davidar
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carly Weber-Levine
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meghana Bhimreddy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Orthopaedic Surgery & Biomedical Engineering, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Asaf BB, Bishnoi S, Vardhanpuri H, Pulle MV, Kumar A. Robotic excision of posterior mediastinal neurogenic tumours: Technique and surgical outcomes. J Minim Access Surg 2024; 20:136-141. [PMID: 37282429 PMCID: PMC11095809 DOI: 10.4103/jmas.jmas_151_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/13/2022] [Accepted: 03/21/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Neurogenic tumours are the most common tumours of the posterior mediastinum and account for 75% of the tumours in this region. Till recently, open transthoracic approach has been the standard of care for their excision. Thoracoscopic excision of these tumours is being commonly employed because of lesser morbidity and shorter hospital stay. The robotic surgical system offers a potential advantage over conventional thoracoscopy. We herein report our technique and surgical outcomes of excision of posterior mediastinal tumours using the Da Vinci Robotic Surgical System. MATERIALS AND METHODS We retrospectively reviewed 20 patients who underwent Robotic Portal-Posterior Mediastinal Tumour (RP-PMT) Excision at our centre. The demographic data, clinical presentation, characteristics of the tumour, operative and post-operative variables including, total operative time, blood loss, conversion rate, duration of the chest tube, hospital stay and complications were noted. RESULTS Twenty patients underwent RP-PMT Excision and were included in the study. The median age was 41.2 years. The most frequent presentation was chest pain. Schwannoma was the most common histopathological diagnosis. There were two conversions. The total operative time was 110 min with an average blood loss of 30 mL. Two patients developed complications. The postoperative hospital stay was 2.4 days. With a median follow-up of 36 months (6-48 months), all except patients are recurrence-free, except the patient with malignant nerve sheath tumour who developed local recurrence. CONCLUSION Our study demonstrates the feasibility and safety of robotic surgery for posterior mediastinal neurogenic tumours with good surgical outcomes.
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Affiliation(s)
- Belal Bin Asaf
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
| | - Sukhram Bishnoi
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
| | - Harsh Vardhanpuri
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
| | - Mohan Venkatesh Pulle
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
| | - Arvind Kumar
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
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Maitiyasen M, Peng H, Liu Y, Li J, Gao C, Chen J, Yi J. Robot-assisted thoracic surgery for benign tumors at the cervicothoracic junction: a propensity-matched study. Sci Rep 2024; 14:4254. [PMID: 38383716 PMCID: PMC10881989 DOI: 10.1038/s41598-024-54653-1] [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: 11/24/2023] [Accepted: 02/15/2024] [Indexed: 02/23/2024] Open
Abstract
This study aimed to assess the feasibility and safety of robot-assisted thoracic surgery (RATS) for resecting benign tumors of the cervicothoracic junction. Between 2017 and 2021, a total of 54 patients with benign cervicothoracic junction tumors were included. Among them, 46 underwent RATS while 8 underwent open surgery. Using a propensity score based on four variables (age, sex, comorbidity, and tumor size). The outcomes compared included short-term outcomes such as blood loss, as well as long-term outcomes including respiratory function and patients' postoperative health-related quality of life. No operative deaths occurred in this study. RATS was associated with less intraoperative blood loss (102 < 380 ml, P = 0.001) and a shorter length of hospital stay (1.8 < 4.8, P < 0.001). After a median follow-up of 37 months, no recurrences were reported, and no statistically significant differences were found in the 3-year survival between the two groups. The postoperative respiratory function of patients with open surgery showed a significant decrease compared to preoperative levels and were lower than those of RATS patients. In terms of health-related quality of life, RATS was associated with a better mean EQ-5D-5L index than open surgery (0.808 > 0.650, P < 0.05). In RATS, tumor sizes > 5 cm (mean ± SD = 0.768 ± 0.111, P = 0.028) and neurogenic tumors (mean ± SD = 0.702 ± 0.082, P < 0.001) remained significantly and independently associated with a lower EQ-5D-5L index. This study demonstrated that robot-assisted thoracic surgery for benign tumors of the cervicothoracic junction is a safe and technically feasible procedure, particularly for tumors < 5 cm and non-neurogenic tumors.
