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Chatterjee S, Das S, Ganguly K, Mandal D. Advancements in robotic surgery: innovations, challenges and future prospects. J Robot Surg 2024; 18:28. [PMID: 38231455 DOI: 10.1007/s11701-023-01801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/16/2023] [Indexed: 01/18/2024]
Abstract
The use of robots has revolutionized healthcare, wherein further innovations have led to improved precision and accuracy. Conceived in the late 1960s, robot-assisted surgeries have evolved to become an integral part of various surgical specialties. Modern robotic surgical systems are equipped with highly dexterous arms and miniaturized instruments that reduce tremors and enable delicate maneuvers. Implementation of advanced materials and designs along with the integration of imaging and visualization technologies have enhanced surgical accuracy and made robots safer and more adaptable to various procedures. Further, the haptic feedback system allows surgeons to determine the consistency of the tissues they are operating upon, without physical contact, thereby preventing injuries due to the application of excess force. With the implementation of teleoperation, surgeons can now overcome geographical limitations and provide specialized healthcare remotely. The use of artificial intelligence (AI) and machine learning (ML) aids in surgical decision-making by improving the recognition of minute and complex anatomical structures. All these advancements have led to faster recovery and fewer complications in patients. However, the substantial cost of robotic systems, their maintenance, the size of the systems and proper surgeon training pose major challenges. Nevertheless, with future advancements such as AI-driven automation, nanorobots, microscopic incision surgeries, semi-automated telerobotic systems, and the impact of 5G connectivity on remote surgery, the growth curve of robotic surgery points to innovation and stands as a testament to the persistent pursuit of progress in healthcare.
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Affiliation(s)
- Swastika Chatterjee
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India
| | | | - Karabi Ganguly
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India
| | - Dibyendu Mandal
- Department of Biomedical Engineering, JIS College of Engineering, Kalyani, West Bengal, India.
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Brassetti A, Ragusa A, Tedesco F, Prata F, Cacciatore L, Iannuzzi A, Bove AM, Anceschi U, Proietti F, D’Annunzio S, Flammia RS, Chiacchio G, Ferriero M, Guaglianone S, Mastroianni R, Misuraca L, Tuderti G, Simone G. Robotic Surgery in Urology: History from PROBOT ® to HUGO TM. SENSORS (BASEL, SWITZERLAND) 2023; 23:7104. [PMID: 37631641 PMCID: PMC10458477 DOI: 10.3390/s23167104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
The advent of robotic surgical systems had a significant impact on every surgical area, especially urology, gynecology, and general and cardiac surgery. The aim of this article is to delineate robotic surgery, particularly focusing on its historical background, its evolution, its present status, and its future perspectives. A comprehensive literature review was conducted upon PubMed/MEDLINE, using the keywords "robotic surgical system", "robotic surgical device", "robotics AND urology". Additionally, the retrieved articles' reference lists were investigated. Analysis concentrated on urological surgical systems for laparoscopic surgery that have been given regulatory approval for use on humans. From the late 1980s, before daVinci® Era in 2000s, ancestor platform as Probot® and PUMA 560 were described to outline historical perspective. Thus, new robotic competitors of Intuitive Surgical such as Senhance®, Revo-I®, Versius®, Avatera®, Hinotori®, and HugoTM RAS were illustrated. Although daVinci® had high level competitiveness, and for many years represented the most plausible option for robotic procedures, several modern platforms are emerging in the surgical market. Growing competition through unique features of the new robotic technologies might extend applications fields, improve diffusion, and increase cost-effectiveness procedures. More experiences are needed to identify the role of these new advancements in surgical branches and in healthcare systems.
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Affiliation(s)
| | - Alberto Ragusa
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (A.B.); (F.T.); (F.P.); (L.C.); (A.I.); (A.M.B.); (U.A.); (F.P.); (S.D.); (R.S.F.); (G.C.); (M.F.); (S.G.); (R.M.); (L.M.); (G.T.); (G.S.)
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Burns HR, McLennan A, Xue EY, Yu JZ, Selber JC. Robotics in Microsurgery and Supermicrosurgery. Semin Plast Surg 2023; 37:206-216. [PMID: 38444959 PMCID: PMC10911899 DOI: 10.1055/s-0043-1771506] [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: 03/07/2024]
Abstract
Microsurgery has changed the ability to perform highly precise and technical surgeries through the utilization of high-powered microscopes and specialized instruments to manipulate and repair anatomical structures as small as a few millimeters. Since the first human trials of robotic-assisted microsurgery in 2006, the expansion of microsurgery to supermicrosurgery (luminal diameter less than 1 mm) has enabled successful repair of previously inaccessible structures. Surgical robotic systems can offer two distinct operative advantages: (1) minimal access surgery-by entering body cavities through ports, flap harvest can be redesigned to affect a minimally invasive approach for flaps such as the rectus abdominis muscle, the latissimus flap, and the deep inferior epigastric perforator flap; and (2) precision-by eliminating physiologic tremor, improving ergonomics, increasing accessibility to difficult spaces, and providing motion scaling, precision is significantly enhanced. Robotic-assisted microsurgery is a promising application of robotics for the plastic surgeon and has played an important role in flap harvest, head and neck reconstruction, nerve reconstruction, gender-affirming surgery, and lymphatic reconstruction-all the while minimizing surgical morbidity. This article aims to review the history, technology, and application of microsurgery and supermicrosurgery in plastic surgery.
