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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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Al Dihan FA, Alghamdi MA, Aldihan FA, Alamer NM, Alshahrani FA, Alqarni A. Knowledge, Attitude, Awareness, and Future Expectations of Robotic Surgery in Patients Attending Surgical Specialties Clinics. Cureus 2024; 16:e56523. [PMID: 38646294 PMCID: PMC11027023 DOI: 10.7759/cureus.56523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction The use of robotic-assisted surgeries (RAS) has been growing in surgical specialties. It allows surgeons to perform higher-quality operations with fewer complications, mortality, and morbidity. However, there are a lot of misconceptions about RAS among patients. Therefore, our study aimed to assess the knowledge, attitude, awareness, and future expectations of RAS in patients attending surgical clinics. Methods A cross-sectional study was conducted in King Abdulaziz Medical City (KAMC) surgical clinics in Riyadh, Saudi Arabia. All participants <18 years of age were excluded. The questionnaire was distributed to 304 patients attending surgical clinics with a confidence level of 95% and a margin of error of 5%. Cluster sampling was used since the respondents were from multiple surgical specialties. Finally, multivariate analysis was performed to assess participants' preference for robotic surgery. Results Most participants (58.6%, n=178) were between 21 and 40 years old, and males were 52% of the participants. Many respondents thought a robot did not do the surgery. 70.7% of respondents had not heard of robotic surgery, with the media being the most common source of information. Internal damage was the prevalent concern (51.0%, n= 155) in malfunctions of robotic surgery. A significant relationship was found between participants from 21 to 40 years of age and a stronger preference for robotic surgery (p=.027). Respondents who preferred robotic surgery were discovered to have a significant relationship with participants who thought robotic surgery was safer and had better results (p<.001). 13.9% of participants who did not prefer robotic surgery also took cost into account significantly (χ2=28.93, p<.001, Cramer's V=.22). 67.2% (n=43) of respondents who preferred robotic surgery believed it might eventually replace present practices. Conclusion Our study concluded that the majority did not favor or were unsure whether to undergo robotic surgeries or not. However, most participants had some misconceptions and a lack of awareness about robotic surgeries. Raising awareness among patients can improve the mutual decision-making between them and their treating physician.
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Affiliation(s)
- Fahad A Al Dihan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohannad A Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Faisal A Aldihan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Nawaf M Alamer
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Faisal A Alshahrani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Ayyob Alqarni
- General and Colorectal Surgery, King Abdulaziz Medical City Riyadh, Riyadh, SAU
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Olsen RG, Hartwell D, Dalsgaard T, Madsen ME, Bjerrum F, Konge L, Røder A. First experience with the Hugo™ robot-assisted surgery system for endometriosis: A descriptive study. Acta Obstet Gynecol Scand 2024; 103:368-377. [PMID: 38031442 PMCID: PMC10823395 DOI: 10.1111/aogs.14727] [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: 09/08/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION The Medtronic Hugo™ Robot-assisted Surgery (RAS) system was recently approved for clinical use. We explored the safety and feasibility of this system for endometriosis surgery. The primary outcome was safe case completion without major surgical complications (Clavien-Dindo grade ≤2) and no conversion to open surgery or laparoscopy. MATERIAL AND METHODS Surgeries for endometriosis performed at the Department of Gynecology, Rigshospitalet, on the Medtronic Hugo™ RAS system were included. Two experienced robotic surgeons performed all surgeries with their usual robotic team. The variables included were patient demographics, peri- and postoperative data, complications and 30-day readmission rate. We used the IDEAL framework 1/2a for surgical innovation in this descriptive study. RESULTS The first 12 patients were included. All cases were completed without intraoperative complications or conversion. Four patients experienced Clavien-Dindo grade 1 postoperative complications. No patients were re-admitted within 30 days. Median docking time (17 minutes), console time (87.5 minutes), blood loss (40 mL) and length of hospital stay (1 day) were acceptable compared with previous literature. CONCLUSIONS In this pilot study, we found the Medtronic Hugo™ RAS system safe and feasible for robot-assisted surgery for endometriosis. The advent of new robotic systems is welcomed to accelerate the development of technology that will advance surgical care for patients across the globe.
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Affiliation(s)
- Rikke Groth Olsen
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Copenhagen Prostate Cancer Center, Department of UrologyCopenhagen University Hospital‐RigshospitaletCopenhagenDenmark
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Dorthe Hartwell
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Torur Dalsgaard
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Mette Elkjær Madsen
- Department of GynecologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Department of Surgery, Herlev‐Gentofte HospitalHerlevDenmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES)CopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Andreas Røder
- Copenhagen Prostate Cancer Center, Department of UrologyCopenhagen University Hospital‐RigshospitaletCopenhagenDenmark
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Ferrari L, Nicolaou S, Adams K. Implementation of a robotic surgical practice in inflammatory bowel disease. J Robot Surg 2024; 18:57. [PMID: 38281204 DOI: 10.1007/s11701-023-01750-4] [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: 10/01/2023] [Accepted: 12/02/2023] [Indexed: 01/30/2024]
Abstract
Robotics adoption has increased in colorectal surgery. While there are well-established advantages and standardised techniques for cancer patients, the use of robotic surgery in inflammatory bowel disease (IBD) has not been studied yet. To evaluate the feasibility and safety of robotic surgery for IBD patients. Prospectively data in IBD patients having robotic resection at Guy's and St Thomas' hospital. All resections performed by a single colorectal surgeon specialised in IBD, utilising DaVinci platform. July 2021 to January 2023, 59 robotic IBD cases performed, 14 ulcerative colitis (UC) and 45 Crohn's disease (CD). Average age; CD patients 35, UC 33 years. Average Body mass index (BMI); 23 for CD and 26.9 for UC patients. In total, we performed 31 ileo-caecal resections (ICR) with primary anastomosis (18 Kono-S anastomosis, 6 mechanical anastomosis and 7 ileo-colostomy), of those 4 had multivisceral resections (large bowel, bladder, ovary). Furthermore, 14 subtotal colectomy (1 emergency), 8 proctectomy, 3 panproctocolectomy and 3 ileoanal J pouch. 18 of the 45 patients (45.0%) with Crohn's disease had ongoing fistulating disease to other parts of the GI tract (small or large bowel). ICR were performed using different three ports position, depending on the anatomy established prior to surgery with magnetic resonance images (MRI). One patient had conversion to open due to anaesthetic problems and one patient required re-operation to refashion stoma. 98.0% cases completed robotically. Median Length of hospital stay (LOS) was 7 days for CD and 7 for UC cases, including LOS in patients on pre-operative parenteral nutrition. Robotic colorectal techniques can be safely used for patients with IBD, even with fistulating disease. Future research and collaborations are necessary to standardize technique within institutions.