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Affiliation(s)
- Maierhaba Maitiyasen
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Hao Peng
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Yvxuan Liu
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Jingfeng Li
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Chuan Gao
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu, People's Republic of China
| | - Jing Chen
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People's Republic of China
| | - Jun Yi
- Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 East Zhongshan Road, Nanjing, Jiangsu, People's Republic of China.
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Khalilullah T, Mignucci-Jiménez G, Huffman H, Karthikeyan H, Hanif Z, Ariwodo O, Panchal RR. Surgical Management of Primary Thoracic Epidural Melanoma. Cureus 2024; 16:e54536. [PMID: 38516457 PMCID: PMC10956551 DOI: 10.7759/cureus.54536] [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: 12/30/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
In this study, we reported one of the first cases where a rare robotic-assisted platform with neuronavigation technology and carbon-fiber-polyetheretherketone (CF/PEEK) screws is employed to surgically treat multilevel thoracic primary spinal epidural melanoma. A 67-year-old male presented with left upper thoracic pain. His magnetic resonance imaging (MRI) of the thoracic spine revealed a dumbbell-shaped left epidural mass at the T2-3 level. Partial resection was performed due to tumor growth into the vertebral bodies and patient discretion for minimal surgery. The patient's neurological conditions improved postoperatively, with reduced reported symptoms of pain and numbness. Postoperative imaging showed evidence of appropriate spinal stabilization. Patient underwent stereotactic body radiation therapy (SBRT), and no adverse events were reported. This case reflects one of the first examples of treating thoracic epidural melanoma with the use of robotic-assisted navigation. Further prospective studies are needed to determine the efficacy of robot-assisted navigation for patients with primary spinal malignant melanoma which may open the possibility of surgery to once presumed non-operative patients.
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Affiliation(s)
| | - Giancarlo Mignucci-Jiménez
- Neurosurgery, Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, Phoenix, USA
| | | | | | - Zaheer Hanif
- Neurosurgery, University of Texas Medical Branch, Galveston, USA
| | - Ogechukwu Ariwodo
- Neurosurgery, Philadelphia College of Osteopathic Medicine South Georgia, Moultrie, USA
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Usenko O, Sydiuk A, Klimas A, Sydiuk O, Teslia O, Kropelnytskyi V. Surgical treatment of a cystic neoplasm of the posterior mediastinum: Case report and literature review. Int J Surg Case Rep 2024; 115:109254. [PMID: 38219516 PMCID: PMC10826805 DOI: 10.1016/j.ijscr.2024.109254] [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: 09/30/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE The study presents a clinical case of removal of a paravertebral tumour by thoracoscopic method and a review of the literature on the diagnosis and treatment of posterior mediastinal tumours. CASE PRESENTATION A 26-year-old female patient presented with an extradural, paravertebral posterior mediastinal tumour and complaints of low back pain. The mass was diagnosed by computer tomography (CT) and magnetic resonance imaging (MRI). The mass was mobilised from the adjacent vital structures without rupturing the capsule by thoracoscopic approach. The histological examination of the extracted mass was diagnosed as a bronchogenic cyst. CLINICAL DISCUSSION Thoracoscopic surgery provides sufficient volume in the mediastinum to perform instrument manipulations with minimal damage to adjacent structures and meets oncological criteria. CONCLUSION Thoracoscopic surgery of posterior mediastinal tumours demonstrates clinically significant benefits and treatment efficacy compared to open surgery, and is characterised by a low incidence of postoperative complications, short surgery duration, rapid postoperative recovery and better cosmetic effect.
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Affiliation(s)
- Oleksandr Usenko
- Department of Thoracoabdominal Surgery, Shalimov's National Institute of Surgery and Transplantology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Andrii Sydiuk
- Department of Thoracoabdominal Surgery, Shalimov's National Institute of Surgery and Transplantology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Andrii Klimas
- Department of Thoracoabdominal Surgery, Shalimov's National Institute of Surgery and Transplantology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Olena Sydiuk
- Department of Intensive Care and Anaesthesiology, Shalimov's National Institute of Surgery and Transplantology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Oleh Teslia
- Department of Thoracoabdominal Surgery, Shalimov's National Institute of Surgery and Transplantology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.
