Da Vinci Robotic System Research Articles

Robotic assisted extended view totally extraperitoneal repair for inguinal hernia

Robotic assisted transabdominal pre-peritoneal inguinal hernia repair is an effective and safe approach. This report describes a new technique of robotic extended view totally extraperitoneal repair. A supraumbilical retro rectus approach, creation of pre-peritoneal space, separation of hernia sac from cord structures, placement of mesh and fixing with vicryl suture was employed in a 58-year gentleman with right inguinal hernia. The surgery was performed with the use of a DaVinci robotic system. No intraoperative problems were encountered. The patient was discharged within 24 hours of surgical intervention. The work has been reported in line with the SCARE criteria. The patient had no groin pain, inguinal or scrotal swelling at 30 day follow up. He was pleased with the cosmetic result and has gone back to work. Robotic e-TEP is a viable option in inguinal hernia repair.

The development of tissue handling skills is sufficient and comparable after training in virtual reality or on a surgical robotic system: a prospective randomized trial

BackgroundVirtual reality is a frequently chosen method for learning the basics of robotic surgery. However, it is unclear whether tissue handling is adequately trained in VR training compared to training on a real robotic system.MethodsIn this randomized controlled trial, participants were split into two groups for “Fundamentals of Robotic Surgery (FRS)” training on either a DaVinci VR simulator (VR group) or a DaVinci robotic system (Robot group). All participants completed four tasks on the DaVinci robotic system before training (Baseline test), after proficiency in three FRS tasks (Midterm test), and after proficiency in all FRS tasks (Final test). Primary endpoints were forces applied across tests.ResultsThis trial included 87 robotic novices, of which 43 and 44 participants received FRS training in VR group and Robot group, respectively. The Baseline test showed no significant differences in force application between the groups indicating a sufficient randomization. In the Midterm and Final test, the force application was not different between groups. Both groups displayed sufficient learning curves with significant improvement of force application. However, the Robot group needed significantly less repetitions in the three FRS tasks Ring tower (Robot: 2.48 vs. VR: 5.45; p < 0.001), Knot Tying (Robot: 5.34 vs. VR: 8.13; p = 0.006), and Vessel Energy Dissection (Robot: 2 vs. VR: 2.38; p = 0.001) until reaching proficiency.ConclusionRobotic tissue handling skills improve significantly and comparably after both VR training and training on a real robotic system, but training on a VR simulator might be less efficient.

Robotic-assisted mitral valve surgery without aortic cross-clamping: a safe and feasible technique.

The primary objective of this study was to evaluate the safety and feasibility of robotic-assisted mitral valve surgery without aortic cross-clamping. From January 2010 to September 2022, 28 patients underwent robotic-assisted mitral valve surgery without aortic cross-clamping in our center using DaVinci Robotic Systems. Clinical data during the perioperative period and early outcomes of the patients were recorded. Most patients were in New York Heart Association (NYHA) class II and III. Mean age and EuroScore II of the patients were 71.5 ± 13.5 and 8.4 ± 3.7 respectively. The patients underwent either mitral valve replacement (n = 16, 57.1%) or mitral valve repair (n = 12, 42.9%). Concomitant procedures were performed including tricuspid valve repair, tricuspid valve replacement, PFO closure, left atrial appendage ligation, left atrial appendage thrombectomy and cryoablation for atrial fibrillation. Mean CPB times were 140.9 ± 44.6 and mean fibrillatory arrest duration was 76.6 ± 18.4. Mean duration of ICU stay was 32.5 ± 28.8 h and mean duration of hospital stay 9.8 ± 8.3 days. One patient (3.6%) underwent revision due to bleeding. New onset renal failure was observed in one (3.6%) patient and postoperative stroke in one (3.6%) patient. Postoperative early mortality was observed in two (7.1%) patients. Robotic-assisted mitral valve surgery without cross-clamping is a safe and feasible technique in high-risk patients undergoing redo mitral surgery with severe adhesions as well as in primary mitral valve cases that are complicated with ascending aortic calcification.

