Advantages Of Robotic Surgery Research Articles

New Surgical Technique for Robotic Myomectomy: Continuous Locking Suture on Myoma (LSOM) Technique.

Robot-assisted laparoscopic myomectomy (RALM) has broadened the indications even in complex myomas. However, the high cost of RALM remains the main disadvantage. Therefore, a surgical technique that can reduce the cost of RALM and still has the advantages of robotic surgery is required. We propose a “locking suture on myoma (LSOM)” technique and compared the operative and perioperative outcomes of patients who underwent RALM with or without the LSOM technique. We included 337 patients who underwent RALM with (n = 160) or without (n = 177) the LSOM technique between March 2019 and August 2020. The LSOM group had low parity and gravidity, with a low rate of Cesarean sections. Myoma type was not different between the groups; however, patients in the LSOM group had larger, heavier, and higher number of myomas, although fewer patients had multiple myomas and were discharged earlier. Total operating time, estimated blood loss, pre- and postoperative hemoglobin levels, transfusion rate, and postoperative fever were not different between the two groups. In conclusion, the LSOM technique may be a viable surgical option for myomas, as it can reduce the cost of RALM by obviating the need for robotic Tenaculum forceps.

Laparoscopic hidden incision endoscopic surgery (hides) nephrectomy VS. Traditional laparoscopic nephrectomy: Non-inferior surgical outcomes and better cosmetic results

The benefits of laparoscopic total nephrectomy in pediatric patients are well established. Traditional Ports placement (TPP) still follows Clayman's classic description: except for the umbilical scar, the other laparoscopic scars are exposed in the abdomen. Advances in robotic surgery permitted the development of HidES (hidden incision endoscopic surgery) technique, to obtain a better final cosmetic aspect with the scars located intraumbilically and in the hypogastric region, in an area easily hidden by underwear. As robotic surgery is related to higher costs and lacks availability, a pure laparoscopic HidES technique was developed. 1.Evaluate safety and efficacy of pure laparoscopic HidES.2. Compare HidES with TPP nephrectomy series to assess non-inferiority and cosmetic outcomes. Twenty-one pediatric patients with symptomatic poor functioning kidneys (DMSA<10%) underwent HidES nephrectomy. Their intra and post-operative outcomes were recorded prospectively. HidES group was compared to an equivalent group of thirty-two patients who underwent TPP nephrectomy. There were no conversions to open surgery in the TPP or HidES groups. There was a significant difference in operative time between HidES (53.4min) and TPP (109.4min), with p=0.004 and the mean bleeding volume was 65.5ml. There was no significant difference in bleeding between HidES (71ml) and TPP (120ml) (p=0.06), no intraoperative complications and no complications above Clavien-Dindo II during the 6-week follow-up. Satisfaction reached 100% in HidES group, whereas in TPP satisfaction was 63% (p=0.004). HidES benefit over TPP is to conceal visible scars above underwear, improving cosmetical outcome. A prospective HidES group was compared to a retrospective TPP database due to decreasing number of nephrectomies being performed, which is a limitation of our study. HidES surgeries were performed by pediatric urologists (associate staff) while TPP group surgeries were performed by PGY-5 urological residents assisted by the associate staff, which is a clear limitation and can explain shorter operative times for HidES. During HidES surgeries an improved visualization of the operative field by the inferior trocar positioning was noted, which helps the posterior dissection of renal pedicle. Previous published study comparing robotic TPP and HidES pyeloplasty showed equal results for both groups with cosmetic advantages. Objective satisfaction was assessed with statistically advantage in favor of HidES procedure, consonant with other evidence that supports the benefit of scar location in patient and parental satisfaction. HidES nephrectomy proved to be safe, feasible and not inferior to the traditional nephrectomy in experienced hands, with better cosmesis.

Advantages of robotic surgery in the treatment of complex pelvic organs prolapse.