| | - Vladyslav Kropelnytskyi
- Department of Pathology, Shalimov's National Institute of Surgery and Transplantology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
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7
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Rückert JC, Huang L. [Robot-assisted Mediastinal Surgery]. Zentralbl Chir 2023; 148:S17-S25. [PMID: 36195108 DOI: 10.1055/a-1921-1530] [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: 11/06/2022]
Abstract
Because of the many important anatomical structures located closely together at very small distances, mediastinal surgery has been traditionally demanding and challenging within thoracic surgery. With their great variability, mediastinal masses in the anterior, middle or posterior mediastinal compartment result in surgical indications with different principle focuses. The technical opportunities of robotic assistance can thereby most effectively support the requirement of precision for all oncological aspects. Anterior mediastinal operations are most often performed, thymectomy being the most common operation. The radicality of thymectomy is of special importance. The worldwide tremendous development of robot-assisted mediastinal surgery confirms its initial and continuous role as a pacemaker for minimally invasive thoracic surgery.
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Affiliation(s)
| | - Luyu Huang
- Thoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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8
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Robotic Mediastinal Surgery. Thorac Surg Clin 2023; 33:89-97. [DOI: 10.1016/j.thorsurg.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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9
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Yang B, Chen R, Li C, Fan K, Lin Y, Liu Y. Initial experience with robotic-assisted thoracic surgery for superior mediastinal masses. Front Surg 2023; 9:1043525. [PMID: 36684169 PMCID: PMC9852329 DOI: 10.3389/fsurg.2022.1043525] [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: 09/13/2022] [Accepted: 10/12/2022] [Indexed: 01/09/2023] Open
Abstract
Objective Minimally invasive surgery is challenging for masses located in the superior mediastinum, especially for those close to the chest outlet. This study aimed to evaluate the feasibility and safety of robotic-assisted thoracic surgery (RATS) for these masses. Methods From June 2015 to January 2020, 35 patients (19 males, 16 females), with a mean age of 41.6 (range, 13-66) years, underwent RATS for the treatment of superior mediastinal masses. Data regarding the operation time, blood loss, pathology, conversion rate, morbidity, mortality, and cost were collected and analyzed. Results The mean (±standard deviation) operation time, blood loss, chest tube use duration, and postoperative hospital day were 117 ± 45.2 (range, 60-270) min, 59.7 ± 94.4 (range, 10-500) ml, 4.1 ± 2.1 (range, 1-10) days, and 5.1 ± 2.1 (range, 2-11) days, respectively. The pathological diagnoses included schwannoma (26 cases), ganglioneuroma (4 cases), bronchogenic cysts (3 cases), ectopic nodular goiter (1 case), and cavernous hemangioma (1 case). The mean diameter of the resected tumor was 4.6 ± 2.0 (range, 2.5-10) cm. No conversion or mortality occurred. Postoperative complications included Horner's syndrome (18 cases: 6 patients with preoperative Horner's syndrome), weakened muscular power (2 cases), and chylothorax (2 cases). The mean cost was $ 8,868.7 (range, $ 4,951-15,883). Conclusions Our experience demonstrated that RATS is safe and feasible for superior mediastinal mass resection. However, the high incidence of postoperative Horner's syndrome requires further research.
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Affiliation(s)
- Bo Yang
- Department of Thoracic Surgery, First Medical Center, Chinese General Hospital of PLA, Beijing, China
| | - Ruiji Chen
- Department of Thoracic surgery, Hainan Hospital of Chinese General Hospital of PLA, Sanya, China
| | - Chengrun Li
- Department of Thoracic Surgery, First Medical Center, Chinese General Hospital of PLA, Beijing, China
| | - Kaijie Fan
- Department of Thoracic Surgery, First Medical Center, Chinese General Hospital of PLA, Beijing, China
| | - Yingxue Lin
- School of Medicine, Nankai University, Tianjin, China
| | - Yang Liu
- Department of Thoracic Surgery, First Medical Center, Chinese General Hospital of PLA, Beijing, China,Correspondence: Yang Liu
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10
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Robotic Mediastinal Tumor Resections: Position and Port Placement. J Pers Med 2022; 12:jpm12081195. [PMID: 35893289 PMCID: PMC9330394 DOI: 10.3390/jpm12081195] [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: 05/31/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to determine the optimal position and port placement during robotic resection for various mediastinal tumors. For anterior mediastinal tumors, total or extended thymectomy is commonly performed in the supine position using the lateral or subxiphoid approach. Although it is unclear which approach is better during robotic thymectomy, technical advantages of subxiphoid approach are beneficial for patients with myasthenia who require extended thymectomy. Partial thymectomy is performed in the supine position using a lateral approach. Superior, middle, and posterior mediastinal tumors are resected in the decubitus position using the lateral approach, whereas dumbbell tumor resection, which requires a posterior approach, can be performed in the prone position. The position and port placement should be chosen depending on the size, location, and aggressiveness of the tumor. In this study, we describe how to choose which of these different robotic approaches can be used based on our experience and previous reports.