Diaphragmatic endometriosis: robotic approaches and techniques

To present different approaches used in the surgical management of diaphragmatic endometriosis using the Davinci Robotic system. A video article presenting patient positioning, port placement, and surgical techniques used in robotic excision of diaphragmatic endometriosis with concomitant pelvic disease. Endometriosis center. Patients undergoing excision of diaphragmatic endometriosis. Systematic robotic approach to excise diaphragmatic lesions depending on the depth of invasion. The advantages and disadvantages of the lithotomy and the lateral decubitus approach were reviewed. Ports placements are illustrated according to the chosen approach. Diaphragmatic peritoneal stripping, diaphragmatic shaving, and diaphragmatic excision are different techniques used according to the depth of invasion. N/A. The choice of approach between the lithotomy position and the left lateral decubitus position depend on the extent of the diaphragmatic disease and the presence of concomitant pelvic lesions. Despite the lack of high-quality evidence, the advantages of the robotic system may improve the outcomes in such difficult cases in comparison with conventional laparoscopy.

Robot-Assisted Laparoscopic Radical Prostatectomy Utilizing Hugo RAS Platform: Initial Experience.

Background: The Hugo RAS™ is a newly launched robotic system for clinical use. This article provides the initial outcomes of patients undergoing radical prostatectomy with Hugo RAS. It also attempts to compare the outcomes with a similar set of patients undergoing the procedure with the DaVinci robotic systems. Methodology: Patients undergoing radical prostatectomy for biopsy-proven prostate cancer were included in this study. Institutional ethical approval was obtained, and patients were counseled preoperatively with informed consent. Both intra- and postoperative data were carefully recorded for the Hugo RAS. Patients who underwent radical prostatectomy in DaVinci robotic systems during a similar period were chosen to compare the outcomes of the Hugo systems in a nonrandomized study. Results: A total of 34 patients were included in this study wherein 17 radical prostatectomies were done in the Hugo RAS system and 17 in the DaVinci system were chosen to compare. The total operative time (210 vs 195 minutes) and dock time (190 vs 170 minutes) were similar between the two groups. An R0 or R1 resection and vesicourethral anastomosis were achieved in all cases. There were no notable intra- or postoperative complications in up to 1-month follow-up. Conclusion: The authors believe that the Hugo RAS platform is a safe robotic system for pelvic procedures such as radical prostatectomy, provides comparable results with existing robotic systems, and is a good addition to the existing arsenal of surgical robots.

Robotic Thymectomy for Thymomas: A Retrospective Follow-up Study in the Netherlands

BackgroundThe Maastricht University Medical Center+ is a Dutch center of expertise appointed by the Netherlands Federation of University Medical Centers for the treatment of thymomas. The aim of this study was to investigate the long-term oncologic, surgical, and neurologic outcomes of all patients who underwent a robotic thymectomy for a thymoma at Maastricht University Medical Center+. MethodsWe retrospectively analyzed the clinical-pathologic data of all consecutive patients with a thymoma who underwent robotic thymectomy using the DaVinci robotic system at Maastricht University Medical Center+ between April 2004 and December 2018. Follow-up data were collected from 60 referring Dutch hospitals. ResultsIn total, 398 robotic thymectomies were performed, and 130 thymomas (32.7%) were found. Median follow-up time was 46 months; median procedure time, 116 minutes; and median hospitalization time, 3 days. In 8.4% of patients, a conversion was performed, and in 20.8%, a complication was registered. The majority of myasthenic patients with a thymoma went into remission, mostly within 12 to 24 months after thymectomy (81%). No statistical difference was found in the number of complications, conversions, incomplete resections, or deaths between patients with myasthenia gravis and nonmyasthenic patients. Thirty-six patients (27.7%) underwent postoperative radiotherapy. The recurrence rate was 9.1%, and the 5-year thymoma-related survival rate was 96.6%. ConclusionsRobotic thymectomy was found to be safe and feasible for early stage thymomas, most advanced-stage thymomas, and thymomatous myasthenia gravis. A national guideline could contribute to the improvement of the oncologic follow-up of thymic epithelial tumors in the Netherlands.

