Advent Of Robotic Surgery Research Articles

Surgical Management of Diverticular Disease in the Elective Setting.

Diverticulosis is a common condition that has increased in prevalence in industrialized countries over the past century. Estimates of developing diverticular disease in the United states range from 5% by 40 years of age up, to over 80% by age 80. It is estimated that approximately 20% of patients with diverticulosis develop diverticulitis over the course of their lifetime. Diverticular disease can be divided into simple and chronic diverticulitis with various sub categories. There are various instances and circumstances where elective resection is indicated for both complex and simple forms of this disease process. When planning surgery there are general preoperative considerations that are important to be reviewed prior to surgery. There are also more specific considerations depending on secondary problem attributed to diverticulitis, that is, fistula vs stricture. Today, treatment for elective resection includes open, laparoscopic and robotic surgery. Over the last several years we have moved away from open surgery to laparoscopic surgery for elective resection. With the advent of robotic surgery and introduction of 3D laparoscopic surgery the discussion of superiority, equivalence between these modalities, is and should remain an important discussion topic.

Laparoscopic pyeloplasty: Initial experience with 3D vision laparoscopy and articulating shears

Laparoscopic reconstructive surgery is associated with a steep learning curve related to the use of two-dimensional (2D) vision and rigid instruments. With the advent of robotic surgery, three-dimensional (3D) vision, and articulated instruments, this learning curve has been facilitated. We present a hybrid alternative to robotic surgery, using laparoscopy with 3D vision and articulated shears. To compare outcomes of children undergoing pyeloplasty using 3D laparoscopy with articulated instruments with those undergoing the same surgery using standard laparoscopy with 2D vision and rigid instruments. Medical charts of 33 consecutive patients with ureteropelvic junction obstruction who underwent laparoscopic pyeloplasty by a single surgeon from 2006 to 2013 were reviewed in a retrospective manner. The current 3D cohort was compared with the previous 2D cohort. Data on age, weight, gender, side, operative time, dimension (2D=19 patients, 3D=8 patients), presence of a crossing vessel, length of hospital stay, and complication rate were compared between the two groups. Articulating shears were used for pelvotomy and spatulation of the ureter in the 3D group. Statistical tests included linear regression models and chi square tests for trends using STATA software. Operative time per case was decreased by an average of 48min in the group undergoing 3D laparoscopic pyeloplasty compared with the group undergoing 2D laparoscopic pyeloplasty (p=0.02) (Figure). Complication rate and length of hospital stay were not significantly affected by the use of 3D laparoscopy. These favorable results are in accordance with previous literature emphasizing the importance of 3D vision in faster and more precise execution of complex surgical maneuvers. The use of flexible instruments has also helped overcome the well-described delicate step of a dismembered pyeloplasty, namely the pelvotomy and ureteral spatulation. Limitations of this study are those inherent to the retrospective study design. The use of 3D vision endoscopy with articulating instruments blurs the distinction between current robotic-assisted and conventional laparoscopic technology, and provides a hybrid alternative deserving further attention.

Robotic Colorectal Surgery

Surgical innovation is constant, most recently is the introduction of robotic surgery. While the incorporation of minimally invasive surgery in the field of colorectal surgery is generally rapid, robotic surgery is yet to gain momentum in the field. Laparoscopic colorectal surgery is now widely practiced, yet it has its own limitations, specifically in rectal surgery and operating in the pelvis. The advent of robotic surgery comes with hopes to address these limitations at no cost of compromising oncological outcomes. There are abundant reports in the literature on early experiences with the robotic technique with early results demonstrating safety and feasibility of the technique. However, as with any new technology, it comes with its own limitations. Benefits, limitations, outcomes, and future directions of this new technology as it applies to colorectal surgery are discussed.

PD48-04 PROSPECTIVE RANDOMIZED TRIAL COMPARING OPEN TO LAPAROSCOPIC PARTIAL NEPHRECTOMY, INTERIM ANALYSIS. (NCT01809119)