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Affiliation(s)
- Linda Ferrari
- Pelvic Floor Unit, Mitchener Ward, St Thomas' Hospital, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK.
| | - Stella Nicolaou
- Pelvic Floor Unit, Mitchener Ward, St Thomas' Hospital, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK
| | - Katie Adams
- Pelvic Floor Unit, Mitchener Ward, St Thomas' Hospital, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK
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Yoon JH, Yun CY, Choi S, Park DC, Kim SI. Is robotic surgery beneficial for the treatment of endometrial cancer? A comparison with conventional laparoscopic surgery. J Cancer 2024; 15:533-538. [PMID: 38169547 PMCID: PMC10758039 DOI: 10.7150/jca.88187] [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: 07/17/2023] [Accepted: 11/08/2023] [Indexed: 01/05/2024] Open
Abstract
Objective: The objective of this study was to compare the oncologic outcomes between those who underwent robotic surgery or conventional laparoscopic surgery for endometrial cancer. Method: We performed a retrospective review of patients from a single institution who underwent either laparoscopic or robotic surgery for the treatment of endometrial cancer between January 2010 and December 2020. Tumor characteristics, recurrence rate, disease-free survival, and overall survival were compared according to surgical approach. Results: Among the 268 patients included in this study, 95 underwent robotic surgery (35.4%) and 173 underwent laparoscopic surgery (64.6%). The median follow-up durations were 51 and 59 months for the robotic surgery and laparoscopic surgery groups, respectively (p = 0.085). The recurrence rate did not differ significantly between the two groups. (p = 0.371). Disease-free survival (p = 0.721) and overall survival (p = 0.453) were similar between the two groups. In both univariate and multivariate analyses, the type of surgery was not related to disease-free survival. The median total cost per admission was significantly higher for RS than for LS (12,123 vs. 6,884 USD, p < 0.0001). Conclusion: With consistently greater costs and similar survival outcomes, robotic systems have few advantages compared with laparoscopy.
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Affiliation(s)
| | | | | | | | - Sang Il Kim
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Shafiei SB, Shadpour S, Mohler JL, Sasangohar F, Gutierrez C, Seilanian Toussi M, Shafqat A. Surgical skill level classification model development using EEG and eye-gaze data and machine learning algorithms. J Robot Surg 2023; 17:2963-2971. [PMID: 37864129 PMCID: PMC10678814 DOI: 10.1007/s11701-023-01722-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/19/2023] [Indexed: 10/22/2023]
Abstract
The aim of this study was to develop machine learning classification models using electroencephalogram (EEG) and eye-gaze features to predict the level of surgical expertise in robot-assisted surgery (RAS). EEG and eye-gaze data were recorded from 11 participants who performed cystectomy, hysterectomy, and nephrectomy using the da Vinci robot. Skill level was evaluated by an expert RAS surgeon using the modified Global Evaluative Assessment of Robotic Skills (GEARS) tool, and data from three subtasks were extracted to classify skill levels using three classification models-multinomial logistic regression (MLR), random forest (RF), and gradient boosting (GB). The GB algorithm was used with a combination of EEG and eye-gaze data to classify skill levels, and differences between the models were tested using two-sample t tests. The GB model using EEG features showed the best performance for blunt dissection (83% accuracy), retraction (85% accuracy), and burn dissection (81% accuracy). The combination of EEG and eye-gaze features using the GB algorithm improved the accuracy of skill level classification to 88% for blunt dissection, 93% for retraction, and 86% for burn dissection. The implementation of objective skill classification models in clinical settings may enhance the RAS surgical training process by providing objective feedback about performance to surgeons and their teachers.
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Affiliation(s)
- Somayeh B Shafiei
- Intelligent Cancer Care Laboratory, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.
| | - Saeed Shadpour
- Department of Animal Biosciences, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Farzan Sasangohar
- Mike and Sugar Barnes Faculty Fellow II, Wm Michael Barnes and Department of Industrial and Systems Engineering at Texas A&M University, College Station, TX, 77843, USA
| | - Camille Gutierrez
- Obstetrics and Gynecology Residency Program, Sisters of Charity Health System, Buffalo, NY, 14214, USA
| | - Mehdi Seilanian Toussi
- Intelligent Cancer Care Laboratory, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Ambreen Shafqat
- Intelligent Cancer Care Laboratory, Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
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Bjøro B, Ballestad I, Rustøen T, Fosmark MH, Bentsen SB. Positioning patients for robotic-assisted surgery: A qualitative study of operating room nurses' experiences. Nurs Open 2023; 10:469-478. [PMID: 36631733 PMCID: PMC9834175 DOI: 10.1002/nop2.1312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 12/21/2021] [Accepted: 07/29/2022] [Indexed: 01/16/2023] Open
Abstract
AIM One of the challenges of robotic-assisted surgery is related to positioning of the patient on the operating table. Technological developments place increased demands on operating room nurses' competence to prevent positioning injuries and ensuring care quality. Therefore, the aim of the present study was to describe operating room nurses' experiences when positioning the patients for robotic-assisted surgery. DESIGN A descriptive qualitative design. METHODS Seven operating room nurses with experience in robotic-assisted surgery were included at a university hospital. Data were obtained through individual interviews and analysed using qualitative content analysis. The Consolidated Criteria for Reporting Qualitative research COREQ checklist was used. RESULTS We identified three categories, (a) patient positioning is challenging during robotic-assisted surgery, (b) operating room nurses take responsibility for patient positioning during robotic-assisted surgery, but teamwork is important and (c) operating room nurses aim to achieve safe patient positioning during robotic-assisted surgery.
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Affiliation(s)
- Benedikte Bjøro
- Department of Operating Services, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
- Department of Nursing Science, Faculty of Medicine, Institute of Health and SocietyUniversity of OsloOsloNorway
| | - Ingvild Ballestad
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Tone Rustøen
- Department of Nursing Science, Faculty of Medicine, Institute of Health and SocietyUniversity of OsloOsloNorway
- Department of Research and Development, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
| | - Monica Hetlesæther Fosmark
- Faculty of Health SciencesUniversity of StavangerStavangerNorway
- Operating DepartmentHelse Stavanger HFStavangerNorway
| | - Signe Berit Bentsen
- Department of Operating Services, Division of Emergencies and Critical CareOslo University HospitalOsloNorway
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
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Kim SI, Yoo JG, Lee SJ, Park DC, Yoon JH. Robot-assisted versus conventional laparoscopic radical hysterectomy in cervical cancer stage IB1. Int J Med Sci 2023; 20:287-291. [PMID: 36860680 PMCID: PMC9969504 DOI: 10.7150/ijms.79830] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023] Open
Abstract
Objective: The aim of this study was to compare survival outcomes of robot-assisted laparoscopic radical hysterectomy (RRH) and conventional laparoscopic radical hysterectomy (LRH) in cervical cancer stage IB1. Method: This is a retrospective study of patients with cervical cancer stage IB1 who surgically treated by either RRH or LRH. Oncologic outcomes of the patients were compared according to surgical approach. Results: In total, 66 and 29 patients were assigned to LRH and RRH groups. All patients had stage IB1 disease (FIGO 2018). Intermediate risk factors (tumor size, LVSI, and deep stromal invasion), proportion of patients receiving adjuvant therapy (30.3% vs. 13.8%, p = 0.09), and median follow-up time (LRH, 61 months; RRH, 50 months; p=0.085) did not differ significantly between the two groups. The recurrence rate was higher in the LRH group; however, there was no significant difference between the two groups (p=0.250). DFS (55.4 vs 48.2 months, p = 0.250), and OS (61.2 vs 50.0 months, p = 0.287) were similar between the LRH and RRH groups. Conclusion: In patients with a tumor size < 2 cm, the recurrence rate was lower in RRH group; however, there was no significant difference. Further large-scale RCTs and clinical studies are required to provide relevant data.
