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Kiani AZ, Progar K, Hill AL, Vachharajani N, Olumba F, Yu J, Chapman WC, Doyle MB, Wellen JR, Khan AS. Robotic living donor nephrectomy is associated with reduced post-operative opioid use compared to hand-assisted laparoscopic approach. Surg Endosc 2024; 38:3654-3660. [PMID: 38777895 DOI: 10.1007/s00464-024-10925-5] [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: 02/12/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Robotic donor nephrectomy (RDN) has emerged as a safe alternative to laparoscopic donor nephrectomy (LDN). Having previously demonstrated comparable efficacy, this study aims to examine postoperative analgesia use (opioid and non-opioid) in the two groups. METHODS We conducted a retrospective review of 300 living donor nephrectomies performed at our center, comparing 150 RDN's with a contemporary cohort of 150 hand-assisted LDN's. In addition to clinical and demographic information, data on postoperative inpatient opioid and non-opioid analgesia (from patient's arrival to the surgical floor after surgery till the time of discharge) was collected. Opioid dosages were standardized by conversion to morphine milligram equivalents (MME). All patients were managed post-operatively under a standardized ERAS pathway for living donor nephrectomy patients. RESULTS There were no significant differences in donor age, gender, and BMI between RDN and LDN groups. Total post-operative opioid use (MME's) was significantly lower in RDN patients (RDN 27.1 vs. LDN 46.3; P < 0.0001). Breakdown of opioid use with post-operative (POD) day demonstrated significantly lower use in RDN group on POD1 (RDN 8.6 vs. LDN 17.0; P < 0.05), and POD2 (RDN 3.9 vs LDN 10; P < 0.05). RDN patients had a shorter post-operative length of stay (LOS) (RDN 1.69 days vs. LDN 1.98; P = 0.0003). There were no differences between groups in non-opioid medication use, complications, and readmission rates. CONCLUSION RDN has comparable safety to hand-assist LDN and offers additional benefits of lower postoperative opioid requirement and a shorter hospital LOS.
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Affiliation(s)
- Amen Z Kiani
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA.
- Department of Surgery, Division of Abdominal Transplant Surgery, Washington University School of Medicine, 660 Euclid Ave St., Louis, MO, 63110, USA.
| | - Kristin Progar
- Department of Pharmacy, Barnes-Jewish Hospital, Barnes-Jewish Hospital Plaza, Saint Louis, MO, 63130, USA
| | - Angela L Hill
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Neeta Vachharajani
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Franklin Olumba
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Jennifer Yu
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - William C Chapman
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Majella B Doyle
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Jason R Wellen
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Adeel S Khan
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
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Nozaki T, Matsuda K, Kagami K, Sakamoto I. Comparison of surgical outcomes between robot-assisted and conventional laparoscopic hysterectomy for large uterus. J Robot Surg 2023; 17:2415-2419. [PMID: 37434073 DOI: 10.1007/s11701-023-01673-0] [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: 04/19/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023]
Abstract
We compared the effectiveness of conventional total laparoscopic hysterectomy (TLH) against robot-assisted total hysterectomy (RAH) in patients with a large uterus. According to the subtype of minimally invasive hysterectomy performed for benign indications, the patients (n = 843) were grouped as follows: TLH (n = 340) and RAH (n = 503). The median operative time (OT) for TLH was 98 min (47-406 min), and the estimated blood loss (EBL) was 50 mL (5-1800 mL). The median OT for RAH was 90 min (43-251 min), and the EBL was 5 mL (5-850 mL), with a significantly shorter OT and a lower EBL in RAH than in TLH. Uterine weight was categorized into four groups in increments of 250 g. The number of cases in each group was 163 (< 250 g), 116 (250-500 g), 41 (500-750 g), and 20 (≥ 750 g) for TLH, and 308 (< 250 g), 137 (250-500 g), 33 (500-750 g), and 25 (≥ 750 g) for RAH. In patients with a uterus < 250 g, there was no significant difference in OT between TLH and RAH, but in patients with a uterus ≥ 250 g, OT tended to be shorter with RAH, which was also true for a uterus ≥ 750 g. The EBL was significantly lower with RAH compared to TLH, regardless of uterine weight. In patients with a large uterus, the advantages of robotic surgery can be utilized, which may lead to a shorter OT and less EBL.
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Affiliation(s)
- Takahiro Nozaki
- Department of Gynecology, Yamanashi Central Hospital, 1-1-1 Fujimi, Yamanashi, 400-0027, Japan.
| | - Kosuke Matsuda
- Department of Gynecology, Yamanashi Central Hospital, 1-1-1 Fujimi, Yamanashi, 400-0027, Japan
| | - Keiko Kagami
- Department of Gynecology, Yamanashi Central Hospital, 1-1-1 Fujimi, Yamanashi, 400-0027, Japan
| | - Ikuko Sakamoto
- Department of Gynecology, Yamanashi Central Hospital, 1-1-1 Fujimi, Yamanashi, 400-0027, Japan
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Olumba FC, Vachharajani N, Yu J, Scherer M, Matson S, Hill AL, Kiani A, Lin Y, Doyle MMB, Chapman WC, Wellen JR, Khan AS. Robotic donor nephrectomy: optimizing outcomes beyond the limitations of laparoscopy. Surg Endosc 2023; 37:7511-7519. [PMID: 37415014 DOI: 10.1007/s00464-023-10246-z] [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: 03/09/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Robotic donor nephrectomy (RDN) has emerged as a safe alternate to laparoscopic donor nephrectomy (LDN), offering improved visualization, instrument dexterity and ergonomics. There is still concern about how to safely transition from LDN to RDN. METHODS We performed a retrospective review of 150 consecutive living donor operations (75 LDN and 75 RDN) at our center, comparing the first 75 RDN's with the last 75 LDN's performed prior to the initiation of the robotic transplant program. Operative times and complications were used as surrogates of efficiency and safety, respectively, to estimate the learning curve with RDN. RESULTS RDN was associated with a longer total operative time (RDN 182 vs LDN 144 min; P < 0.0001) but a significantly shorter post-operative length of stay (RDN 1.8 vs LDN 2.1 days; P = 0.0213). Donor complications and recipient outcomes were the same between both groups. Learning curve of RDN was estimated to be about 30 cases. CONCLUSIONS RDN is a safe alternate to LDN with acceptable donor morbidity and no negative impact on recipient outcomes even during the early part of the RDN learning curve. Surgeon preferences for the robotic approach compared to traditional laparoscopy will require further scrutiny to improve ergonomics and operative efficiency.