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VI1 Apr 2016PD48-04 PROSPECTIVE RANDOMIZED TRIAL COMPARING OPEN TO LAPAROSCOPIC PARTIAL NEPHRECTOMY, INTERIM ANALYSIS. (NCT01809119) Giuliano Guglielmetti, Sanarelly Adonias, Rafael Coelho, Mauricio Cordeiro, Leonardo Borges, José Roberto Colombo, Rodrigo Pessoa, Luiz Neves, José Pontes, Adriano Nesrallah, Miguel Srougi, and William Nahas Giuliano GuglielmettiGiuliano Guglielmetti More articles by this author , Sanarelly AdoniasSanarelly Adonias More articles by this author , Rafael CoelhoRafael Coelho More articles by this author , Mauricio CordeiroMauricio Cordeiro More articles by this author , Leonardo BorgesLeonardo Borges More articles by this author , José Roberto ColomboJosé Roberto Colombo More articles by this author , Rodrigo PessoaRodrigo Pessoa More articles by this author , Luiz NevesLuiz Neves More articles by this author , José PontesJosé Pontes More articles by this author , Adriano NesrallahAdriano Nesrallah More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , and William NahasWilliam Nahas More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2726AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) is the treatment of choice for T1a renal tumors (RT) and has progressively gained acceptance for the treatment of T1b and even bigger tumors. Despite no good quality evidence proving that minimally invasive surgery offers as good results as open surgery, it has been widely used for PN and is growing in usage especially after advent of robotic surgery. The objective of this study is to determine if laparoscopic partial nephrectomy can provide good functional and oncological outcomes with acceptable morbidity for the treatment of T1 RT. METHODS Since 2013, patients with RT smaller than 7 cm are being recruited for the study. Inclusion criteria included: T1 RT, candidates for partial nephrectomy. Exclusion criteria are: anatomical or functional solitary kidney, multiple RTs and glomerular filtration rate (GFR) less than 30ml/min. Patients are randomized in 1:1 proportion into 2 groups: Group 1 – laparoscopic partial nephrectomy, Group 2 – open partial nephrectomy. GFR is measured with 51Cr-EDTA realized before, at 3 and 12 months after surgery. Unexpected events up to 3 months after surgery are considered surgical complications and classified following Clavien-Dindo Grading System. RESULTS This is an interim analysis performed in may/2015. 110 patients had been randomized. 35 patients were excluded from analysis because didn’t have sufficient follow-up after surgery. Data from 34 patients in group 1 and 41 patients in group 2 were analyzed. Intra-operative and pathological data are presented in table 1. Group 2 patients had significantly less warm ischemia time. There was no difference in terms of surgical complications or GFR decrease 3 or 12 months after surgery (table 2). CONCLUSIONS Laparoscopic partial nephrectomy offers same functional and oncological outcomes when compared to open surgery, with equivalent morbidity. In specialized centers, laparoscopic approach should be preferred due to its advantages related to surgical access. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1176 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Giuliano Guglielmetti More articles by this author Sanarelly Adonias More articles by this author Rafael Coelho More articles by this author Mauricio Cordeiro More articles by this author Leonardo Borges More articles by this author José Roberto Colombo More articles by this author Rodrigo Pessoa More articles by this author Luiz Neves More articles by this author José Pontes More articles by this author Adriano Nesrallah More articles by this author Miguel Srougi More articles by this author William Nahas More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Robotics in Plastic Surgery

The advent of robotic surgery has revolutionized the modern treatment of a multitude of surgical diseases. With its enhanced precision, greater degrees of freedom, superior three-dimensional vision, improved resolution, and tremor elimination, robotic surgery is now playing a pivotal role in minimally invasive gynecologic, cardiothoracic, urologic, otolaryngologic, and gastrointestinal procedures. During the past decade, the field of plastic and reconstructive surgery has also started to embrace this innovative technology, especially for challenging reconstructive cases. Robotic surgery has not only enabled plastic surgeons to perform flap harvest procedures with minimal donor-site morbidity and enhanced cosmesis, but it has also allowed them to perform procedures never possible before. In this review, we illustrate the current clinical applications of robotics in plastic surgery and analyze their limitations based on the literature and our own experience in the field. We finish by presenting the technological challenges restricting the widespread use of robotics in plastic surgery, and outline some of our recent research efforts aimed at overcoming those limitations and promoting broader application of this innovative technology.

Surgical repair of pelvic organ prolapse in elderly patients.

Epidemiologic data suggests that our population greater than 65 years of age will nearly double. In addition, the incidence of women undergoing surgery for pelvic organ prolapse will rise. Chronologic age does not preclude a woman from undergoing a reconstructive procedure, yet the preoperative assessment should be approached most judiciously with great care to insure patient is maximally medically prepared for surgery. Surgical procedures in this review include: the abdominal sacral colpopexy, anterior repair, posterior repair, sacrospinous ligament fixation, uterosacral suspension, and iliococcygeus fixation. The advent of robotic surgery has decreased the perioperative morbidity of several of these procedures. However, the risk of more severe complications does appear higher following robotic procedures, when compared with vaginal procedures. Intuitively, one would surmise that there is a point where vaginal surgery should be considered as the primary procedure based on age, risk and durability of the surgery - unfortunately that age is not clear. Thus, the proper selection of prevalence of organ prolapse surgery can only be done after careful discussion with the patient and including the patient in the selection process as much as possible.