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Affiliation(s)
- Sang Il Kim
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Geun Yoo
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Jong Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Choon Park
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo Hee Yoon
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Baker MV, Teles Abrao Trad A, Tamhane P, Weaver AL, Visscher SL, Borah BJ, Klingele CJ, Gebhart JB, Trabuco EC. Abdominal and robotic sacrocolpopexy costs following implementation of enhanced recovery after surgery. Int J Gynaecol Obstet 2022; 161:655-660. [PMID: 36504261 DOI: 10.1002/ijgo.14623] [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: 07/06/2022] [Revised: 11/04/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare perioperative costs and morbidity between open and robotic sacrocolpopexy after implementation of enhanced recovery after surgery (ERAS) pathway. METHODS The present retrospective cohort study of patients undergoing open or robotic sacrocolpopexy (January 1, 2014, through November 30, 2017) used an ERAS protocol with liposomal bupivacaine infiltration of laparotomy incisions. Primary outcomes were costs associated with index surgery and hospitalization, determined with Medicare cost-to-charge ratios and reimbursement rates and adjusted for variables expected to impact costs. Secondary outcomes included narcotic use, length of stay (LOS), and complications from index hospitalization to postoperative day 30. RESULTS For the total of 231 patients (open cohort, 90; robotic cohort, 141), the adjusted mean cost of robotic surgery was $3239 higher compared with open sacrocolpopexy (95% confidence interval [CI] $1331-$5147; P < 0.001). Rates were not significantly different for intraoperative complications (robotic, 4.3% [6/141]; open, 5.6% [5/90]; P = 0.754), 30-day postoperative complications (robotic, 11.4% [16/141]; open, 16.7% [15/90]; P = 0.322), or readmissions (robotic, 5.7% [8/141]; open, 3.3% [3/90]; P = 0.535). The percentage of patients dismissed on postoperative day 1 was greater in the robotic group (89.4% [126/141] vs. 48.9% [44/90], P < 0.001). CONCLUSIONS Decreased LOS associated with ERAS provided significant cost savings with open sacrocolpopexy versus robotic sacrocolpopexy without adverse impacts on perioperative complications or readmissions.
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Affiliation(s)
- Mary V Baker
- Department of Obstetrics and Gynecology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Ayssa Teles Abrao Trad
- Department of Obstetrics and Gynecology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Prajakta Tamhane
- Department of Family Medicine, Reid Health, Richmond, Indiana, USA
| | - Amy L Weaver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Sue L Visscher
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bijan J Borah
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - John B Gebhart
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Emanuel C Trabuco
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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Kampan NC, Teik CK, Shafiee MN. Where are we going with sentinel nodes mapping in ovarian cancer? Front Oncol 2022; 12:999749. [PMID: 36408149 PMCID: PMC9669053 DOI: 10.3389/fonc.2022.999749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Lymph node involvement is a major predictive indicator in early-stage epithelial ovarian cancer (EOC). There is presently no effective way to determine lymph node involvement other than surgical staging. As a result, traditional ovarian cancer surgery still includes pelvic and paraaortic lymphadenectomy. However, it might be linked to higher blood loss, lengthier operations, and longer hospital stays. The creation of a technique for accurately predicting nodal status without significant lymphadenectomy is thus the subject of ongoing research. Sentinel lymph nodes (SLN) mapping is a routine procedure in oncological surgery and has been proven to be effective and safe in cervical, vulvar, and uterine cancer. On the other hand, SLN mapping is not yet widely accepted and recognized in EOC. A thorough search of the literature was conducted between January 1995 to March 2022, using PubMed and Embase. This review included studies on lymphatic outflow of the ovaries and the sentinel lymph node method. A total of 13 studies involving 212 patients who underwent sentinel lymph node mapping for ovaries were included. Both open and laparoscopic approach are used. The most popular injection site is the ovarian ligaments, and a variety of agents are utilized, although the main markers were, technetium-99m radiocolloid (Tc-99m) or indocyanine green, either alone or in combination. Overall detection rate for SLN in ovaries is 84.5% (interquartile range: 27-100%). We suggest a standardized method for sentinel lymph node mapping in ovarian cancer. The detection rates, characterization and true positive rates of the approach in investigations support further study. The use of ultra-staging is essential for lower-volume metastasis and reproducibility. To ascertain the clinical utility of sentinel node in early ovarian cancer, larger collaborative prospective clinical trials are necessary.
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Chandrakar I, Pajai S, Toshniwal S. Robotic Surgery: The Future of Gynaecology. Cureus 2022; 14:e30569. [DOI: 10.7759/cureus.30569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022] Open
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Micha JP, Rettenmaier MA, Bohart RD, Goldstein BH. Robotic-Assisted Surgery for the Treatment of Breast and Cervical Cancers. JSLS 2022; 26:JSLS.2022.00014. [PMID: 35815331 PMCID: PMC9215693 DOI: 10.4293/jsls.2022.00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Robotic-assisted surgery facilitates the performance of numerous, complex procedures, namely conferring precision, flexibility, and control that is otherwise unavailable with conventional laparoscopy; and compared to open surgery, robotic-assisted surgery is ostensibly associated with fewer complications, reduced intraoperative complications, and shorter hospital stay duration. Nevertheless, the American College of Obstetricians and Gynecologists and the Food and Drug Administration have criticized the pervasive acceptance of robotic-assisted surgery, given the absence of randomized clinical trial data compared to traditional laparoscopy and open procedures, not to mention the increased surgical cost. Conclusions: While the research data continue to be borne out, surgeons should exercise considerable discretion in selecting the surgical approach from which their patients would derive the greatest clinical benefit.
