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Ji J, Ali M, Wang W, Ren J, Wang L, Tang D, Wang D. Tumor size impact on TNM staging which define post-operative complications in rectal cancer. J Robot Surg 2024; 18:161. [PMID: 38578471 DOI: 10.1007/s11701-024-01920-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
The purpose of this study was to see how accurate tumor size was at predicting T and N stages in rectal malignancies. Tumor sizes of 40 mm and greater than 40 mm were used to assess post-operative challenges in related to T1-T2 and T3-T4 stages, as well as between node N0 and node N1 and N2 patients. A total of 131 patients were treated for colorectal cancer, with 54 patients < 40 mm and 77 patients > 40 mm receiving Da Vinci colorectal surgery. Conferring to the Clavien-Dindo classification grade III, there's an increase in the percentage of tumors > 40 mm, which also impacts the percentage of intestinal obstruction, anastomotic leakage, GERD, and sepsis with a P < 0.05. A tumor size of more than 40 mm is strongly associated with advanced pT stages. Tumor size may serve in addition to clinical staging and improve the management of rectal cancer.
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Affiliation(s)
- Jin Ji
- Department of Gastrointestinal Surgery, Clinical Medical College Yangzhou University, Northern Jiangsu People's Hospital Affiliated Yangzhou University, Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Muhammad Ali
- Department of Gastrointestinal Surgery, Clinical Medical College Yangzhou University, Northern Jiangsu People's Hospital Affiliated Yangzhou University, Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Wei Wang
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Jun Ren
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Liuhua Wang
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Dong Tang
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Daorong Wang
- Department of Gastrointestinal Surgery, Clinical Medical College Yangzhou University, Northern Jiangsu People's Hospital Affiliated Yangzhou University, Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China.
- Medical College of Yangzhou University, Yangzhou, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China.
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China.
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Meyer J, Meyer E, Meurette G, Liot E, Toso C, Ris F. Robotic versus laparoscopic right hemicolectomy: a systematic review of the evidence. J Robot Surg 2024; 18:116. [PMID: 38466445 DOI: 10.1007/s11701-024-01862-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/01/2024] [Indexed: 03/13/2024]
Abstract
Robotics may facilitate the realization of fully minimally invasive right hemicolectomy, including intra-corporeal anastomosis and off-midline extraction, when compared to laparoscopy. Our aim was to compare laparoscopic right hemicolectomy with robotic right hemicolectomy in terms of peri-operative outcomes. MEDLINE was searched for original studies comparing laparoscopic right hemicolectomy with robotic right hemicolectomy in terms of peri-operative outcomes. The systematic review complied with the PRISMA 2020 recommendations. Variables related to patients' demographics, surgical procedures, post-operative recovery and pathological outcomes were collected and qualitatively assessed. Two-hundred and ninety-three publications were screened, 277 were excluded and 16 were retained for qualitative analysis. The majority of included studies were observational and of limited sample size. When the type of anastomosis was left at surgeon's discretion, intra-corporeal anastomosis was favoured in robotic right hemicolectomy (4/4 studies). When compared to laparoscopy, robotics allowed harvesting more lymph nodes (4/15 studies), a lower conversion rate to open surgery (5/14 studies), a shorter time to faeces (2/3 studies) and a shorter length of stay (5/14 studies), at the cost of a longer operative time (13/14 studies). Systematic review of existing studies, which are mostly non-randomized, suggests that robotic surgery may facilitate fully minimally invasive right hemicolectomy, including intra-corporeal anastomosis, and offer improved post-operative recovery.
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Affiliation(s)
- Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil,14, 41211, Geneva, Switzerland.
- Medical School, University of Geneva, Rue Michel-Servet, 11206, Geneva, Switzerland.
| | - Elin Meyer
- Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden
| | - Guillaume Meurette
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil,14, 41211, Geneva, Switzerland
- Medical School, University of Geneva, Rue Michel-Servet, 11206, Geneva, Switzerland
| | - Emilie Liot
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil,14, 41211, Geneva, Switzerland
- Medical School, University of Geneva, Rue Michel-Servet, 11206, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil,14, 41211, Geneva, Switzerland
- Medical School, University of Geneva, Rue Michel-Servet, 11206, Geneva, Switzerland
| | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil,14, 41211, Geneva, Switzerland
- Medical School, University of Geneva, Rue Michel-Servet, 11206, Geneva, Switzerland
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Adhikari K, Penmetsa GK, Krishnappa D, Taori R, Raghunath SK. Revolutionizing urology: the advancements and applications of robotic platforms. J Robot Surg 2024; 18:106. [PMID: 38436766 DOI: 10.1007/s11701-023-01758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/14/2023] [Indexed: 03/05/2024]
Abstract
Robot-assisted surgery is developing as an acme of minimally invasive surgery, given its utmost dominance over laparoscopic surgery. The objective was to review the status of robotic surgery in urological practice with its advantages and disadvantages in current scenario. We conducted a literature search using MEDLINE and identified 72 articles which were relevant to urology. Single-port and various multiport robotic platforms like Da Vinci, Versius, Hugo RAS, Revo-I, Senhance, Mantra, Avatera, Hinotori, and MicroSurge are described with pros and cons. With a surge in different medical surgical robots purging into the market and a race to become the next standard of care in robotic surgery, it is only a matter of time when robotic surgery becomes financially comparable to laparoscopic surgeries.
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Affiliation(s)
- Kinju Adhikari
- Department of Uro Oncology and Robotic Surgery, HCG Cancer Center, Bengaluru, India
| | | | - Deepak Krishnappa
- Department of Uro Oncology and Robotic Surgery, HCG Cancer Center, Bengaluru, India
| | - Ravi Taori
- Department of Uro Oncology and Robotic Surgery, HCG Cancer Center, Bengaluru, India
| | - S K Raghunath
- Department of Uro Oncology and Robotic Surgery, HCG Cancer Center, Bengaluru, India.
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Evangelopoulos N, Nessi A, Achtari C. Minimally invasive sacrocolpopexy: efficiency of robotic assistance compared to standard laparoscopy. J Robot Surg 2024; 18:72. [PMID: 38340232 PMCID: PMC10858822 DOI: 10.1007/s11701-023-01799-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/16/2023] [Indexed: 02/12/2024]
Abstract
Minimally invasive abdominal sacrocolpopexy (SC) is the treatment of choice for symptomatic, high-grade, apical or multi-compartmental pelvic organ prolapse (POP), in terms of anatomical correction and treatment durability. Robot-assisted sacrocolpopexy (RASC) could be an attractive alternative to the gold standard laparoscopic sacrocolpopexy (LSC), for its ergonomic advantages in such a technically demanding procedure. However, it has not yet proven its superiority, consequently raising cost-effectiveness issues. Our primary objective was to assess if RASC can achieve better overall operative time (OOT) over LSC, with at least equivalent perioperative results. This was a single-center retrospective study including 100 patients (58 consecutive RASC cases and 42 LSC within the same time-period), with primary endpoint the OOT in both groups. Secondary results included complication rate, hospital stay, short-term anatomic results and OOT within and beyond the RASC learning curve. A multivariate linear regression was carried out for our primary outcome. The groups had comparable characteristics, except for BMI, which was lower in RASC group. The mean OOT was significantly lower in the RASC group (188 vs. 217 min, p ≤ 0.01), even after adjusting for possible confounders. Short-term anatomic results, complication rate, and blood loss were similar in the two groups. Mean hospital stay was significantly longer in the RASC group. Average RASC OOT was significantly shorter after the first 20 cases realized. This study demonstrated a significant reduction of OOT for RASC compared to LSC, with similar perioperative results, encouraging further use of the robotic technology for this indication.
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Affiliation(s)
- Nikolaos Evangelopoulos
- Women, Mother, Children Department (DFME)-Urogynecology Unit, Vaud University Hospital Center (CHUV), Av. Pierre-Decker 2, 1011, Lausanne, Switzerland.
| | - Aude Nessi
- Women, Mother, Children Department (DFME)-Urogynecology Unit, Vaud University Hospital Center (CHUV), Av. Pierre-Decker 2, 1011, Lausanne, Switzerland
| | - Chahin Achtari
- Women, Mother, Children Department (DFME)-Urogynecology Unit, Vaud University Hospital Center (CHUV), Av. Pierre-Decker 2, 1011, Lausanne, Switzerland
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Loniewski S, Farah K, Mansouri N, Albader F, Settembre N, Litré CF, Malikov S, Fuentes S. Da Vinci Robotic Assistance for Anterolateral Lumbar Arthrodesis: Results of a French Multicentric Study. World Neurosurg 2024; 181:e685-e693. [PMID: 37898271 DOI: 10.1016/j.wneu.2023.10.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The da Vinci robot (DVR) is the most widely used robot in abdominal, urological, and gynecological surgery. Due to its minimally invasive approach, the DVR has demonstrated its effectiveness and improved safety in these different disciplines. The aim of our study was to report its use in an anterior approach of complex lumbar surgery. METHODS In a retrospective multicenter observational study, 10 robotic-assisted procedures were performed from March 2021 to May 2022. Six oblique lumbar interbody fusion procedures and 4 lumbar corpectomies were performed by anterolateral approach assisted by the DVR. The characteristics of the patients and the intraoperative and postoperative data were recorded. RESULTS Six men and 4 women underwent surgery (mean age 50.5 years; body mass index 28.6 kg/m2). No vascular injuries were reported, and no procedures required conversion to open surgery. Mean surgical time were 219 minutes for 1-level oblique lumbar interbody fusion (3 patients), 286 minutes for 2-level oblique lumbar interbody fusion (3 patients), and 390 minutes for corpectomy (4 patients). Four patients experienced nonserious adverse events due to lumbar plexus nerve damage. One patient had a vertebral body plate fracture requiring posterior revision surgery, and 1 patient had a psoas hematoma requiring transfusion. No abdominal wall complications or surgical site infection were found. Seven patients were reviewed at 12 months, none had complications, and all showed radiological evidence of fusion. CONCLUSIONS The use of the DVR in lumbar surgery allows a safe minimally invasive transperitoneal approach, but to date, only hybrid procedures have been performed.
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Affiliation(s)
- Stanislas Loniewski
- Department of Neurosurgery, Hôpital Maison Blanche, CHU de Reims, Reims, France.
| | - Kaissar Farah
- Department of Neurosurgery, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Nacer Mansouri
- Department of Neurosurgery, Hôpital Central, CHRU Nancy, Nancy, France
| | - Faisal Albader
- Department of Neurosurgery, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Nicla Settembre
- Department of Vascular surgery, Hôpitaux de Brabois, CHRU Nancy, Nancy, France
| | - Claude-Fabien Litré
- Department of Neurosurgery, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | - Serguei Malikov
- Department of Vascular surgery, Hôpitaux de Brabois, CHRU Nancy, Nancy, France
| | - Stéphane Fuentes
- Department of Neurosurgery, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
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Bravi CA, Balestrazzi E, De Loof M, Rebuffo S, Piramide F, Mottaran A, Paciotti M, Sorce G, Nocera L, Sarchi L, Peraire M, Colla'-Ruvolo C, Frego N, Piro A, Ticonosco M, De Backer P, Farinha R, Van Den Bossche H, De Naeyer G, D'Hondt F, De Groote R, Mottrie A. Robot-assisted Radical Prostatectomy Performed with Different Robotic Platforms: First Comparative Evidence Between Da Vinci and HUGO Robot-assisted Surgery Robots. Eur Urol Focus 2024; 10:107-114. [PMID: 37634969 DOI: 10.1016/j.euf.2023.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/22/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND In the field of robotic surgery, there is a lack of comparative evidence on surgical and functional outcomes of different robotic platforms. OBJECTIVE To assess the outcomes of patients receiving robot-assisted radical prostatectomy (RARP) at a high-volume robotic center with daVinci and HUGO robot-assisted surgery (RAS) surgical systems. DESIGN, SETTING, AND PARTICIPANTS We analyzed the data of 542 patients undergoing RARP ± extended pelvic lymph node dissection at OLV hospital (Aalst, Belgium) between 2021 and 2023. All procedures were performed by six surgeons using daVinci or HUGO RAS robots; the use of one platform rather than the other did not follow any specific preference and/or indication. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable analyses investigated the association between robotic system (daVinci vs HUGO RAS) and surgical outcomes after adjustment for patient- and tumor-related factors. Urinary continence recovery was defined as the use of no/one safety pad. RESULTS AND LIMITATIONS A total of 378 (70%) and 164 (30%) patients underwent RARP with daVinci and HUGO RAS surgical systems, respectively. Despite a higher rate of palpable disease in the HUGO RAS group (34% vs 25%), baseline characteristics did not differ between the groups (all p > 0.05). After adjusting for confounders, we did not find evidence of a difference between the groups with respect to operative time (estimate: 16.71; 95% confidence interval [CI]: -6.35, 39.78; p = 0.12), estimated blood loss (estimate: 3.12; 95% CI: -67.03, 73.27; p = 0.9), and postoperative Clavien-Dindo ≥2 complications (odds ratio [OR]: 1.66; 95% CI: 0.34, 8.15; p = 0.5). On final pathology, 55 (15%) and 20 (12%) men in, respectively, the daVinci and the HUGO RAS group had positive surgical margins (PSMs; p = 0.5). On multivariable analyses, we did not find evidence of an association between a robotic system and PSMs (OR: 1.08; 95% CI: 0.56, 2.07; p = 0.8). Similarly, the odds of recovering continence did not differ between daVinci and HUGO RAS cases after both 1 mo (OR: 0.78; 95% CI: 0.45, 1.38; p = 0.4) and 3 mo (OR: 1.17; 95% CI: 0.49, 2.79; p = 0.7). CONCLUSIONS Among patients receiving RARP with daVinci or HUGO RAS surgical platforms, we did not find differences in surgical and functional outcomes between the robots. This may be a result of a standardized surgical technique that allowed surgeons to transfer their skills between robotic systems. Awaiting future investigations with longer follow-up, these results have important implications for patients, surgeons, and health care policymakers. PATIENT SUMMARY We compared surgical and functional outcomes of patients receiving robot-assisted radical prostatectomy with daVinci versus HUGO robot-assisted surgery (RAS) robots. The two platforms were able to achieve similar outcomes, suggesting that the introduction of HUGO RAS is safe and allows for optimal outcomes after radical prostatectomy.