Postprostatectomy Erectile Dysfunction: A Review.

In the current era of the early diagnosis of prostate cancer (PCa) and the development of minimally invasive surgical techniques, erectile dysfunction (ED) represents an important issue, with up to 68% of patients who undergo radical prostatectomy (RP) complaining of postoperative erectile function (EF) impairment. In this context, it is crucial to comprehensively consider all factors possibly associated with the prevention of post-RP ED throughout the entire clinical management of PCa patients. A careful assessment of both oncological and functional baseline characteristics should be carried out for each patient preoperatively. Baseline EF, together with age and the overall burden of comorbidities, has been strongly associated with the chance of post-RP EF recovery. With this goal in mind, internationally validated psychometric instruments are preferable for ensuring proper baseline EF evaluations, and questionnaires should be administered at the proper time before surgery. Careful preoperative counselling is also required, both to respect the patient's wishes and to avoid false expectations regarding eventual recovery of baseline EF. The advent of robotic surgery has led to improvements in the knowledge of prostate surgical anatomy, as reflected by the formal redefinition of nerve-sparing techniques. Overall, comparative studies have shown significantly better EF outcomes for robotic RP than for open techniques, although data from prospective trials have not always been consistent. Preclinical data and several prospective randomized trials have demonstrated the value of treating patients with oral phosphodiesterase 5 inhibitors (PDE5is) after surgery, with the concomitant potential benefit of early re-oxygenation of the erectile tissue, which appears to be crucial for avoiding the eventual penile structural changes that are associated with postoperative neuropraxia and ultimately result in severe ED. For patients who do not properly respond to PDE5is, proper counselling regarding intracavernous treatment should be considered, along with the further possibility of surgical treatment for ED involving the implantation of a penile prosthesis.

Latest developments and techniques in gynaecological oncology surgery.

To highlight the advances and the data published in the field of gynaecological oncology surgery in the last few years. The review includes not only newly introduced surgical techniques but also data that consolidate recent developments. Ultimate data on the use of laparoscopy in the treatment of gynaecologic malignancies have proven similar survival outcomes to the traditional surgical route and confirmed the benefits in terms of faster recovery and lower morbidity. Thanks to a faster learning curve, the use of robotic surgery has contributed to the increase in the number of surgeons who moved away from open surgery. A few pioneers are expanding the indications of laparoscopy to exenterative surgery and treatment of ovarian cancer. Laparoscopic surgery has become the gold standard treatment for patients with primary endometrial or cervical cancer. The advent of robotic surgery has reinforced the domain of endoscopic surgery.

Cancer imaging in the era of precision treatment: present and future

Cancer imaging in the era of precision treatment: present and future

English

English

Changing trends in pelvic lymphadenectomy in radical prostatectomy with the advent of robotic surgery.

39 Background: It is important to determine whether changes in technology have impacted surgical practice. With the adoption of robotic surgery, it is our hypothesis that rates of pelvic lymphadenectomy (LND) have decreased, even when controlling for cancer risk and comorbidities. To assess whether adoption of surgical technology versus practice patterns in the extent of surgery over time changed, we propose to compare the rates of pelvic LND at the time of radical prostatectomy during the time period when robotic surgery was adopted. Methods: Data was extracted from CaPSURE, a multi-institutional, longitudinal observational database of men with prostate cancer. A total of 3,938 men diagnosed with localized prostate cancer between 2000 and 2011 were included in the analysis if they underwent surgical extirpation. The inclusion of LND was calculated for both groups. Other information included site type, age at diagnosis, comorbidities, and CAPRA risk assessment score. Results: A total of 3,616 open retropubic prostatectomies and 322 robotic prostatectomies were included for analysis. Among the open prostatectomies, 78.9% underwent pelvic LND. During the same time period, among robotic prostatectomies, 45.3% underwent pelvic LND. There was a statistically significant correlation between method of radical prostatectomy and the performance of LND (p < 0.001). There were no statistically significant differences between the two groups in CAPRA score, age, or comorbidities (p= 0.06, 0.29, and 0.60; respectively). The adjusted odds ratio of LND for the open group compared to the robotic group is 5.90 (95% CI [4.48,7.78]) while adjusting for clinical stage, grade, and PSA. Conclusions: Controlling for other factors, the difference in rates of LND between the open and robotic groups were statistically significant. These data suggest changes in surgical practice may have been altered by the adoption of a new technique to perform surgery (rather than new scientific data supporting omission of LND).