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Affiliation(s)
- John P Micha
- Women's Cancer Research Foundation, Newport Beach, CA
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Agbafe V, Berlin NL, Butler CE, Hawk E, Offodile Ii AC. Prescriptions for Mitigating Climate Change-Related Externalities in Cancer Care: A Surgeon's Perspective. J Clin Oncol 2022; 40:1976-1979. [PMID: 35333584 DOI: 10.1200/jco.21.02581] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Victor Agbafe
- University of Michigan Medical School, Ann Arbor, MI
| | | | - Charles E Butler
- Department of Plastic and Reconstructive Surgery, UT MD Anderson Cancer Center, Houston, TX
| | - Ernest Hawk
- Division of Cancer Prevention and Population Sciences, UT MD Anderson Cancer Center, Houston, TX
| | - Anaeze C Offodile Ii
- Department of Plastic and Reconstructive Surgery, UT MD Anderson Cancer Center, Houston, TX.,Baker Institute for Public Policy, Rice University, Houston, TX
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Learning Curve Analysis of Single-Site Robot-Assisted Hysterectomy. J Clin Med 2022; 11:jcm11051378. [PMID: 35268470 PMCID: PMC8911377 DOI: 10.3390/jcm11051378] [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: 01/07/2022] [Revised: 02/19/2022] [Accepted: 02/28/2022] [Indexed: 02/01/2023] Open
Abstract
We aim to analyze the surgical outcomes and learning curve of single-site robot-assisted hysterectomy. This was a retrospective cohort study from a single academic medical center. A total of 123 patients who underwent single-site robotic surgery for gynecologic disease were enrolled. Gynecologic surgeries were performed by a single surgeon using single-site robot-assisted hysterectomy. The median age of enrolled patients was 49 years (range: 30–74 years). The median operation time was 131 min (range: 59–502 min) and the median docking time was 3 min (range: 1–10 min). In addition, the median console time was 76 min (range: 29–465 min). The cumulative sum (CUSUM) graph for total operation time indicated an initial decrease at case 41, generating 3 distinct performance phases: learning (n = 41 initial cases), competence (n = 54 middle cases), and mastery (n = 28 final cases). There was one case conversion to open surgery due to the difficulty in securing the field of view because of a 16-cm bulky mass protruding from the left pelvic wall. No patients required a transfusion and two complications including vaginal cuff dehiscence were identified. The single-site robot-assisted hysterectomy is a safe and feasible procedure. The learning curve consisted of 41 cases to significantly decrease the total operation time.
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Abstract
Compared with other fields, adoption of robotics in colorectal surgery remains relatively slow. One of the reasons for this is that the expected benefits of robotics, such as greater accuracy, speed, and better patient outcomes, are not born out in evidence comparing use of robotics for colorectal procedures to conventional laparoscopy. But evidence also suggests that outcomes with colorectal robotic procedures depend on the experience of the surgeon, suggesting that a steep learning curve is acting as a barrier to the benefits of robotics being realized. In this paper, we analyze exactly why surgeon skill and proficiency is such a critical factor in colorectal surgery, especially around the most complex procedures associated with cancer. Shortening of the learning curve is crucial for both the adoption of the technique and the efficient use of expert trainers. Looking beyond the basics of training and embracing a new generation of digital learning technologies that facilitate peer-to-peer collaboration and development beyond the confines of individual institutions may be an important contributor to achieve these goals in the future.
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Affiliation(s)
- Nadine Hachach-Haram
- Department of Surgery and Clinical Innovation, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Danilo Miskovic
- Department of Surgery and Clinical Innovation, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
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Kelkar D, Borse MA, Godbole GP, Kurlekar U, Slack M. Interim safety analysis of the first-in-human clinical trial of the Versius surgical system, a new robot-assisted device for use in minimal access surgery. Surg Endosc 2021; 35:5193-5202. [PMID: 32989548 PMCID: PMC8346419 DOI: 10.1007/s00464-020-08014-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to provide an interim safety analysis of the first 30 surgical procedures performed using the Versius Surgical System. BACKGROUND Robot-assisted laparoscopy has been developed to overcome some of the important limitations of conventional laparoscopy. The new system is currently undergoing a first-in-human prospective clinical trial to confirm the safety and effectiveness of the device when performing minimal access surgery (MAS). METHODS Procedures were performed using Versius by a lead surgeon supported by an operating room (OR) team. Male or female patients aged between 18 and 65 years old and requiring elective minor or intermediate gynaecological or general surgical procedures were enrolled. The primary endpoint was the rate of unplanned conversion of procedures to other MAS or open surgery. RESULTS The procedures included nine cholecystectomies, six robot-assisted total laparoscopic hysterectomies, four appendectomies, five diagnostic laparoscopy cases, two oophorectomies, two fallopian tube recanalisation procedures, an ovarian cystectomy and a salpingo-oophorectomy procedure. All procedures were completed successfully without the need for conversion to MAS or open surgery. No patient returned to the OR within 24 h of surgery and readmittance rate at 30 and 90 days post-surgery was 1/30 (3.3%) and 2/30 (6.7%), respectively. CONCLUSIONS This first-in-human interim safety analysis demonstrates that the Versius Surgical System is safe and can be used to successfully perform minor or intermediate gynaecological and general surgery procedures. The cases presented here provide evidence that the Versius clinical trial can continue to extend recruitment and begin to include major procedures, in alignment with the IDEAL-D Framework Stage 2b: Exploration.
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Affiliation(s)
- Dhananjay Kelkar
- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Mahindra A Borse
- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Girish P Godbole
- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Utkrant Kurlekar
- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Mark Slack
- CMR Surgical Ltd, 1 Evolution Business Park, Milton Road, Cambridge, CB24 9NG, UK.
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Alshowaikh K, Karpinska-Leydier K, Amirthalingam J, Paidi G, Iroshani Jayarathna AI, Salibindla DBAMR, Ergin HE. Surgical and Patient Outcomes of Robotic Versus Conventional Laparoscopic Hysterectomy: A Systematic Review. Cureus 2021; 13:e16828. [PMID: 34367836 PMCID: PMC8336353 DOI: 10.7759/cureus.16828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/02/2021] [Indexed: 11/05/2022] Open
Abstract
Hysterectomy is a commonly performed gynecologic surgery that can be associated with significant morbidity and mortality. However, the evolution of the surgical approach, from open to minimally invasive gynecologic surgery (MIGS), has substantially improved patient outcomes by reducing perioperative complications, pain, and length of hospitalization. The evident advantages and the approval of the da Vinci Surgical System by the Food and Drug Administration led to the exponential rise in the use of MIGS. In particular, robotic hysterectomy (RH) witnessed unparalleled popularity compared to other MIGS despite the lack of strong evidence demonstrating its superiority. Therefore, we conducted a systematic review of the literature to evaluate and compare various patient and surgical outcomes of RH with conventional laparoscopic hysterectomy (CLH), including operating time, estimated blood loss, length of hospitalization, overall complications, survival, and cost. Overall, the outcomes were comparable between RH and CLH except concerning cost. RH is significantly more expensive than CLH due to the higher costs of robotic equipment, including disposable instruments, equipment maintenance, and sterilization. Although RH demonstrated comparable outcomes and higher costs, its technical advantages such as improved ergonomics, three-dimensional view, a wider range of wristed mobility, mechanical lifting of robot's hand, and greater stability might benefit patient subsets (e.g., obesity, large uterine weights >750 g). Therefore, large and multicentered randomized control trials are imperative to determine the most effective surgical approach between RH and other MIGS for different patient subsets.