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Affiliation(s)
- Heather R. Burns
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Alexandra McLennan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Erica Y. Xue
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jessie Z. Yu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jesse C. Selber
- Department of Plastic Surgery, Corewell Health, Grand Rapids, Michigan
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Dolci ME, Lobo RD, Nunes JA, Acuna AA, Thimoteo Cavassin LG, Monte KM, Levin AS, Bozola FJD, Oliveira MS. Evaluation of cleaning process efficacy of instruments for robotic surgery using the adenosine triphosphate test. Surgery 2023; 174:296-300. [PMID: 37263878 DOI: 10.1016/j.surg.2023.04.024] [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: 11/03/2022] [Revised: 03/16/2023] [Accepted: 04/09/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Despite the advances in robotic surgery and its benefits for the patient and surgeon, there are difficulties and challenges in reprocessing surgical instruments, including with regard to patient safety, such as the risk of infection. The aim of this article is to evaluate the effectiveness of manual plus ultrasonic cleaning of EndoWrist devices used in robotic surgery using the adenosine triphosphate bioluminescence quantitative test. METHODS A prospective cross-sectional study assessed the cleanliness of robotic instrumentals used in surgeries. Surgical instruments were collected immediately after the end of the surgery and sent for cleaning and disinfection following standard hospital procedures. The adenosine triphosphate test was done after visual evaluation. According to our hospital standard, instruments were classified as "approved" if the test found ≤50 relative light units. FINDINGS We evaluated 279 EndoWrist instruments from 65 robotic surgeries. The most frequently used instruments were needle drivers (102; 39%), followed by bipolar instruments (65; 25%). Median relative light units were 49 (range = 4-13,095); 54% of instruments were classified as approved according to the hospital's threshold (relative light units ≤50) and 78% when the manufacturer's threshold (relative light units ≤150) was used. Monopolar instruments presented the best rate of approval (94% considering relative light units ≤50 and 100% with relative light units ≤150). The average relative light units did not vary with the number of reuses. There were no surgical site infections. CONCLUSION Manual plus automated cleaning processes reduced bioburden in all situations evaluated. It seems that instruments can be safely reprocessed ≤9 times and that monopolar instruments are the easiest to clean.
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Affiliation(s)
| | | | | | - Andrea Alfaya Acuna
- Sterile Supply Center, Hospital Sírio Libanês, São Paulo, Brazil; Department of Surgery, Hospital Sírio Libanês, São Paulo, Brazil
| | | | | | - Anna S Levin
- Department of Infection Control, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Pisla D, Crisan N, Gherman B, Andras I, Tucan P, Radu C, Pusca A, Vaida C, Al Hajjar N. Safety Issues in the Development of an Innovative Medical Parallel Robot Used in Renal Single-Incision Laparoscopic Surgery. J Clin Med 2023; 12:4617. [PMID: 37510731 PMCID: PMC10380956 DOI: 10.3390/jcm12144617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Robotic-assisted single-incision laparoscopic surgery (SILS) is becoming an increasingly widespread field worldwide due to the benefits it brings to both the patient and the surgeon. The goal of this study is to develop a secure robotic solution for SILS, focusing specifically on urology, by identifying and addressing various safety concerns from an early design stage. Starting with the medical tasks and protocols, the technical specifications of the robotic system as well as potential; hazards have been identified. By employing competitive engineering design methods such as Analytic Hierarchy Process (AHP), Risk assessment, and Failure Mode and Effects Analysis (FMEA), a safe design solution is proposed. A set of experiments is conducted to validate the proposed concept, and the results strongly support the development of the experimental model. The Finite Element Analysis (FEA) method is applied to validate the mechanical architecture within a set of simulations, demonstrating the compliance of the robotic system with the proposed technical specifications and its capability to safely perform SILS procedures.