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Abstract
STUDY DESIGN Systematic review. OBJECTIVE The aim of this review is to present an overview of robotic spine surgery (RSS) including its history, applications, limitations, and future directions. SUMMARY OF BACKGROUND DATA The first RSS platform received United States Food and Drug Administration approval in 2004. Since then, robotic-assisted placement of thoracolumbar pedicle screws has been extensively studied. More recently, expanded applications of RSS have been introduced and evaluated. METHODS A systematic search of the Cochrane, OVID-MEDLINE, and PubMed databases was performed for articles relevant to robotic spine surgery. Institutional review board approval was not needed. RESULTS The placement of thoracolumbar pedicle screws using RSS is safe and accurate and results in reduced radiation exposure for the surgeon and surgical team. Barriers to utilization exist including learning curve and large capital costs. Additional applications involving minimally invasive techniques, cervical pedicle screws, and deformity correction have emerged. CONCLUSION Interest in RSS continues to grow as the applications advance in parallel with image guidance systems and minimally invasive techniques. IRB APPROVAL N/A.
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12
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Bishnoi S, Asaf BB, Puri HV, Pulle MV, Parikh MB, Kumar R, Kumar A. Thoracoscopic management of posterior mediastinal neurogenic tumours. J Minim Access Surg 2022; 18:366-371. [PMID: 35708381 PMCID: PMC9306111 DOI: 10.4103/jmas.jmas_234_20] [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] [Indexed: 11/16/2022] Open
Abstract
Background: This study describes the surgical technique of thoracoscopic resection of posterior mediastinal neurogenic tumours and reporting the surgical outcomes. Methods: This is a retrospective analysis of 21 patients operated over 7 years in a dedicated thoracic surgery centre. The demographic and post-operative parameters along with complications were recorded and analysed. Results: Twelve patients had right-sided tumours, while 9 had left-sided lesions, and 9 were on the left side. The most common diagnosis was schwannoma (n = 15, 71.42%), followed by neurofibroma (n = 4, 19.04%). The average surgery duration was 104 min (85–135 min), and the mean blood loss was 120 ml (25 ml–250 ml). The average lesion size was 4.8 cm (2 cm–7 cm). Conversion to open procedure was required in one patient. Two patients (14.2%) developed complications. One patient developed Horner's Syndrome and the other developed post-operative lung atelectasis. The median follow-up was 36 months (6–90 months). No recurrence was observed during the follow-up period. Conclusions: Thoracoscopic approach to posterior mediastinal neurogenic tumours is feasible and allows for low morbidity, short hospital stay and superior cosmesis.
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Affiliation(s)
- Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | | | - Reena Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Rückert JC, Elsner A, Andreas MN. [Mediastinal Tumors]. Zentralbl Chir 2022; 147:99-120. [PMID: 35235970 DOI: 10.1055/a-1674-0693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
If mediastinal tumours cause symptoms these are related to their anatomical localization or a paraneoplastic syndrome. The differential diagnosis is based on the clinical situation with finding the lesion, and, furthermore, taking into account the age and sex of the patient, and the mediastinal compartment where the lesion is located. Cross-sectional radiographic diagnostic is essential for defining the therapeutic strategy. The anterior mediastinum is dominated by thymic tumours, mediastinal lymphomas, germ cell tumours and ectopic mediastinal poiters. The middle mediastinal compartment is the most frequent place of mediastinal cystic tumours, whereas the posterior mediastinum is the domain of neurogenic tumours. For selected cases a tissue biopsy is required. Surgery is the mainstay for most mediastinal tumours. Median sternotomy is the most frequent conventional surgical technique while minimally invasive surgery with thoracoscopic and above all robot assisted operation techniques are increasingly frequent. Combined chemotherapy and modern radiotherapy are essential components of the comprehensive treatment for mediastinal tumours.