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Affiliation(s)
- Khadija Alshowaikh
- Obstetrics and Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Jashvini Amirthalingam
- General Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Gokul Paidi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | | | - Huseyin Ekin Ergin
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Masghati S, McDaniel A, Swainston D, Howard DL. Residents' Participation in Robotic Surgery and Operative Time: Does Attending Surgeons’ Volume Influence This Relationship? J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Salome Masghati
- Fellowship Program in Minimally Invasive Gynecologic Surgery, Las Vegas Minimally Invasive Surgery/University of Nevada, Las Vegas, Nevada, USA
| | - Alexandra McDaniel
- Sunrise Health GME Consortium Residency Program in Obstetrics and Gynecology, Las Vegas, Nevada, USA
| | - Darin Swainston
- Sunrise Health GME Consortium Residency Program in Obstetrics and Gynecology, Las Vegas, Nevada, USA
| | - David L. Howard
- Sunrise Health GME Consortium Residency Program in Obstetrics and Gynecology, Las Vegas, Nevada, USA
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19
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Robotic hysterectomy compared with laparoscopic hysterectomy: is it still more costly to perform? J Robot Surg 2021; 16:537-541. [PMID: 34232449 DOI: 10.1007/s11701-021-01273-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/26/2021] [Indexed: 10/20/2022]
Abstract
To establish the economic value of simple robotic hysterectomy vs laparoscopic hysterectomy and assess the impact of surgeon's experience. Retrospective cohort study. University-affiliated US regional healthcare system. Reproductive and post-menopausal women undergoing hysterectomy for benign indications. Robotic or laparoscopic hysterectomy. Between January 2018 and December 2019, a total of 985 simple laparoscopic and robotic hysterectomies were performed by 47 different gynecologists. Overall, the mean payment, direct cost, and profit were comparable (p value > 0.05) among simple robotic and laparoscopic hysterectomy. However, the mean operative time was significantly shorter for robotic hysterectomy compared to laparoscopic hysterectomy (106 min vs 127 min, respectively, p < 0.05). Operative time decreased as a surgeon's annual robotic case volume increased. Per-minute profitability of robotic hysterectomy increased significantly when a surgeon performed greater than 45 cases annually (p = 0.04). This effect became most pronounced when a surgeon performed 60 or more cases per year (p = 0.01). Simple robotic hysterectomy has shorter operative time compared to laparoscopic hysterectomy, with direct costs being similar. Robotic hysterectomy has higher per-minute profit compared to laparoscopic hysterectomy when a surgeon performs > 45 cases per year.
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20
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Iqbal MJ, Javed Z, Sadia H, Qureshi IA, Irshad A, Ahmed R, Malik K, Raza S, Abbas A, Pezzani R, Sharifi-Rad J. Clinical applications of artificial intelligence and machine learning in cancer diagnosis: looking into the future. Cancer Cell Int 2021; 21:270. [PMID: 34020642 PMCID: PMC8139146 DOI: 10.1186/s12935-021-01981-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) is the use of mathematical algorithms to mimic human cognitive abilities and to address difficult healthcare challenges including complex biological abnormalities like cancer. The exponential growth of AI in the last decade is evidenced to be the potential platform for optimal decision-making by super-intelligence, where the human mind is limited to process huge data in a narrow time range. Cancer is a complex and multifaced disorder with thousands of genetic and epigenetic variations. AI-based algorithms hold great promise to pave the way to identify these genetic mutations and aberrant protein interactions at a very early stage. Modern biomedical research is also focused to bring AI technology to the clinics safely and ethically. AI-based assistance to pathologists and physicians could be the great leap forward towards prediction for disease risk, diagnosis, prognosis, and treatments. Clinical applications of AI and Machine Learning (ML) in cancer diagnosis and treatment are the future of medical guidance towards faster mapping of a new treatment for every individual. By using AI base system approach, researchers can collaborate in real-time and share knowledge digitally to potentially heal millions. In this review, we focused to present game-changing technology of the future in clinics, by connecting biology with Artificial Intelligence and explain how AI-based assistance help oncologist for precise treatment.
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Affiliation(s)
- Muhammad Javed Iqbal
- Department of Biotechnology, Faculty of Sciences, University of Sialkot, Sialkot, Pakistan
| | - Zeeshan Javed
- Office for Research Innovation and Commercialization (ORIC), Lahore Garrison University, Sector-C, DHA Phase-VI, Lahore, Pakistan
| | - Haleema Sadia
- Department of Biotechnology, Balochistan University of Information Technology Engineering and Management Sciences (BUITEMS), Quetta, Pakistan
| | | | - Asma Irshad
- Department of Life Sciences, University of Management Sciences and Technology, Lahore, Pakistan
| | - Rais Ahmed
- Department of Microbiology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Kausar Malik
- Center for Excellence in Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - Shahid Raza
- Office for Research Innovation and Commercialization (ORIC), Lahore Garrison University, Sector-C, DHA Phase-VI, Lahore, Pakistan
| | - Asif Abbas
- Department of Biotechnology, Faculty of Sciences, University of Sialkot, Sialkot, Pakistan
| | - Raffaele Pezzani
- Dept. Medicine (DIMED), OU Endocrinology, University of Padova, via Ospedale 105, 35128 Padova, Italy
- AIROB, Associazione Italiana Per La Ricerca Oncologica Di Base, Padova, Italy
| | - Javad Sharifi-Rad
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Facultad de Medicina, Universidad del Azuay, Cuenca, Ecuador
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21
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[Epithelial ovarian cancers and minimally invasive cytoreductive surgery after neoadjuvant chemotherapy: A systematic review]. ACTA ACUST UNITED AC 2021; 49:736-743. [PMID: 33636412 DOI: 10.1016/j.gofs.2021.02.006] [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: 11/06/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Advanced epithelial ovarian cancer (EOC) is associated with high mortality and often managed first with neoadjuvant chemotherapy (NACT) followed by debulking surgery. Laparoscopic surgery with or without robotic assistance (Minimally Invasive Surgery (MIS)) may represent a beneficial option for these patients. The objective of this literature review is to clarify the place of MIS in the management of advanced EOC for selected patients. METHOD Pubmed, Cochrane and Clinicaltrials.gov online databases were used for this review, to select English or French published articles. RESULTS We selected 11 original articles published between 2015 and 2020, 6 of which compared MIS and laparotomy. Among these 11 studies, 8 were retrospective cohorts, 2 were phase II trials, and one was a case-control study. In total, there were 3721 patients, of which 854 (23%) were treated with MIS. The robotic assistance was used with 224 patients (26%) of those MIS patients. Looking specifically at MIS patients, the laparoconversion rate was 9.5%, the rate of complete resection (CC-0) was 83.4%. Finally, the MIS complication rate was 1% intraoperatively and 12% postoperatively. The rate of complete resection, postoperative complication, as well as overall survival (OS) were comparable between patients treated with MIS or laparotomy. One study found an improved disease-free survival (DFS) in MIS versus laparotomy (18 months versus 12 months; P=0.027). CONCLUSION MIS seems feasible, effective, and reliable in comparison to laparotomy for the completion of cytoreductive surgery after NACT without compromising oncological safety. Prospective randomized controlled trials are needed to confirm the role of MIS in advanced EOC.