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Affiliation(s)
- Doina Pisla
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Nicolae Crisan
- Department of Urology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Bogdan Gherman
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Iulia Andras
- Department of Urology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Paul Tucan
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Corina Radu
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Alexandru Pusca
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Calin Vaida
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Department of Urology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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Singh K, Agrawal A. Robotic surgery: is it here to flourish? Med J Armed Forces India 2023; 79:1-5. [PMID: 36605343 PMCID: PMC9807742 DOI: 10.1016/j.mjafi.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- K.J. Singh
- Consultant (Surgery & GI Surgery), Command Hospital (Western Command), Chandimandir, Panchkula, Haryana, India
| | - Amit Agrawal
- Senior Advisor (Surgery) & Urologist, Army Hospital (R&R), Delhi Cantt, India
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Fang JK, Hsiao PJ, Chiu HC, Huang CP. Robot-assisted anatrophic nephrolithotomy for complete staghorn stone. Medicine (Baltimore) 2022; 101:e30154. [PMID: 36042683 PMCID: PMC9410623 DOI: 10.1097/md.0000000000030154] [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: 12/01/2022] Open
Abstract
To assess the efficacy and safety of robot-assisted anatrophic nephrolithotomy (RANL) as a choice of minimally invasive treatment for patients with complete staghorn stone. In a single-tertiary referral center retrospective study, 10 consecutive patients underwent RANL for complete staghorn stone. After dissection to the renal hilum and clamping of the renal vessels, an incision was made along the Brodel line and exposed the collecting system to extract the stone. Then, the collecting system and parenchyma were closed in layers. The outcomes included reduction of the stone burden, short- and long-term postoperative kidney function, and pain score. The average age of patients was 54.6 years and body mass index was 27.58 kg/m2. Mean warm ischemia time was 28.40 minutes, mean robotic console time was 137 minutes, and mean estimated blood loss was 83 mL. The mean length of stay was 5.4 days and there were no severe perioperative complications. Eight of 10 patients had >90% reduction in stone burden and 5 (50%) patients were completely stone-free. There was no significant decrease in postoperative estimated glomerular filtration rate compared with preoperative values after 1 month and 1 year. Our experience with RANL demonstrated efficacy and safety in the minimally invasive treatment of complete staghorn stone in short- and long-term follow-up periods.
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Affiliation(s)
- Jen-Kai Fang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Po-Jen Hsiao
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Chieh Chiu
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- Division of Urology, Department of Surgery, Asia University Hospital, Asia University College of Medical and Health Science, Taichung, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- *Correspondence: Chi-Ping Huang, No. 2, Yude Road, North District, Taichung, Taiwan (e-mail: )
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Morrell ALG, Morrell-Junior AC, Morrell AG, Mendes JMF, Tustumi F, DE-Oliveira-E-Silva LG, Morrell A. The history of robotic surgery and its evolution: when illusion becomes reality. Rev Col Bras Cir 2021; 48:e20202798. [PMID: 33470371 PMCID: PMC10683436 DOI: 10.1590/0100-6991e-20202798] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/06/2020] [Indexed: 11/21/2022] Open
Abstract
The term "robot" was concepted in the beginning of last century, coming originally from the Czech word "robota", meaning "labor". More recently, computer assistance and robotics based in the telepresence and virtual reality concept have been applied to surgical procedures. The application of robots in surgery dates approximately 35 years, experiencing significant growth in the last two decades fueled by the advent of advanced technologies. Despite its recent and brief status in surgery history, robotic technology has already proven its enhanced visualization, superior dexterity and precision during minimally invasive procedures. Currently, the worldwide diffused and predominant robot system used in surgery is Da Vinci by Intuitive Surgical, however robotic surgery evolution is far from over, with multiple potential competitors on the horizon pushing forward its paradigms. We aim to describe the history and evolution of robotic surgery in the last years as well as present its future perspectives.
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Affiliation(s)
- Andre Luiz Gioia Morrell
- - Instituto Morrell, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Albert Einstein, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP -Brasil
- - Rede D'Or São Luiz, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Hospital Vila Nova Star, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia do Aparelho Digestivo, Bariátrica e Metabólica Robótica - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Alexander Charles Morrell-Junior
- - Instituto Morrell, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Albert Einstein, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP -Brasil
- - Rede D'Or São Luiz, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Hospital Vila Nova Star, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia do Aparelho Digestivo, Bariátrica e Metabólica Robótica - São Paulo - SP - Brasil
| | - Allan Gioia Morrell
- - Instituto Morrell, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Albert Einstein, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP -Brasil
- - Rede D'Or São Luiz, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Hospital Vila Nova Star, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia do Aparelho Digestivo, Bariátrica e Metabólica Robótica - São Paulo - SP - Brasil
| | - Jose Mauricio Freitas Mendes
- - Sociedade Beneficente Israelita Brasileira Albert Einstein, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP -Brasil
- - Rede D'Or São Luiz, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Hospital Vila Nova Star, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Francisco Tustumi
- - Instituto Morrell, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
| | | | - Alexander Morrell
- - Instituto Morrell, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Albert Einstein, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP -Brasil
- - Rede D'Or São Luiz, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Hospital Vila Nova Star, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia do Aparelho Digestivo, Bariátrica e Metabólica Robótica - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Departamento de Cirurgia - São Paulo - SP - Brasil
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Oesterwitz H. [45 years of microsurgery in urology : Contemporary witnesses report with special reference to vasectomy reversal]. Urologe A 2020; 59:1523-1540. [PMID: 32757026 DOI: 10.1007/s00120-020-01292-9] [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: 11/26/2022]
Abstract
On the occasion of the 45th anniversary of the introduction of microsurgery in urology, the author describes the historical development of urologic microsurgery in Germany, with special reference to vasectomy reversal. Together with contemporary witnesses, a critical historical review is drawn and the current status is analyzed as well as an outlook is given.
