1
|
Jain Y, Lanjewar R, Shinde RK. Revolutionising Breast Surgery: A Comprehensive Review of Robotic Innovations in Breast Surgery and Reconstruction. Cureus 2024; 16:e52695. [PMID: 38384645 PMCID: PMC10879655 DOI: 10.7759/cureus.52695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
Robotic innovations in breast surgery have ushered in a new era of precision, safety, and patient-centred care. This comprehensive review explores the multifaceted realm of robotic breast surgery, from preoperative planning to postoperative outcomes, learning curves for surgeons, and the implications for healthcare policies. We examine the ethical considerations, cost-effectiveness, and future directions, including integrating artificial intelligence and telesurgery. Key findings reveal that robotic systems provide improved surgical precision, reduced complications, and enhanced patient satisfaction. Ethical concerns encompass informed consent, resource allocation, and equitable access. The future of breast surgery lies in continued research and development, ensuring that robotics becomes a standard of care accessible to all patients. This technology is reshaping breast surgery and offering new possibilities for minimally invasive, patient-centred care, ultimately redefining the standards of care in this critical field of medicine.
Collapse
Affiliation(s)
- Yashraj Jain
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ranjana Lanjewar
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
2
|
Reddy K, Gharde P, Tayade H, Patil M, Reddy LS, Surya D. Advancements in Robotic Surgery: A Comprehensive Overview of Current Utilizations and Upcoming Frontiers. Cureus 2023; 15:e50415. [PMID: 38222213 PMCID: PMC10784205 DOI: 10.7759/cureus.50415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
Robotic surgery, a groundbreaking advancement in medical technology, has redefined the landscape of surgical procedures. This comprehensive overview explores the multifaceted world of robotic surgery, encompassing its definition, historical development, current applications, clinical outcomes, benefits, emerging frontiers, challenges, and future implications. We delve into the fundamentals of robotic surgical systems, examining their components and advantages. From general and gynecological surgery to urology, cardiac surgery, orthopedics, and beyond, we highlight the diverse specialties where robotic surgery is making a significant impact. The many benefits discussed include improved patient outcomes, reduced complications, faster recovery times, cost-effectiveness, and enhanced surgeon experiences. The outlook reveals a healthcare landscape where robotic surgery is increasingly vital, enabling personalized medicine, bridging healthcare disparities, and advancing surgical precision. However, challenges such as cost, surgeon training, technical issues, ethical considerations, and patient acceptance remain relevant. In conclusion, robotic surgery is poised to continue shaping the future of health care, offering transformative possibilities while emphasizing the importance of collaboration, innovation, and ethical governance.
Collapse
Affiliation(s)
- Kavyanjali Reddy
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Gharde
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshal Tayade
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mihir Patil
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Lucky Srivani Reddy
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dheeraj Surya
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
3
|
Chiu CC, Huang CY, Chang KM, Lin SC, Liu YH, Liao PH, Hung CJ, Cho CF, Liao JY, She YY, Kang BH. Learning Curve of Upper Aerodigestive Tract Foreign Body Management for Otorhinolaryngology Residents. ORL J Otorhinolaryngol Relat Spec 2021; 84:193-199. [PMID: 34333498 DOI: 10.1159/000517307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/14/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Foreign body ingestion is the most common reason for otolaryngology specialist consultations in emergency departments. Among the different types of foreign bodies, fish bones are the most common, particularly in Asian populations. In Taiwan, upper aerodigestive tract foreign bodies (UADT-FBs) are mostly managed by residents in the otorhinolaryngology (ORL) department. Considering the learning curve required for all procedures, different management types between residents, and possible resulting safety issues, this study explored the outcomes of UADT-FB management by residents in different years of ORL training. MATERIALS AND METHODS The medical records of 2,283 patients who visited Kaohsiung Veterans General Hospital's Emergency Department for UADT-FB during June 2013-August 2019 were retrospectively reviewed. The reviewed data included the demographic data of enrolled patients, outcomes of foreign body management, and follow-up chart records of the patients. RESULTS Among the 2,283 patients, 1,324 (58%) were found to be negative for foreign bodies, and foreign bodies in 951 (41.7%) were removed immediately. In the negative finding (NF) group, 2 (4.9%) patients were later found to be positive for foreign bodies during follow-up in the outpatient department. One (2.4%) patient developed a deep neck infection and esophageal perforation. The percentage of NFs decreased from 62.58% in residents in the first half of their first year (R1a) to 54% for third-year residents (R3). Comparing R1a with R3, the number needed to harm for retained UADT-FBs after patients visited the emergency department was 12.2. DISCUSSION/CONCLUSION This study provides data from 1 referral center regarding the management of UADT-FBs. With increasing resident training, the percentage of NFs declined from 62.58 to 54%. Young residents, especially those in the first 6 months of their training, should have senior residents perform a second examination if UADT-FBs are not found in suspected cases.