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22
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Giovannopoulou E, Prodromidou A, Blontzos N, Iavazzo C. The Emerging Role of Robotic Single-site Approach for Myomectomy: A Systematic Review of the Literature. Surg Innov 2021; 28:352-359. [PMID: 33555235 DOI: 10.1177/1553350620988227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective. To review the existing studies on single-site robotic myomectomy and test the safety and feasibility of this innovative minimally invasive technique. Data Sources. PubMed, Scopus, Google Scholar (from their inception to October 2019), as well as Clinicaltrials.gov databases up to April 2020. Methods of Study Selection. Clinical trials (prospective or retrospective) that reported the outcomes of single-site robotic myomectomy, with a sample of at least 20 patients were considered eligible for the review. Results. The present review was performed in accordance with the guidelines for Systematic Reviews and Meta-Analyses (PRISMA). Four (4) studies met the inclusion criteria, and a total of 267 patients were included with a mean age from 37.1 to 39.1 years and BMI from 21.6 to 29.4 kg/m2. The mean operative time ranged from 131.4 to 154.2 min, the mean docking time from 5.1 to 5.45 min, and the mean blood loss from 57.9 to 182.62 ml. No intraoperative complications were observed, and a conversion rate of 3.8% was reported by a sole study. The overall postoperative complication rate was estimated at 2.2%, and the mean hospital stay ranged from 0.57 to 4.7 days. No significant differences were detected when single-site robotic myomectomy was compared to the multiport technique concerning operative time, blood loss, and total complication rate. Conclusion. Our findings support the safety of single-site robotic myomectomy and its equivalency with the multiport technique on the most studied outcomes. Further studies are needed to conclude on the optimal minimally invasive technique for myomectomy.
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Retrospective Analysis of Route Selection for Hysterectomy for Benign Indications at Ochsner Baptist Hospital. Ochsner J 2020; 20:368-372. [PMID: 33408573 PMCID: PMC7755548 DOI: 10.31486/toj.20.0017] [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] Open
Abstract
Background: Hysterectomy, the most common gynecologic procedure in the United States, can be performed in a number of ways. A shift in surgical practice toward cost-effective and minimally invasive approaches provides an impetus to maximize early training in vaginal surgery for resident physicians. Methods: A total of 62 abdominal, 303 robotic, and 41 vaginal hysterectomies performed between January 1, 2015 and December 31, 2017 at Ochsner Baptist Hospital in New Orleans, LA, that met inclusion criteria were retrospectively reviewed with a previously published route selection algorithm. We applied the algorithm using preoperative and postoperative data collected via medical record review to determine if our practices favor minimally invasive approaches. Results: Analysis using preoperative variables identified 152 robotic cases that were vaginal hysterectomy candidates (50.2%). Postoperative analysis of the same cases identified 127 (41.9%) vaginal hysterectomy candidates. Among abdominal cases, 37 (59.7%) called for a less invasive approach by preoperative findings: 7 (11.3%) vaginal and 30 (48.4%) laparoscopic. The algorithm sorted only 25 of the 62 abdominal cases (40.3%) to the abdominal approach. Conclusion: Use of a hysterectomy route selection algorithm preoperatively improves identification of candidates for minimally invasive hysterectomy.
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Schuessler Z, Liu S. Trends in hospital readmissions and emergency room visits 60 days after robotic-assisted and laparoscopic hysterectomy. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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25
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Chung G, Hinoul P, Coplan P, Yoo A. Trends in the diffusion of robotic surgery in prostate, uterus, and colorectal procedures: a retrospective population-based study. J Robot Surg 2020; 15:275-291. [PMID: 32564221 DOI: 10.1007/s11701-020-01102-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022]
Abstract
This study aimed to propose quantifiable metrics on the adoption lifecycle of robotic-assisted surgery (RAS) within and across prostate, hysterectomy, and colorectal procedures. This was a retrospective population-based cohort study of commonly performed RAS procedures in the US conducted from July 2001 to July 2015. The patients were identified from the Premier Hospital Database using International Classification of Diseases, 9th revision, Clinical Modification codes denoting prostate, uterus, and colorectal procedures. The Diffusion of Innovations theory was applied to percent RAS utilization to determine discrete eras of technology adoption. Overall and by-era patient baseline characteristics were compared between robotic and non-robotic groups. This study included a total of 2,098,440 RAS procedures comprising prostate (n = 155,342), uterus (n = 1,300,046), and colorectal (n = 643,052) procedures. Prostate (76.7%) and uterus (28.9%) procedures had the highest robotic utilization by the end of the study period and appear to be in the last adoption era (Laggard). However, robotic utilization in colorectal procedures (7.5%) was low and remained in the first era (Innovator) for a longer time (15 vs 60 vs 135 months). Whites, privately insured, patients with fewer comorbidities, and those admitted in large teaching hospitals were more likely to undergo RAS in the early study period. AS-associated patient and hospital profiles changed over time, suggesting that selected patient cohorts should be contextualized by overall adoption of a novel medical technology. The time-discretized analysis may also inform patient selection criteria and appropriate timing for clinical study stages proposed by the Idea, Development, Exploration, Assessment, Long-term study-Devices framework.
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Affiliation(s)
- Gary Chung
- Johnson & Johnson, Medical Devices Epidemiology and Real-World Sciences, New Brunswick, NJ, USA
| | - Piet Hinoul
- Ethicon, Inc., Clinical and Medical Affairs, Somerville, NJ, USA
| | - Paul Coplan
- Johnson & Johnson, Medical Devices Epidemiology and Real-World Sciences, New Brunswick, NJ, USA
| | - Andrew Yoo
- Johnson & Johnson, C-SATS, Outcomes Research and Medical Affairs, Seattle, United States.
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Parker VL, Parker WAE, Davies HM, Ramshaw HJ, D'Arcy EK, Al-Mohammad A, Mateszko O, Kew FM, Braidley PC. Benefits and Challenges of Robotic Pelvic Surgery in a Cardiac Transplant Recipient. Surg Innov 2020; 27:697-698. [PMID: 32525451 DOI: 10.1177/1553350620936007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Victoria L Parker
- Academic Unit of Reproductive and Developmental Medicine, 7315University of Sheffield, UK
| | - William A E Parker
- The Heart & Lung Transplant Unit, Northern General Hospital, 7318Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Holly M Davies
- 156677Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, UK
| | - Helen J Ramshaw
- The Heart & Lung Transplant Unit, Northern General Hospital, 7318Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Emma K D'Arcy
- The Heart & Lung Transplant Unit, Northern General Hospital, 7318Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Abdallah Al-Mohammad
- The Heart & Lung Transplant Unit, Northern General Hospital, 7318Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Olena Mateszko
- Department of Anaesthesia, Royal Hallamshire Hospital, 7318Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Fiona M Kew
- Department of Gynaecological Oncology, Royal Hallamshire Hospital, 7318Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Peter C Braidley
- The Heart & Lung Transplant Unit, Northern General Hospital, 7318Sheffield Teaching Hospitals NHS Foundation Trust, UK
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27
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The shifting trends towards a robotically-assisted surgical interface: Clinical and financial implications. HEALTH POLICY AND TECHNOLOGY 2020. [DOI: 10.1016/j.hlpt.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
The robotic-assisted laparoscopic surgical approach has improved complex gynecologic surgeries. It has the advantages of excellent visualization through the high-resolution 3-dimensional view, a wrist-like motion of the robotic arms and improved ergonomics. Similar to conventional laparoscopic surgeries, it is associated with a decrease in long-term surgical morbidity, early recovery and return to work, and improved esthetics. We discuss preoperative planning, surgical techniques, and some of the latest clinical results of robotic-assisted laparoscopic gynecologic surgery.