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Affiliation(s)
- Jens-Carsten Rückert
- Chirurgische Klinik Campus Charité Mitte, Charité Universitätsmedizin, Berlin, Deutschland
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14
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Li X, Zhang H, Chen LQ. Robot-assisted thoracoscopic transdiaphragmatic resection of an infradiaphragmatic desmoid-type fibromatosis. Asian J Surg 2022; 45:976-977. [PMID: 35012853 DOI: 10.1016/j.asjsur.2021.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/17/2021] [Indexed: 02/08/2023] Open
Affiliation(s)
- Xiaoyang Li
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Hanlu Zhang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Wang F, Zhang H, Qiu G, Wang Y. Robot-assisted thoracic surgery for apex-located neurogenic tumors. Asian J Surg 2021; 45:662-663. [PMID: 34801372 DOI: 10.1016/j.asjsur.2021.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/04/2021] [Indexed: 02/08/2023] Open
Affiliation(s)
- Fuqiang Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hanlu Zhang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guanghao Qiu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Podobed AV. [Minimally invasive surgery for cervico-mediastinal tumors: the choice of surgical approach]. Khirurgiia (Mosk) 2021:47-55. [PMID: 34786916 DOI: 10.17116/hirurgia202111147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To improve postoperative outcomes in patients with cervico-mediastinal tumors using minimally invasive surgical approaches. MATERIAL AND METHODS A retrospective analysis included 67 patients with cervico-mediastinal tumors who underwent surgery between 2002 and 2020. Outcomes of conventional surgeries (n=29), VATS (n=17), supraclavicular approach (n=19) and their combination were analyzed. RESULTS Minimally invasive approaches were characterized by significantly less blood loss (p<0.001), complication rate (p<0.001), duration of postoperative drainage (p<0.001) and hospital-stay (p<0.001). There was no postoperative mortality. No patient had tumor recurrence throughout the follow-up period (median 35 months). CONCLUSION VATS is advisable for tumors <6 cm localized predominantly in the mediastinum (>50% of volume). Supraclavicular approach is preferred mainly for cervical tumors. Minimally invasive surgical approaches are followed by more favorable early postoperative outcomes in patients with cervico-mediastinal tumor compared to traditional technique.
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Affiliation(s)
- A V Podobed
- Alexandrov National Cancer Center of Belarus, Lesnoy, Belarus
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Alshammari FA, Alotaibi AM, Alali MA, Alkhileiwi NS, Alshammari SM, Albagami MT, Alarimah YG, Aldughaim FA, Alsadady KA, Alshammari FF, Alhedires KM, Albejais NA, Alharbi MF, Alharthi AM, Alshammari M. Schwannoma: A Rare Etiology of Pancoast Syndrome. Cureus 2021; 13:e19418. [PMID: 34909333 PMCID: PMC8660959 DOI: 10.7759/cureus.19418] [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] [Accepted: 11/09/2021] [Indexed: 11/05/2022] Open
Abstract
Musculoskeletal disorders represent a major public health problem and they are frequently managed in primary care centers. Shoulder pain is a frequent musculoskeletal complaint and it can result from intrinsic disorders of the shoulder or referred pain. We present the case of a 24-year-old woman who presented to the family medicine clinic complaining of left shoulder pain for three months duration. The pain was not associated with numbness or weakness. There was no history of preceding trauma. The initial diagnosis was supraspinatus tendinosis. The patient was prescribed oral analgesics and was advised to undergo multiple physiotherapy sessions. Later, the patient presented to the clinic again and reported she did not have any improvement in her symptoms. The patient was referred to the orthopedic clinic for further evaluation and management. The patient underwent a frontal radiograph of the chest which demonstrated a well-defined opacity located in the apex of the left lung. A computed tomography scan of the chest demonstrated the presence of erosion to the vertebral body raising the suspicion for a neurogenic tumor as was later supported by magnetic resonance imaging. The patient underwent video-assisted thoracotomy with brachial plexus exploration. Complete resection of the tumor was achieved with no complications. The present case highlights those common musculoskeletal complaints, such as shoulder pain, which could indicate underlying non-orthopedic pathology.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Noor A Albejais
- Family Medicine, Prince Saud Bin Jalawy Hospital, Al-Mubarraz, SAU
| | | | | | - Malak Alshammari
- Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Qin J, Jing T, Wang P, Xia D, Wang S. Retroperitoneal robot-assisted resection of a lower posterior mediastinal benign schwannoma using a transdiaphragmatic approach: A case report. Medicine (Baltimore) 2020; 99:e21765. [PMID: 32957306 PMCID: PMC7505376 DOI: 10.1097/md.0000000000021765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Neurogenic tumors are the most frequent neoplasms of the lower posterior mediastinum. Traditionally, lower posterior mediastinal tumors are excised by video-assisted thoracic surgery. However, the available robotic treatment for the lower posterior mediastinum tumors to date are rare. Herein, we report a case of a right lower posterior mediastinal tumors successfully treated with retroperitoneal robot-assisted surgery using a transdiaphragmatic approach. PATIENT CONCERNS A 54-year-old male patient without any symptoms was admitted into our department with a right lower posterior mediastinal paravertebral tumor that was detected during a medical check-up. DIAGNOSIS A right lower posterior mediastinal paravertebral tumor. INTERVENTIONS Retroperitoneal robot-assisted resection using a transdiaphragmatic approach was performed. OUTCOMES The patient was treated with retroperitoneal robot-assisted surgery using a transdiaphragmatic approach and remained disease-free throughout a 6-month follow-up. His postoperative course was uneventful. Histopathological examination revealed a benign schwannoma. CONCLUSION Our initial experience showed that retroperitoneal robot-assisted resection of a lower posterior mediastinal tumor using a transdiaphragmatic approach is technically feasible and can be considered a potential alternative for either video-assisted thoracic surgery or a thoracotomy.
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Pu F, Zhang Z, Chen Z, Cai K, Wang B, Wu Q, Shi D, Liu J, Shao Z. Application of the da Vinci surgical robot system in presacral nerve sheath tumor treatment. Oncol Lett 2020; 20:125. [PMID: 32934694 PMCID: PMC7471688 DOI: 10.3892/ol.2020.11984] [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: 03/25/2020] [Accepted: 07/08/2020] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to investigate the feasibility of da Vinci robotic surgery in the treatment of presacral tumors, and to observe its efficacy and safety. Between March 2016 and April 2019, 12 patients with presacral nerve sheath tumors underwent da Vinci robotic surgery, and the integrity of the tumor resection, surgical duration, pre- and postoperative visual analog scale (VAS) score, intra- and postoperative blood losses, postoperative bedtime, hospital stay and complications were observed. The tumor was completely removed in all 12 patients, the surgical duration ranged between 76 and 245 min (mean, 106.08 min) and the intraoperative blood loss was 76-145 ml (mean, 101.67 ml). The average preoperative VAS score of the patients was 3.25, and the average VAS score at 1 week, 1 month and 3 months post operation were 1.08, 0.42 and 0.08, respectively. All patients were out of bed on the second day after surgery, and the postoperative drainage was 10-50 ml (mean, 33.50 ml). The patients were hospitalized for 3-5 days (mean, 3.92 days). No complications occurred peri- or postoperatively, and wound pain was the main source of postoperative discomfort. In conclusion, the da Vinci robot can be applied to presacral nerve sheath tumors with high surgical safety, low-level bleeding, a rapid recovery and a short hospital stay, making it worthy of further study.
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Affiliation(s)
- Feifei Pu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Zhicai Zhang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Zhaohui Chen
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Kailin Cai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Baichuan Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Qiang Wu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Deyao Shi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Jianxiang Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Zengwu Shao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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20
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Li XK, Cong ZZ, Xu Y, Zhou H, Wu WJ, Wang GM, Qiang Y, Shen Y. Clinical efficacy of robot-assisted thoracoscopic surgery for posterior mediastinal neurogenic tumors. J Thorac Dis 2020; 12:3065-3072. [PMID: 32642229 PMCID: PMC7330773 DOI: 10.21037/jtd-20-286] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Robot-assisted thoracic surgery (RATS) has an increasing usage throughout the world. This retrospective cohort study aimed to objectively compare the surgical results between video-assisted thoracic surgery (VATS) and RATS in posterior mediastinal neurogenic tumors (PMNT). Methods We retrospectively reviewed the clinical data of 130 patients diagnosed with posterior mediastinal neurogenic tumor between 2015 and 2018. Magnetic resonance imaging (MRI) or enhanced computed tomography scan (CT-scan) was used to locate the tumor and investigate the Adamkiewicz’s artery preoperatively. The individual surgical approach was determined by both tumor size and patient’s willings. Results The surgical time in RATS (43.2±12.6 min) was tended to be less than that in VATS (47.4±11.9 min) (P=0.054). Meanwhile, the estimated blood loss in RATS group (85.8±22.6 mL) was significantly less than that in VATS group (95.3±28.4 mL) (P=0.040). However, the duration of chest tube (days) and volume of drainage (mL) had no significant difference between two groups (P=0.12 and P=0.68, respectively). The postoperative hospital stay (days) of patients in RATS group (2.2±0.4 days) was significantly shorter than that in VATS group (2.4±0.6 days) (P=0.031). There were no significant differences between two groups in the incidence of the postoperative complications and adverse reactions. Conclusions RATS has the superiorities in terms of surgical blood loss and postoperative hospital stay over VATS for posterior mediastinal neurogenic tumor. In conclusion, RATS could be a feasible and safe way for resecting posterior mediastinal neurogenic tumor.