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Affiliation(s)
- Franklin C Olumba
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Neeta Vachharajani
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Jennifer Yu
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Meranda Scherer
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Sarah Matson
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Angela L Hill
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Amen Kiani
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Yiing Lin
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Majella M B Doyle
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - William C Chapman
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Jason R Wellen
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Adeel S Khan
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA.
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Lee KB, Chon SJ, Kim S, Kim DY, Park CW, Shin SJ, Kim SM, Lee KH, Ji YI. Using Type I Collagen Gel to Prevent Postoperative Intrauterine Adhesion: A Multicenter Retrospective Study. J Clin Med 2023; 12:jcm12113764. [PMID: 37297959 DOI: 10.3390/jcm12113764] [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: 03/22/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
We evaluated the clinical outcomes of using type 1 collagen gel after therapeutic resectoscopy; overall, 150 women aged > 20 who planned to undergo therapeutic resectoscopy were enrolled. The patients were randomly assigned to either of the anti-adhesive treatment groups: the type 1 collagen gel (Collabarrier®) (study group; N = 75) or the sodium hyaluronate and sodium carboxymethylcellulose gel group (control group; N = 75) after resectoscopy. One month after applying anti-adhesive materials, postoperative intrauterine adhesions were evaluated using second-look hysteroscopy; the incidence rate of postoperative intrauterine adhesions examined through second-look hysteroscopy showed no significant differences between the groups. There were no statistical differences between the frequency and mean scores of the type and intensity of adhesions in both groups. Finally, no significant differences in adverse events, serious adverse events, adverse device effects, and serious adverse device effects were noted between the two groups; type 1 collagen gel can be effectively and safely used in intrauterine surgery to minimize postoperative adhesions, thereby eventually decreasing the prevalence of infertility, secondary amenorrhea, and recurrent pregnancy loss in reproductive women.
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Affiliation(s)
- Kwang Beom Lee
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Seung Joo Chon
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Women's Cancer Clinic, Institute of Women's Life Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Dae Yeon Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Chan Woo Park
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 13496, Republic of Korea
| | - So Jin Shin
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Seok Mo Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Ki Hwan Lee
- Department of Obstetrics and Gynecology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon 34134, Republic of Korea
| | - Yong Il Ji
- Department of Obstetrics and Gynecology, Inje University, Haeundae Paik Hospital, Busan 48108, Republic of Korea
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Yamamoto D, Kotake M, Ishibayashi K, Fujimori D, Saito H, Sawada K, Oshima M, Hayashi H, Oyama K, Hara T, Inaki N. Robot-assisted low anterior resection for a rectal cancer patient with ileal conduit: A case report. Asian J Endosc Surg 2023. [PMID: 37161600 DOI: 10.1111/ases.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023]
Abstract
Surgery for rectal cancer patients with an ileal conduit after total cystectomy is difficult because adhesions in the pelvis and around the ileal conduit are expected. In the present case, we performed robot-assisted low anterior resection of the rectum in a 69-year-old male patient with rectal cancer who underwent ileal conduit diversion after total cystectomy. In this procedure, the port was inserted into the left upper abdomen as a first step, and two additional ports were added on the left side. Low anterior resection was performed using two left hands to create more space in the abdominal cavity for the ileal conduit. We present this minimally invasive robotic procedure that is extremely useful for dissection of adhesions in a narrow pelvic cavity.
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Affiliation(s)
- Daisuke Yamamoto
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Masanori Kotake
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | | | - Daisuke Fujimori
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Hiroshi Saito
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Koichiro Sawada
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Masahiro Oshima
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Hironori Hayashi
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Kaeko Oyama
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Takuo Hara
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Gradurate School of Medical Sciences, Kanazawa, Japan
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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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Milone M, Manigrasso M, Anoldo P, D’Amore A, Elmore U, Giglio MC, Rompianesi G, Vertaldi S, Troisi RI, Francis NK, De Palma GD. The Role of Robotic Visceral Surgery in Patients with Adhesions: A Systematic Review and Meta-Analysis. J Pers Med 2022; 12:jpm12020307. [PMID: 35207795 PMCID: PMC8878352 DOI: 10.3390/jpm12020307] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 12/17/2022] Open
Abstract
Abdominal adhesions are a risk factor for conversion to open surgery. An advantage of robotic surgery is the lower rate of unplanned conversions. A systematic review was conducted using the terms “laparoscopic” and “robotic”. Inclusion criteria were: comparative studies evaluating patients undergoing laparoscopic and robotic surgery; reporting data on conversion to open surgery for each group due to adhesions and studies including at least five patients in each group. The main outcomes were the conversion rates due to adhesions and surgeons’ expertise (novice vs. expert). The meta-analysis included 70 studies from different surgical specialities with 14,329 procedures (6472 robotic and 7857 laparoscopic). The robotic approach was associated with a reduced risk of conversion (OR 1.53, 95% CI 1.12–2.10, p = 0.007). The analysis of the procedures performed by “expert surgeons” showed a statistically significant difference in favour of robotic surgery (OR 1.48, 95% CI 1.03–2.12, p = 0.03). A reduced conversion rate due to adhesions with the robotic approach was observed in patients undergoing colorectal cancer surgery (OR 2.62, 95% CI 1.20–5.72, p = 0.02). The robotic approach could be a valid option in patients with abdominal adhesions, especially in the subgroup of those undergoing colorectal cancer resection performed by expert surgeons.