Collapse
Affiliation(s)
- Ching-Ching Chiu
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,
| | - Chien-Yu Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Keng-Ming Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Sheng-Chiao Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yu-Hsi Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Hsun Liao
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chuan-Jen Hung
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chin-Fang Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jyun-Yi Liao
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yun-Ying She
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Bor-Hwang Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Pharmacy, Tajen University, Pintung, Taiwan
| |
Collapse
|
4
|
Devlin CM, Fowler S, Biyani CS, Forster JA. Changes in UK renal oncological surgical practice from 2008 to 2017: implications for cancer service provision and surgical training. BJU Int 2021; 128:206-217. [PMID: 33249738 DOI: 10.1111/bju.15310] [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] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine and analyse the temporal changes in oncological nephrectomy practice and training opportunities using data obtained from the UK British Association of Urological Surgeons nephrectomy register from 2008 to 2017. PATIENT AND METHODS All nephrectomies within the dataset for this time period were analysed (n = 54 251). Cases were divided into radical nephrectomy (RN), partial nephrectomy (PN) and nephroureterectomy (NU). Simple nephrectomy, donor nephrectomy and benign PN were excluded. The annual frequencies for each oncological nephrectomy method, surgical approach, grade of surgeon, hospital caseload numbers and short-term surgical outcomes were determined. RESULTS Reported annual nephrectomy numbers increased by 2.5-fold in the 9-year time period. The number of hospitals performing nephrectomies decreased by 22%, however, more than 40% of centres performed more than 70 cases a year. There was a trend towards a decrease in overall length of hospital stay (9 vs 5 days; P < 0.01) and decreased transfusion rates. The proportion of minimally invasive procedures increased from 57% to 75%, with nephron-sparing rates increasing from 8.9% overall to 24.8%. With regard to surgical technique, robot-assisted surgery saw a mean annual increase of 222%. Overall, there was a 10% decrease in the proportion of PNs performed by trainee surgeons. CONCLUSIONS Renal surgery has changed considerably with regard to volume and also surgical approach, with rates of nephron-sparing surgery and minimally invasive surgery significantly increasing. Increasing hospital centralization and institutional experience, and a shift to robot-assisted surgery appear to have contributed to the observed improved patient outcomes. The increasing utilization of robot-assisted surgery has potential implications and challenges for the training of future urology surgeons.
Collapse
Affiliation(s)
- Conor M Devlin
- Urology Department, Bradford Royal Infirmary, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Sarah Fowler
- British Association of Urological Surgeons, London, UK
| | - Chandra Shekhar Biyani
- Department of Urology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James A Forster
- Urology Department, Bradford Royal Infirmary, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| |
Collapse
|
5
|
Celentano V, Smart N, McGrath J, Cahill RA, Spinelli A, Challacombe B, Belyansky I, Hasegawa H, Munikrishnan V, Pellino G, Ahmed J, Muysoms F, Saklani A, Khan J, Popowich D, Ballecer C, Coleman MG. How to report educational videos in robotic surgery: an international multidisciplinary consensus statement. Updates Surg 2020; 73:815-821. [PMID: 32146699 PMCID: PMC8184705 DOI: 10.1007/s13304-020-00734-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/24/2020] [Indexed: 11/17/2022]
Abstract
The swift endorsement of the robotic surgical platform indicates that it might prevail as the preferred technique for many complex abdominal and pelvic operations. Nonetheless, use of the surgical robotic system introduces further layers of complexity into the operating theatre necessitating new training models. Instructive videos with relevant exposition could be optimal for early training in robotic surgery and the aim of this study was to develop consensus guidelines on how to report a robotic surgery video for educational purposes to achieve high quality educational video outputs that could enhance surgical training. A steering group prepared a Delphi survey of 46 statements, which was distributed and voted on utilising an electronic survey tool. The selection of committee members was designed to include representative surgical trainers worldwide across different specialties, including lower and upper gastrointestinal surgery, general surgery, gynaecology and urology. 36 consensus statements were approved and classified in seven categories: author’s information and video introduction, case presentation, demonstration of the surgical procedure, outcomes of the procedure, associated educational content, review of surgical videos quality and use of surgical videos in educational curricula. Consensus guidelines on how to report robotic surgery videos for educational purposes have been elaborated utilising Delphi methodology. We recommend that adherence to the guidelines presented could support advancing the educational quality of video outputs when designed for training.