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Affiliation(s)
- Horst Oesterwitz
- Zentrum für Refertilisierungschirurgie, Klinik für Urologie, Klinikum Ernst von Bergmann, Charlottenstraße 72, 14467, Potsdam, Deutschland.
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Leung T, Vyas D. Robotic Surgery: Applications. AMERICAN JOURNAL OF ROBOTIC SURGERY 2014; 1:1-64. [PMID: 26501128 PMCID: PMC4615607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Tiffany Leung
- College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Suite 655, Lansing, MI 48912, USA
| | - Dinesh Vyas
- Department of Surgery; Institute of International Health; MS Surgery Clerkship, College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Suite 655, Lansing, MI 48912, USA
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Affiliation(s)
- Jay Shah
- College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Suite 655, Lansing, MI 48912
| | - Arpita Vyas
- Assistant Professor, Department of Pediatrics, Adjunct Professor, Institute of International Health, College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Suite 655, Lansing, MI 48912
| | - Dinesh Vyas
- Assistant Professor, Department of Surgery, Advanced Robotic and GI Surgeon, Adjunct Professor, Institute of International Health, Director, MS Surgery Clerkship, College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Suite 655, Lansing, MI 48912,
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Abstract
PURPOSE OF REVIEW Since its inception in early 2000, robotic assistance with urologic procedures continues to expand. The magnification, three-dimensional visualization, and surgical control offered by the latest daVinci Si-HD system has led to its integration into microsurgical procedures for male infertility. The addition of robotic assistance may allow an improvement in outcomes similar to when the operating microscope was introduced in microsurgery. Though the use of robotics in microsurgery is still in its early phases, initial findings are encouraging. RECENT FINDINGS This review covers robotic microsurgical procedures and tools for infertility and chronic orchialgia/testicular pain such as vasovasostomy, vasoepididymostomy, varicocelectomy, testicular sperm extraction and targeted denervation of the spermatic cord. Preliminary human clinical studies appear to show improved operative efficiency and comparable outcomes. The use of robotic assistance during robotic microsurgical vasovasostomy appears to decrease operative duration and improve the rate of return of postoperative sperm counts compared to the pure microsurgical technique. SUMMARY Long-term prospective controlled trials are necessary to assess the true benefit for robotic-assisted microsurgery. The preliminary findings are promising, but further evaluation is warranted.
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Robotic microsurgery 2011: male infertility, chronic testicular pain, postvasectomy pain, sports hernia pain and phantom pain. Curr Opin Urol 2011; 21:121-6. [PMID: 21285717 DOI: 10.1097/mou.0b013e3283435ac4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW The use of robotic assistance during microsurgical procedures has evolved from its early beginnings in the early 2000s. Currently, its use is expanding in the treatment of male infertility and patients with chronic testicular or groin pain. The addition of this technology may allow an improvement in outcomes as when the operating microscope was introduced in microsurgery. However, this is yet to be proven. RECENT FINDINGS This review covers new robotic microsurgical tools and applications of the robotic platform in microsurgical procedures such as vasectomy reversal, varicocelectomy, microsurgical denervation of the spermatic cord for chronic testicular or groin pain, post-vasectomy pain, sports hernia pain, postnephrectomy, donor nephrectomy and phantom groin pain. Preliminary animal studies show an advantage in terms of improved operative efficiency and improved surgical outcomes. Preliminary human clinical studies appear to support these findings. The use of robotic assistance during robotic microsurgical vasovasostomy appears to decrease operative duration and improve early postoperative sperm counts compared to the pure microsurgical technique. SUMMARY Long-term prospective controlled trials are necessary to assess the true cost-benefit ratio for robotic assisted microsurgery. The preliminary findings are promising and evidence is mounting, but further evaluation is warranted.
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Current world literature. Curr Opin Urol 2011; 21:166-72. [PMID: 21285721 DOI: 10.1097/mou.0b013e328344100a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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