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Affiliation(s)
- Xiao-Kun Li
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhuang-Zhuang Cong
- Department of Cardiothoracic Surgery, Jingling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yang Xu
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Hai Zhou
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Wen-Jie Wu
- Department of Clinical Medicine, School of Medicine, Southeast University, Nanjing, China
| | - Gao-Ming Wang
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yong Qiang
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yi Shen
- Department of Cardiothoracic Surgery, Jingling Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Cardiothoracic Surgery, Jingling Hospital, School of Clinical Medicine, Nanjing Medical University, Nanjing, China
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21
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Chen K, Zhang X, Jin R, Xiang J, Han D, Zhang Y, Li H. Robot-assisted thoracoscopic surgery for mediastinal masses: a single-institution experience. J Thorac Dis 2020; 12:105-113. [PMID: 32190360 DOI: 10.21037/jtd.2019.08.105] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The objectives of this study were to evaluate the feasibility and safety of robot-assisted thoracic surgery (RATS) using the da Vinci robotic system for mediastinal mass resection and to describe the surgical approach for masses in different mediastinal regions. Methods We retrospectively reviewed data from 84 patients who underwent RATS for resection of a mediastinal mass from June 2015 to April 2019. The results were analyzed with descriptive statistics. Results The mediastinal mass was resected successfully in all patients, with one patient requiring conversion to conventional open surgery. There were no intraoperative complications. The most common diagnoses were thymoma (n=17), bronchogenic cyst (n=16), and schwannoma (n=12). The surgical approach was determined by the location of the lesion and the planned extent of surgical resection. Resection was performed in the lateral decubitus position in 29 patients with posterior mediastinal tumor, semi-lateral decubitus position in 42 patients who only need resection of anterior mediastinal mass, and reverse Trendelenburg position in 13 patients undergoing thymectomy. The mean (± standard deviation) operation time was 91.86±56.42 min, duration of chest tube use was 1.83±0.93 days, and postoperative hospital stay was 3.62±7.52 days. Three patients (3.5%) developed postoperative complications: one chylous fistula, which required reoperation, and one case each of atrial fibrillation and pulmonary infection, which were treated conservatively. Conclusions Our experience demonstrated that different surgical approaches of RATS are safe and feasible for mediastinal mass resection. An appropriate approach can be selected based on the mediastinal region in which the tumor is located.
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Affiliation(s)
- Kai Chen
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xianfei Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Runsen Jin
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jie Xiang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Dingpei Han
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yajie Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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22
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Moses ZB, Barzilai O, O'Toole JE. Benign Intradural and Paraspinal Nerve Sheath Tumors: Advanced Surgical Techniques. Neurosurg Clin N Am 2020; 31:221-229. [PMID: 32147013 DOI: 10.1016/j.nec.2019.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Traditional surgical techniques for benign intradural and paraspinal nerve sheath tumors often consisted of open posterior approaches. However, these were limited by the morbidity of open surgery. In addition, iatrogenic instability is often required for total resection of larger or laterally located tumors, thus necessitating the use of additional hardware for spinal fusion. Advances in surgical techniques and technologies have allowed for a plethora of minimally invasive approaches throughout the cervical, thoracic, and lumbar regions. These approaches and their particular applications for the resection of benign peripheral nerve sheath tumors are described, with special attention to modern surgical strategies.
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Affiliation(s)
- Ziev B Moses
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Ori Barzilai
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - John E O'Toole
- Department of Neurosurgery, Coleman Foundation Comprehensive Spine Tumor Clinic, Rush University Medical Center, 1725 West Harrison Street, Suite 855, Chicago, IL 60612, USA.