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Affiliation(s)
- Ashley S Moon
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, USA.
| | - John Garofalo
- Department of Obstetrics, Gynecology and Reproductive Biology, Norwalk Hospital, Nuvance Health, 30 Stevens Street, Norwalk, CT 06850, USA
| | - Pratistha Koirala
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, USA
| | - Mai-Linh T Vu
- Complete Women Care, 3711 Long Beach Boulevard, Suite 110, Long Beach, CA 90807, USA
| | - Linus Chuang
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, USA
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Prodromidou A, Spartalis E, Tsourouflis G, Dimitroulis D, Nikiteas N. Robotic versus laparoendoscopic single-site hysterectomy: a systematic review and meta-analysis. J Robot Surg 2020; 14:679-686. [DOI: 10.1007/s11701-020-01042-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
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30
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Bjøro B, Mykkeltveit I, Rustøen T, Candas Altinbas B, Røise O, Bentsen SB. Intraoperative peripheral nerve injury related to lithotomy positioning with steep Trendelenburg in patients undergoing robotic-assisted laparoscopic surgery - A systematic review. J Adv Nurs 2019; 76:490-503. [PMID: 31736124 DOI: 10.1111/jan.14271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/08/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022]
Abstract
AIMS To examine the incidence of intraoperative peripheral nerve injury, symptoms, risk factors, functions, and quality of life in patients undergoing robotic-assisted laparoscopic surgery to lithotomy positioning with steep Trendelenburg. DESIGN A systematic review. DATA SOURCES The Cochrane Library catalogue, PubMed, EMBASE, CINHAL and SveMed + databases were searched from January 2000 - February 2019. REVIEW METHODS Titles and abstracts were screened for inclusion. Full-text assessments of each paper were conducted by two reviewers. The quality of the included papers was assessed using the Mixed Methods Appraisal Tool. Descriptive statistics and thematic analysis were used to synthesize the data. RESULTS Eleven quantitative studies were included with three themes: (a) incidence of intraoperative peripheral nerve injury; (b) upper extremity intraoperative peripheral nerve injury related to steep Trendelenburg positioning; and (c) lower extremity intraoperative peripheral nerve injury related to lithotomy positioning. The overall incidence of intraoperative peripheral nerve injury in robotic-assisted laparoscopic urologic, gynaecologic and colorectal surgery was 0.16%-10.0% and the symptoms appeared immediately after surgical procedures. Risk factors for intraoperative peripheral injury were prolonged operative time, high American Society of Anesthesiologists scores, comorbidities and high body mass index. CONCLUSION Intraoperative peripheral nerve injuries are rare, but occasionally serious when related to lithotomy positioning with steep Trendelenburg. Operating room nurses have a responsibility both for positioning patients and for being familiar with the technological developments that will influence the preoperative handling of patients. IMPACT This systematic review emphasizes the need for operating room nurses together with surgical team to have knowledge about mechanisms for injury, positioning, anatomy/physiology, and evaluation of risk factors to ensure that patients are not exposed for intraoperative peripheral nerve injuries. Increased robotic-assisted laparoscopic surgery necessitates further research examining the incidence of intraoperative peripheral nerve injury related to positioning and how these affect patients' function and the quality of life.
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Affiliation(s)
- Benedikte Bjøro
- Department of Operating Services, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Ida Mykkeltveit
- Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Tone Rustøen
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Bahar Candas Altinbas
- Department of Surgical Disease Nursing, Faculty of Health Science, Karadeniz Technical University, Trabzon, Turkey
| | - Olav Røise
- Division of Orthopedics Surgery, Faculty of health Sciences, Oslo University Hospital, SHARE-Center for Resilience in Healthcare, University of Stavanger, Stavanger, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Signe Berit Bentsen
- Department of Operating Services, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Chen I, Choudhry AJ, Tulandi T. Hysterectomy Trends: A Canadian Perspective on the Past, Present, and Future. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 2:S340-S342. [PMID: 31785691 DOI: 10.1016/j.jogc.2019.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Innie Chen
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON; The Ottawa Hospital Research Institute, Ottawa, ON
| | | | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montréal, QC
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Pelizzo G, Nakib G, Calcaterra V. Pediatric and adolescent gynecology: Treatment perspectives in minimally invasive surgery. Pediatr Rep 2019; 11:8029. [PMID: 31871603 PMCID: PMC6908954 DOI: 10.4081/pr.2019.8029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 09/05/2019] [Indexed: 12/01/2022] Open
Abstract
Minimally invasive surgery (MIS) is widely utilized across multiple surgical disciplines, including gynecology. To date, laparoscopy is considered a common surgical modality in children and adolescents to treat gynecological conditions. Robotic surgical devices were developed to circumvent the limitations of laparoscopy and have expanded the surgical armamentarium with better magnification, dexterity enhanced articulating instruments with 5-7 degrees of freedom, and ability to scale motion thus eliminating physiologic tremor. There are well-documented advantages of MIS over laparotomy, including decreased post-operative pain, shorter recovery times, and better cosmetic results. Indications for MIS in pediatric gynecology are reported in this review and technical considerations are described to highlight new treatment perspectives in children and adolescents, which have already been described in the literature regarding adult patients.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, Children's Hospital, ARNASCivico-Di Cristina-Benfratelli, Palermo, Italy
| | - Ghassan Nakib
- Department of Pediatric Surgery, Mediclinic Middle East, Mediclinic City Hospital Dubai, UAE
| | - Valeria Calcaterra
- Pediatric Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Italy
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Chen I, Choudhry AJ, Tulandi T. Évolution de l'hystérectomie : un regard canadien sur le passé, le présent et l'avenir. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 2:S343-S346. [DOI: 10.1016/j.jogc.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tan YPA, Liverneaux P, Wong JKF. Current Limitations of Surgical Robotics in Reconstructive Plastic Microsurgery. Front Surg 2018; 5:22. [PMID: 29740585 PMCID: PMC5931136 DOI: 10.3389/fsurg.2018.00022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/27/2018] [Indexed: 12/27/2022] Open
Abstract
Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet benefitted significantly from technical developments observed over the last two decades. Several studies have successfully demonstrated the feasibility of utilising surgical robots in plastic surgery procedures, yet limited work has been done to identify and analyse current barriers that have prevented wide-scale adaptation of surgical robots for microsurgery. Therefore, a systematic review using PubMed, MEDLINE, Embase and Web of Science databases was performed, in order to evaluate current state of surgical robotics within the field of reconstructive microsurgery and their limitations. Despite the theoretical potential of surgical robots, current commercially available robotic systems are suboptimal for plastic or reconstructive microsurgery. Absence of bespoke microsurgical instruments, increases in operating time, and high costs associated with robotic-assisted provide a barrier to using such systems effectively for reconstructive microsurgery. Consequently, surgical robots provide currently little overall advantage over conventional microsurgery. Nevertheless, if current barriers can be addressed and systems are specifically designed for microsurgery, surgical robots may have the potential of meaningful impact on clinical outcomes within this surgical subspeciality.