A case report of endomrtrial carcinoma by DA Vinci robotic surgical system

A case report of endomrtrial carcinoma by DA Vinci robotic surgical system

V03-06 ZINNER SYNDROME, ROBOTIC MANAGEMENT IN PEDIATRIC PATIENTS WITH SEMINAL VESICLE CYSTS

You have accessJournal of UrologyPediatrics (V03)1 Sep 2021V03-06 ZINNER SYNDROME, ROBOTIC MANAGEMENT IN PEDIATRIC PATIENTS WITH SEMINAL VESICLE CYSTS Igor Voznesensky, Thomas Shelton, Joseph Allen, Ihor Yosypiv, Erik Castle, and Aaron Martin Igor VoznesenskyIgor Voznesensky More articles by this author , Thomas SheltonThomas Shelton More articles by this author , Joseph AllenJoseph Allen More articles by this author , Ihor YosypivIhor Yosypiv More articles by this author , Erik CastleErik Castle More articles by this author , and Aaron MartinAaron Martin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001991.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Zinner Syndrome is a rare congenital abnormality of the mesonephric (Wolffian) duct consisting of the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. While most patients with this anomaly are asymptomatic until the second or third decade of life, some may report nonspecific symptoms such as urinary urgency, dysuria, painful ejaculation, and perineal discomfort. Surgical resection of the cyst and the seminal vesicle is often necessitated because of the high rate of recurrence after conservative treatment. METHODS: Using the DaVinci robotic surgical system, we performed minimally invasive surgical management for two Zinner Syndrome patients, aged 14 and 17. For both procedures, cystoscopy was first utilized to identify the large posterior extravesical cystic masses and to cannulate the normal healthy contralateral ureter with a safety wire. We then incised the peritoneum, identifying and mobilizing the remnant distal ureteral stump and tracing towards the vas deferens. Once the seminal vesicle cyst was identified and mobilized from surrounding tissues, we proceeded to excise the SV cyst in its entirety. Due to the thin walled nature of the seminal vesical cyst in both patients, a small cystotomy was necessitated to facilitate complete excision. The cystotomy was then closed in standard fashion with pre-placed sensor wire used to facilitate identification and preservation of normal contralateral ureter. Lastly, the peritoneum was then reapproximated with running absorbable suture. RESULTS: Both patients were sent home the day following surgery. Post op imaging showed resolution of the seminal vesicle cysts and the patients reported symptomatic relief. Pathology demonstrated benign urothelium and underlying fibromuscular stromal tissue along with a portion of benign ureter. CONCLUSIONS: Using technology such as the DaVinci robot we can offer pediatric patients a minimally invasive approach for management even in the setting of rare pelvic pathology and clinical presentations. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e224-e224 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Igor Voznesensky More articles by this author Thomas Shelton More articles by this author Joseph Allen More articles by this author Ihor Yosypiv More articles by this author Erik Castle More articles by this author Aaron Martin More articles by this author Expand All Advertisement Loading ...

Robotic thoracoscopic parathyroidectomy for ectopic mediastinal parathyroid adenoma

The publication presents the successful experience of using the DaVinci robotic system for the treatment of persistent hyperparathyroidism caused by mediastinal ectopic parathyroid adenoma in 62 years old female patient. The role of single photon emission computed tomography in diagnostics was demonstrated.

Radical hysterectomy (II) and systemic lymphadenectomy with DA Vinci robotic surgical system

Radical hysterectomy (II) and systemic lymphadenectomy with DA Vinci robotic surgical system

An analysis of thelearning curve for robotic-assisted mitral valve repair.

Many cardiac surgeons receive training for sternotomy-based cardiac surgical operations in residency programs and only a few education programs offer training specifically in minimally invasive cardiac surgery. In this report, we aimed to search and analyze the learning curve for robotic-assisted mitral valve (MV) repair in cardiac surgeons. Between January 2010 and July 2019, 60 robotic-assisted isolated MV repair surgeries were performed with DaVinci Robotic Systems in our center. Different kinds of surgical techniques were used. The assessment of the learning curve was based on cardiopulmonary bypass (CPB) and transthoracic aortic clamp (CC) times. There were 23 (38.3%) men and 37 (61.7%) women with a mean age of 48.3 years. The lesions of the MV were posterior leaflet prolapsus (n = 42, 70.0%), anterior leaflet prolapsus (n = 8, 13.3%), Barlow disease (n = 3, 5%), and annular dilatation (n = 7, 11.6%). The patients underwent notochordal implantation (n = 27, 45%), quadrangular or triangular resection (n = 23, 38.3%), isolated ring annuloplasty (n = 7, 11.7%), resection, and leaflet reduction (n = 2, 3.3%) or edge to edge repair (n = 1, 1.7%). The maturation of the learning curve appeared to be about 30 cases. The statistical analysis showed that the mean CPB and CC times for the first 30 cases were greater compared with the 30 after learning curve (155.3 vs. 118.9 min[p = .00], 102.3 vs. 80 min[p = .00], respectively). There was no case of conversion to open surgery. No perioperative mortality was observed. The maturation of the learning curve for robotic-assisted MV repair appeared to be about 30 cases in our group of patients. This study had encouraging results for surgeons who desire to start a robotic mitral surgery program.