Robot-assisted surgery is safe and effective to treat the complex pelvic organs prolapse (C-POP). The present study analyzes all the robotic procedures and their advantages in the treatment of C-POP performed in a Proctologic and Pelvic Floor Clinical Centre. All the patients affected by C-POP who had robot-assisted surgery were retrospective analyzed. The anatomical and functional outcomes were respectively evaluated through POP-Q grading system and Wexner score about constipation and incontinence. The satisfaction rate was investigated using a five-point scale. From September 2014 to December 2018, 229 women underwent robotic surgery. The follow-up was 12months. There were no robot-related complications. One hematoma (4.5%) of the recto-vaginal space occurred after Robotic Ventral Rectopexy with Folded Mesh (R-VRP-FM). In the robotic assisted lateral suspension (R-ALS) group there was one case of anterior vaginal wall mesh exposure (0.9%). After the robotic ventral rectopexy (R-VRP) the recurrence rate of external rectal prolapse, internal rectal prolapse, rectocele and enterocele was respectively 6.6, 9.5, 7.4 and 9.5%. After R-VRP-FM only one cystocele (14%) and one partial rectal prolapse (25%) recurred. Vaginal bulge symptoms resolution rate was 95.4%. The mean Wexner constipation score significantly decreased after R-VRP and R-VRP-FM. Vaginal bulge symptoms improved in 98.3% of cases with any apical prolapse recurrence after robotic abdominal colposacropexy. Success rate after R-ALS was 99.1% and 96.4% for apical and anterior prolapse respectively. Robotic assistance makes some surgical steps easier and more precise and this may result in less morbidity and better results.

Systematic Review Comparing the Effectiveness of Robotic Verse Laparoscopic Liver Surgery in Colorectal Liver Metastasis (CRLM)

Introduction: Colorectal cancer (CRC) is the third most common cancer in the world. According to Cancer Research UK, 42,000 new cases are diagnosed in the UK every year. The liver is the most common site of metastasis with 15 to 25% of patients presenting with synchronous colorectal liver metastasis (CRLM) at the time of diagnosis. Modern chemotherapy has resulted in improved survival rates. Patients with resectable disease, surgical resection remain the only potentially curative treatment. This study aimed to evaluate the short and long-term outcomes and directly comparing the effectiveness of laparoscopic and robotic CRLM surgery. Methodology: A literature search was performed and all studies that reported on operative characteristics, oncological outcomes for CRLM, morbidity or mortality and cost effectiveness on robotic or laparoscopic surgery were included. Present study was designed according to the PRISMA guidelines. Results: From the initial 575 manuscripts identified, 17 studies (9 laparoscopic & 8 robotic) were included in the final qualitative synthesis. Our study shows that robotic surgery can be used safely for colorectal liver resections with a limited conversion rate, blood loss, and postoperative morbidity. However, robotic and laparoscopic liver resection displays similar safety and feasibility for CRLM. Conclusion: Experienced Hepatobiliary surgeons can safely perform robotic surgery. Long-term oncological outcomes are unclear, but short-term perioperative results are comparable to those of laparoscopic liver resection. The main drawback of advanced robotic surgery is the associated cost and further studies are needed to clarify the exact role of robotics in liver surgery.

Robot-assisted laparoscopic pediatric right hepatectomy

Hepatoblastoma (HB) is the most common malignant tumor of the liver in children. With the introduction of Cisplatin-based chemotherapy combined with radical resection of the tumor, the outcomes improved in recent times. The introduction of robot-assisted laparoscopy has led to the rapid adaptation of this key instrument in micro-invasive surgery, including liver surgery. We present a case of Robot-Assisted Laparoscopic resection of HB and we discuss the significance and feasibility of Robot-assisted Hepatectomy. This article aims to compare the safety and effectiveness of Robotic surgery with conventional laparoscopic surgery, and put forth the advantages of robotic surgery over the open and conventional laparoscopic liver surgery.

A narrative review of the role of robotics in cancer surgery

: In recent times the use of minimally invasive laparoscopic surgery has greatly expanded, becoming increasingly developed since its advent. This technical innovation has allowed more complex procedures to be undertaken. Standard laparoscopic surgery has several limitations, for example positioning of the camera being operator dependent, mostly only providing two-dimensional views and restricted instrument movements for the surgeon. Robotic-assisted surgery allows improved control of the instruments over traditional laparoscopic instruments, more able to achieve the movements that the operator requires thus permitting more and more technically challenging procedures to be accomplished. Advantages of robotic surgery are that it integrates into enhanced recovery after surgery (ERAS) programmes through enabling faster recovery for patients with a shorter length of hospital stay, reduced postoperative pain, fewer wound complications, better cosmetic outcome and reduced blood loss. Robotic surgery also offers three-dimensional views with magnification and surgical instruments capable of increasing degrees of freedom thus replicating hand movements with greater precision. The use of robotics has implications for the anaesthetist including the potential for more restricted access to the patient’s airway. This article explores the history of robotic surgery and reviews the literature available for several surgical specialities as well as an insight into areas for the future development of robotics.