Collapse
Affiliation(s)
- Valerio Celentano
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK. .,University of Portsmouth, Portsmouth, UK.
| | - Neil Smart
- Exeter Surgical Health Services, Research Unit, Royal Devon & Exeter Hospital, Exeter, Devon, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter NHS Trust, Exeter, UK.,University of Exeter Medical School, Exeter, UK
| | - Ronan A Cahill
- Colorectal Unit, Mater Misericordiae University Hospital, Dublin, Ireland.,Section of Surgery and Surgical Specialities, School of Medicine, University College Dublin, Dublin, Ireland
| | - Antonino Spinelli
- Humanitas Clinical and Research Center - IRCCS, 20089, via Manzoni 56, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Ben Challacombe
- Department of Urology, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, SE1 9RT, UK
| | - Igor Belyansky
- Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway, Suite 100, Annapolis, MD, 21401, USA
| | - Hirotoshi Hasegawa
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
| | | | - Gianluca Pellino
- Department of Medical, Surgical, Neurological, Metabolic, and Ageing Sciences, Universitá Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Jamil Ahmed
- Department of Colorectal Surgery, The Royal Bournemouth Hospital NHS Foundation Trust, Bournemouth, UK
| | - Filip Muysoms
- Departement of Surgery, Maria Middelares Hospital, Ghent, Belgium
| | | | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK.,University of Portsmouth, Portsmouth, UK
| | - Daniel Popowich
- Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Conrad Ballecer
- Center for Minimally Invasive and Robotic Surgery, Phoenix, AZ, USA
| | - Mark G Coleman
- University Hospitals Plymouth NHS Trust, Derriford Hospital, Plymouth, UK
| |
Collapse
|
6
|
Schuessler Z, Scott Stiles A, Mancuso P. Perceptions and experiences of perioperative nurses and nurse anaesthetists in robotic‐assisted surgery. J Clin Nurs 2019; 29:60-74. [DOI: 10.1111/jocn.15053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/02/2019] [Accepted: 08/24/2019] [Indexed: 01/04/2023]
Affiliation(s)
| | | | - Peggy Mancuso
- College of Nursing Texas Woman's University Denton Texas
| |
Collapse
|
7
|
Washington K, Watkins JR, Jay J, Jeyarajah DR. Oncologic Resection in Laparoscopic Versus Robotic Transhiatal Esophagectomy. JSLS 2019; 23:JSLS.2019.00017. [PMID: 31148912 PMCID: PMC6532833 DOI: 10.4293/jsls.2019.00017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background and Objectives: As the use of robotic surgery continues to increase, little is known about robotic oncologic outcomes compared with traditional methods in esophagectomy. The aim of this study was to examine the perioperative oncologic outcomes of patients undergoing laparoscopic versus robot-assisted transhiatal esophagectomy (THE). Methods: Thirty-six consecutive patients who underwent laparoscopic and robot-assisted THE for malignant disease over a 3-year period were identified in a retrospective database. Eighteen patients underwent robotic-assisted THE with cervical anastomosis, and 18 patients underwent laparoscopic THE. All procedures were performed by a single foregut and thoracic surgeon. Results: Patient demographics were similar between the 2 groups with no significant differences. Lymph node yields for both laparoscopic and robot-assisted THE were similar at 13.9 and 14.3, respectively (P = .90). Ninety-four percent of each group underwent R0 margins, but only 1 patient from each modality had microscopic positive margins. All of the robot-assisted patients underwent neoadjuvant chemoradiation, whereas 83.3% underwent neoadjuvant therapy in the laparoscopy group (P = .23). Clinical and pathologic stagings were similar in each group. There was 1 death after laparoscopic surgery in a cirrhotic patient and no mortalities among the robot-assisted THE patients (P = .99). One patient from each group experienced an anastomotic leak, but neither patient required further intervention. Conclusions: Laparoscopic and robot-assisted THEs yield similar perioperative oncologic results including lymph node yield and margin status. In the transition from laparoscopic surgery, robotic surgery should be considered oncologically noninferior compared with laparoscopy.