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Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.D.); (M.C.G.); (G.R.); (S.V.); (R.I.T.); (G.D.D.P.)
- Correspondence: ; Tel.: +39-333-299-3637
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.M.); (P.A.)
| | - Pietro Anoldo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (M.M.); (P.A.)
| | - Anna D’Amore
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.D.); (M.C.G.); (G.R.); (S.V.); (R.I.T.); (G.D.D.P.)
| | - Ugo Elmore
- Department of Surgery, San Raffaele Hospital and San Raffaele Vita-Salute University, 20132 Milan, Italy;
| | - Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.D.); (M.C.G.); (G.R.); (S.V.); (R.I.T.); (G.D.D.P.)
| | - Gianluca Rompianesi
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.D.); (M.C.G.); (G.R.); (S.V.); (R.I.T.); (G.D.D.P.)
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.D.); (M.C.G.); (G.R.); (S.V.); (R.I.T.); (G.D.D.P.)
| | - Roberto Ivan Troisi
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.D.); (M.C.G.); (G.R.); (S.V.); (R.I.T.); (G.D.D.P.)
| | | | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (A.D.); (M.C.G.); (G.R.); (S.V.); (R.I.T.); (G.D.D.P.)
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Chen Q, Zhu S, Wang D, Chen M, Zhao Y, Zhang Q. Hidden blood loss and its risk factors in patients undergoing conventional laparoscopic surgery and laparoendoscopic single-site surgery for ovarian cystectomy. Int J Gynaecol Obstet 2021; 157:424-430. [PMID: 34328652 DOI: 10.1002/ijgo.13842] [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: 04/26/2021] [Revised: 07/11/2021] [Accepted: 07/28/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To quantify the volume of hidden blood loss (HBL) between conventional laparoscopic surgery (CLS) and laparoendoscopic single-site surgery (LESS) for ovarian cyst and to explore its risk factors. METHODS A total of 310 patients who underwent CLS or LESS were enrolled in this study. The Nadler formula and Gross formula were used to calculate each patient's estimated blood volume and total blood loss, multiple linear regression analysis was applied to identify the risk factors. RESULTS The HBL in LESS was more than in CLS (P = 0.000). Operative time (p = 0.015), pre-hematocrit (P = 0.002), pre-hemoglobin (P = 0.015), and pelvic adhesions (P = 0.037) were positively correlated with HBL in CLS. Intraoperative bleeding (P = 0.026), operative time (P = 0.000), pre-hematocrit (P = 0.042), CA125 (P = 0.047), and cyst volume (P = 0.012) were independent risk factors for HBL in LESS. CONCLUSION A large amount of HBL occurs in ovarian cystectomy surgery and cannot be ignored in clinical work; fully and correctly understanding HBL and exploring its causes can ensure the safety and improve the prognosis of patients.
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Affiliation(s)
- Qiuyu Chen
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital and Yuying, Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Sennan Zhu
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital and Yuying, Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Danhan Wang
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital and Yuying, Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Miaomiao Chen
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital and Yuying, Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yu Zhao
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital and Yuying, Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qiong Zhang
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital and Yuying, Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Safety and feasibility of robotic liver resection after previous abdominal surgeries. Surg Endosc 2021; 36:2842-2849. [PMID: 34076760 DOI: 10.1007/s00464-021-08572-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND While minimally invasive liver surgery has been increasingly adopted at least for minor resections, experience with robotic liver surgery is still limited to a few highly specialized centers. Due to the fear of abdominal adhesions, a history of prior surgeries is still used as an argument for open approaches. METHODS Clinical data of all consecutive robotic resections at our center, using the da Vinci Xi surgical system, between April, 2018 and December, 2020, were collected and analyzed as part of a prospective, post-marketing observational study (DRKS00017229). Prior abdominal surgeries were specified according to the surgical approach and localization. Baseline and perioperative outcome criteria were compared between patients with prior surgeries (PS) and patients with no prior surgeries (NPS) in univariate and multivariate analyses. RESULTS Out of the 126 patients undergoing robotic liver resections, 59% had a history of abdominal surgeries, which were most often colorectal resections (28%) followed by liver resections (20%). Patients with NPS were more likely to undergo robotic liver resection for hepatocellular carcinoma or benign tumors, and to have underlying liver cirrhosis when compared to patients with PS. Other baseline characteristics as well as the extent of resections were similar. Duration of surgery (258 min), conversion rates (6%), and postoperative complications rates (21% Clavien-Dindo ≥ 3) showed no differences between NPS and PS. A subgroup of patients with a history of prior liver surgery showed a longer duration of surgery in univariate analysis. However, this was not confirmed in multivariate analysis which instead revealed tumor entity and liver cirrhosis as independently correlated with duration of surgery. CONCLUSIONS We propose robotic liver resection to be safe and feasible, including in patients with prior abdominal surgeries. Each patient should be evaluated for a minimally invasive procedure regardless of a history of previous operations.