Surgical Technique for Sentinel Lymph Node Sampling in Presumed Early-stage Ovarian Cancer

Surgical staging for apparent early-stage ovarian cancer includes systematic pelvic and para-aortic lymph node evaluation to detect occult stage III disease [1]. Although, lymphadenectomy procedure is associated with increased duration of surgery and a 13% risk of lymphocyst formation [2]. Sentinel lymph node (SLN) biopsy is still investigational, and no standardized approach has been studied. Recent mounting evidence has approved the applicability of SLN technique in early-stage ovarian cancer [3,4]. The objective of this video is to demonstrate a surgical technique for robotic performance of SLN biopsy in presumed early-stage ovarian cancer. Stepwise demonstration of the robotic technique for SLN sampling in presumed early-stage ovarian cancer. This video report is part of an institutional, investigational review board-approved study. Academic tertiary referral center. This video presents our team's robotic technique for SLN sampling in a 37-year-old woman who presented to our center with a 10-cm right complex adnexal mass, suspicious for malignancy. A 27-gauge spinal needle was inserted through the abdominal wall under direct visualization. We injected 0.5 mL of dilute indocyanine green solution (Novadaq Technologies, Mississauga, Ontario, Canada) (1.25 mg/mL) subperitoneally into the utero-ovarian ligament. The SLN was checked with the fluorescence-guided camera of the Xi DaVinci robotic system (Sunnyvale, CA). Eight to 10 minutes after the injection, a right para-aortic SLN was identified, and dissection was performed. After dissection, the node was extracted and sent to pathology for evaluation by ultra-staging. The final pathology revealed a stage IA low-grade serous ovarian cancer. SLN sampling appears to be feasible in presumed early-stage ovarian cancer and may allow the avoidance of systematic lymph node dissection in this set of patients.

Precision surgery using davinci robotic system for prostate cancer &amp; its role in improving functional outcome

Precision surgery using davinci robotic system for prostate cancer &amp; its role in improving functional outcome