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Affiliation(s)
- Carlo Andrea Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK.
| | - Eleonora Balestrazzi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Manon De Loof
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Silvia Rebuffo
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Federico Piramide
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Angelo Mottaran
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Paciotti
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Gabriele Sorce
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luigi Nocera
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Sarchi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Urology Unit, ASST Santi Paolo e Carlo, La Statale University, Milan, Italy
| | - Maria Peraire
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Claudia Colla'-Ruvolo
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Nicola Frego
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Adele Piro
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Ticonosco
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Pieter De Backer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Rui Farinha
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Hannes Van Den Bossche
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; Department of Urology, General Hospital West, Veurne, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Frederiek D'Hondt
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
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Komatsu H, Wada I, Harada T, Taniguchi F. First report of robotic-assisted total hysterectomy using the Hugo™ RAS system. Updates Surg 2024; 76:315-318. [PMID: 38070071 DOI: 10.1007/s13304-023-01710-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/18/2023] [Indexed: 01/24/2024]
Abstract
This study describes the first reported treatment of a benign gynecological disease with the Medtronic's Hugo™ RAS System, the first robot-assisted device used in the field of gynecology in Japan. Patients who underwent robot-assisted total laparoscopic hysterectomy with the Hugo™ RAS System at the Tottori University Hospital between March 2023 and June 2023 were included in this study. In the first case, the patient was in her 40 s and had uterine fibroids. We describe our experience and compare the device with the conventional da Vinci surgical system. We discuss the key features of the Hugo system (including the independent arms, open console, and pistol-shaped handle), the convenience of robotic surgery, the potential to improve quality of life, and how this technology could revolutionize the field of surgery.
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Affiliation(s)
- Hiroaki Komatsu
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Y36-1 Nishicho, Yonago, Tottori, 683-8503, Japan.
| | - Ikumi Wada
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Y36-1 Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Y36-1 Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Tottori University, Y36-1 Nishicho, Yonago, Tottori, 683-8503, Japan
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8
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Martin G, Montalva L, Paré S, Ali L, Martinez-Vinson C, Colas AE, Bonnard A. Robotic-assisted colectomy in children: a comparative study with laparoscopic surgery. J Robot Surg 2023; 17:2287-2295. [PMID: 37336840 DOI: 10.1007/s11701-023-01647-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
The aim of this study was to compare outcomes of laparoscopic and robotic-assisted colectomy in children. All children who underwent a colectomy with a laparoscopic (LapC) or robotic-assisted (RobC) approach in our institution (January 2010-March 2023) were included. Demographics, surgical data, and post-operative outcomes within 30 days were collected. Additional cost related to the robotic approach was calculated. Comparisons were performed using Fisher tests for categorical variables and Mann-Whitney tests for continuous variables. A total of 55 colectomies were performed: 31 LapC and 24 RobC (median age: 14.9 years). Main indications included: inflammatory bowel disease (n = 36, 65%), familial adenomatous polyposis (n = 6, 11%), sigmoid volvulus (n = 5, 9%), chronic intestinal pseudo-obstruction (n = 3, 5%). LapC included 22 right, 4 left, and 5 total colectomies. RobC included 15 right, 4 left, and 5 total colectomies. Robotic-assisted surgery was associated with increased operative time (3 h vs 2.5 h, p = 0.02), with a median increase in operative time of 36 min. There were no conversions. Post-operative complications occurred in 35% of LapC and 38% of RobC (p = 0.99). Complications requiring treatment under general anesthesia (Clavien-Dindo 3) occurred in similar rates (23% in LapC vs 13% in RobC, p = 0.49). Length of hospitalization was 10 days in LapC and 8.5 days in RobC (p = 0.39). The robotic approach was associated with a median additional cost of 2156€ per surgery. Robotic-assisted colectomy is as safe and feasible as laparoscopic colectomy in children, with similar complication rates but increased operative times and cost.
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Affiliation(s)
- Garance Martin
- Department of Pediatric Surgery, Robert-Debré Children University Hospital, 48 Boulevard Sérurier, 75019, Paris, France
- Paris-Cité University, Paris, France
| | - Louise Montalva
- Department of Pediatric Surgery, Robert-Debré Children University Hospital, 48 Boulevard Sérurier, 75019, Paris, France.
- Paris-Cité University, Paris, France.
| | - Stéphane Paré
- Paris-Cité University, Paris, France
- Management Control Department, Robert-Debré Children University Hospital, Paris, France
| | - Liza Ali
- Department of Pediatric Surgery, Robert-Debré Children University Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | | | - Anne-Emmanuelle Colas
- Department of Pediatric Anesthesia, Robert-Debré Children University Hospital, Paris, France
| | - Arnaud Bonnard
- Department of Pediatric Surgery, Robert-Debré Children University Hospital, 48 Boulevard Sérurier, 75019, Paris, France
- Paris-Cité University, Paris, France
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Brassetti A, Ragusa A, Tedesco F, Prata F, Cacciatore L, Iannuzzi A, Bove AM, Anceschi U, Proietti F, D’Annunzio S, Flammia RS, Chiacchio G, Ferriero M, Guaglianone S, Mastroianni R, Misuraca L, Tuderti G, Simone G. Robotic Surgery in Urology: History from PROBOT ® to HUGO TM. Sensors (Basel) 2023; 23:7104. [PMID: 37631641 PMCID: PMC10458477 DOI: 10.3390/s23167104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
The advent of robotic surgical systems had a significant impact on every surgical area, especially urology, gynecology, and general and cardiac surgery. The aim of this article is to delineate robotic surgery, particularly focusing on its historical background, its evolution, its present status, and its future perspectives. A comprehensive literature review was conducted upon PubMed/MEDLINE, using the keywords "robotic surgical system", "robotic surgical device", "robotics AND urology". Additionally, the retrieved articles' reference lists were investigated. Analysis concentrated on urological surgical systems for laparoscopic surgery that have been given regulatory approval for use on humans. From the late 1980s, before daVinci® Era in 2000s, ancestor platform as Probot® and PUMA 560 were described to outline historical perspective. Thus, new robotic competitors of Intuitive Surgical such as Senhance®, Revo-I®, Versius®, Avatera®, Hinotori®, and HugoTM RAS were illustrated. Although daVinci® had high level competitiveness, and for many years represented the most plausible option for robotic procedures, several modern platforms are emerging in the surgical market. Growing competition through unique features of the new robotic technologies might extend applications fields, improve diffusion, and increase cost-effectiveness procedures. More experiences are needed to identify the role of these new advancements in surgical branches and in healthcare systems.
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Affiliation(s)
| | - Alberto Ragusa
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (A.B.); (F.T.); (F.P.); (L.C.); (A.I.); (A.M.B.); (U.A.); (F.P.); (S.D.); (R.S.F.); (G.C.); (M.F.); (S.G.); (R.M.); (L.M.); (G.T.); (G.S.)
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10
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Meyer J, van der Schelling G, Wijsman J, Ris F, Crolla R. Predictors for selective flexure mobilization during robotic anterior resection for rectal cancer: a prospective cohort analysis. Surg Endosc 2023:10.1007/s00464-023-10008-x. [PMID: 37010604 DOI: 10.1007/s00464-023-10008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/09/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION Splenic flexure mobilization (SFM) may be indicated during anterior resection to provide a tension-free anastomosis. However, to date, no score allows identifying patients who may benefit from SFM. METHODS Patients who underwent robotic anterior resection for rectal cancer were identified from a prospective register. Demographic and cancer-related variables were extracted, and predictors of SFM were identified using regression models. Thereafter, 20 patients with SFM and 20 patients without SFM were randomly selected and their pre-operative CTscan were reviewed. The radiological index was defined as 1/(sigmoid length/pelvis depth). The optimal cut-off value for predicting SFM was identified using ROC curve analysis. RESULTS Five hundred and twenty-four patients were included. SFM was performed in 121 patients (27.8%) and increased operative time by 21.8 min (95% CI: 11.3 to 32.4, p < 0.001). The incidence of postoperative complications did not differ between patient with or without SFM. Realization of an anastomosis was the main predictor for SFM (OR: 42.4, 95% CI: 5.8 to 308.5, p < 0.001). In patients with colorectal anastomosis, both sigmoid length (15 ± 5.1 cm versus 24.2 ± 80.9 cm, p < 0.001) and radiological index (1 ± 0.3 versus 0.6 ± 0.2, p < 0.001) differed between patients who had SFM and patients who did not. ROC curve analysis of the radiological index indicated an optimal cut-off value of 0.8 (sensitivity: 75%, specificity: 90%). CONCLUSION SFM was performed in 27.8% of patients who underwent robotic anterior resection, and increased operative time by 21.8 min. For optimal surgical planning, patients requiring SFM can be identified based on pre-operative CT using the index 1/(sigmoid length/pelvis depth) with a cut-off value set at 0.8.
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Affiliation(s)
- Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.
- Medical School, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland.
- Amphia Ziekenhuis, Molengracht 21, 4818CK, Breda, Netherlands.
| | | | - Jan Wijsman
- Amphia Ziekenhuis, Molengracht 21, 4818CK, Breda, Netherlands
| | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
- Medical School, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
| | - Rogier Crolla
- Amphia Ziekenhuis, Molengracht 21, 4818CK, Breda, Netherlands
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11
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Watanaskul S, Schwab ME, Colley A, Chern H, Varma MG, Hoffman WY, Sarin A. Robotic repair of perineal hernias: a video vignette and review of the literature. Surg Endosc 2023; 37:2290-2294. [PMID: 35982283 PMCID: PMC10017789 DOI: 10.1007/s00464-022-09521-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Perineal hernias can be secondarily acquired following abdominoperineal resection of the rectum. While transabdominal minimally invasive techniques have traditionally used laparoscopy, there are few studies published on the robotic platform, which has been gaining popularity for other types of hernia repairs. We review the existing literature, share a video vignette, and provide practical tips for surgeons interested in adopting this approach. METHODS A literature search in Pubmed was performed to include all articles in English describing robotic repair of perineal hernias with identification of variables of interest related to repair. A case presentation with an accompanying video vignette and lessons learned from the experience are provided. RESULTS Seven case reports (four containing video) published between 2019 and 2022 were included. Most articles (n = 5) utilized the Da Vinci Si or Xi, and most patients (n = 5) had undergone abdominoperineal resection with neoadjuvant chemotherapy to treat rectal cancer. Patients were positioned in Trendelenburg with rightward tilt (n = 2), modified lithotomy (n = 1), or a combination of the two (n = 1). All articles (n = 7) reported closing the defect and using mesh. Three articles describe placing five ports (one camera, three robotic, one assistant). There were no significant intraoperative or postoperative complications reported, and no recurrence noted at 3-27 months follow-up. Based on our experience, as shown in the video vignette, we recommend lithotomy positioning, using porous polypropylene mesh anchored to the periosteum of the sacrum and peritoneum overlying the bladder and side wall, and placing a drain above the mesh. CONCLUSIONS A robotic transabdominal approach to perineal hernia repair is a viable alternate to laparoscopy based on low complication rates and lack of recurrence. Prospective and longer duration data are needed to compare the techniques.