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Mangalath AS, Kumar L, Sawant AB, Kesavan R, Ravindran G, Sunil R. Comparison of analgesic requirements in robot-assisted versus conventional laparoscopic abdominal surgeries. J Anaesthesiol Clin Pharmacol 2021; 37:79-84. [PMID: 34103828 PMCID: PMC8174415 DOI: 10.4103/joacp.joacp_354_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Robot-assisted surgery is advantageous in the precision of tissue handling and shorter postoperative recovery. We compared postoperative analgesic requirements in laparoscopic versus robot-assisted surgery in the first 24 h as our primary objective. The secondary outcomes were extubation on table, time to ambulation, and length of ICU stay. Material and Methods After approval from the ethics committee 48 patients undergoing either laparoscopic (group L [n = 24]) or robotic abdominal surgery (group R [n = 24]) were evaluated for analgesic requirements postoperative targeting a numerical rating scale ≤3 in a prospective comparative study. Postoperative patients were allotted to a three-tier pain management, level 1 comprising paracetamol 1 g intravenously every 8 h, level 2, 1.5 mg/kg tramadol every 8 h, and level 3 fentanyl 0.5 μg/kg. The total analgesic consumption in the first 24 h was calculated for each group. Statistical analysis was performed using the Chi-square test and Mann-Whitney U test. Results Age, weight, and types of surgery were comparable between the groups. The intraoperative opioid use was comparable between both groups but the duration of surgery was longer in group R. Postoperative analgesic requirements were significantly less in group R (P = 0.024) and the length of ICU stay was shorter (P < 0.05). The time to ambulation was significantly shorter in group R patients (P < 0.001). Conclusion Analgesic requirements were significantly less in robot-assisted laparoscopic surgery in the first 24 h. The time to ambulation and length of ICU stay were shorter in the robot-assisted group in comparison to the laparoscopic group.
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Affiliation(s)
- Athira Suresh Mangalath
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Lakshmi Kumar
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Ambreen Basheer Sawant
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Rajesh Kesavan
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Greeshma Ravindran
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Rajan Sunil
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Matsuo K, Mandelbaum RS, Nusbaum DJ, Chang EJ, Zhang RH, Matsuzaki S, Klar M, Roman LD. Risk of Upper-body Adverse Events in Robot-assisted Total Laparoscopic Hysterectomy for Benign Gynecologic Disease. J Minim Invasive Gynecol 2021; 28:1585-1594.e1. [PMID: 33497727 DOI: 10.1016/j.jmig.2021.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/09/2021] [Accepted: 01/19/2021] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVE Recent studies suggest that prolonged Trendelenburg positioning during robot-assisted total laparoscopic hysterectomy (RA-TLH) may lead to fluid shifts and pulmonary, airway, head and neck, and cranial complications in the upper body. This study examined the upper-body complications during RA-TLH for benign gynecologic disease. DESIGN Population-based retrospective study. SETTING The National Inpatient Sample. PATIENTS A total of 771 412 women who had total hysterectomy for benign gynecologic disease from October 2008 to September 2015, including 661 284 women who had total abdominal hysterectomy (TAH), 51 544 women who had traditional TLH, and 58 584 women who had RA-TLH. INTERVENTIONS A multiple-group generalized boosted model to balance the measured baseline covariates across the 3 hysterectomy groups and a generalized estimating equation model to assess the effect size of complication risk (overall and upper-body complications). MEASUREMENTS AND MAIN RESULTS Women in the RA-TLH group were more likely to be older, white, and have a higher comorbidity index (all, p <.001). The overall rate of upper-body complications was 4.6% across the 3 groups. RA-TLH was not associated with increased risk of upper-body complications compared with traditional TLH (odds ratio [OR] 1.06; 95% confidence interval [CI], 0.90-1.26) or TAH (OR 0.98; 95% CI, 0.87-1.11). In contrast, RA-TLH was associated with decreased risk of overall perioperative complications compared with TAH (12.0% vs 18.6%; OR 0.64; 95% CI, 0.59-0.70; p <.001). RA-TLH and traditional TLH had similar risk of overall perioperative complications (12.0% vs 13.1%; OR 0.91; 95% CI, 0.8-1.02; p = .099). Women who developed upper-body complications had a higher perioperative mortality rate (0.4% vs <0.01%; OR 79.1; 95% CI, 36.0-174). The highest rates of complications (62.5%) were observed in morbidly obese women aged 70-79 with a comorbidity index of ≥4. CONCLUSION In hysterectomy for benign gynecologic disease, RA-TLH was not associated with an increased risk of upper-body complications compared with TAH or traditional TLH. However, older age and higher comorbidity are key risk factors that increase the risk of upper-body complications which carry a disproportionally high mortality rate.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (Drs. Matsuo, Mandelbaum, Chang, Matsuzaki, and Roman), University of Southern California, Los Angeles, California; USC Norris Comprehensive Cancer Center (Drs. Matsuo and Roman), Los Angeles, California.
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (Drs. Matsuo, Mandelbaum, Chang, Matsuzaki, and Roman), University of Southern California, Los Angeles, California
| | - David J Nusbaum
- Section of Urology, University of Chicago (Dr. Nusbaum), Chicago
| | - Erica J Chang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (Drs. Matsuo, Mandelbaum, Chang, Matsuzaki, and Roman), University of Southern California, Los Angeles, California
| | - Renee H Zhang
- Keck School of Medicine (Ms. Zhang), University of Southern California, Los Angeles, California
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (Drs. Matsuo, Mandelbaum, Chang, Matsuzaki, and Roman), University of Southern California, Los Angeles, California
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg (Dr. Klar), Freiburg, Germany
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (Drs. Matsuo, Mandelbaum, Chang, Matsuzaki, and Roman), University of Southern California, Los Angeles, California; USC Norris Comprehensive Cancer Center (Drs. Matsuo and Roman), Los Angeles, California
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12
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Lunde S, Petersen KK, Kugathasan P, Arendt-Nielsen L, Søgaard-Andersen E. Correction to: Chronic Postoperative Pain After Robot-Assisted Laparoscopic Hysterectomy for Endometrial Cancer by Lunde S, Petersen KK, Kugathasan P, Arendt-Nielsen L and Søgaard-Andersen E. Journal of Gynecologic Surgery 2019;35(3);140-146. DOI: 10.1089/gyn.2018.0068. J Gynecol Surg 2020. [PMID: 32293603 DOI: 10.1089/gyn.2018.0068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
[This corrects the article DOI: 10.1089/gyn.2018.0068.].