Collapse
Affiliation(s)
| | | | - John Jay
- Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas
| | - D Rohan Jeyarajah
- Department of Surgery, Methodist Richardson Medical Center, Dallas, Texas
| |
Collapse
|
8
|
Ju T, Haskins IN, Kuang X, Amdur RL, Brody FJ, Obias V, Agarwal S. Robotic Right Colectomy for Colon Cancer: Comparison of Outcomes from a Single Institution with the ACS-NSQIP Database. J Laparoendosc Adv Surg Tech A 2018; 29:40-44. [PMID: 30096003 DOI: 10.1089/lap.2018.0358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Robotic surgery has increased in recent years for the treatment of colorectal cancer; however, it is not yet the standard of care. This study aims to compare the 30-day outcomes after robotic colectomy for right-sided colon cancer from our institution with those from a national dataset, the targeted colectomy American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS Patients undergoing elective, robotic, right colon resection for stage I, II, and III colon cancer were identified within the targeted colectomy ACS-NSQIP database from 2012 to 2014. Patients meeting the same criteria were identified within a prospectively maintained institutional database from 2009 to 2015. Univariate analyses using chi-square tests and Student's t-tests were done where appropriate to compare baseline characteristics and outcomes between the two groups. RESULTS Patients at our institution had a significantly higher average number of lymph nodes retrieved (24.4 versus 20.1, P = .046). There was no statistically significant difference between the two groups regarding the incidence of wound infections, anastomotic leaks, blood transfusions, unplanned return to the operating room, or prolonged length of hospital stay. There were no 30-day mortalities at our institution and only one in the ACS-NSQIP database. CONCLUSIONS Our institutional experience with robotic right colon resection is equivalent to that of a national sample. This study demonstrates the safety of performing robotic right hemicolectomy for the treatment of colon cancer.
Collapse
Affiliation(s)
- Tammy Ju
- 1 Division of Colon and Rectal Surgery, Department of Surgery, The George Washington University, Washington, District of Columbia
| | - Ivy N Haskins
- 1 Division of Colon and Rectal Surgery, Department of Surgery, The George Washington University, Washington, District of Columbia
| | - Xiangyu Kuang
- 1 Division of Colon and Rectal Surgery, Department of Surgery, The George Washington University, Washington, District of Columbia
| | - Richard L Amdur
- 1 Division of Colon and Rectal Surgery, Department of Surgery, The George Washington University, Washington, District of Columbia
| | - Fred J Brody
- 2 Department of Surgery, The Washington DC VA Medical Center, Washington, District of Columbia
| | - Vincent Obias
- 1 Division of Colon and Rectal Surgery, Department of Surgery, The George Washington University, Washington, District of Columbia
| | - Samir Agarwal
- 1 Division of Colon and Rectal Surgery, Department of Surgery, The George Washington University, Washington, District of Columbia.,3 Section of Colon and Rectal Surgery, Department of Surgery, West Virginia University, Morgantown, West Virginia
| |
Collapse
|
9
|
Face and content validity of Xperience™ Team Trainer: bed-side assistant training simulator for robotic surgery. Updates Surg 2017; 70:113-119. [DOI: 10.1007/s13304-017-0509-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 12/16/2017] [Indexed: 01/16/2023]
|
10
|
Mehta A, Patel S, Robison W, Senkowski T, Allen J, Shaw E, Senkowski C. Can teenage novel users perform as well as General Surgery residents upon initial exposure to a robotic surgical system simulator? J Robot Surg 2017; 12:165-171. [PMID: 28585104 DOI: 10.1007/s11701-017-0715-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/16/2017] [Indexed: 02/02/2023]
Abstract
New techniques in minimally invasive and robotic surgical platforms require staged curricula to insure proficiency. Scant literature exists as to how much simulation should play a role in training those who have skills in advanced surgical technology. The abilities of novel users may help discriminate if surgically experienced users should start at a higher simulation level or if the tasks are too rudimentary. The study's purpose is to explore the ability of General Surgery residents to gain proficiency on the dVSS as compared to novel users. The hypothesis is that Surgery residents will have increased proficiency in skills acquisition as compared to naive users. Six General Surgery residents at a single institution were compared with six teenagers using metrics measured by the dVSS. Participants were given two 1-h sessions to achieve an MScoreTM in the 90th percentile on each of the five simulations. MScoreTM software compiles a variety of metrics including total time, number of attempts, and high score. Statistical analysis was run using Student's t test. Significance was set at p value <0.05. Total time, attempts, and high score were compared between the two groups. The General Surgery residents took significantly less Total Time to complete Pegboard 1 (PB1) (p = 0.043). No significant difference was evident between the two groups in the other four simulations across the same MScoreTM metrics. A focused look at the energy dissection task revealed that overall score might not be discriminant enough. Our findings indicate that prior medical knowledge or surgical experience does not significantly impact one's ability to acquire new skills on the dVSS. It is recommended that residency-training programs begin to include exposure to robotic technology.