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Affiliation(s)
- Sarah Watanaskul
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Marisa E Schwab
- Department of Surgery, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA.
| | - Alexis Colley
- Department of Surgery, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
| | - Hueylan Chern
- Department of Surgery, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
| | - Madhulika G Varma
- Department of Surgery, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
| | - William Y Hoffman
- Department of Plastic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ankit Sarin
- Department of Surgery, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
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12
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Coco D, Leanza S. Robotic thymectomy: a review of techniques and results. Kardiochir Torakochirurgia Pol 2023; 20:36-44. [PMID: 37077455 PMCID: PMC10107420 DOI: 10.5114/kitp.2023.126097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/03/2022] [Indexed: 04/21/2023]
Abstract
Thymectomy is a well-established therapeutic option in the multidisciplinary treatment of nonthymomatous myasthenia gravis (MG) and in thymoma treatment. Although many surgical procedures for thymectomy have been identified, the transsternal method is still regarded as the gold standard. Minimally invasive procedures, on the other hand, have achieved popularity in the last decades and are now extensively used in this field of surgery. Among them, robotic thymectomy has been the most cutting-edge surgical procedure. Several authors and meta-analyses have shown that a minimally invasive approach to thymectomy is associated with improved surgical results and fewer complications in surgery compared to transsternal open thymectomy, without any substantial changes in myasthenia gravis complete rates of remission. Hence, in the present review of the literature, we aimed to describe and delineate the techniques, advantages, outcomes, and future perspectives of robotic thymectomy. Existing evidence suggests that robotic thymectomy will likely become the gold standard for thymectomy in early stage thymomas and MG subjects. Many of the drawbacks related to other minimally invasive procedures appear to be resolved by robotic thymectomy, and long-term neurological outcomes are satisfactory. In addition, improved vision and high dexterity of instrument movements enable safe and complete thymic tissue dissection, superior to standard thoracoscopic procedures. The access with minimally invasive surgery VATS (video-assisted thoracoscopic surgery) or RATS (robot-assisted thoracic surgery) access in its various variants allows the extent of mediastinal fat resection due to the possibility of ectopic thymic foci in the mediastinum determining the long-term outcome in the group of patients operated on for myasthenia gravis. However, it was recommended to carry out better designed, multi-centre, randomized studies to arrive at definitive conclusions on robotic thymectomy for thymomas and myasthenia gravis treatment.
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Affiliation(s)
- Danilo Coco
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro (PU), Italy
| | - Silvana Leanza
- Department of General Surgery, Carlo Urbani Hospital, Jesi (AN), Italy
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13
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Hawksworth J, Radkani P, Filice R, Aguirre O, Nguyen B, Fishbein T, Winslow E. Robotic Central Hepatectomy and Right Anterior Sectionectomy: Minimally Invasive Parenchyma Sparing Surgery for Central Liver Tumors. J Gastrointest Surg 2023; 27:407-10. [PMID: 36600076 DOI: 10.1007/s11605-022-05554-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/01/2022] [Indexed: 01/06/2023]
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14
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Saqib SU, Raza MZ, Evans C, Bajwa AA. The robotic learning curve for a newly appointed colorectal surgeon. J Robot Surg 2023; 17:73-78. [PMID: 35325433 DOI: 10.1007/s11701-022-01400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/11/2022] [Indexed: 11/24/2022]
Abstract
Robotic colorectal surgery allows for better ergonomics, superior retraction, and fine movements in the narrow anatomy of the pelvis. Recent years have seen the uptake of robotic surgery in all pelvic surgeries specifically in low rectal malignancies. However, the learning curve of robotic surgery in this cohort is unclear as established training pathways are not formalized. This study looks at the experience and learning curve of a single laparoscopic trained surgeon in performing safe and effective resections, mainly for low rectal and anal malignancies using the da Vinci robotic system by evaluating metrics related to surgical process and patient outcome. A serial retrospective review of the robotic colorectal surgery database, in the University Hospital Coventry and Warwickshire (UHCW), was undertaken. All 48 consecutive cases, performed by a recently qualified colorectal surgeon, were included in our study. The surgical process was evaluated using both console and total operative time recorded in each case along with the adequacy of resections performed; in addition, patient-related outcomes including intraoperative and postoperative complications were analyzed to assess differences in the learning curve. Forty eight sequential recto-sigmoid resections were included in the study performed by a single surgeon. The cases were divided into four cohorts in chronological order with comparable demographics, tumour stage, location, and complexity of the operation (mean age 65, male 79%, and female 29%). The results showed that the mean console time dropped from 3 to 2.5 h, while total operative time dropped from 6 h to 5.5 h as the surgeon became more experienced; however, this was not found to be statistically significant. In addition, no significant difference in pathological staging was seen over the study period. No major intra-op and post-op complications were observed and no 30-day mortality was recorded. Moreover, after 30 cases, the learning curve developed the plateau phase, suggesting the gain of maximum proficiency of skills required for robotic colorectal resections. The learning curve in robotic rectal surgery is short and flattens early; complication rates are low during the learning curve and continue to decrease with time. This shows that with proper training and proctoring, new colorectal surgeons can be trained in a short time to perform elective colorectal pelvic resections.
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Affiliation(s)
- Sabah Uddin Saqib
- Clinical Fellow Colorectal Surgery, University Hospital Coventry, Coventry, UK.
| | - Muhammad Zeeshan Raza
- Robotic Research Fellow in Robotic Colorectal Surgery, University Hospital Coventry, Coventry, UK
| | - Charles Evans
- Consultant Colorectal Surgeon, University Hospital Coventry, Coventry, UK
| | - Adeel Ahmad Bajwa
- Consultant Colorectal Surgeon, University Hospital Coventry, Coventry, UK
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15
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Del Conte F, Montalva L, Ali L, Langeron M, Colas AE, Bonnard A. Scarless laparoscopic incisions in Pfannenstiel (slip): the first 50 cases using an innovative approach in pediatric robotic surgery. J Robot Surg 2023; 17:215-221. [PMID: 35622191 DOI: 10.1007/s11701-022-01419-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
Abstract
Incisions in the supra-pubic region have been described robotic-assisted surgery to improve cosmetic results in adults, but seldom in children. We aimed to present an innovative trocar placement in the Pfannenstiel line, named Scarless Laparoscopic Incisions in Pfannenstiel (SLIP), and evaluate its feasibility for various intra-abdominal procedures and its cosmetic results in pediatric robotic surgery. We performed a monocentric prospective study, including children undergoing robotic-assisted surgeries using a SLIP approach (July 2019-September 2021). Data regarding demographics, surgery, and outcome were collected and reported as median (range), or number (percentage). Cosmetic results were evaluated with a questionnaire. A SLIP approach was performed in 50 children (24 cholecystectomies, 12 splenectomies, 2 cholecystectomies and splenectomies, 9 colonic resections, 2 choledochal cyst resections, and 1 pancreatic pseudocyst resection). Median age was 11 years (2-18) and median weight 35 kg (10.5-80). Conversion to laparoscopy occurred in two cases. Post-operative complications occurred in 5 patients (10%), after colectomies [intrabdominal abscess (n = 3), stoma dysfunction (n = 1), parietal abscess (n = 1)], of which 3 (6%) required reintervention (intrabdominal abscess n = 2, stoma dysfunction n = 1). Regarding scars, 68% (n = 28) of parents and patients reported the maximal score of 5/5 for global satisfaction and 63% (n = 26) had all scars hidden by underwear. SLIP approach is versatile and can be used in supra- and infra-mesocolic robotic-assisted procedures. The low complication rate shows its safety in both young children and teenagers and does not increase operative difficulties. It results in high patient satisfaction regarding scars, and a scarless abdomen.
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Affiliation(s)
- Fulvia Del Conte
- Department of Pediatric General Surgery and Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Robert-Debré Children University Hospital, 48 boulevard Sérurier, 75019, Paris, France.,Department of Pediatric General Surgery and Urology, University Hospital, Federico II, Naples, Italy
| | - Louise Montalva
- Department of Pediatric General Surgery and Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Robert-Debré Children University Hospital, 48 boulevard Sérurier, 75019, Paris, France.,Paris Cité University, Paris, France
| | - Liza Ali
- Department of Pediatric General Surgery and Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Robert-Debré Children University Hospital, 48 boulevard Sérurier, 75019, Paris, France
| | - Margaux Langeron
- Department of Pediatric General Surgery and Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Robert-Debré Children University Hospital, 48 boulevard Sérurier, 75019, Paris, France
| | - Anne-Emmanuelle Colas
- Department of Pediatric Anesthesiology, Robert-Debré Children University Hospital, Paris, France
| | - Arnaud Bonnard
- Department of Pediatric General Surgery and Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Robert-Debré Children University Hospital, 48 boulevard Sérurier, 75019, Paris, France. .,Paris Cité University, Paris, France.
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16
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Gouni-Berthold I, Schaper F, Schatz U, Tabbert-Zitzler A, Fraass U, Sauer S, Ray KK. Low-density lipoprotein cholesterol goal attainment in Germany: Results from the DA VINCI study. Atheroscler Plus 2022; 50:10-16. [PMID: 36643801 PMCID: PMC9833225 DOI: 10.1016/j.athplu.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/01/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023]
Abstract
Background and aims Cardiovascular mortality is high in Germany. For patients with high or very high cardiovascular risk, the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines recommend intensive lipid lowering therapy (LLT). This study aimed to assess dyslipidaemia management and achievement of the ESC/EAS guideline-recommended low-density lipoprotein cholesterol (LDL-C) goals. Methods This European 18-country, cross-sectional, observational DA VINCI study (EUPAS22075) collected data during a single visit between June 2017 and November 2018 and included LLT in the preceding 12 months and the patients' most recent LDL-C measurement. Achievement of the risk-based 2016 and 2019 ESC/EAS LDL-C goals while receiving stabilized LLT was assessed. Data from the German cohort are presented here. Results Seven German sites enrolled a total of 421 primary and secondary prevention patients, 327 were receiving stabilized LLT at the time of LDL-C measurement, i.e. statin monotherapy of high (16%; n = 53), moderate (49%; n = 160) or low (7%; n = 24) intensity, ezetimibe combination (18%; n = 58), proprotein convertase subtilisin/kexin type 9 antibody combination (3%; n = 9), and other LLT (7%; n = 23). The 2016 and 2019 risk-based LDL-C goals were attained by 46% (n = 149) and 28% (n = 92) of patients, respectively. Conclusions There is a large gap between ESC/EAS recommendations and LDL-C goal achievement in routine clinical practice in high and very high-risk patients in Germany. Low-to-moderate-intensity statin monotherapy was the most frequently used LLT; use of high-intensity statins and combination therapy was limited. In addition to optimizing statin intensity, combination with non-statin LLT may be needed in most of these patients.
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Affiliation(s)
- Ioanna Gouni-Berthold
- University of Cologne, Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany,Corresponding author.Lipid Research Clinic, Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | | | - Ulrike Schatz
- University Hospital “Carl Gustav Carus”, Technische Universität, Dresden, Germany
| | | | | | | | - Kausik K. Ray
- Imperial Centre for Cardiovascular Disease Prevention and Imperial Clinical Trials Unit, Imperial College, London, UK
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Liatsikos E, Tsaturyan A, Kyriazis I, Kallidonis P, Manolopoulos D, Magoutas A. Market potentials of robotic systems in medical science: analysis of the Avatera robotic system. World J Urol 2021; 40:283-289. [PMID: 34424374 PMCID: PMC8381715 DOI: 10.1007/s00345-021-03809-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/04/2021] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the potential opportunities and possible competitiveness of Avatera robotic system (ARS) (Avateramedical, Germany), and perform predictive cost-analysis for its implementation and dissemination. MATERIAL AND METHODS Our study employed a projective quantitative research design. SWOT (strengths, weaknesses, opportunities, threats) analysis was used to map ARS internal competencies towards external contexts, and potential opportunities and risks in the robotic market. The ARS purchase and procedural costs were evaluated in two different scenarios. RESULTS In the first scenario, setting the purchase cost of the Avatera at around $1.3-1.5 million, a total $400 procedural cost reduction compared to the RAS performed with the da Vinci Xi can be calculated. In the second scenario, with a purchase cos of the ARS of $700.000-800.000 and considering a 5-year period with an annual ARS volume of 500 procedures, only an additional $300 will be attributed to the robot itself. Our projections revealed that for an effective competition the purchase cost of ARS should range between $700.000 and $800.000 during the initial phase of market entry. The marketing strategy of the ARS should be oriented towards countries without any robotic system in operational use, followed by countries where the competition intensity in the marketplace is low. CONCLUSION The introduction of new robotic systems will greatly affect and reshape the market of robotic surgery. The ARS has all the technical capacity ensuring the performance of high-quality surgical procedures. A fast spread and implementation of the ARS could be expected should the purchase and maintenance costs be kept low.