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Affiliation(s)
- Søren Lunde
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
- Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Kristian Kjær Petersen
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Pirathiv Kugathasan
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Erik Søgaard-Andersen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
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13
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Marra AR, Puig-Asensio M, Edmond MB, Schweizer ML, Bender D. Infectious complications of laparoscopic and robotic hysterectomy: a systematic literature review and meta-analysis. Int J Gynecol Cancer 2020; 29:518-530. [PMID: 30833440 DOI: 10.1136/ijgc-2018-000098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE We performed a systematic review of the literature and meta-analysis of the infectious complications of hysterectomy, comparing robotic-assisted hysterectomy to conventional laparoscopic-assisted hysterectomy. METHODS We searched PubMed, CINAHL, CDSR, and EMBASE through July 2018 for studies evaluating robotic-assisted hysterectomy, laparoscopic-assisted hysterectomy, and infectious complications. We employed random-effect models to obtain pooled OR estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. Pooled ORs were calculated separately based on the reason for hysterectomy (eg, benign uterine diseases, endometrial cancer, and cervical cancer). RESULTS Fifty studies were included in the final review for the meta-analysis with 176 016 patients undergoing hysterectomy. There was no statistically significant difference in the number of infectious complication events between robotic-assisted hysterectomy and laparoscopic-assisted hysterectomy (pooled OR 0.97; 95 % CI 0.74 to 1.28). When we performed a stratified analysis, similar results were found with no statistically significant difference in infectious complications comparing robotic-assisted hysterectomy to laparoscopic-assisted hysterectomy among patients with benign uterine disease (pooled OR 1.10; 95 % CI 0.70 to 1.73), endometrial cancer (pooled OR 0.97; 95 % CI 0.55 to 1.73), or cervical cancer (pooled OR 1.09; 95 % CI 0.60 to 1.97). CONCLUSION In our meta-analysis the rate of infectious complications associated with robotic-assisted hysterectomy was no different than that associated with conventional laparoscopic-assisted hysterectomy.
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Affiliation(s)
- Alexandre R Marra
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mireia Puig-Asensio
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
| | - Michael B Edmond
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Marin L Schweizer
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - David Bender
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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14
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Douissard J, Obias V, Johnson CS, Hagen ME, Keller D, Ouellette JR, Hellan M. Totally robotic vs hybrid abdominoperineal resection: A retrospective multicenter analysis. Int J Med Robot 2019; 16:e2073. [PMID: 31876089 DOI: 10.1002/rcs.2073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/15/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Laparoscopic abdominoperineal resection (APR) for low rectal cancers is technically demanding. Robotic assistance may be of help and can be hybrid (HAPR) or totally robotic (RAPR). The present study describes outcomes of robotic APR and compares both approaches. MATERIAL AND METHODS A multicentric retrospective analysis of rectal cancer patients undergoing either HAPR or RAPR was conducted. Patients' demographics, surgeons' experience, oncologic results, and intraoperative and postoperative outcomes were collected. RESULTS One hundred twenty-five patients were included, 48 in HAPR group and 77 in RAPR group. Demographics and comorbidities were comparable. Operative time was reduced in RAPR group (266.9 ± 107.8 min vs 318.9 ± 75.1 min, P = .001). RAPR patients were discharged home more frequently (91.18% vs 66.67%, P = .001), and experienced fewer parastomal hernias (3.71% vs 9.86%, P = .001). CONCLUSION RAPR is safe and feasible with appropriate oncologic outcomes. Totally robotic approach reduces operative time and may improve functional outcomes.
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Affiliation(s)
- Jonathan Douissard
- Visceral Surgery Department, Geneva University Hospital, Geneva, Switzerland
| | - Vincent Obias
- Division of Colorectal Surgery, Department of Surgery, George Washington University Hospital, Washington, DC
| | | | - Monika E Hagen
- Visceral Surgery Department, Geneva University Hospital, Geneva, Switzerland
| | - Deborah Keller
- Division of Colorectal Surgery, Department of Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
| | - James R Ouellette
- Surgical Oncology Division, Wright State University - Boonshoft School of Medicine, Centerville, Ohio
| | - Minia Hellan
- Wright State University - Boonshoft School of Medicine, Kettering Cancer Care, Kettering, Ohio
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15
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Xiong Z, Rindos NB, Lee T. Increasing the Rate of Laparoscopic Hysterectomy Safely for Benign Gynecologic Disease. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2019.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zhoufang Xiong
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Noah B. Rindos
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee–Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ted Lee
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee–Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA
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16
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Sinha R, Bana R, Sanjay M. Comparison of Robotic and Laparoscopic Hysterectomy for the Large Uterus. JSLS 2019; 23:JSLS.2018.00068. [PMID: 30675091 PMCID: PMC6328360 DOI: 10.4293/jsls.2018.00068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background and Objectives: We compared the outcome of robotic hysterectomy (RH) with laparoscopic hysterectomy (LH) for large uteri (≥16 weeks). Methods: This was a retrospective review over 5 years of 165 women (RH, 46; LH, 119). Demographic data, conversion, hemoglobin drop, indication, operating time, postoperative stay, and intra-operative strategies (adhesiolysis, myomectomy) were recorded. Results: Mean age was 45.7 ± 6.4 years and 44.5 ± 5.4 years (no diff) and body mass index was 30.2 ± 6.3 kg/m2 and 27.8 ± 4.8 kg/m2 (P = .009) in the RH and LH groups. There was no difference in percentage of women with previous laparotomy (RH, 15.2% vs LH, 13.4%) and mean number of lower-segment caesarean section (RH, 1.0 vs LH, 0.8). Mean size of uterus was similar (RH, 20.0 weeks vs LH, 17.4 weeks). The mean number of ports was higher in the RH group (RH, 4.2 vs LH, 3.4; P < .001) as was needed for adhesiolysis (RH, 71.7% vs LH, 35.3%; P < .001). Difficult bladder dissection was more in the RH group (56.5% vs 26.1%; P < .001). Vaginal morcellation was similar in both groups (RH, 89.1%; LH, 83.2%). RH took longer operating time (131.0 vs 110.6 minutes; P = .006). RH had less drop in Hb (1.0 vs 1.8 g/dL; P < .001) and remained the same after multiple regression analysis. Postoperative stay was similar in both groups (1.4 days). Requirement of intravenous analgesia was significantly lower in the RH group (12.5 vs 30.9 hours; P < .001). Open conversion rate was 4.3% (RH) and 10.9% (LH) but not significant. Conclusion: A higher body mass index, more adhesiolysis, and difficult bladder dissection imply a more challenging nature of women who underwent RH. Despite this, RH was shown to be feasible and safe with a lower blood loss.