Learning curve of Da Vinci robot-assisted radical gastrectomy for gastric cancer

Objective To investigate the learning curve of Da Vinci robot-assisted laparoscopic radical gastrectomy for gastric cancer. Methods The retrospective cohort study was conducted. The clinicopathological data of 42 patients who underwent Da Vinci robot-assisted radical gastrectomy for gastric cancer in the First Affiliated Hospital of Xi′an Jiaotong University from October 2017 to August 2018 were collected. There were 30 males and 12 females, aged from 36 to 84 years, with an average age of 59 years. The learning curve was evaluated using the cumulative sum (CUSUM) analysis and the best fitting curve method. According to the minimum number of surgeries required to cross the learning curve, the patients were divided into learning stage group and mastery stage group. Then general data and surgical efficacy of the two groups were compared. Observation indicators: (1) surgical situations; (2) results of CUSUM analysis; (3) comparison of general data between the two groups; (4) comparison of surgical efficacy between the two groups; (5) follow-up. Patients were followed up by outpatient examination or telephone interview to detect the postoperative complications, tumor recurrence and metastasis up to February 2019. Measurement data with normal distribution were presented as Mean±SD, and comparison between groups was done using the independent sample t test. Count data were represented as absolute number, and comparison between groups was analyzed using the chi-square test or Fisher exact propability. Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. Results (1) Surgical situations: all the 42 patients underwent Da Vinci robot-assisted radical gastrectomy for gastric cancer successfully, without conversion to open surgery or perioperative death. Fourteen out of 42 patients underwent Da Vinci robot-assisted total radical gastrectomy and 28 underwent Da Vinci robot-assisted distal radical gastrectomy. The operation time and docking time were (213±31)minutes and (26±11)minutes. The operation time and docking time had a tendency to decreasing as the surgical cases increasing. (2) Results of CUSUM analysis. The CUSUM learning curve were best modeled as a polynomial with equation: CUSUM (operation time)=0.016 9X3-1.913 3X2+ 50.985X-16.595, CUSUM(docking time)=0.012 8X3-1.070 7X2+ 22.189X-23.097 respectively (X means the surgical case). The P value of fitting test of models was 0.05). There was no significant difference in the previous abdominal surgery history between the two groups (P>0.05). (4) Comparison of surgical efficacy between the two groups: operation time, volume of intraoperative blood loss, number of lymph nodes harvested, time to first liquid food intake, cases with postoperative complications and duration of postoperative hospital stay were (230±25)minutes, (176±103)mL, 21±7, (5.1±2.0)days, 2, (9.3±2.5)days in the learning stage group, and (191±18)minutes, (95±41)mL, 21±6, (4.7±1.7)days, 3, (8.4±2.1)days in the mastery stage group, respectively. There were statistically significant differences in the operation time and volume of intraoperative blood loss between the two groups (t=5.951, -3.359, P 0.05). There was no significant difference in the cases with postoperative complications between the two groups (P>0.05). (5) Follow-up: all the 42 patients were followed up for 6-16 months, with a median time of 11 months. No serious long-term complications, tumor recurrence and metastasis or death occurred during the follow-up. Conclusions The CUSUM learning curve of Da Vinci robot-assisted radical gastrectomy for gastric cancer can be divided into the learning stage and the mastery stage. It is suggested that the surgeons need to finish 19 cases or more to master Da Vinci robot-assisted radical gastrectomy for gastric cancer. Key words: Gastric neoplasms; Gastric cancer; Cumulative sum analysis; Best fitting curve; Learning curve; Da Vinci robotic surgical system

Clinical efficacy of Da Vinci robot-assisted radical resection for right colon cancer

Objective To investigate the clinical efficacy of Da Vinci robot-assisted radical resection for right colon cancer. Methods The retrospective cross-sectional study was conducted. The clinical data of 85 patients with right colon cancer who were admitted to the First Hospital Affiliated to Army Medical University from August 2013 to February 2019 were collected. There were 56 males and 29 females, aged from 29 to 84 years, with an average age of 60 years. All patients underwent Da Vinci robot-assisted radical resection of right colon cancer, named right hemicolon D3 + complete mesocolic excision, and received infection prevention and total parenteral nutrition treatment after surgery. According to clinical pathological staging of guideline issued by National Comprehensive Cancer Network, patients underwent postoperative chemotherapy within 1 year after surgery. Observation indicators: (1) treatment status; (2) postoperative pathological examination; (3) follow-up. Follow-up was conducted using outpatient examination, telephone interview and mail every 3 months within 1 year after surgery, every 6 months from 1 to 3 years after surgery, and once a year from 3 to 5 years after surgery up to March 2019. The postoperative tumor metastasis and survival of patients were obtained. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were described as M (range). Count data were expressed as absolute number. Survival rates were calculated using life-table method. Results (1) Treatment status: 85 patients underwent Da Vinci robot-assisted right hemicolon D3 + complete mesocolic excision successfully. The operation time, volume of intraoperative blood loss, time for postoperative out-of-bed activities, time to recovery of gastrointestinal function, time to liquid diet intake were (178±28)minutes, (85±33)mL, (2.9±1.8)days, (3.1± 2.7)days, (3.9±1.9)days, respectively. There was no perioperative death. Eleven patients had postoperative complications including 5 of anastomotic leakage, 2 of anastomotic bleeding, 2 of pulmonary infection, 1 of gastric emptying disorder and 1 of incomplete intestinal obstruction; they were cured and discharged after conservative treatment. All the 85 patients received postoperative infection prevention and total parenteral nutrition support, including 64 receiving systemic intravenous chemotherapy with 6-8 cycles of FOLFOX or XELOX, 7 receiving 6-8 cycles of oral capecitabine, and 14 receiving no chemotherapy. (2) Postoperative pathological examination: the number of harvested lymph nodes was 20±11 and 25 had lymph node metastasis. The length of proximal and distal cutting edge of the specimens was (16±5)cm and (9±5)cm, respectively. There was no cancerous cell on the cutting edge. High-differentiated adenocarcinoma, moderate-differentiated adenocarcinoma, moderate-differentiated tubular adenocarcinoma, low-differentiated adenocarcinoma, mucinous adenocarcinoma, tubular combined with mucinous adenocarcinoma were detected in 2, 40, 14, 16, 9, 4 patients, respectively. There were 8, 28, 24, 5, 12, 8 patients inⅠstage, ⅡA stage, ⅡB stage, ⅡC stage, ⅢB stage, ⅢC stage of TNM staging, respectively. (3) Follow-up: 85 patients were followed up for 1-67 months, with a median follow-up time of 19 months. During the follow-up, 1 of 85 patients had liver metastasis at 14 months after surgery and had survived after radiofrequency ablation treatment up to the end of follow-up. Three cases died of abdominal tumor metastases, 1 of which inⅡC stage died at 32 months after surgery, 1 in ⅢB stage died at 4 months after surgery and 1 in ⅢB stage died at 16 months after surgery. The 1-, 3-year overall survival rates were 97.1% and 94.0%, respectively. Conclusion Da Vinci robot-assisted radical resection of right colon cancer is safe and feasible, with good short- and long-term outcomes. Key words: Colon neoplasms; Right colon cancer; Right hemicolectomy; Da Vinci robotic surgical system; Prognosis