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Affiliation(s)
- Evangelos Liatsikos
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece. .,Department of Urology, Medical University of Vienna, Vienna, Austria. .,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
| | - Arman Tsaturyan
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Iason Kyriazis
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Dimitris Manolopoulos
- School of Social Sciences, Hellenic Open University, Athens, Greece.,Department of Business Administration, Athens University of Economics and Business, Athens, Greece
| | - Anastasios Magoutas
- School of Social Sciences, Hellenic Open University, Athens, Greece.,General Department, National and Kapodistrian University of Athens, Athens, Greece
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Vásquez-Lastra C, Decanini-Terán C, Maffuz-Aziz A, Alfaro-Alfaro J, Huante-Pérez JA, Wolpert-Barraza E, Sánchez-Marle LF, Gutiérrez-Hernández A. Robotic surgery at ABC Medical Center: first 500 procedures experience. GAC MED MEX 2021; 157:181-186. [PMID: 34270532 DOI: 10.24875/gmm.m21000545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Robotic surgery is a technological advance that is used in multiple surgical specialties in the world. Its acceptance in various areas has been supported by comparative studies with laparoscopic surgery and open surgery. Objective To document the robotic surgery program initial experience in a private hospital of Mexico City by analyzing its results and complications. Material and method The first 500 robotic surgeries practiced at ABC Medical Center were included, covering a three-year period (January 2017 to December 2019). The following was documented: specialties involved, surgeries broken down by specialty and type of surgery, surgical times, complications and number of doctors involved in the initial experience. Results Out of 500 patients, 367 (73.4 %) were males and 133 (26.4 %) were females. The three most common surgeries were radical prostatectomy (269), hysterectomy (64) and inguinal repair (33). Average age was 58 years (range: 18 to 90 years). A total of 40 certified surgeons from five specialties performed all the procedures. Conclusions Starting a program in a private medical center has several implications. The creation of a robotic surgery committee made up of certified robotic surgery specialists from each specialty and hospital authorities for the accreditation of guidelines for both certification and recertification of their doctors can benefit programs like ours by creating a center of excellence in robotic surgery and thus reduce complications and improve results.
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19
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Osofsky R, Kamya C, Hanif H, Phuoc V. A rare cause of lower gastrointestinal bleeding treated with robotic colorectal surgery. Surg Case Rep 2021; 7:125. [PMID: 34014406 PMCID: PMC8137796 DOI: 10.1186/s40792-021-01207-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background Metastatic melanoma to the colon is rarely diagnosed with an incidence of only 0.3% and more than 95% of cases identified post-mortem. Survival for patients with metastatic melanoma to the colon is poor, with 5-year survival rates of 26.5%. Nonetheless, surgical resection of the colonic metastatic melanoma lesions is recommended as it is associated with improved survival. Additionally, surgical resection is also indicated for palliative reasons, as symptom resolution is achieved in 90% of such patients. Use of the surgical robot has increased dramatically in the past decades, especially in the field of colorectal surgery. Furthermore, recent studies have demonstrated comparable outcomes between patients undergoing either laparoscopic or robotic-assisted colorectal surgery for cancer. Here, we describe the first case, to the authors knowledge, of a robot-assisted sigmoid colectomy for metastatic melanoma. Case presentation A 72-year-old male with a history of metastatic melanoma diagnosed in 2015 with a favorable response to immunotherapy presented to the emergency department with symptomatic lower gastrointestinal bleeding (LGIB). Endoscopy demonstrated a friable melanotic lesion of the sigmoid colon with biopsy demonstrating histopathologic evidence of metastatic melanoma. After further evaluation, the patient consented for an elective robot-assisted segmental colectomy for palliative intent. Diagnostic laparoscopy identified no evidence of further intra-abdominal metastatic disease. After identifying the metastatic lesion in the sigmoid colon, the mesentery of involved segment of sigmoid colon adjacent to the lesion was divided using the bipolar electrosurgical vessel sealer device. The colon was divided both proximal and distal to the lesion using a robotic stapler and a tension-free colo-colonic anastomosis was created intracorporeally. Postoperatively, the patient had an unremarkable course and was discharged home on post-operative day 3. On follow-up, the patient was doing well with resolution of preoperative LGIB. Conclusion This case highlights a rare presentation of metastatic melanoma to the colon in a patient presenting with LGIB. Furthermore, this case demonstrates the feasibility of the minimally invasive robotic-assisted approach for an uncommon pathology.
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Affiliation(s)
- Robin Osofsky
- Department of Surgery, UNM Hospital - 2ACC, University of New Mexico Hospital School of Medicine, Albuquerque, NM, 87131, USA.
| | - Cyril Kamya
- Department of Surgery, UNM Hospital - 2ACC, University of New Mexico Hospital School of Medicine, Albuquerque, NM, 87131, USA
| | - Hamza Hanif
- Shifa College of Medicine, Sector H-8/4, Islamabad, 44000, Federal Capital, Pakistan
| | - Victor Phuoc
- Department of Surgery, UNM Hospital - 2ACC, University of New Mexico Hospital School of Medicine, Albuquerque, NM, 87131, USA
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Nair S, Vijay DM, Venkatakarthikeyan C. Transoral robotic surgery for angiomyxoma of upper alveolus. Natl J Maxillofac Surg 2021; 12:116-119. [PMID: 34188413 PMCID: PMC8191561 DOI: 10.4103/njms.njms_116_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/24/2020] [Accepted: 02/08/2021] [Indexed: 11/21/2022] Open
Abstract
Angiomyxomas are benign, slow-growing mesenchymal tumors. Intraoral angiomyxoma are extremely rare with very few reported cases in the existing literature. The primary line of management is surgical resection with a long-term follow-up, due to their tendency to recur. Here, we report a rare case of angiomyxoma of the upper alveolus eroding the hard palate and extending into the maxillary antrum, in a middle-aged male. Transoral robotic surgery (TORS) was performed due to the nature of the tumor (bulky benign lesion with bony erosion), inaccessibility and poor visualization of the superior extent of the tumor. The three-dimensional endoscopic camera and flexible robotic arms allowed easy dissection around the tumor margins and en bloc resection of the tumor. The patient had a smooth recovery with the best possible functional outcome. This is the first case of robot-assisted excision of a large benign oral tumor with superior extension through erosion of the palate and can be included as an extended indication of TORS.
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Affiliation(s)
- Swati Nair
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - Deepika M Vijay
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - C Venkatakarthikeyan
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
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21
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Assam JH, DeHaan MC, Bakken S, Spanos WC. Adverse event reporting in head and neck transoral robotic surgery: a MAUDE database study. J Robot Surg 2021. [PMID: 33484416 DOI: 10.1007/s11701-020-01185-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Transoral robotic surgery (TORS) using the da Vinci Surgical system was approved by the US Food and Drug Administration in 2009. Currently, most available safety information on TORS procedures describes adverse events occurring in the context of clinical trials or series at high-volume academic centers. The goal of this study was to catalog reported adverse events associated with the da Vinci device in head and neck procedures by querying an FDA database. A search was performed on the MAUDE database inspecting for TORS safety incident reports generated from January 2009 through May 2020 using key words "da Vinci" and "Intuitive Surgical". A total of 3312 medical device records were produced. Of these 36 head and neck adverse events, reports were identified through manual screening of the data by the authors. Death was found to be the most common adverse event reported overall, manifesting in 44% of all reported incidents. The most frequent source of mortality was found to be hemorrhaging in the perioperative period rather than incidents of device malfunction or structural damage from surgery. This was found to be similar to the results of other published series for transoral ablative surgery. This study suggests that the small number of reported adverse events related to TORS with the da Vinci system seems to mirror what would be expected from the same procedures using other methods for transoral surgery.
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22
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Liu H, Xu M, Liu R, Jia B, Zhao Z. The art of robotic colonic resection: a review of progress in the past 5 years. Updates Surg 2021; 73:1037-48. [PMID: 33481214 DOI: 10.1007/s13304-020-00969-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 12/28/2020] [Indexed: 01/12/2023]
Abstract
Surgery is developing in the direction of minimal invasiveness, and robotic surgery is becoming increasingly adopted in colonic resection procedures. The ergonomic improvements of robot promote surgical performance, reduce workload for surgeons and benefit patients. Compared with laparoscopy-assisted colon surgery, the robotic approach has the advantages of shorter length of hospital stay, lower rate of conversion to open surgery, and lower rate of intraoperative complications for short-term outcomes. Synchronous robotic liver resection with colon cancer is feasible. The introduction of the da Vinci Xi System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has introduced more flexibility to colonic operations. Optimization of the suprapubic surgical approach may shorten the length of hospital stay for patients who undergo robotic colonic resection. Single-port robotic colectomy reduces the number of robotic ports for better looking and faster recovery. Intestinal anastomosis methods using totally robotic surgery result in shorter time to bowel function recovery and tolerance to a solid diet, although the operative time is longer. Indocyanine green is used as a tracer to assess blood supplementation in the anastomosis and marks lymph nodes during operation. The introduction of new surgical robots from multiple manufacturers is bound to change the landscape of robotic surgery and yield high-quality surgical outcomes. The present article reviews recent advances in robotic colonic resection over the past five years.
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23
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Rahimli M, Perrakis A, Schellerer V, Gumbs A, Lorenz E, Franz M, Arend J, Negrini VR, Croner RS. Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center. World J Surg Oncol 2020; 18:333. [PMID: 33353551 DOI: 10.1186/s12957-020-02113-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Minimally invasive liver surgery (MILS) in the treatment of colorectal liver metastases (CRLM) is increasing in incidence. The aim of this work was to present our experience by reporting short-term and long-term outcomes after MILS for CRLM with comparative analysis of laparoscopic (LLS) and robotic liver surgery (RLS). METHODS Twenty-five patients with CRLM, who underwent MILS between May 2012 and March 2020, were selected from our retrospective registry of minimally invasive liver surgery (MD-MILS). Thirteen of these patients underwent LLS and 12 RLS. Short-term and long-term outcomes of both groups were analyzed. RESULTS Operating time was significantly longer in the RLS vs. the LLS group (342.0 vs. 200.0 min; p = 0.004). There was no significant difference between the laparoscopic vs. the robotic group regarding length of postoperative stay (8.8 days), measured blood loss (430.4 ml), intraoperative blood transfusion, overall morbidity (20.0%), and liver surgery related morbidity (4%). The mean BMI was 27.3 (range from 19.2 to 44.8) kg/m2. The 30-day mortality was 0%. R0 resection was achieved in all patients (100.0%) in RLS vs. 10 patients (76.9%) in LLS. Major resections were carried out in 32.0% of the cases, and 84.0% of the patients showed intra-abdominal adhesions due to previous abdominal surgery. In 24.0% of cases, the tumor was bilobar, the maximum number of tumors removed was 9, and the largest tumor was 8.5 cm in diameter. The 1-, 3- and 5-year overall survival rates were 84, 56.9, and 48.7%, respectively. The 1- and 3-year overall recurrence-free survival rates were 49.6 and 36.2%, respectively, without significant differences between RLS vs. LLS. CONCLUSION Minimally invasive liver surgery for CRLM is safe and feasible. Minimally invasive resection of multiple lesions and large tumors is also possible. RLS may help to achieve higher rates of R0 resections. High BMI, previous abdominal surgery, and bilobar tumors are not a barrier for MILS. Laparoscopic and robotic liver resections for CRLM provide similar long-term results which are comparable to open techniques.
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Abstract
The surgical treatment of oropharyngeal squamous cell carcinoma (OSCC) has undergone a considerable evolution, with, among others, transoral robotic surgery (TORS). However, TORS is rarely used for the surgery of soft palate. A 73-year-old man presented a human papilloma virus OSCC of the posterior soft palate. The tumor was resected using TORS. This report describes the surgical technique step by step of the tumor resection. The resection of early stage OSCC of the posterior surface of soft palate is possible through TORS. The procedure is noninvasive, rapid, and seems to be associated with excellent functional outcomes.