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Affiliation(s)
- Rooma Sinha
- Department of Gynecology, Apollo Hospitals, Jubilee Hills, Hyderabad, India
| | - Rupa Bana
- Department of Gynecology, Apollo Hospitals, Jubilee Hills, Hyderabad, India
| | - Madhumathi Sanjay
- Department of Gynecology, Apollo Hospitals, Jubilee Hills, Hyderabad, India
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17
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Purohit R, Sharma JG, Meher D, Rakh SR, Malik S. Completion of vaginal hysterectomy by electro surgery using anteroposterior approach in benign cases faced with obliterated posterior cul-de-sac. Int J Womens Health 2018; 10:529-536. [PMID: 30271220 PMCID: PMC6147202 DOI: 10.2147/ijwh.s171575] [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] [Indexed: 11/23/2022] Open
Abstract
Background Obliterated posterior cul-de-sac has been a real surgical challenge during vaginal hysterectomy. The present study demonstrates an anteroposterior approach to accomplish the vaginal hysterectomy in cases faced with an obliterated posterior cul-de-sac. Methods In a retrospective study in private setup, 51 consecutive cases with obliterated posterior cul-de-sac during vaginal hysterectomy due to severe benign pelvic adhesions were studied to know the feasibility of the anteroposterior approach. The upper limit of uterus size was that of 16 weeks of gestation. Results Vaginal hysterectomy was completed in 49 (96.08%) cases with obliterated posterior cul-de-sac due to severe benign pelvic adhesions. Two (3.92%) cases needed laparoscopic assistance to complete vaginal hysterectomy. Mean operation time was 109.92±40.13 (45-217) minutes due to the need for careful separation of adhesions from the uterus and indicated additional procedures. Mean weight of specimen uterus was 162±106.51 (40-460) grams. There was no major intra- or postoperative morbidity. Conclusion Completion of vaginal hysterectomy was feasible using the anteroposterior approach in most of the cases with obliterated posterior cul-de-sac due to severe benign pelvic adhesions.
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Affiliation(s)
- Ramkrishna Purohit
- Department of Obstetrics and Gynaecology, Purohit General Hospital, Bargarh, India,
| | - Jay Gopal Sharma
- Department of Obstetrics and Gynaecology, Purohit General Hospital, Bargarh, India,
| | - Devajani Meher
- Department of Obstetrics and Gynaecology, Purohit General Hospital, Bargarh, India,
| | - Sanjay Raosaheb Rakh
- Department of Obstetrics and Gynaecology, Purohit General Hospital, Bargarh, India,
| | - Surya Malik
- Department of Obstetrics and Gynaecology, Purohit General Hospital, Bargarh, India,
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18
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Ngan TYT, Zakhari A, Czuzoj-Shulman N, Tulandi T, Abenhaim HA. Laparoscopic and Robotic-Assisted Hysterectomy for Uterine Leiomyomas: A Comparison of Complications and Costs. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:432-439. [DOI: 10.1016/j.jogc.2017.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/13/2017] [Accepted: 08/01/2017] [Indexed: 11/30/2022]
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19
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Kwon ST, Zhao L, Reddy RM, Chang AC, Orringer MB, Brummett CM, Lin J. Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection. J Thorac Cardiovasc Surg 2017; 154:652-659.e1. [DOI: 10.1016/j.jtcvs.2017.02.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 01/16/2017] [Accepted: 02/05/2017] [Indexed: 11/16/2022]
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Chinbe H, Yoneyama T, Watanabe T, Miyashita K, Nakada M. Finger-attachment device for the feedback of gripping and pulling force in a manipulating system for brain tumor resection. Int J Comput Assist Radiol Surg 2017; 13:3-12. [DOI: 10.1007/s11548-017-1640-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/28/2017] [Indexed: 11/30/2022]
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21
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Jin SJ, Park JY, Kim DH, Yoon SH, Kim E, Hwang JH, Song C, Kim YK. Comparison of postoperative pain between laparoscopic and robot-assisted partial nephrectomies for renal tumors: A propensity score matching analysis. Medicine (Baltimore) 2017; 96:e7581. [PMID: 28723795 PMCID: PMC5521935 DOI: 10.1097/md.0000000000007581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Robot-assisted partial nephrectomy (RAPN) has emerged as an alternative to laparoscopic partial nephrectomy (LPN) for removal of renal tumors. Several advantages of robotic surgery have been reported, but there is no comparative study on postoperative pain between the 2 techniques. Therefore, we compared the postoperative numerical rating scale (NRS) of pain intensity between patients who underwent LPN and those who underwent RAPN.We included 705 patients who underwent either LPN (n = 200) or RAPN (n = 505) for renal tumors between January 2000 and September 2016. After 1:1 propensity score matching, the final analysis included 142 patients each in the LPN and RAPN groups. The primary endpoint was postoperative NRS of pain intensity. The secondary endpoints were opioid requirement, opioid-related complications, and duration of hospital stay.Preoperative and intraoperative values of propensity score matched patients (n = 284) were not significantly different between the LPN and RAPN groups. There was no significant difference in NRS of pain intensity between the 2 groups. Opioid requirement was different between the 2 groups on postoperative day (POD) 0 (12.4 vs 11.3 mg of morphine-equivalent dose), but not from POD 1 to POD 4. The incidence of opioid-related complications and duration of hospital stay were not significantly different between the 2 groups.Postoperative pain was not significantly different between patients who underwent RAPN and those who underwent LPN. This result provides a potentially useful knowledge of postoperative pain characteristics in RAPN and LPN.