Clinical efficacy of Da Vinci robot-assisted radical gastrectomy for gastric cancer

Objective To explore the clinical efficacy of Da Vinci robot-assisted radical gastrectomy for gastric cancer. Methods The retrospective cohort study was conducted. The clinicopathological data of 472 patients who underwent radical gastrectomy for gastric cancer in the 940 Hospital of the People′s Liberation Joint Service from June 2016 to June 2018 were collected. There were 372 males and 100 females, aged (57±11)years, with a range from 17 to 85 years. Patients underwent gastrointestinal angiography, magnetic resonance imaging, computed tomography or gastrointestinal endoscopy before surgery, and were diagnosed with gastric cancer by biopsy. Of the 472 patients, 241 underwent Da Vinci robot-assisted radical gastrectomy for gastric cancer were allocated into robotic group and 231 underwent laparoscopy-assisted radical gastrectomy were allocated into laparoscopic group. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up and survival. Follow-up using outpatient examination and telephone interview was performed to detect the tumor recurrence and metastasis and survival of patients up to January 30, 2019. Measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were described as M (range). Count data were described as absolute number or percentage, and the chi-square test was used for comparison between groups. Comparison of ordinal data was done using the rank-sum test. The accumulative survival rate, tumor-bearing survival rate and mortality of tumor recurrence were calculated by the Kaplan-Meier method, and Log-rank test was used for survival analysis. Results (1) Surgical situations: 472 patients underwent successful operation, with R0 margin. Cases with total gastrectomy + D2 lymph node dissection + Roux-en-Y anastomosis, cases with distal subtotal gastrectomy + D2 lymph node dissection + Billroth Ⅱ anastomosis, operation time, upper margin distance, lower margin distance, tumor diameter, cases with shallow muscular invasion, deep muscular invasion, subserosal invasion and serosal invasion (depth of tumor invasion)were 107, 134, (234±44)minutes, (4±3)cm, (6±4)cm, (5 ±3)cm, 8, 17, 32, 184 in the robotic group, and 94, 137, (239±46)minutes, (4±3)cm, (6±4) cm, (5±3)cm, 7, 19, 30, 175 in the laparoscopic group, respectively; there was no significant difference in above indicators between the two groups (χ2=0.200, 2.459, t=-1.212, -1.074, -0.420, -1.236, Z=0.171, P>0.05). The volume of intraoperative blood loss, number of lymph nodes dissected in total gastrectomy, number of lymph nodes dissected in distal subtotal gastrectomy were (126±113)mL, 45±14, and 36±18 in the robotic group, and (149±132) mL, 39±14, 30±16 in the laparoscopic group, showing statistically significant differences between the two groups (t=-2.093, 3.275, 2.195, P 0.05). Eighteen out of 472 patients had complications. There were 3 cases of anastomotic leakage in the robotic group, 2 cases of gastroplegia, 1 case of duodenal stump, and 1 case of pulmonary infection, with a incidence of postoperative complication as 2.90%(7/241). There were 4 cases of anastomotic leakage in the laparoscopic group, 1 case of gastroplegia, 1 case of duodenal stump, and 3 cases of pulmonary infection, with a incidence of postoperative complication as 3.90%(9/231). There was no statistically significant difference in the incidence of postoperative complication between the two groups (χ2=1.503, P>0.05). Patients with digestive tract fistula were re-explored and performed continuous flushing-negative pressure aspiration and nutritional support treatment, and then discharged after improvement. Patients with gastroplegia and lung infection were discharged after corresponding conservative treatment. (3) Follow-up and survival: 404 out of 472 patients were followed up for 7-31 months, with a median follow-up time of 19 months, including 212 in the robotic group and 192 in the laparoscopic group. The 3-year survival rates were 96.70% and 91.67% in the robotic group and laparoscopic group, with no statistically significant difference between the two groups (χ2=1.037, P>0.05). During the follow-up, the tumor-bearing survival rate and mortality of tumor recurrence of the robotic group were 0.47% and 2.36%, respectively, versus 1.04% and 6.77% of the laparoscopic group, with statistically significant differences between the two groups (χ2=3.198, 4.208, P<0.05). Conclusion The Da Vinci robot-assisted radical gastrectomy for gastric cancer is safe and effective, which can reduce volume of intraoperative blood loss, shorten the postoperative recovery time, increase the number of lymph node dissection, however, it will increase the treatment expense. Key words: Gastric neoplasms; Gastric cancer; Radical gastrectomy; Efficacy; Economy; Da Vinci robotic surgical system; Laparoscopy