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Affiliation(s)
- Emilien Chebib
- Robotic Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Jérôme R Lechien
- Robotic Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Younes Chekkoury
- Robotic Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Stéphane Hans
- Robotic Study Group of Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, 37918Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
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Chiu PWY, de Groot EM, Yip HC, Egberts JH, Grimminger P, Seto Y, Uyama I, van der Sluis PC, Stein H, Sallum R, Ruurda JP, van Hillegersberg R. Robot-assisted cervical esophagectomy: first clinical experiences and review of the literature. Dis Esophagus 2020; 33:5863451. [PMID: 33241301 DOI: 10.1093/dote/doaa052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022]
Abstract
Pulmonary complications, and especially pneumonia, remain one of the most common complications after esophagectomy for esophageal cancer. These complications are reduced by minimally invasive techniques or by avoiding thoracic access through a transhiatal approach. However, a transhiatal approach does not allow for a full mediastinal lymphadenectomy. A transcervical mediastinal esophagectomy avoids thoracic access, which may contribute to a decrease in pulmonary complications after esophagectomy. In addition, this technique allows for a full mediastinal lymphadenectomy. A number of pioneering studies have been published on this topic. Here, the initial experience is presented as well as a review of the current literature concerning transcervical esophagectomy, with a focus on the robot-assisted cervical esophagectomy procedure.
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Affiliation(s)
- Philip Wai-Yan Chiu
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Hon-Chi Yip
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jan-Hendrik Egberts
- Department for General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, University Hospital Schleswig Holstein, Kiel, Germany
| | - Peter Grimminger
- Department for General, Visceral-, Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | | | - Hubert Stein
- Department of Global Clinical Development, Intuitive Surgical Inc., Sunnyvale CA, USA
| | - Rubens Sallum
- Departament of Gastroenterological Surgery, University of São Paulo, São Paulo, Brazil
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Douissard J, Meyer J, Dupuis A, Peloso A, Mareschal J, Toso C, Hagen M. Robotic versus open primary ventral hernia repair: A randomized controlled trial (Robovent Trial). Int J Surg Protoc 2020; 21:27-31. [PMID: 32368702 PMCID: PMC7186553 DOI: 10.1016/j.isjp.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/26/2022] Open
Abstract
Robotic primary ventral hernia repair (PVHR) combines minimal access, closure of defect and pre-peritoneal mesh placement. The protocol designs a randomized single-blinded controlled trial comparing robotic PVHR to open PVHR. The primary outcome will be the incidence of wound-related complication within 1 month.
Background The objective of the present study is to compare the outcomes open PVHR and robotic PVHR. Methods/Design The present study will be a randomized single-blinded controlled trial with intention-to-treat analysis comparing robotic PVHR to open PVHR in adult patients undergoing elective PVHR with a defect ranging between 1–5 cm. Patient refusing to participate, not able to give informed consent, with history of intra-abdominal surgery contraindicating a robotic surgical approach will be excluded. The intervention will consist in laparoscopic robotically assisted trans-abdominal pre-peritoneal epigastric or umbilical PVHR with closure of fascial defect and non-adsorbable mesh reinforcement. The control will be open pre-peritoneal epigastric or umbilical hernia repair with closure of fascial defect and non-absorbable mesh reinforcement. The primary outcome will be the incidence of wound-related complication within 1 month. The secondary outcomes will be esthetic satisfaction, pain, pain-killers consumption, general complications, costs, operative time and early hernia recurrence. Discussion Open PVHR is potentially associated to more wound-related complications, but has the advantages of cost-effectiveness, short operative time and totally extra-peritoneal repair. Laparoscopic PVHR has lower wound-related complications but implies placing the mesh in intra-peritoneal position, requires advanced laparoscopic skills, usually does not allow the closure of the defect, and can lead to excessive pain and pain-killers consumption. Robotic PVHR uses the same laparoscopic access as laparoscopic PVHR, but thanks to the extended range of motion given by the robotic system, allows defect closure, pre-peritoneal placement of the mesh and requires less technical skills. In the present randomized controlled trial, we expect to show that robotic PVHR leads to better wound-related outcomes than open PVHR. Trial registration The present randomized controlled trial was registered into clinicaltrials.gov under registration number NCT04171921.
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Affiliation(s)
- Jonathan Douissard
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland
| | - Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland
| | - Arnaud Dupuis
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland
| | - Andrea Peloso
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland
| | - Julie Mareschal
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland
| | - Monika Hagen
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland
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27
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Venkatakarthikeyan C, Nair S, Gowrishankar M, Rao S. Robotic Surgery in Head and Neck in Pediatric Population: Our Experience. Indian J Otolaryngol Head Neck Surg 2020; 72:98-103. [PMID: 32158664 DOI: 10.1007/s12070-019-01768-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022] Open
Abstract
Robot assisted surgery of the head and neck is a relatively novel approach in the management of head and neck tumors. There are very few reported cases of robot-assisted surgery of the head and neck in pediatric population in the world literature and no report of such procedures in the Indian subcontinent. In this article we present three such cases we performed for the first time in the country. The first case is that of second branchial cleft cyst, the second is a 4-year-old boy with a tongue base cyst and the third patient is a 12-year-old girl with left parotid gland tumor. All the patients underwent successful Robotic surgeries. Case 1 underwent robotic excision of the cyst through a retroauricular hairline incision. Case 2 underwent transoral robotic excision of the tongue base cyst. Case 3 underwent robotic excision of the tumor through a modified facelift incision. The mean docking time for the robot was 12.33 min and approximate blood loss was less than 10 ml in all cases. The patient and their parents were extremely satisfied with the cosmetic outcomes of the scarless surgery. Robot assisted surgery has the advantage of performing minimally invasive procedures within constrained spaces especially in children. The multiarticulated endowrist movements of the robotic arms combined with higher magnification and three-dimensional depth perception allows a precise surgery with better visualization in otherwise inaccessible areas resulting in better surgical outcome. With exceptional advantages of scarless surgery, minimal blood loss and postoperative pain and better surgeon ergonomics, robotic technique is an effective and feasible option in Pediatric Head and neck Surgery.
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Affiliation(s)
- C Venkatakarthikeyan
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, Room No. 25B Sindoori Block, Ground Floor, 21 Greams Lane, Off Greams Road, Chennai, 600006 India
| | - Swati Nair
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, C-304 Pawitra Apartments, Vasundhara Enclave, Delhi, 110096 India
| | - M Gowrishankar
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, Room No. 25B Sindoori Block, Ground Floor, 21 Greams Lane, Off Greams Road, Chennai, 600006 India
| | - Soorya Rao
- Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, C-304 Pawitra Apartments, Vasundhara Enclave, Delhi, 110096 India.,Department of Otorhinolaryngology and Head and Neck Surgery, Apollo Main Hospital, S2, Gopalakrishna Flats, No. 14/21, Lake View Road, West Mambalam, Chennai, 600033 India
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28
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Makris MC, Athanasopoulos PG, Kornaropoulos M, Chrysocheris P, Antonakopoulos F, Mathioulaki A, Tsilimigras DI, Ioannidis A, Konstantinidis MK, Moris D, Konstantinidis KM. Robotic resection of a giant retroperitoneal leiomyosarcoma: A case report. Mol Clin Oncol 2019; 11:599-601. [PMID: 31693012 DOI: 10.3892/mco.2019.1928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 04/11/2019] [Indexed: 11/06/2022] Open
Abstract
The management of abdominal leiomyosarcoma is challenging. Surgical excision is considered the only effective treatment; however, this is associated with considerable morbidity. Robotic surgery has emerged during the past decades and has enhanced the general surgery armamentarium, allowing surgeons to carry out demanding operations in a safe manner. The surgical resection of retroperitoneal leiomyosarcoma (RPLM) can be associated with significant morbidity, which is primarily due to the origin or the close proximity of the tumor with important vascular structures, including the inferior vena cava and tributaries, the duodenum and the ureter. The present case describes the first case of robotic resection of RPLM in a high-volume robotic center. In the present case, a large RPLM was safely removed with respect to oncological principles with the use of the Da Vinci platform.
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Affiliation(s)
- Marinos C Makris
- First Surgical Department, General Hospital of Athens 'G. Gennimatas', Athens 11527, Greece.,Alpha Institute of Biomedical Sciences (AIBS), Athens 15123, Greece
| | - Panos G Athanasopoulos
- Department of General, Laparoscopic, Robotic and Bariatric Surgery, Athens Medical Center, Athens 15125, Greece
| | - Michael Kornaropoulos
- First Surgical Department, General Hospital of Athens 'G. Gennimatas', Athens 11527, Greece
| | - Periclis Chrysocheris
- Department of General, Laparoscopic, Robotic and Bariatric Surgery, Athens Medical Center, Athens 15125, Greece
| | - Fotios Antonakopoulos
- Department of General, Laparoscopic, Robotic and Bariatric Surgery, Athens Medical Center, Athens 15125, Greece
| | - Antonia Mathioulaki
- Department of General, Laparoscopic, Robotic and Bariatric Surgery, Athens Medical Center, Athens 15125, Greece
| | | | - Argyrios Ioannidis
- Second Surgical Department, Sismanoglion General Hospital, Athens 15126, Greece
| | | | - Demetrios Moris
- School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece
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Feng Z, Feng MP, Feng DP, Solórzano CC. Robotic-assisted adrenalectomy using da Vinci Xi vs. Si: are there differences? J Robot Surg 2019; 14:349-355. [PMID: 31273609 DOI: 10.1007/s11701-019-00995-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/02/2019] [Indexed: 02/07/2023]
Abstract
Da Vinci Xi, the fourth generation platform, was released in 2014 and introduced as the successor to the Si platform for minimal invasive surgery. We reviewed our experience with robotic-assisted adrenalectomy and compared peri-operative outcomes using the da Vinci robot model Xi vs. Si. Since June of 2014, 85 consecutive patients underwent robotic-assisted adrenalectomy by a high-volume adrenal surgeon at our institution. Patients were divided into two groups: Xi group (n = 25) and Si group (n = 60). The average anesthesia time was 145.8 min for the Xi group and 170.4 min for the Si group (p = 0.001). The mean procedure time for the Xi group (skin to skin) was 92.1 min and for the Si group it was 122.5 min (p = 0.001). The average docking time for the Xi group was 18.2 min and for the Si group 20.3 min (p = 0.04). The average consumables fees for the Xi group were $1246 and for the Si group $1106 (p = 0.04). The calculated relative costs for the Xi group were $3375 and for the Si group $3527 (p = 0.03). The average post-operative hospital stay for the Xi group was 1.6 days and for the Si group 1.7 days (p = 0.18). Robotic-assisted adrenalectomy using the da Vinci Xi system is effective and efficient. This study shows that outcomes were similar between Xi and Si groups.
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Affiliation(s)
- Zuliang Feng
- Department of Perioperative Services, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Michael P Feng
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David P Feng
- Department of Urology Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carmen C Solórzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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30
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Magistri P, Pecchi A, Franceschini E, Pesi B, Guadagni S, Catellani B, Assirati G, Guidetti C, Guerrini GP, Tarantino G, Ballarin R, Codeluppi M, Morelli L, Coratti A, Di Benedetto F. Not just minor resections: robotic approach for cystic echinococcosis of the liver. Infection 2019; 47:973-979. [PMID: 31236898 DOI: 10.1007/s15010-019-01333-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/06/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Human echinococcosis is among the 17 neglected tropical diseases recognized by the World Health Organization. It is responsible for over $3 billion of health costs every year being endemic in large areas worldwide, and liver is affected in 70% of the cases. Surgery associated to medical treatment is the gold standard and robotic approach may be a valuable tool to achieve safe, parenchyma sparing resections. METHODS We retrospectively analyzed the outcomes of patients that underwent robotic radical surgical treatment for hydatid liver disease, from prospectively maintained databases of three Italian centers. RESULTS 15 patients were included in this study, median age 51 years (24-76). 1 right hepatectomy, 2 left lateral sectionectomies, 5 segmentectomies (including 1 caudatectomy), 3 wedge resections and 5 cyst-pericystectomies were performed. Median estimated blood loss was of 100 ml (50-550 ml), and median operative time including docking was 210 min (95-590 min), with no need for conversion to open. Median hospital stay was 4 days, with only one readmission for fever. Only one patient experienced recurrence in a different liver segment. CONCLUSIONS In our experience, robotic approach for cystic echinococcosis of the liver proved to be a safe and effective strategy also in the so-called "difficult segments", with short post-operative stay and quick return to daily activities, along with the absence of surgical site recurrences. To the best of our knowledge, this is the largest report of robotic approach to hydatid liver disease.