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Affiliation(s)
| | | | | | | | - Eunkyul Kim
- Department of Anesthesiology and Pain Medicine
| | | | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Arian SE, Munoz JL, Kim S, Falcone T. Robot-assisted laparoscopic myomectomy: current status. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:7-18. [PMID: 30697559 PMCID: PMC6193424 DOI: 10.2147/rsrr.s102743] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Robotic-assisted surgery has seen a rapid development and integration in the field of gynecology. Since the approval of the use of robot for gynecological surgery and considering its several advantages over conventional laparoscopy, it has been widely incorporated especially in the field of reproductive surgery. Uterine fibroids are the most common benign tumors of the female reproductive tract. Many reproductive-aged women with this condition demand uterine-sparing surgery to preserve their fertility. Myomectomy, the surgical excision of uterine fibroids, remains the only surgical management option for fibroids that entails preservation of fertility. In this review, we focus on the role of robotic-assisted laparoscopic myomectomy and its current status, in comparison with other alternative approaches for myomectomy, including open, hysteroscopic, and traditional laparoscopic techniques. Several different surgical techniques have been demonstrated for robotic myomectomy. This review endeavors to share and describe our surgical experience of using the standard laparoscopic equipment for robotic-assisted myomectomy, together with the da Vinci Robot system. For the ideal surgical candidate, robotic-assisted myomectomy is a safe minimally invasive surgical procedure that can be offered as an alternative to open surgery. The advantages of using the robot system compared to open myomectomy include a shorter length of hospital stay, less postoperative pain and analgesic use, faster return to normal activities, more rapid return of the bowel function, and enhanced cosmetic results due to smaller skin incision sizes. Some of the disadvantages of this technique include high costs of the robotic surgical system and equipment, the steep learning curve of this novel system, and prolonged operative and anesthesia times. Robotic technology is a novel and innovative minimally invasive approach with demonstrated feasibility in gynecological and reproductive surgery. This technology is expected to take the lead in gynecological surgery in the upcoming decade.
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Affiliation(s)
- Sara E Arian
- Department of Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA,
| | - Jessian L Munoz
- Department of Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA,
| | - Suejin Kim
- Department of Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA,
| | - Tommaso Falcone
- Department of Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA,
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23
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Evaluation of the surgical outcome and complications of total laparoscopic hysterectomy in patients with enlarged uteruses. Int J Surg 2016; 36:90-95. [DOI: 10.1016/j.ijsu.2016.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/17/2016] [Indexed: 11/18/2022]
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24
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Chen CH, Chen HH, Liu WM. Complication reports for robotic surgery using three arms by a single surgeon at a single institution. J Minim Access Surg 2016; 13:22-28. [PMID: 27251839 PMCID: PMC5206835 DOI: 10.4103/0972-9941.181774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND: The aim of this study is to evaluate perioperative complications related to robotic-assisted laparoscopic surgery for management of gynaecologic disorders. MATERIALS AND METHODS: Eight hundred and fifty-one women who underwent robotic procedures between December 2011 and April 2015 were retrospectively included for analysis. Patient demographics, surgical outcomes and complications were evaluated. RESULTS: The overall complication rate was 5.5%, whereas the rate of complications for oncologic cases was 8.4%. Intra-operative complications (n = 7, 0.8%) consisted of five cases of bowel lacerations, one case of ureter laceration and one case of bladder injury. Early and late post-operative complications were 4.0% (n = 34) and 0.8% (n = 6), respectively. Six patients (0.7%) experienced Grade III complications based on the Clavien-Dindo classification and required further surgical intervention. CONCLUSION: Robotic-assisted laparoscopic surgery is a feasible approach for management of gynaecologic disorders; the complication rates for this type of procedure are acceptable.