Parallel and sequential structures of manipulators in robotic surgery

The problems of modern robotics associated with the requirements for devices designed for various purposes are considered. The daVinci robotic surgical manipulation system is analyzed. The developed robotic system with a parallel structure designed for various kinds of surgical operations is proposed.

Clinical efficacy of Da Vinci robot-assisted iliofemoral vein bypass grafting

Objective To explore the clinical efficacy of Da Vinci robot-assisted iliofemoral vein bypass grafting. Methods The retrospective descriptive study was conducted. The clinical data of one 66-year-old male patient who underwent Da Vinci robot-assisted iliofemoral vein bypass grafting in the First Affiliated Hospital of Army Military Medical University in March 2019 were collected. The patient was failed to recanalize iliofemoral vein stent thrombosis by endovascular measures and underwent Da Vinci robot-assisted iliofemoral vein bypass grafting after balloon occlusion preset in the common iliac vein. Observation indicators: (1) intra- and post-operative situations; (2) follow-up and survival situations. Follow-up using outpatient examination was performed to detect the patient′s postoperative survival and swelling reduction of affected extremity up to April 2019. Results (1) Intra- and post-operative situations: the patient underwent Da Vinci robot-assisted iliofemoral vein bypass grafting successfully. The operation time of balloon occlusion preset by digital subtraction angiography was 35 minutes. The operation time of Da Vinci robot-assisted iliofemoral vein bypass grafting was 502 minutes (50 minutes of exposure time of femoral vein, 80 minutes of exposure time of iliac vein, 40 minutes of great saphenous vein harvesting time, 70 minutes of end to side anastomosis between autogenous great saphenous vein and femoral vein, 10 minutes of subcutaneous tunnel construction, 90 minutes of end to side anastomosis between autogenous great saphenous vein and iliac vein, 60 minutes of suturing except vessel closure, 102 minutes of preparation time, check and washing time). The volume of intraoperative blood loss was 500 mL and no intraoperative complications occurred. The autogenous great saphenous vein graft was well filled and no bleeding was found at both proximal and distal anastomoses after iliofemoral vein bypass grafting. There were 4 abdominal Trocar holes including 2 of 1.2 cm and 2 of 0.8 cm. The incisional length of right groin and left great saphenous vein harvesting region was 5.0 cm and 15.0 cm, respectively. At the discharge time, the patient had swelling subsided partially at right lower extremity and skin tesion reduced significantly compared with the admission. The perimeters at 15 cm above right knee joint and left knee joint were 53.5 cm and 48.0 cm. The maximum perimeters of right calf and left calf were 41.0 cm and 38.0 cm. No postoperative complications occurred. Duration of hospital stay after surgery was 3 days. (2) Follow-up and survival situations: the patient was followed up for 1 month, with good survival. The patient had swelling subsided of affected extremity. The perimeters at 15 cm above right and left knee joint were 52.0 cm and 48.0 cm. The maximum perimeters of right calf and left calf were 40.0 cm and 38.0 cm. Conclusion The Da Vinci robot-assisted iliofemoral vein bypass grafting is safe and feasible, with good short-term outcomes. Key words: Vein thrombus; Da Vinci robotic surgical system; Vein; Bypass grafting; Minimally invasive surgery