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Affiliation(s)
- Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Annarita Pecchi
- Department of Radiology, "Policlinico" University Hospital of Modena, 41124, Modena, MO, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, "Policlinico" University Hospital of Modena, 41124, Modena, MO, Italy
| | - Benedetta Pesi
- Division of Oncologic Surgery and Robotics, Azienda Ospedaliero-Universitaria Di Careggi, 50139, Florence, FI, Italy
| | - Simone Guadagni
- Department of Translational and New Technologies in Medicine and Surgery, University of Pisa, 56124, Pisa, Italy
| | - Barbara Catellani
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Giacomo Assirati
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Cristiano Guidetti
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Gian Piero Guerrini
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Giuseppe Tarantino
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Roberto Ballarin
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy
| | - Mauro Codeluppi
- Department of Infectious Diseases, "Policlinico" University Hospital of Modena, 41124, Modena, MO, Italy
| | - Luca Morelli
- Department of Translational and New Technologies in Medicine and Surgery, University of Pisa, 56124, Pisa, Italy
| | - Andrea Coratti
- Division of Oncologic Surgery and Robotics, Azienda Ospedaliero-Universitaria Di Careggi, 50139, Florence, FI, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy.
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Dai Y, Abiri A, Pensa J, Liu S, Paydar O, Sohn H, Sun S, Pellionisz PA, Pensa C, Dutson EP, Grundfest WS, Candler RN. Biaxial sensing suture breakage warning system for robotic surgery. Biomed Microdevices. 2019;21:10. [PMID: 30631976 DOI: 10.1007/s10544-018-0357-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The number of procedures performed with robotic surgery may exceed one million globally in 2018. The continual lack of haptic feedback, however, forces surgeons to rely on visual cues in order to avoid breaking sutures due to excessive applied force. To mitigate this problem, the authors developed and validated a novel grasper-integrated system with biaxial shear sensing and haptic feedback to warn the operator prior to anticipated suture breakage. Furthermore, the design enables facile suture manipulation without a degradation in efficacy, as determined via measured tightness of resulting suture knots. Biaxial shear sensors were integrated with a da Vinci robotic surgical system. Novice subjects (n = 17) were instructed to tighten 10 knots, five times with the Haptic Feedback System (HFS) enabled, five times with the system disabled. Seven suture failures occurred in trials with HFS enabled while seventeen occurred in trials without feedback. The biaxial shear sensing system reduced the incidence of suture failure by 59% (p = 0.0371). It also resulted in 25% lower average applied force in comparison to trials without feedback (p = 0.00034), which is relevant because average force was observed to play a role in suture breakage (p = 0.03925). An observed 55% decrease in standard deviation of knot quality when using the HFS also indicates an improvement in consistency when using the feedback system. These results suggest this system may improve outcomes related to knot tying tasks in robotic surgery and reduce instances of suture failure while not degrading the quality of knots produced.
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Nik-Ahd F, Souders CP, Zhao H, Houman J, McClelland L, Chughtai B, Anger JT. Robotic urologic surgery: trends in litigation over the last decade. J Robot Surg 2019; 13:729-34. [PMID: 30618023 DOI: 10.1007/s11701-018-00905-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022]
Abstract
There is a lack of information regarding malpractice claims and indemnity payments associated with robotic cases in surgery. Malpractice claims and indemnity payouts will elucidate and mitigate harms of future adoption of new technology into surgery. We analyzed claims filed against Intuitive Surgical, Inc. from 2000 to 2017. A law librarian identified product liability claims from 2000 to 2017 with the defendant "Intuitive Surgical, Inc." using the Bloomberg Law database. We reviewed all available legal documents pertaining to identified claims, and extracted data points including filing date, surgery date, surgery type, robot type, instrument type, complications, and case outcomes. Since 2000, 123 claims were filed; 108 met criteria for inclusion. Gynecologic surgeries comprised the majority of claims (62%, 67 claims), followed by urologic surgeries (20%, 22 claims). Number of claims filed peaked in 2013 (30%, 32 claims) and then decreased each year, with 6% (7 claims) filed in 2016, and only 1% (1 claim) filed in 2017. Of the 22 claims regarding robotic urologic surgeries, 19 claims (86%) pertained to prostatectomy. Commonly alleged injuries in urologic cases were bowel injury (8 claims), erectile dysfunction (5 claims), bowel fistulas (4 claims), and incontinence (4 claims). Device failure was cited in only 2 claims. Early adopters of robotic surgery were at highest risk of litigation. This risk subsequently decreased despite the wide spread adoption of this technology. Almost all claims were secondary to surgical complications and not device failure, thus demonstrating a need for more systematic training for novel devices and early adopters.
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Zhang T, Zhao ZM, Gao YX, Lau WY, Liu R. The learning curve for a surgeon in robot-assisted laparoscopic pancreaticoduodenectomy: a retrospective study in a high-volume pancreatic center. Surg Endosc. 2019;33:2927-2933. [PMID: 30483970 DOI: 10.1007/s00464-018-6595-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/13/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is one of the most technically difficult abdominal operations. Recent advances have allowed surgeons to attempt PD using minimally invasive surgery techniques. This retrospective study aimed to analyze the learning curve of a single surgeon who had carried out his first 100 robot-assisted laparoscopic pancreaticoduodenectomy (RPD) in a high-volume pancreatic center. METHODS The data on consecutive patients who underwent RPD for malignant or benign pathologies were prospectively collected and retrospectively analyzed. The data included the demographic data, operative time, estimated blood loss, postoperative length of hospital stay, morbidity rate, mortality rate, and final pathological results. The cumulative sum (CUSUM) analysis was used to identify the inflexion points which corresponded to the learning curve. RESULTS Between 2012 and 2016, 100 patients underwent RPD by a single surgeon. From the CUSUM operation time (CUSUM OT) learning curve, two distinct phases of the learning process were identified (early 40 patients and late 60 patients). The operation time (mean, 418 min vs. 317 min), hospital stay (mean, 22 days vs. 15 days), and estimated blood loss (mean, 227 ml vs. 134 ml) were significantly lower after the first 40 patients (P < 0.05). The pancreatic fistula, postoperative hemorrhage, delayed gastric emptying, and reoperation rates also decreased in the late 60 patients group (P < 0.05). Non-significant reductions were observed in the incidences of major (Clavien-Dindo Grade II or higher) morbidity, postoperative death, bile leakage, gastric fistula, wound infection, and open conversion. CONCLUSIONS RPD was technically feasible and safe in selected patients. The learning curve was completed after 40 RPD. Further studies are required to confirm the long-term oncological outcomes of RPD.
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Li GT, Chen P, Yan L, Li HT, Xu L, Liu HB. Curative effect of Da Vinci robot assisted radical gastrectomy for gastric cancer. Shijie Huaren Xiaohua Zazhi 2018; 26:1455-1462. [DOI: 10.11569/wcjd.v26.i24.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the value of Da Vinci robot in radical gastrec-tomy for gastric cancer.
METHODS The information of patients who underwent Da Vinci robot assisted radical gastrectomy for gastric cancer at the Department of General Surgery, Lanzhou General Hospital of the Chinese People's Liberation Army from December 2016 to April 2017 was collected. The information of patients who received laparoscopic radical gastrectomy for gastric cancer was also obtained. The information on surgical treatment, postoperative recovery, hospital expenses, and prognosis was statistically analyzed between the two groups.
RESULTS Compared with the laparoscopic group, the Da Vinci group had less bleeding during operation (P < 0.05), more complete lymph node dissection (P < 0.05), and safer incision margin (P < 0.05), but the operative time was increased (P < 0.05). In the postoperative recovery of patients of the two groups, the time to first food intake, the time to the recovery of the digestive tract, and the incidence of complications were not significantly different between the two groups (P > 0.05), but surgical cost was significantly increased (P < 0.05). The hospital stay was significantly shorter in patients who received Da Vinci robot assisted radical gastrectomy than in the laparoscopy group (P < 0.05), but this difference was not found in patients who underwent distal radical gastrectomy (P > 0.05). There was no significant difference in long-term survival between the two groups (P > 0.05).
CONCLUSION Da Vinci robot assisted radical gastrectomy has certain advantages over laparoscopic radical gastrectomy in the treatment of gastric cancer, but it is still necessary for practitioners to improve their skills and be cautious.
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Affiliation(s)
- Gai-Tian Li
- Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Peng Chen
- Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Long Yan
- Department of General Surgery, Lanzhou General Hospital of the Chinese People's Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Hong-Tao Li
- Department of General Surgery, Lanzhou General Hospital of the Chinese People's Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Lin Xu
- Department of General Surgery, Lanzhou General Hospital of the Chinese People's Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Hong-Bin Liu
- Department of General Surgery, Lanzhou General Hospital of the Chinese People's Liberation Army, Lanzhou 730050, Gansu Province, China
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Shay SG, Chrin JD, Wang MB, Mendelsohn AH. Initial and Long-term Retention of Robotic Technical Skills in an Otolaryngology Residency Program. Laryngoscope 2018; 129:1380-1385. [PMID: 30098045 DOI: 10.1002/lary.27425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/21/2018] [Accepted: 06/11/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To objectively assess the initial and long-term retention of robotic surgical skills of otolaryngology residents. STUDY DESIGN This study was performed in an academic otolaryngology residency training program. Between October 2015 and November 2016, residents were invited to complete a prospective, multiphase robotic surgical skills training course: 1) online da Vinci Surgical System Assessment and didactic, 2) faculty-supervised robotic simulator training, 3) robotic docking and draping training, 4) robotic dry-lab exercises. To optimize surgical skill retention, the training laboratory was repeated 2 weeks after the initial training session. METHODS Twenty otolaryngology residents were included. Primary outcome was measured as robotic skill assessment scores on three tasks: camera targeting, peg board, and needle targeting. Skill assessments were completed prior to training, between the two training sessions, and at 1 month and 6 months after training. Residents were also asked to complete a self-assessment questionnaire. RESULTS Camera targeting scores were improved at midtraining (P < .001) and 1-month posttraining (P = .010). Peg board scores were improved at 1 month training (P = .043). Needle targeting scores were improved at midtraining (P = .002), 1 month (P = .002), and 6 months posttraining (P < .001). Resident self-assessment scores demonstrating comfort with using the robotic console (P < .01) and docking/draping (P < .01) improved significantly following the training. CONCLUSIONS Following a multiphase robotic training program, otolaryngology residents demonstrated significant, objective skill acquisition and retention at 1 month and 6 months follow-up. Although the proposed training strategy may be considered an important step in otolaryngology residency training, additional innovations are being designed toward a formal robotic training curriculum. LEVEL OF EVIDENCE NA Laryngoscope, 129:1380-1385, 2019.
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Affiliation(s)
- Sophie G Shay
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann and Robert Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan D Chrin
- Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Ronald Reagan Medical Center, University of California Los Angeles, Los Angeles, California
| | - Marilene B Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Abie H Mendelsohn
- Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Ronald Reagan Medical Center, University of California Los Angeles, Los Angeles, California.,Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Fantus RJ, Cohen A, Riedinger CB, Kuchta K, Wang CH, Yao K, Park S. Facility-level analysis of robot utilization across disciplines in the National Cancer Database. J Robot Surg 2019; 13:293-9. [PMID: 30062641 DOI: 10.1007/s11701-018-0855-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/23/2018] [Indexed: 01/23/2023]
Abstract
To evaluate trends in contemporary robotic surgery across multiple organ sites as they relate to robotic prostatectomy volume. We queried the National Cancer Database for patients who underwent surgery from 2010 to 2013 for prostate, kidney, bladder, corpus uteri, uterus, cervix, colon, sigmoid, rectum, lung and bronchus. The trend between volumes of robotic surgery for each organ site was analyzed using the Cochran-Armitage test. Multivariable models were then created to determine independent predictors of robotic surgery within each organ site by calculating the odds ratio with 95% CI. Among the 566,399 surgical cases analyzed, 35.1% were performed using robot assistance. Institutions whose robotic prostatectomy volume was in the top 75 percentile compared to the bottom 25 percentile performed a larger percentage of robotic surgery on the following sites: kidney 32.6 vs. 28.8%, bladder 23.6 vs. 18.6%, uterus 52.5 vs. 47.7%, cervix 43.5 vs. 39.2%, colon 3.2 vs. 2.9%, rectum 10.7 vs. 8.9%, and lung 7.3 vs. 6.8% (all p < 0.0001). It appears that increased trends toward robotic surgery in urology have lead to increased robotic utilization within other surgical fields. Future analysis in benign utilizations of robotic surgery as well as outcome data comparing robotic to open approaches are needed to better understand the ever-evolving nature of minimally invasive surgery within the United States.