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Affiliation(s)
- Youri P. A. Tan
- The Manchester Centre for Plastic Surgery and Burns, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Philippe Liverneaux
- Department of Hand Surgery, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS, Illkirch, France
| | - Jason K. F. Wong
- The Manchester Centre for Plastic Surgery and Burns, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, United Kingdom
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Single-site port robotic-assisted hysterectomy: an update. J Robot Surg 2018; 12:201-213. [PMID: 29453728 DOI: 10.1007/s11701-018-0789-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/11/2018] [Indexed: 02/08/2023]
Abstract
Single-incision approach in robotic gynecology is a relatively new concept. The role of single-port systems in robotic hysterectomy, their advantages and disadvantages, as well as the technical challenges, are still under investigation. A systematic review was performed by searching in PubMed and Scopus databases. In 810 out of 1225 patients, hysterectomy was performed for non-neoplastic disease. Single-Site® was the most common port system. Duration of the procedure and relative blood loss ranged from 60 to 311 min and 7 to 750 ml, respectively. The weight of the removed uteri ranged from 39 to 520 g. 4.9% of the included patients presented complications, among which bleeding, vaginal haematoma, laceration and dehiscence, umbilical hernia, and visceral injuries. Conversion rate to laparotomy reached 2.8%. Although some technical difficulties are still described in the literature, the single-port approach is becoming more standardized nowadays and performed by more surgeons. The initial phase of the learning curve can be achieved after five cases, while a proficiency in intracorporeal cuff suturing after 14 cases. Uterus weight and previous abdominal surgical history can still be limitations of the technique. Compared to our previous study, we can see that the technique has been used in more elderly or obese patients. The complication rate can reach 4.9% while the conversion rate can reach 2.8%. However, we consider that complication and conversion rates as well as surgical time could be improved with experience. Regarding post-operative pain and cosmetic outcomes, the lack of information do not allow us to draw any safe conclusions.
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Taylan E, Oktay KH. Robotics in reproduction, fertility preservation, and ovarian transplantation. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:19-24. [PMID: 30697560 PMCID: PMC6193444 DOI: 10.2147/rsrr.s123703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Robotic technology is one of the most promising and rapidly developing advancements of the twenty-first century with a potential to make significant contributions to reproductive surgery and preservation of fertility. Along with the major advances in cancer therapy, the number of female cancer survivors of reproductive age has dramatically increased. As a consequence, fertility preservation has gained more emphasis in reproductive science in the last few decades. A broad range of surgical procedures such as tubal reanastomosis, ovarian transposition, radical trachelectomy, and ovarian transplantation has been introduced to restore or preserve fertility in selected patients. These procedures can be accomplished through various surgical routes, including open surgery and minimally invasive approaches. In this review, we aim to present the current applications, advantages, and disadvantages of robotic technology in the field of reproductive surgery with a special interest in ovarian transplantation for fertility preservation.
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Affiliation(s)
- Enes Taylan
- Department of Obstetrics and Gynecology, Laboratory of Molecular Reproduction and Fertility Preservation New York Medical College, Valhalla, NY, USA, .,Innovation Institute for Fertility Preservation and In Vitro Fertilization, NY, USA,
| | - Kutluk H Oktay
- Department of Obstetrics and Gynecology, Laboratory of Molecular Reproduction and Fertility Preservation New York Medical College, Valhalla, NY, USA, .,Innovation Institute for Fertility Preservation and In Vitro Fertilization, NY, USA,
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Solodova RF, Galatenko VV, Nakashidze ER, Andreytsev IL, Galatenko AV, Senchik DK, Staroverov VM, Podolskii VE, Sokolov ME, Sadovnichy VA. Instrumental tactile diagnostics in robot-assisted surgery. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:377-382. [PMID: 27826218 PMCID: PMC5096743 DOI: 10.2147/mder.s116525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Robotic surgery has gained wide acceptance due to minimizing trauma in patients. However, the lack of tactile feedback is an essential limiting factor for the further expansion. In robotic surgery, feedback related to touch is currently kinesthetic, and it is mainly aimed at the minimization of force applied to tissues and organs. Design and implementation of diagnostic tactile feedback is still an open problem. We hypothesized that a sufficient tactile feedback in robot-assisted surgery can be provided by utilization of Medical Tactile Endosurgical Complex (MTEC), which is a novel specialized tool that is already commercially available in the Russian Federation. MTEC allows registration of tactile images by a mechanoreceptor, real-time visualization of these images, and reproduction of images via a tactile display. MATERIALS AND METHODS Nine elective surgeries were performed with da Vinci™ robotic system. An assistant performed tactile examination through an additional port under the guidance of a surgeon during revision of tissues. The operating surgeon sensed registered tactile data using a tactile display, and the assistant inspected the visualization of tactile data. First, surgeries where lesion boundaries were visually detectable were performed. The goal was to promote cooperation between the surgeon and the assistant and to train them in perception of the tactile feedback. Then, instrumental tactile diagnostics was utilized in case of visually undetectable boundaries. RESULTS In robot-assisted surgeries where lesion boundaries were not visually detectable, instrumental tactile diagnostics performed using MTEC provided valid identification and localization of lesions. The results of instrumental tactile diagnostics were concordant with the results of intraoperative ultrasound examination. However, in certain cases, for example, thoracoscopy, ultrasound examination is inapplicable, while MTEC-based tactile diagnostics can be efficiently utilized. CONCLUSION The study proved that MTEC can be efficiently used in robot-assisted surgery allowing correct localization of visually undetectable lesions and visually undetectable boundaries of pathological changes of tissues.
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Affiliation(s)
- Rozalia F Solodova
- Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University
| | - Vladimir V Galatenko
- Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University
| | | | | | | | - Dmitriy K Senchik
- Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University
| | | | - Vladimir E Podolskii
- Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University
| | - Mikhail E Sokolov
- Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University
| | - Victor A Sadovnichy
- Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University
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Abstract
Over the past few decades, robotic surgery has developed from a futuristic dream to a real, widely used technology. Today, robotic platforms are used for a range of procedures and have added a new facet to the development and implementation of minimally invasive surgeries. The potential advantages are enormous, but the current progress is impeded by high costs and limited technology. However, recent advances in haptic feedback systems and single-port surgical techniques demonstrate a clear role for robotics and are likely to improve surgical outcomes. Although robotic surgeries have become the gold standard for a number of procedures, the research in colorectal surgery is not definitive and more work needs to be done to prove its safety and efficacy to both surgeons and patients.
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Affiliation(s)
- Allison Weaver
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Scott Steele
- Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA
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