Collapse
Affiliation(s)
- A Mehta
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
- Mercer University School of Medicine, Savannah, Georgia
| | - S Patel
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA.
| | - W Robison
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
- Mercer University School of Medicine, Savannah, Georgia
| | - T Senkowski
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
| | - J Allen
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
| | - E Shaw
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
- Mercer University School of Medicine, Savannah, Georgia
| | - C Senkowski
- Department of Surgery, Memorial Health University Medical Center, Savannah, GA, USA
- Mercer University School of Medicine, Savannah, Georgia
| |
Collapse
|
11
|
Sivaraman A, Sanchez-Salas R, Prapotnich D, Yu K, Olivier F, Secin FP, Barret E, Galiano M, Rozet F, Cathelineau X. Learning curve of minimally invasive radical prostatectomy: Comprehensive evaluation and cumulative summation analysis of oncological outcomes. Urol Oncol 2017; 35:149.e1-149.e6. [DOI: 10.1016/j.urolonc.2016.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 08/08/2016] [Accepted: 10/23/2016] [Indexed: 12/30/2022]
|
12
|
Díaz CE, Fernández R, Armada M, García F. A research review on clinical needs, technical requirements, and normativity in the design of surgical robots. Int J Med Robot 2017; 13. [PMID: 28105687 DOI: 10.1002/rcs.1801] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/04/2016] [Accepted: 11/21/2016] [Indexed: 12/14/2022]
Abstract
Nowadays robots play an important role in society, mainly due to the significant benefits they provide when utilized for assisting human beings in the execution of dangerous or repetitive tasks. Medicine is one of the fields in which robots are gaining greater use and development, especially those employed in minimally invasive surgery (MIS). However, due to the particular conditions of the human body where robots have to act, the design of these systems is complex, not only from a technical point of view, but also because the clinical needs and the normativity aspects are important considerations that have to be taken into account in order to achieve better performances and more secure systems for patients and surgeons. Thus, this paper explores the clinical needs and the technical requirements that will trace the roadmap for the next scientific and technological advances in the field of robotic surgery, the metrics that should be defined for safe technology development and the standards that are being elaborated for boosting the industry and facilitating systems integration.
Collapse
Affiliation(s)
- Carlos Eduardo Díaz
- Universidad Tecnológica del Valle de Toluca, Carretera del Departamento del D. F., Lerma, México
| | - Roemi Fernández
- Centre for Automation and Robotics CAR (CSIC-UPM), Madrid, Spain
| | - Manuel Armada
- Centre for Automation and Robotics CAR (CSIC-UPM), Madrid, Spain
| | - Felipe García
- Universidad Tecnológica del Valle de Toluca, Carretera del Departamento del D. F., Lerma, México
| |
Collapse
|
13
|
Mottrie A, Novara G, van der Poel H, Dasgupta P, Montorsi F, Gandaglia G. The European Association of Urology Robotic Training Curriculum: An Update. Eur Urol Focus 2015; 2:105-108. [PMID: 28723444 DOI: 10.1016/j.euf.2015.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/05/2015] [Accepted: 09/08/2015] [Indexed: 11/15/2022]
Abstract
The European Association of Urology robotic training curriculum is a validated structured program to provide standardized training and to certify surgeons for specific urologic procedures.