Massive Subcutaneous Emphysema in Robotic Sacrocolpopexy

The advent of robotic surgery has increased the popularity of laparoscopic sacrocolpopexy. Carbon dioxide insufflation, an essential component of laparoscopy, may rarely cause massive subcutaneous emphysema, which may be coincident with life-threatening situations such as hypercarbia, pneumothorax, and pneumomediastinum. Although the literature contains several reports of massive subcutaneous emphysema after a variety of laparoscopic procedures, we were not able to identify any report of this complication associated with laparoscopic or robotic sacrocolpopexy. Massive subcutaneous emphysema occurred in 3 women after robotic sacrocolpopexy in our practice. The patients had remarkable but reversible physical deformities lasting up to 1 week. A valveless endoscopic dynamic pressure system was used in all 3 of our cases. Our objective is to define the risk of massive subcutaneous emphysema during robotic sacrocolpopexy in light of these cases and discuss probable predisposing factors including the use of valveless endoscopic dynamic pressure trocars.

Laparoscopic Splenectomy: Conventional Versus Robotic Approach—A Comparative Study

Laparoscopic splenectomy is accepted as a safe approach in the surgical treatment of blood disorders worldwide. Compared with the laparotomic technique, it is associated with a lower risk of intraoperative bleeding, less postoperative pain, and faster discharge times. The advent of robotic surgery (RS) has changed the concept of minimally invasive surgery because, in addition to allowing a three-dimensional view, it permits greater freedom of movement and higher levels of accuracy than laparoscopic surgery (LS). The aim of this study was to comparatively evaluate whether RS presents advantages over LS in spleen surgery. In two Surgical Units with experience in laparoscopic splenectomy, over a 7-year period, two groups of 45 patients underwent LS and RS. The two groups were well matched for demographic characteristics, indications, and spleen size. No statistically significant differences were found regarding intraoperative blood loss, conversion rate to laparotomy, food intake, drain removal, postoperative complications, and median time to discharge. On the contrary, statistically increased differences were observed in median operative time and costs. In both groups, the transfusion and mortality rate was 0%. At the 6-month follow-up no surgical complications were observed. Although RS offers a three-dimensional view, greater freedom of movement, and higher levels of accuracy, it is associated with longer operative times and higher costs. It can consequently be concluded that with the intrinsic limits of the study design used, at the current time, RS does not have any significant advantage over LS in splenectomy.

Current surgical management of mitral regurgitation

From Walton Lillehei, who performed the first successful open mitral valve surgery in 1956, until the advent of robotic surgery in the 21st Century, only 50 years have passed. The introduction of the first heart valve prosthesis, in 1960, was the next major step forward. However, correction of mitral disease by valvuloplasty results in better survival and ventricular performance than mitral valve replacement. However, the European Heart Survey demonstrated that only 40% of the valves are repaired. The standard procedures (Carpentier’s techniques and Alfieri’s edge-to-edge suture) are the surgical basis for the new technical approaches. Minimally invasive surgery led to the development of video-assisted and robotic surgery and interventional cardiology is already making the first steps on endovascular procedures, using the classical concepts in highly differentiated approaches. Correction of mitral regurgitation is a complex field that is still growing, whereas classic surgery is still under debate as the new era arises.

Virtual Reality-Assisted Robotic Surgery Simulation

For more than a decade, advancing computer technologies have allowed incorporation of virtual reality (VR) into surgical training. This has become especially important in training for laparoscopic procedures, which often are complex and leave little room for error. With the advent of robotic surgery and the development and prevalence of a commercial surgical system (da Vinci robot; Intuitive Surgical, Sunnyvale, CA), a valid VR-assisted robotic surgery simulator could minimize the steep learning curve associated with many of these complex procedures and thus enable better outcomes. To date, such simulation does not exist; however, several agencies and corporations are involved in making this dream a reality. We review the history and progress of VR simulation in surgical training, its promising applications in robotic-assisted surgery, and the remaining challenges to implementation.