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Osaka Y, Tachibana S, Ota Y, Suda T, Makuuti Y, Watanabe T, Iwasaki K, Katsumata K, Tsuchida A. Usefulness of robot-assisted thoracoscopic esophagectomy. Gen Thorac Cardiovasc Surg 2018; 66:225-231. [PMID: 29397486 DOI: 10.1007/s11748-018-0897-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/28/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We started robot-assisted thoracoscopic esophagectomy using the da Vinci surgical system from June 2010 and operated on 30 cases by December 2013. Herein, we examined the usefulness of robot-assisted thoracoscopic esophagectomy and compared it with conventional esophagectomy by right thoracotomy. METHODS Patients requiring an invasion depth of up to the muscularis propria with preoperative diagnosis were considered for surgical adaptation, excluding bulky lymph node metastasis or salvage surgery cases. The outcomes of 30 patients who underwent robot-assisted surgery (robot group) and 30 patients who underwent conventional esophagectomy by right thoracotomy (thoracotomy group) up to December 2013 were retrospectively examined. Five ports were used in the robot-assisted thoracoscopic esophagectomy: 3rd intercostal (da Vinci right arm), 6th intercostal (da Vinci camera), 9th intercostal (da Vinci left arm), 4th and 8th intercostals (for assistance). RESULTS There was no significant difference in patient characteristics. Robot group/right thoracotomy group: Operation time, 563/398 min; thoracic procedure bleeding volume, 21/135 ml; number of thoracic lymph node radical dissections, 25/23. Postoperative complications were recurrent nerve paralysis, 16.7/16.7%; pneumonia, 6.7%/10.0%; anastomotic leakage, 10.0/20.0%; surgical site infection, 0/10.0%; hospitalization, 17/30 days. For the robot group, the operation time was significantly longer, but the amount of intraoperative bleeding and postoperative hospitalization were significantly reduced. CONCLUSIONS Robot-assisted thoracoscopic esophagectomy enables delicate surgical procedures owing to the 3D effect of the field of view and articulated forceps of the da Vinci. This procedure reduces bleeding and postoperative hospitalization and is less invasive than conventional esophagectomy by right thoracotomy.
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Affiliation(s)
- Yoshiaki Osaka
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Shingo Tachibana
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yoshihiro Ota
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takeshi Suda
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yosuke Makuuti
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takafumi Watanabe
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kenichi Iwasaki
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kenji Katsumata
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Akihiko Tsuchida
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Scott-Wittenborn N, Jackson RS. Intraoperative imaging during minimally invasive transoral robotic surgery using near-infrared light. Am J Otolaryngol 2018; 39:220-2. [PMID: 29128262 DOI: 10.1016/j.amjoto.2017.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 08/31/2017] [Accepted: 09/05/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to determine if the use of the FIREFLY imaging system could be an asset in transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC). The system uses indocyanine green dye (ICG), which fluoresces when illuminated by near-infrared light from the Da Vinci robot. The system may improve visualization of tumor margins, highlight important vascular structures, and help identify the location of tumors and unknown primary head and neck cancers. METHODS Six patients with OPSCC were enrolled in the study. Two of these cases were unknown primaries, one was base of tongue, and three were palatine tonsils. Each patient was given two 3ml doses of ICG, one at the beginning of the surgical case and one during resection of the tumor. The oropharynx was then visualized using the near-infrared light of the Da Vinci robot for a minute after injection. RESULTS The FIREFLY system was unable to detect gross tumors, positive margins, unknown primaries, or vascular structures in any of the six subjects in the study. In addition, there were no adverse events or side effects in any of the subjects. CONCLUSION The use of the FIREFLY system with indocyanine green fluorescence did not identify tumor boundaries, unknown primary head and neck cancers, or vascular structures in the oropharynx.
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Kolachalam R, Dickens E, D'Amico L, Richardson C, Rabaza J, Gamagami R, Gonzalez A. Early outcomes of robotic-assisted inguinal hernia repair in obese patients: a multi-institutional, retrospective study. Surg Endosc 2017. [PMID: 28646321 DOI: 10.1007/s00464-017-5665-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Minimally invasive inguinal hernia repair (IHR) in general and particularly in obese patients has not been widely adopted, potentially due to the perceived technical challenges and the well-documented learning curve associated with laparoscopic repair. Outcomes in robotic-assisted IHR in obese (BMI ≥ 30 kg/m2) patients have not been described and warrant study. METHODS Seven surgeons conducted a multicenter retrospective chart review of their early robotic-assisted IHR (RHR) cases and compared them with their open IHR (OHR) cases. Demographics, operative characteristics, and perioperative morbidity were compared for unadjusted and propensity-matched populations. RESULTS 651 robotic-assisted cases and 593 open cases were collected. The outcomes of 148 RHRs to 113 OHRs in obese patients were compared. For obese populations-whether unadjusted (robotic-assisted, n = 148; open, n = 113) or matched (1:1) (robotic-assisted, n = 95; open, n = 93)-the robotic-assisted and open cohorts were comparable in terms of demographics and baseline characteristics. Significantly higher percentages of OHR patients experienced postoperative complications post-discharge (unadjusted: 11.5% vs. 2.7%, p = 0.005; and matched: 10.8% vs. 3.2%, p = 0.047). More concomitant procedures and bilateral repairs were conducted in obese RHR patients than in obese OHR patients (unadjusted 29.7% vs. 16.8%, p = 0.019; and unadjusted 35.1% vs. 11.5%, p < 0.0001-respectively). Prior laparoscopic IHR experience did not affect 30-day outcomes. CONCLUSIONS Obese patients who undergo RHR have a lower rate of postoperative complications compared to obese patients who undergo OHR. Previous laparoscopic IHR experience, more bilateral repairs, and more concomitant procedures were not associated with increased complications in RHR patients. These outcomes may facilitate increased adoption of minimally invasive IHR approaches in the obese population.
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Affiliation(s)
- Ramachandra Kolachalam
- Department of Surgery, Providence-Providence Park Hospital, 26850, Providence Pkwy, Suite 460, Novi, MI, 48374, USA.
| | - Eugene Dickens
- Hillcrest Medical Center and Oklahoma Physician Group, Tulsa, OK, USA
| | - Lawrence D'Amico
- ValleyCare Health System of Ohio, Trumbull Memorial Hospital, Warren, OH, USA
| | | | - Jorge Rabaza
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
| | | | - Anthony Gonzalez
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
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Iavazzo C, Iavazzo PE, Gkegkes ID. The possible role of the da Vinci robot for patients with vulval carcinoma undergoing inguinal lymph node dissection. J Turk Ger Gynecol Assoc 2017; 18:96-98. [PMID: 28381390 PMCID: PMC5458443 DOI: 10.4274/jtgga.2016.0193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Inguinal lymph node dissection represents the gold standard of treatment for patients with vulval carcinoma. The application of minimally invasive techniques, such as robotics, in the surgical treatment of gynecologic cancer, reduced the rate of postoperative complications, which has an important impact on the quality of patients’ life. Robotic inguinal lymph node dissection is a safe and oncologically effective but expensive and time-consuming approach in patients with penile cancer or melanoma. However, it is related with less postoperative complications, especially less lymphocele or lymphedema rates, and can improve the patients’ quality of life while minimizing cost for health systems. The introduction of robot- assisted inguinal lymph node dissection in the treatment of vulval carcinoma may be identified as a provisional option for the gynecologic oncologist. Our intention was to present a brief review/commentary on the possible use of a robot-assisted technique on inguinal lymphadenectomy for patients with vulval cancer.
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Affiliation(s)
- Christos Iavazzo
- Department of Gynecological Oncology, Northampton General Hospital, Northampton, United Kingdom
| | | | - Ioannis D Gkegkes
- First Department of Surgery, General Hospital of Attica "KAT", Athens, Greece
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Kornaropoulos M, Moris D, Beal EW, Makris MC, Mitrousias A, Petrou A, Felekouras E, Michalinos A, Vailas M, Schizas D, Papalampros A. Total robotic pancreaticoduodenectomy: a systematic review of the literature. Surg Endosc 2017; 31:4382-92. [PMID: 28389798 DOI: 10.1007/s00464-017-5523-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 03/15/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is a complex operation with high perioperative morbidity and mortality, even in the highest volume centers. Since the development of the robotic platform, the number of reports on robotic-assisted pancreatic surgery has been on the rise. This article reviews the current state of completely robotic PD. MATERIALS AND METHODS A systematic literature search was performed including studies published between January 2000 and July 2016 reporting PDs in which all procedural steps (dissection, resection and reconstruction) were performed robotically. RESULTS Thirteen studies met the inclusion criteria, including a total of 738 patients. Data regarding perioperative outcomes such as operative time, blood loss, mortality, morbidity, conversion and oncologic outcomes were analyzed. No major differences were observed in mortality, morbidity and oncologic parameters, between robotic and non-robotic approaches. However, operative time was longer in robotic PD, whereas the estimated blood loss was lower. The conversion rate to laparotomy was 6.5-7.8%. CONCLUSIONS Robotic PD is feasible and safe in high-volume institutions, where surgeons are experienced and medical staff are appropriately trained. Randomized controlled trials are required to further investigate outcomes of robotic PD. Additionally, cost analysis and data on long-term oncologic outcomes are needed to evaluate cost-effectiveness of the robotic approach in comparison with the open technique.
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Abstract
Although robot-assisted pancreatic surgery has been considered critically in the past, it is nowadays an established standard technique in some centers, for distal pancreatectomy and pancreatic head resection. Compared with the laparoscopic approach, the use of robot-assisted surgery seems to be advantageous for acquiring the skills for pancreatic, bile duct and vascular anastomoses during pancreatic head resection and total pancreatectomy. On the other hand, the use of the robot is associated with increased costs and only highly effective and professional robotic programs in centers for pancreatic surgery will achieve top surgical and oncological quality, acceptable operation times and a reduction in duration of hospital stay. Moreover, new technologies, such as intraoperative fluorescence guidance and augmented reality will define additional indications for robot-assisted pancreatic surgery.
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Affiliation(s)
- B Müssle
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - M Distler
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - J Weitz
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - T Welsch
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie (VTG), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
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Abstract
The history of the expression of three-dimensional structure in art can be traced from the use of occlusion in Palaeolithic cave paintings, through the use of shadow in classical art, to the development of perspective during the Renaissance. However, the history of the use of stereoscopic techniques is controversial. Although the first undisputed stereoscopic images were presented by Wheatstone in 1838, it has been claimed that two sketches by Jacopo Chimenti da Empoli (c. 1600) can be to be fused to yield an impression of stereoscopic depth, while others suggest that Leonardo da Vinci’s Mona Lisa is the world’s first stereogram. Here, we report the first quantitative study of perceived depth in these works, in addition to more recent works by Salvador Dalí. To control for the contribution of monocular depth cues, ratings of the magnitude and coherence of depth were recorded for both stereoscopic and pseudoscopic presentations, with a genuine contribution of stereoscopic cues revealed by a difference between these scores. Although effects were clear for Wheatstone and Dalí’s images, no such effects could be found for works produced earlier. As such, we have no evidence to reject the conventional view that the first producer of stereoscopic imagery was Sir Charles Wheatstone.