Collapse
Affiliation(s)
- Alexandre Mottrie
- OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
| | - Giacomo Novara
- OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Urology Clinic, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Henk van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
14
|
Acar Ö, Işık EÖ, Mut T, Sağlıcan Y, Onay A, Vural M, Musaoğlu A, Esen T. Comparison of the trifecta outcomes of robotic and open nephron-sparing surgeries performed in the robotic era of a single institution. SPRINGERPLUS 2015; 4:472. [PMID: 26361573 PMCID: PMC4559550 DOI: 10.1186/s40064-015-1274-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/25/2015] [Indexed: 01/20/2023]
Abstract
Purpose In this study we aimed to report a comparative analysis between open and robotic nephron sparing surgeries (NSS) from a single institutional database. Methods Patients who have undergone NSS during the robotic era of our institution were included in this study. Open (n = 74) and robotic (n = 59) groups were compared regarding trifecta outcome. Trifecta was defined as; warm ischemia time (WIT) <25 min, negative surgical margins and the absence of perioperative complications. Results A total of 57 (77 %) and 45 (76 %) patients in the open and robotic groups, respectively achieved the trifecta outcome. Overall trifecta rate was 77 % (n = 102/133). The only statistically significant difference between trifecta positive and trifecta negative patients was the length of hospitalization (LOH). Except LOH; none of the tested parameters were shown to be predictive of trifecta outcome on univariate and multivariate analyses. Concerning trifecta positive patients; those in the open surgery group had larger tumors with a higher degree of morphometric complexity and were hospitalized for a longer period of time. Additionally, operative duration was significantly higher in the robotic group. Conclusions In our cohort, no significant difference in achieving the trifecta outcome was reported after open and robotic NSS. Length of hospitalization was the only parameter that differed significantly between trifecta positive and trifecta negative patients. Surgical approach was not a significant predictor of simultaneous achievement of trifecta outcomes. Irrespective of the trifecta definition; larger and more complicated tumors were handled via open NSS.
Collapse
Affiliation(s)
- Ömer Acar
- Department of Urology, School of Medicine, Koc University, Istanbul, Turkey
| | - Esin Öztürk Işık
- Biomedical Engineering Institute, Boğaziçi University, Istanbul, Turkey
| | - Tuna Mut
- Department of Urology, VKF American Hospital, Istanbul, Turkey
| | - Yeşim Sağlıcan
- Department of Pathology, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Aslıhan Onay
- Department of Radiology, School of Medicine, Koc University, Istanbul, Turkey
| | - Metin Vural
- Department of Radiology, VKF American Hospital, Istanbul, Turkey
| | - Ahmet Musaoğlu
- Department of Urology, VKF American Hospital, Istanbul, Turkey
| | - Tarık Esen
- Department of Urology, School of Medicine, Koc University, Istanbul, Turkey ; Department of Urology, VKF American Hospital, Istanbul, Turkey
| |
Collapse
|
15
|
Vetter MH, Green I, Martino M, Fowler J, Salani R. Incorporating resident/fellow training into a robotic surgery program. J Surg Oncol 2015; 112:684-9. [PMID: 26289120 DOI: 10.1002/jso.24006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/27/2015] [Indexed: 01/09/2023]
Abstract
With the rapid uptake of the robotic approach in gynecologic surgery, a thorough understanding of the technology, including its uses and limitations, is critical to maximize patient outcomes and safety. This review discusses the role of training modalities and development of curricula for robotic surgery. Furthermore, methods for incorporating the entire surgical team and the process of credentialing/maintaining privileges are described.
Collapse
Affiliation(s)
| | | | - Martin Martino
- University of South Florida, Allentown, Pennsylvania
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | | | | |
Collapse
|
16
|
Geiger JD, Hirschl RB. Innovation in surgical technology and techniques: Challenges and ethical issues. Semin Pediatr Surg 2015; 24:115-21. [PMID: 25976146 DOI: 10.1053/j.sempedsurg.2015.02.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The pace of medical innovation continues to increase. The deployment of new technologies in surgery creates many ethical challenges including how to determine safety of the technology, what is the timing and process for deployment of a new technology, how are patients informed before undergoing a new technology or technique, how are the outcomes of a new technology evaluated and how are the responsibilities of individual patients and society at large balanced. Ethical considerations relevant to the implementation of ECMO and robotic surgery are explored to further discussion of how we can optimize the delicate balance between innovation and regulation.
Collapse
Affiliation(s)
- James D Geiger
- Michigan Pediatric Device Consortium, University of Michigan, CS Mott Children's Hospital, Ann Arbor, 1540 E Hospital Dr SPC 4211, Michigan 48109.
| | - Ronald B Hirschl
- Section of Pediatric Surgery, University of Michigan, CS Mott Children's Hospital, Ann Arbor, Michigan
| |
Collapse
|