Minimal access in cardiac surgery.

Over the past two decades, minimally invasive cardiac surgery has been adopted with the use of endoscopic methods in 1990s and advanced robotic surgery since the early 2000s. In parallel with technological developments, surgical experience has increased and several cardiac operations are able to be performed using different mini-incisions. In this review, we discuss approaches to minimally invasive cardiac surgery, incisions, technical details, and suggestions.

Robotic surgery for gastric cancer in the west: A systematic review and meta-analyses of short-and long-term outcomes.

This review aims to merge all the western studies dealing with robotic gastrectomies (RG) to provide pooled results and higher levels of evidence supporting the use of robotic gastrectomy for the treatment of gastric cancer also at western latitudes. A systematic literature search was performed in PubMed, Embase, and Scopus for studies published between 2010 and 2020 concerning RG in western centers. Case series and comparative studies (robotic versus open and robotic versus laparoscopic) were included. After screening 1732 articles, 10 articles with a total of 988 patients undergoing RG in western centers were eligible for inclusion. Included studies showed a relatively low risk of bias. The pooled conversion rate was 3.9% (95% CI 1.2-7.9). The pooled overall complications rate was 15% (7.1-25.3) with a mortality rate of 2.5% (1.1-4.7). The pooled 5-year overall survival rate was 60.4% (46.0-74.1). The pooled analyses of the comparative studies (robotic versus open) included 132 robotic and 305 open gastrectomies and showed comparable safety parameters. The robotic group had a pooled 5-year overall survival of 55.2% (33.7-75.8) versus 50.8% (36.4-65.2) of the open group (RR 1.10, 0.78-1.55; p=0.248 - I2 51.8, 0.0-86.1; p=0.125). The meta analyses of the results from the studies comparing the robotic (n=679) and the laparoscopic (n=1355) approach (LG) showed similar morbidity (RG 19.9%, 10.2-32.0 versus LG 15.6%, 8.7-24.0; p=0.706) and mortality rates (RG 5.5%, 3.9-7.3 versus LG 4.3%, 3.3-5.4; p=0.272). RG had longer operative time (RG 327min, 297-358 versus LG 248, 222-275; p=0.001) and lower blood loss (RG 99ml, 96-103 versus LG 133, 104-161; p<0.001) than laparoscopic gastrectomy. Based on the available data from western centers, robotic gastrectomy is comparable with the open and the laparoscopic approaches with regards to short term outcomes. Survival data of RG were similar to open gastrectomies, but studies on long-term outcomes are required to confirm these results.

Basic knowledge of and a small trick for atraumatic needle driving in laparoscopic suturing.

Highlight Although recent advances in robotic surgery have enabled more precise movements of the needle driver, a sophisticated laparoscopic suturing technique is still desired. Honda and colleagues describe the basic knowledge of and a small but useful trick for atraumatic needle driving in laparoscopic suturing, based on mechanistic considerations.

RSILS: initial clinical experience with single-port robotic (SPr) right colectomy.

The da Vinci Single-Port (SP) robot is a novel platform designed to facilitate single-incision robotic surgery (rSILS). The objective of this study was to describe our initial experience using this platform for SP robotic (SPr) right colectomy. Under a Food and Drug Administration-regulated feasibility study and Institutional Review Board approval, a patient with cecal adenocarcinoma underwent an SPr right colectomy. The primary endpoint was the safety and feasibility of the first SPr right colectomy performed in the USA. Secondary endpoints included perioperative metrics, morbidity and mortality. An SPr Standard right colectomy was performed through a 4-cm single incision without the need for conversion or additional port placement. Estimated blood loss was 100mL and there were no intraoperative complications. The robot was docked once with a docking time of 19min. Total console time was 116min and operative time was 219min. The patient tolerated clear liquids on postoperative day (POD) 0 and a low-residue diet on POD 1. The patient had flatus and a bowel movement on POD 1. She was discharged home on POD 3. Final pathology showed pT3N0 cecal adenocarcinoma with negative margins and 0/24 lymph nodes positive for disease. Our initial experience demonstrates that an SPr right colectomy is feasible and can be safely completed. We completed an oncologic resection of a cecal adenocarcinoma without complications. The SP robot facilitates the utilization of robotic technology in a single-incision platform to perform colorectal procedures and offers promising benefits in the advancement of robotic surgery.