Efficacy analysis of Da Vinci robotic and laparoscopic distal gastrectomy for gastric cancer using propensity score matching

Objective To investigate the clinical efficacy of Da Vinci robotic and laparoscopic distal gastrectomy for gastric cancer. Methods The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 171 patients with gastric cancer who were admitted to the First Affiliated Hospital of Nanchang University from January 2015 to October 2016 were collected. There were 110 males and 61 females, aged from 38 to 81 years, with a median age of 57 years. Of 171 patients, 70 undergoing Da Vinci robotic distal gastrectomy for gastric cancer and 101 undergoing laparoscopic distal gastrectomy were allocated into the robotic group and laparoscopic group, respectively. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after the propensity score matching; (2) intraoperative and postoperative situations; (3) situations of pathological examination; (4) follow-up. Patients were followed up by outpatient examination and telephone interview to detect severe complications and survival after discharge up to October 2018. The overall survival time was from the operation data to end of follow-up or time of death. The propensity score matching was used to perform 1∶1 matching by Empower Stats. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using the Mann-Whitney U test. Count data were represented as absolute number, and comparison between groups was analyzed using the chi-square test and comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. The survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method, and Log-rank test was used for survival analysis. Results (1) The propensity score matching conditions and comparison of general data between the two groups after the propensity score matching: 124 of 171 patients had successful matching, including 62 in each group. The body mass index (BMI) and tumor diameter before matching were (24.2±2.4)kg/m2 and (50±13)mm in the robotic group, (25.1±2.1)kg/m2 and (45±14)mm in the laparoscopic group, showing statistically significant differences between the two groups (t=-2.676, 2.045, P 0.05). (2) Intraoperative and postoperative situations: the total operation time, volume of intraoperative blood loss, level of C-reactive protein at day 1 postoperatively, level of C-reactive protein at day 3 postoperatively, volume of totally abdominal drainage were (147±13)minutes, (115±12)mL, (52.2±7.2)mg/L, (33.7±11.9)mg/L, 353.5 mL (range, 267.0-1 350.0 mL) in the robotic group, and (140±12)minutes, (131±12)mL, (58.2±7.4)mg/L, (41.1±16.9)mg/L, 397.0 mL (range, 255.0-1 600.0 mL) in the laparoscopic group, respectively, showing statistically significant differences in the above indexes between the two groups (t=3.163, -7.814, -4.631, -2.840, Z=-4.351, P 0.05). Conclusions Compared with laparoscopic surgery, Da Vinci robotic distal gastrectomy for gastric cancer has advantages in postoperative recovery and minimally invasion. There are similar 2-year overall survival rates in the two groups. Key words: Gastric neoplasms; Gastric cancer; Da Vinci robotic surgery system; Laparoscopy; Propensity score matching; Clinical efficacy

Problems and strategies in the Da Vinci robotic surgery for gastric cancer

Da Vinci robotic surgery for gastric cancer has been performed and accepted gradually in domestic and abroad, due to the advantages of defibrillation, three dimensional (3D) view and flexible, precise, stable operation. However, its indication is controversy, surgical process, lymphadenectomy, digestive reconstruction need to be further regulated. There is lack of prospective case-control study of large sample on short and long term efficacy. Therefore, problems and strategies in the Da Vinci robotic surgery for gastric cancer should be analyzed and evidence-based researches should be strengthened to provide tangible and credible evidence for the Da Vinci robotic surgery for gastric cancer. Key words: Gastric neoplasms; Gastric cancer; Laparoscopy; Da Vinci robotic surgical system; Radical gastrectomy