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23
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24
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Garg B, Mehta N, Malhotra R. Robotic spine surgery: Ushering in a new era. J Clin Orthop Trauma 2020; 11:753-760. [PMID: 32904238 PMCID: PMC7452360 DOI: 10.1016/j.jcot.2020.04.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 01/19/2023] Open
Abstract
The endeavour to make spine surgery safe with reproducible, consistent outcomes has led to growing interest and research in the field of intraoperative imaging, navigation and robotics. The advent of surgical robot systems in spine surgery is relatively recent - with only a few systems approved for commercial use. At present, pedicle screw insertion remains the primary application of robotic systems in spine surgery. The purported advantages of robot-assisted pedicle screw insertion over other conventional techniques are its increased accuracy, reproducible consistency and reduced radiation exposure. Many of these claims have been supported or refuted by individual studies - and high quality evidence for the same is lacking. Robotic spine surgery also has its share of limitations which include increased operative time, considerable learning curve and technical pitfalls unique to the robotic systems. The applications of robotic spine surgery are evolving and expanding to spinal deformity, spine oncology and needle-based interventional treatments. This review provides an overview of the evolution and current status of robotic spine surgery along with an evidence-based discussion of its current applications in spine surgery.
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Affiliation(s)
| | - Nishank Mehta
- Corresponding author. Department of Orthopaedics, 110029, India.
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25
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Zhang H, Wang Z, Zheng Y, Wang F, Geng Y, Chen LQ, Wang Y. Robotic-assisted simultaneous resection of a left-sided thymic neoplasm and a right-sided lower thoracic paravertebral neoplasm via the same ports and two docking steps: a case report. J Cardiothorac Surg 2019; 14:182. [PMID: 31665049 PMCID: PMC6819585 DOI: 10.1186/s13019-019-0989-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/02/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The authors presented a 63-year old female synchronously complicated with a thymic tumor located at the left-side of the superior mediastinum, and a paravertebral tumor located at the right-side of the lower thorax. Conventional thoracoscopic surgical procedure using rigid instruments to simultaneously resect the two tumors via the same ports might be technically challenging. To our knowledge, the use of a surgical robot allowed the surgeon to perform precise dissection from extreme angles with the characteristic of articulating surgical instruments. CASE PRESENTATION Two lesions were successfully dissected using the da Vinci Surgical System through the same four ports on the right side of the chest and two-step docking. Firstly, the patient cart came from the dorsal side of the patient and the paravertebral neoplasm was dissected. Afterwards, the patient cart was undocked and the operation table was rotated 180 degrees counterclockwise. The robot was re-introduced and the patient cart came from the ventral side of the patient and the whole thymus was resected. CONCLUSION This case report suggests that two-step docking via the same four ports for these two tumors located at different directions of the thorax was safe and effective, demonstrating a clear advantage of the surgical robot.
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Affiliation(s)
- Hanlu Zhang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Zihao Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yu Zheng
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Fuqiang Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yingcai Geng
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Sayari AJ, Pardo C, Basques BA, Colman MW. Review of robotic-assisted surgery: what the future looks like through a spine oncology lens. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:224. [PMID: 31297389 DOI: 10.21037/atm.2019.04.69] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent advancements in medical technology have led to the emergence of robotic-assisted surgery with the hope of creating a safer and more efficient surgical environment for the patient and surgical team. Spine surgery and spine tumor surgery involve challenging anatomy and demand highly precise surgical maneuvers, creating an important niche for robotic systems. While still in its infancy, robotics in spine surgery have proven successful in pedicle screw placement. Similarly, robotics has begun to be used for accurate resections and surgical planning in tumor surgery. As future studies are published and robotics systems continue to evolve, we can expect more tactile haptic feedback and implementation of useful instruments to improve preoperative planning, resection guidance, and reconstruction during spine tumor surgery.
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Affiliation(s)
- Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Coralie Pardo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Veronesi G, Solinas M. From manual to robotic video-assisted resection of posterior mediastinal masses. J Thorac Dis 2017; 9:2884-2887. [PMID: 29220040 DOI: 10.21037/jtd.2017.08.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Giulia Veronesi
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Michela Solinas
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
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Affiliation(s)
- Carmelina Cristina Zirafa
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Franca Melfi
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
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