A Video Case Report of a Modified Dual-Docking Retromuscular Umbilical Prosthetic Hernia Repair

Introduction: The advances in robotic surgery have permitted the application of such technology to various surgical fields including hernia repairs. This video depicts the treatment of two primary ...

Robotic thymectomy for advanced thymic epithelial tumor: indications and technical aspects.

Robotic thymectomy is widely accepted as a valuable treatment option for surgical resection of thymic epithelial tumor as minimally invasive surgery has shown better early clinical outcomes than open surgery. Technical advances in robotic surgery have expanded the indications for robotic thymectomy, and the technique can be used to perform complete resection of advanced thymic epithelial tumor requiring concomitant resection of adjacent structures. To ensure complete resection, a multi-disciplinary approach, with thorough preoperative evaluation, must be adopted to determine whether a patient shows surgical indications for advanced thymic epithelial tumor. The early clinical outcomes after robotic thymectomy to treat advanced thymic epithelial tumor are promising; however, the long-term oncologic outcomes should be evaluated in the further studies.

Robotic Management of Fibroids: Discussion of Use, Criteria and Advantages.

Fibroids are the most common benign tumors affecting fertility and quality of life. Different methods either definitive or fertility sparing are used for their management by using open, laparoscopic and robotic techniques. This is a narrative review presenting the role and the advantages of robotic surgery in fibroids (myomectomies or hysterectomies). Such a management is effective, safe and feasible in hands of well-trained teams even for multiple, large or deep located fibroids.

Robots in Cancer Surgery: A Boon or Bane

It is an ongoing task to keep exploring and applying the best available technology to alleviate the pain and sufferings of the cancer patients. Since the discovery of robotic surgery, da Vinci surgical systems have played a special and significant role in cancer surgeries worldwide, however, surgeons are still skeptical with the clinical and oncological outcomes which are almost comparable to the laparoscopic approach in several cancers. Many meta-analyses using mostly retrospective studies indicated significant advantage of robotic surgery over laparoscopic or open surgery approaches for various cancers, however, scarcity of technically sound robot savvy surgeons and quality multicentered, multinational, coordinated, random clinical trials had not done justice to the positives of robotic surgery which were quite often suppressed by the negative factors like operative cost and oncological outcomes. Nevertheless, robotic surgery approach has been clinically accepted for hysterectomy and prostatectomy. This overview briefly discusses the comparative approaches (open, laparoscopic, robotic assisted) and their clinical outcomes in the surgery of various cancers.

A601 Comparative study of laparoscopy and robotics in revisional bariatric surgery – outcomes in 138 patients

The rate of both revisional and robotic bariatric surgery is increasing. The advantages of robotic surgery in this setting are not clearly defined. Compare patient characteristics and outcomes of laparoscopic and robotic revisional bariatric surgery

Robotic proctectomy for rectal cancer in the US: a skewed population.

Socioeconomic and racial differences have been associated with disparities in cancer care within the US, including disparate access to minimally invasive surgery for rectal cancer. We hypothesized that robotic approach to rectal cancer may be associated with similar disparities. The National Cancer Database (NCDB) was used to identify patients over 18years old with clinical stage I-III rectal adenocarcinoma who underwent a proctectomy between 2010 and 2014. Demographic and hospital factors were analyzed for association with robotic approach. Factors identified on bivariate analyses informed multivariate analysis. We identified 33,503 patients who met inclusion criteria; 3702 (11.1%) underwent robotic surgery with 7.8% conversion rate. Patients who received robotic surgery were more likely to be male, white, privately insured and with stage III cancer. They were also more likely to live in a metropolitan area, more than 25 miles away from the hospital and with a higher high school graduation rate. The treating hospital was more likely to be academic and high volume. Robotic surgery is performed rarely and access to it is limited for patients who are female, black, older, non-privately insured and unable to travel to high-volume teaching institutions. The advantages of robotic surgery may not be available to all patients given disparate access to the robot. This inherent bias in access to robot may skew study populations, preventing generalizability of robotic surgery research.