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Affiliation(s)
- Ching-Hui Chen
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Huang-Hui Chen
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wei-Min Liu
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Bhattu AS, Ganpule A, Sabnis RB, Murali V, Mishra S, Desai M. Robot-Assisted Laparoscopic Donor Nephrectomy vs Standard Laparoscopic Donor Nephrectomy: A Prospective Randomized Comparative Study. J Endourol 2015; 29:1334-40. [DOI: 10.1089/end.2015.0213] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amit Satish Bhattu
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Ravindra B. Sabnis
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Vinodh Murali
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Shashikant Mishra
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
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Driessen SRC, Sandberg EM, la Chapelle CF, Twijnstra ARH, Rhemrev JPT, Jansen FW. Case-Mix Variables and Predictors for Outcomes of Laparoscopic Hysterectomy: A Systematic Review. J Minim Invasive Gynecol 2015; 23:317-30. [PMID: 26611613 DOI: 10.1016/j.jmig.2015.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 12/14/2022]
Abstract
The assessment of surgical quality is complex, and an adequate case-mix correction is missing in currently applied quality indicators. The purpose of this study is to give an overview of all studies mentioning statistically significant associations between patient characteristics and surgical outcomes for laparoscopic hysterectomy (LH). Additionally, we identified a set of potential case-mix characteristics for LH. This systematic review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. We searched PubMed and EMBASE from January 1, 2000 to August 1, 2015. All articles describing statistically significant associations between patient characteristics and adverse outcomes of LH for benign indications were included. Primary outcomes were blood loss, operative time, conversion, and complications. The methodologic quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. The included articles were summed per predictor and surgical outcome. Three sets of case-mix characteristics were determined, stratified by different levels of evidence. Eighty-five of 1549 identified studies were considered eligible. Uterine weight and body mass index (BMI) were the most mentioned predictors (described, respectively, 83 and 45 times) in high quality studies. For longer operative time and higher blood loss, uterine weight ≥ 250 to 300 g and ≥500 g and BMI ≥ 30 kg/m(2) dominated as predictors. Previous operations, adhesions, and higher age were also considered as predictors for longer operative time. For complications and conversions, the patient characteristics varied widely, and uterine weight, BMI, previous operations, adhesions, and age predominated. Studies of high methodologic quality indicated uterine weight and BMI as relevant case-mix characteristics for all surgical outcomes. For future development of quality indicators of LH and to compare surgical outcomes adequately, a case-mix correction is suggested for at least uterine weight and BMI. A potential case-mix correction for adhesions and previous operations can be considered. For both surgeons and patients it is valuable to be aware of potential factors predicting adverse outcomes and to anticipate this. Finally, to benchmark clinical outcomes at an international level, it is of the utmost importance to introduce uniform outcome definitions.
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Affiliation(s)
- Sara R C Driessen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Evelien M Sandberg
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Claire F la Chapelle
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andries R H Twijnstra
- Department of Obstetrics and Gynecology, Bronovo Hospital, The Hague, The Netherlands
| | - Johann P T Rhemrev
- Department of Obstetrics and Gynecology, Bronovo Hospital, The Hague, The Netherlands
| | - Frank Willem Jansen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands; Department BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands.
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Hoste G, Van Trappen P. Robotic hysterectomy using the Vessel Sealer for myomatous uteri: technique and clinical outcome. Eur J Obstet Gynecol Reprod Biol 2015; 194:241-4. [PMID: 26454809 DOI: 10.1016/j.ejogrb.2015.09.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/05/2015] [Accepted: 09/17/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Robotic procedures using the Vessel Sealer are not well reported in the literature, especially given the advantages of sealing devices already studied in standard laparoscopic procedures. This study reports our experience with the EndoWrist(®) One™ Vessel Sealer in robotic hysterectomy for myomatous uteri. STUDY DESIGN In this retrospective cohort study of the first 50 consecutive patients with myomatous uteri undergoing a robotic hysterectomy, we report our experience with the EndoWrist(®) One™ Vessel Sealer (Intuitive Surgical Inc., Sunnyvale, CA) during this procedure. The learning curve was evaluated, and the operative times as well as the complications were recorded. RESULTS After the first 10 cases, the median console and total (skin-to-skin) operative time dropped significantly from 110 to 60min and from 158 to 105min, respectively (p=0.018 and p=0.008 respectively). The body mass index (≤ or >30kg/m(2)), uterine weight (≤ or >250g), and uterine size had no statistical significant effect on the total operative time. Median blood loss during surgery was 63mL in all cases (range: 0-400mL). The morbidity was low, and approximately 50% of cases could be discharged from the hospital after one to two days. CONCLUSION Robotic hysterectomy using the Vessel Sealer has, after a short learning curve of 10 cases, similar operative times than other published reports on robotic hysterectomy or laparoscopic hysterectomy using a sealing device for myomatous or large uteri.
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Affiliation(s)
- Griet Hoste
- Department of Gynaecology and Gynaecological Oncology, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Philippe Van Trappen
- Department of Gynaecology and Gynaecological Oncology, AZ Sint-Jan Hospital, Bruges, Belgium.
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Chen CH, Chiu LH, Chen HH, Chan C, Liu WM. Comparison of robotic approach, laparoscopic approach and laparotomy in treating epithelial ovarian cancer. Int J Med Robot 2015; 12:268-75. [DOI: 10.1002/rcs.1655] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 01/13/2015] [Accepted: 03/02/2015] [Indexed: 02/01/2023]
Affiliation(s)
- Ching-Hui Chen
- Department of Obstetrics and Gynaecology; Taipei Medical University Hospital; Taipei Taiwan
- Department of Obstetrics and Gynaecology, College of Medicine; Taipei Medical University; Taipei Taiwan
| | - Li-Hsuan Chiu
- Department of Obstetrics and Gynaecology; Taipei Medical University Hospital; Taipei Taiwan
| | - Huang-Hui Chen
- Department of Obstetrics and Gynaecology; Taipei Medical University Hospital; Taipei Taiwan
| | - Cindy Chan
- Department of Obstetrics and Gynaecology; Taipei Medical University Hospital; Taipei Taiwan
| | - Wei-Min Liu
- Department of Obstetrics and Gynaecology; Taipei Medical University Hospital; Taipei Taiwan
- Department of Obstetrics and Gynaecology, College of Medicine; Taipei Medical University; Taipei Taiwan
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