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Affiliation(s)
- Kevin R Brooks
- Department of Psychology and Perception and Action Research Centre, Faculty of Human Sciences, Macquarie University, Sydney, Australia
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Hagen ME, Jung MK, Ris F, Fakhro J, Buchs NC, Buehler L, Morel P. Early clinical experience with the da Vinci Xi Surgical System in general surgery. J Robot Surg 2016; 11:347-353. [PMID: 28028750 DOI: 10.1007/s11701-016-0662-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/04/2016] [Indexed: 11/24/2022]
Abstract
The da Vinci Xi Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) has been released in 2014 to facilitate minimally invasive surgery. Novel features are targeted towards facilitating complex multi-quadrant procedures, but data is scarce so far. Perioperative data of patients who underwent robotic general surgery with the da Vinci Xi system within the first 6 month after installation were collected and analyzed. The gastric bypass procedures performed with the da Vinci Xi Surgical System were compared to an equal amount of the last procedures with the da Vinci Si Surgical System. Thirty-one foregut (28 Roux-en-Y gastric bypasses), 6 colorectal procedures and 1 revisional biliary procedure were performed. The mean operating room (OR) time was 221.8 (±69.0) minutes for gastric bypasses and 306.5 (±48.8) for colorectal procedures with mean docking time of 9.4 (±3.8) minutes. The gastric bypass procedure was transitioned from a hybrid to a fully robotic approach. In comparison to the last 28 gastric bypass procedures performed with the da Vinci Si Surgical System, the OR time was comparable (226.9 versus 230.6 min, p = 0.8094), but the docking time significantly longer with the da Vinci Xi Surgical System (8.5 versus 6.1 min, p = 0.0415). All colorectal procedures were performed with a single robotic docking. No intraoperative and two postoperative complications occurred. The da Vinci Xi might facilitate single-setups of totally robotic gastric bypass and colorectal surgeries. However, further comparable research is needed to clearly determine the significance of this latest version of the da Vinci Surgical System.
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Affiliation(s)
- Monika E Hagen
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
| | - Minoa K Jung
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Frederic Ris
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Jassim Fakhro
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Nicolas C Buchs
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Leo Buehler
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Philippe Morel
- Division of Digestive and Transplant Surgery, Department of Surgery, University Hospital Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
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Abiri A, Paydar O, Tao A, LaRocca M, Liu K, Genovese B, Candler R, Grundfest WS, Dutson EP. Tensile strength and failure load of sutures for robotic surgery. Surg Endosc 2016; 31:3258-3270. [PMID: 27928670 DOI: 10.1007/s00464-016-5356-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 11/12/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Robotic surgical platforms have seen increased use among minimally invasive gastrointestinal surgeons (von Fraunhofer et al. in J Biomed Mater Res 19(5):595-600, 1985. doi: 10.1002/jbm.820190511 ). However, these systems still suffer from lack of haptic feedback, which results in exertion of excessive force, often leading to suture failures (Barbash et al. in Ann Surg 259(1):1-6, 2014. doi: 10.1097/SLA.0b013e3182a5c8b8 ). This work catalogs tensile strength and failure load among commonly used sutures in an effort to prevent robotic surgical consoles from exceeding identified thresholds. Trials were thus conducted on common sutures varying in material type, gauge size, rate of pulling force, and method of applied force. METHODS Polydioxanone, Silk, Vicryl, and Prolene, gauges 5-0 to 1-0, were pulled till failure using a commercial mechanical testing system. 2-0 and 3-0 sutures were further tested for the effect of pull rate on failure load at rates of 50, 200, and 400 mm/min. 3-0 sutures were also pulled till failure using a da Vinci robotic surgical system in unlooped, looped, and at the needle body arrangements. RESULTS Generally, Vicryl and PDS sutures had the highest mechanical strength (47-179 kN/cm2), while Silk had the lowest (40-106 kN/cm2). Larger diameter sutures withstand higher total force, but finer gauges consistently show higher force per unit area. The difference between material types becomes increasingly significant as the diameters decrease. Comparisons of identical suture materials and gauges show 27-50% improvement in the tensile strength over data obtained in 1985 (Ballantyne in Surg Endosc Other Interv Tech 16(10):1389-1402, 2002. doi: 10.1007/s00464-001-8283-7 ). No significant differences were observed when sutures were pulled at different rates. Reduction in suture strength appeared to be strongly affected by the technique used to manipulate the suture. CONCLUSIONS Availability of suture tensile strength and failure load data will help define software safety protocols for alerting a surgeon prior to suture failure during robotic surgery. Awareness of suture strength weakening with direct instrument manipulation may lead to the development of better techniques to further reduce intraoperative suture breakage.
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Affiliation(s)
- Ahmad Abiri
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA. .,UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, CA, USA.
| | - Omeed Paydar
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA.,UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, CA, USA
| | - Anna Tao
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA
| | - Megan LaRocca
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA
| | - Kang Liu
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA
| | - Bradley Genovese
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA.,UCLA Department of Surgery, Los Angeles, CA, USA
| | - Robert Candler
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA.,UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, CA, USA
| | - Warren S Grundfest
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA.,UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, CA, USA
| | - Erik P Dutson
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA.,UCLA Department of Surgery, Los Angeles, CA, USA
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Villanueva-Sáenz E, Ramírez-Ramírez MM, Zubieta-O'Farrill G, García-Hernández L. [Initial experience in robot-assisted colorectal surgery in Mexico]. CIR CIR 2017; 85:284-91. [PMID: 27855992 DOI: 10.1016/j.circir.2016.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 09/09/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Colorectal surgery has advanced notably since the introduction of the mechanical suture and the minimally invasive approach. Robotic surgery began in order to satisfy the needs of the patient-doctor relationship, and migrated to the area of colorectal surgery. An initial report is presented on the experience of managing colorectal disease using robot-assisted surgery, as well as an analysis of the current role of this platform. MATERIAL AND METHODS A retrospective study was conducted in order to review five patients with colorectal disease operated using a robot-assisted technique over one year in the initial phase of the learning curve. Gender, age, diagnosis and surgical indication, surgery performed, surgical time, conversion, bleeding, post-operative complications, and hospital stay, were analysed and described. A literature review was performed on the role of robotic assisted surgery in colorectal disease and cancer. RESULTS The study included 5 patients, 3 men and 2 women, with a mean age of 62.2 years. Two of them were low anterior resections with colorectal primary anastomoses, one of them extended with a loop protection ileostomy, a Frykman-Goldberg procedure, and two left hemicolectomies with primary anastomoses. The mean operating time was 6hours and robot-assisted 4hours 20minutes. There were no conversions and the mean hospital stay was 5 days. CONCLUSION This technology is currently being used worldwide in different surgical centres because of its advantages that have been clinically demonstrated by various studies. We report the first colorectal surgical cases in Mexico, with promising results. There is enough evidence to support and recommend the use of this technology as a viable and safe option.
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Krishnan S, Connell J, Ofo E. Transoral robotic surgery base of tongue mucosectomy for head and neck cancer of unknown primary. ANZ J Surg 2016; 87:E281-E284. [PMID: 27860242 DOI: 10.1111/ans.13741] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 05/06/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Head and neck cancer of unknown primary (HNCUP) is a source of diagnostic uncertainty. Patients presenting with cytologically positive neck lumps without a clinically identifiable primary, require extensive investigation including imaging, tonsillectomy, panendoscopy and tissue biopsy. Treatment typically involves neck dissection, wide field radiotherapy and chemotherapy. Transoral robotic surgery (TORS) has emerged as an expanding surgical technique for resecting tumours of the oropharynx. Its role in base of tongue (BOT) mucosectomy for HNCUP can alleviate diagnostic uncertainty and provide an adjunct treatment modality with few complications. METHODS We conducted a 7-year chart review of consecutive patients presenting with HNCUP that were treated with TORS BOT mucosectomy. We examined the efficacy, diagnostic rates and complications associated with TORS BOT mucosectomy when used for treating HNCUP. RESULTS TORS BOT mucosectomy was performed in seven cases of squamous cell carcinoma of unknown primary. Robotic mucosectomy diagnosed BOT as the primary tumour site in five cases (71.4%). All five cases were p16 positive. Average time before return to normal swallowing function was 2.7 days. There were no major surgical complications. CONCLUSION TORS BOT mucosectomy is an expanding surgical technique with a key role in head and neck surgery. It can be utilized to good effect where head and neck cancer is diagnosed without an identifiable primary. Incorporating robotic surgery in the diagnostic and treatment pathway offers low complication rates, reduced morbidity and improved tumour identification.
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Affiliation(s)
- Suren Krishnan
- Department of Otolaryngology Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - James Connell
- Department of Otolaryngology Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Enyinnaya Ofo
- Department of Otolaryngology Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Huang GJ, Liu HB, Zhang JX, Luo MS, Zhu CM. [Application progress of transoral robotic surgery in treatment of laryngeal cancer]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:1744-1746. [PMID: 29871191 DOI: 10.13201/j.issn.1001-1781.2016.21.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Indexed: 11/12/2022]
Abstract
Transoral robotic surgery(TORS) with the Da Vinci robot has been used for the removal of laryngeal cancer,which can improve functional and aesthetic outcomes without worsening survival. We reviews the composition of the robotic surgical system, unique advantages, potential applications and limitations of existing solutions and prospects in Surgery for laryngeal cancer.Major technical improvements are expected. Smaller, more ergonomic, new-generation robots adapted to the head and neck will probably be available in the near future.
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Wang M, Cai Y, Li Y, Peng B. Robotic Pancreaticoduodenectomy: Single-Surgeon Initial Experience. Indian J Surg 2016; 80:42-47. [PMID: 29581684 DOI: 10.1007/s12262-016-1555-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/07/2016] [Indexed: 02/05/2023] Open
Abstract
Minimally invasive surgery has gained increasing acceptance over the last few years, which has expanded to pancreaticoduodenectomy. Laparoscopic pancreaticoduodenectomy has been determined to be a feasible, safe, and effective procedure in an experienced surgeon's hands, but the adaptations to the clumsy instruments are needed. The improved dexterity of the Da Vinci robotic system provides a good opportunity to perform this challenging procedure in the minimally invasive context. The aim of this study was to share our preliminary experience of totally robotic pancreaticoduodenectomy. From April 2015 to August 2015, four patients were selected to undergo totally robotic pancreaticoduodenectomy in the Department of Pancreatic Surgery, West China Hospital, Sichuan University, China. The demographic characteristics, perioperative details, and pathological results were retrospectively reviewed. One female and two male patients underwent totally robotic pancreaticoduodenectomy, while another male patient underwent robotic total pancreatectomy due to the severe atrophy of pancreatic body and tail. The mean age of the four patients was 56.8 years. The average operation time and intraoperative blood loss were 563 min and 228 mL, respectively. No one needed blood transfusion, conversion to open pancreaticoduodenectomy, or postoperative analgesia. The postoperative courses of these patients were uneventful. The mean postoperative hospital stay was 10 days. No one required to be readmitted, and there was no death within 30 days following the surgery. Final pathologic examinations revealed one malignant pancreatic ductal adenocarcinoma, and three benign lesions. Based on this initial study, robotic pancreaticoduodenectomy is safe and feasible, with acceptable oncological outcomes for highly selected patients in experienced surgeons' hands. However, concerns such as long-term outcomes, cost-effectiveness analysis, and learning curve analysis should be fully demonstrated before the popularization of this challenging procedure.
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Affiliation(s)
- Mingjun Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041 China
| | - Yunqiang Cai
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041 China
| | - Yongbin Li
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041 China
| | - Bing Peng
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041 China
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Lee GI, Lee MR, Green I, Allaf M, Marohn MR. Surgeons' physical discomfort and symptoms during robotic surgery: a comprehensive ergonomic survey study. Surg Endosc 2017; 31:1697-706. [PMID: 27515836 DOI: 10.1007/s00464-016-5160-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/27/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND It is commonly believed that robotic surgery systems provide surgeons with an ergonomically sound work environment; however, the actual experience of surgeons practicing robotic surgery (RS) has not been thoroughly researched. In this ergonomics survey study, we investigated surgeons' physical symptom reports and their association with factors including demographics, specialties, and robotic systems. METHODS Four hundred and thirty-two surgeons regularly practicing RS completed this comprehensive survey comprising 20 questions in four categories: demographics, systems, ergonomics, and physical symptoms. Chi-square and multinomial logistic regression analyses were used for statistical analysis. RESULTS Two hundred and thirty-six surgeons (56.1 %) reported physical symptoms or discomfort. Among those symptoms, neck stiffness, finger, and eye fatigues were the most common. With the newest robot, eye symptom rate was considerably reduced, while neck and finger symptoms did not improve significantly. A high rate of lower back stiffness was correlated with higher annual robotic case volume, and eye symptoms were more common with longer years practicing robotic surgery (p < 0.05). The symptom report rate from urology surgeons was significantly higher than other specialties (p < 0.05). Noticeably, surgeons with higher confidence and helpfulness levels with their ergonomic settings reported lower symptom report rates. Symptoms were not correlated with age and gender. CONCLUSION Although RS provides relatively better ergonomics, this study demonstrates that 56.1 % of regularly practicing robotic surgeons still experience related physical symptoms or discomfort. In addition to system improvement, surgeon education in optimizing the ergonomic settings may be necessary to maximize the ergonomic benefits in RS.
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