Robotic surgery: finding value in 2019 and beyond

Despite its significant associated costs, demand for robotic surgery continues to grow exponentially, with surgeons and patients alike increasingly gravitating towards health systems that provide access to robotic surgery. As it continues to develop its competitive advantage in robotic surgery, it is imperative for the modern health care systems to remain well-informed on the current state of robotic surgery and its role in improving health care quality and providing value to the system. The demand for robotic surgery is at an all-time high and continues to grow. Heavy marketing of da Vinci , and its role in improving minimally invasive surgery have led to substantial growth at hospitals and surgical centers around the country. However, current offerings require large initial capital investments and have high recurrent costs. Moreover, research to date has not proven robotic surgery superior to conventional laparoscopy for a majority of surgeries. As healthcare executives, this raises a dilemma: “Is robotic surgery worth it?” In short, the answer is “yes!” This requires careful consideration of several factors including a shift in frame of comparison, a focus on long-term outcomes, finding ways to increase robotic volume, and considering the effect of competition. The robotic surgery industry continues to grow exponentially; it is clear that it is here to stay. Intuitive Surgical has entrenched itself in the American Healthcare system with its aggressive marketing and advanced robotic surgery system. However, in current research, robotic surgery has not proven itself superior to conventional laparoscopy; costs often exceed those of laparoscopy. The increased demand and da Vinci’s perceived flaws have sparked new competition aimed at improving value by improving quality and lowering costs. While more research is needed, this report suggests that it is indeed possible to derive significant value from robotic surgery.

Advances in robotic surgery for pediatric ureteropelvic junction obstruction and vesicoureteral reflux: history, present, and future.

The introduction of robotic surgical technology into urological reconstruction, particularly pediatrics, has introduced new horizons for reducing the morbidity and enhancing the efficacy of surgical repair of congenital conditions in children. In reviewing the evolution of pediatric urological applications of robotic surgery, we wanted to address the different levels of reported utilization of pyeloplasty and ureteral reimplantation as two of the most common procedures. Review of the published literature sought to explore the described variation in clinical application of these two common procedures, and the evolution of the practice over time. Reported outcomes suggest that variations in patient selection, the learning curve and in reporting of outcomes all contribute to the wide variation in utilization of pediatric robotic pyeloplasty and ureteral reimplantation. These technologies are demonstrating their potential as well as the challenges of use in children and there is a steady evolution of capability. Practitioners should be aware of both the possibilities as well as the risks of such new technology in the care of our patients. This requires thorough and open reporting of outcomes, the willingness to introduce change and integrate new findings into practice.

Utility of robot-assisted radical cystectomy with intracorporeal urinary diversion for muscle-invasive bladder cancer.

Radical cystectomy remains the gold standard for treatment of muscle‐invasive bladder cancer. Robot‐assisted radical cystectomy has technical advantages over laparoscopic radical cystectomy and has emerged as an alternative to open radical cystectomy. Despite the advancements in robotic surgery, experience with total intracorporeal reconstruction of urinary diversion remains limited. Most surgeons have carried out the hybrid approach of robot‐assisted radical cystectomy and extracorporeal reconstruction of urinary diversion, as intracorporeal reconstruction of urinary diversion remains technically challenging. However, intracorporeal reconstruction of urinary diversion might potentially proffer additional benefits, such as decreased fluid loss, reduction in estimated blood loss and a quicker return of bowel function. The adoption of intracorporeal ileal neobladder reconstruction has hitherto been limited to high‐volume academic institutions. In the present review, we compare the totally intracorporeal robot‐assisted radical cystectomy approach with open radical cystectomy and robot‐assisted radical cystectomy + extracorporeal reconstruction of urinary diversion in muscle‐invasive bladder cancer patients.

Optimization of renal function preservation during robotic partial nephrectomy.

Over the past few years, the role of robotic-assisted partial nephrectomy (RPN) has exponentially grown. Multiple recognized factors contribute to postoperative renal function in patients undergoing RPN. The aim of this review is to identify these potential factors, and to evaluate strategies that may help optimize the goal of renal function preservation. A nonsystematic literature review was performed to retrieve the most recent evidence on factors contributing to renal function post-RPN. Analyzed elements include baseline factors (tumor complexity and patient characteristics), intraoperative (surgical) factors (control of the renal hilum and type of ischemia, resection technique, renorrhaphy technique), and pharmacotherapeutics. In conclusion, the advantages of robotic surgery in the setting of partial nephrectomy (PN) are becoming well established. Maximal preservation of renal function remains a priority goal of the procedure, and it is influenced by a plethora of factors. Adequate patient selection using radiomics, control of comorbidities, utilization of evidence-based intraoperative techniques/strategies, and postoperative care are key components of postoperative preservation of renal function. Further investigations regarding these factors and their effects on long-term renal function are necessary and will continue to aid in guiding appropriate patient care.