Da Vinci Surgical Research Articles

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.

A comparative study of robot BABA path and traditional surgery for thyroid cancer with hyperthyroidism

Objective To evaluate the safety and feasibility of Da Vinci robot in the treatment of thyroid cancer with hyperthyroidism via bilateral axillo-breast approach (BABA). Methods The clinical data of 21 patients with thyroid cancer complicated with hyperthyroidism who received thyroidectomy + central lymph node dissection and(or)neck lymph node dissection using the Da Vinci through axillo-bilateral-breast approach in the thyroid and breast surgery of the 960th Hospital of the PLA Joint Logistics Support Force, from February 2014 to February 2019 were analyzed retrospectively. The clinical data of 21 patients were used as observation group, including 5 males and 16 females, aged (46.03±3.08) years. At the same period, 19 patients with the thyroid cancer complicated with hyperthyroidism who underwent traditional open surgery were selected as the control group, including 5 males and 14 females, aged (47.06±2.03) years. The t test, rank sum test, and χ2 test were used to compare the operation time, postoperative hospital stay, postoperative drainage volume, postoperative pain (VAS), cosmetic outcome satisfaction, and related surgical complications between the two groups. Results All the patients of the two groups completed the operation successfully. The operation time of the observation group was longer than that of the control group [(191.12±3.17) vs (145.37±6.37) min, P 0.05). There was no significant difference in Tg level and recurrence rate between the two groups (P>0.05). Conclusion Da Vinci robotic assisted treatment for thyroid cancer with hyperthyroidism is safe and feasible, which with good cosmetic and privacy protection effects. Key words: Robotics; Surgical procedures, operative; Thyroid neoplasms; Hyperthyroidism

Single-port robotic left colectomy: first clinical experience using the SP robot (rSILS).

The single-port daVinci robot is a new platform designed to facilitate single-incision surgeries. The objective of this study was to describe the first clinical experience in colorectal surgery using a novel single-port robotic system and report its feasibility and safety. After Institutional Review Board approval was obtained and the study was registered with ClinicalTrials.gov, we performed single port robot-assisted left colectomy using the novel daVinci SP surgical system on two patients. The surgeries were completed through a single incision. The multichannel port accommodates a three-dimensional articulating camera and three double-jointed articulating instruments. The primary aim of this study was to report, for the first time in the USA, the technical feasibility of the procedure in the living human. The secondary aim was to report the outcomes including blood loss, number of incisions, number of dockings, docking time of the robot, incision length, operative time, console time, need for additional port and instrumentation, intraoperative complications, morbidity and mortality, time for tolerating diet, bowel function, and discharge. Both surgeries were completed without conversion through a single incision, 4.0 and 4.5cm in size. Estimated blood loss was less than 60ml in both cases. The robot was docked two and three times. Mean time to dock was 13min (range 3-33min). There were no intraoperative complications, no morbidity or death. Discharges occurred on postoperative days 2 and 3. Single-port robotic colectomy using the new robot is feasible and can be safely completed. The overall utility and functionality of the SP robot portends wide utilization and expansion of this technique. Careful development and analysis of the procedure outcomes, training, and cost will be necessary to properly advance the field.

Partial Cystectomy for Deeply Infiltrating Endometriosis of the Bladder with Cystotomy Repair

Video Objective To demonstrate safe surgical technique and management of partial bladder cystectomy and simple cystotomy repair due to deeply infiltrating endometriosis (DIE) using the Xi DaVinci robot. Setting A 32yo patient with dysmenorrhea and dyspareunia found to have DIE of the bladder undergoing surgical management at a large academic center. Interventions The bladder lesion was initially found on preoperative MRI and confirmed during robotic assisted surgery. The lesion was felt to be full thickness and required partial bladder cystectomy for adequate excision of the implant. The DaVinci robot was used to remove the lesion with good margins. The resulting cystotomy repair was repaired, with good seal noted when the bladder was backfilled and on cystoscopy. A foley catheter was maintained for 7 days postoperatively and removed after a cystogram showing adequate bladder recovery. Conclusion Deeply infiltrating endometriosis of the bladder is rare but can be safely managed with laparoscopic partial bladder cystectomy and cystotomy repair. Adequate preoperative planning and thorough inspection of the lesion during surgery can assist with full removal of the lesion, which improves patient symptoms and decreases incidence of recurrence.

Robotic Roux-en-Y Gastric Bypass as a Revisional Bariatric Procedure: a Single-Center Prospective Cohort Study

Roux-en-Y gastric bypass (RYGB) is the procedure of choice to manage the failure of primary bariatric surgery. However, the current evidence on the role of the robotic technology in revisional bariatric surgery is very limited. The aim of this study is to report safety and effectiveness of revisional RYGB performed with the DaVinci Robotic Surgical System (R-rRYGB) after failed primary bariatric surgery. Clinical data of consecutive patients undergoing R-rRYGB were included in a prospectively collected database. Intraoperative findings, early postoperative outcomes, and 1-year follow-up results were considered. Primary outcome was postoperative morbidity rate. Secondary outcomes were conversion to open surgery, length of stay, percentage of excess weight loss (%EWL), resolution of complications, and costs. A total of 68 patients underwent R-rRYGB at our department from 2011 to 2016. Primary procedures were laparoscopic adjustable gastric banding (n = 10), vertical banded gastroplasty (n = 43), and sleeve gastrectomy (n = 15). Conversion rate to open surgery was 2.9%. Postoperative morbidity rate was 8.8%, with no anastomotic leaks reported. Total cost for surgical procedure was 14,334.7 ± 2920.4 €. Revisional RYGB is a complex procedure but can be performed with the robotic approach with a low morbidity rate. Weight loss outcomes and resolution of complications of the index procedure are satisfactory.

Formulation and Solution of the Problem of the Positions of a Mechanism with a Parallel–Series Structure Used in Surgery as an Alternative to the DA VINCI Robot

This article provides analysis of a robot-assisted system, an alternative to the da Vinci system. The diagram of the developed mechanism with a parallel–series structure is provided. The problem of the positions has been solved.

Da Vinci robot assistance surgical coordination for the resection of azygous vein aneurysm: a case report

Objective Summary of a patient who was diagnosed as an azygous vein aneurysm during Da Vinci robotic surgery, which continue to complete surgical resection of varicose veins by Da Vinci robot assistance. Methods After the patient is diagnosed as the azygos vein aneurysm during the operation, the emergency plan is started immediately, and the nursing cooperation is determined according to the operative coordination of the main problems during the operation. Results With the close cooperation of the medical team, an azygous vein aneurysm with a size of approximately 5 cm×4 cm×3 cm was successfully removed with the Da Vinci robot assistance, no complications occurred after surgery, and good recovery occurred, the patient was discharged on the fourth postoperative day. Conclusions It is essential to make corresponding emergency plan and exercise for Da Vinci robot operation, and to start contingency plan immediately when needed, which is an important guarantee to continue to complete misdiagnosis surgery under the aid of Da Vinci robot. Key words: Azygous vein aneurysm; Mediastinal mass; Da Vinci robot; Contingency plan

Short-term effect analysis of Da Vinci robotic surgical system-assisted and laparoscopy-assisted operations for gastrointestinal stromal tumor

Objective To compare the short-term clinical effects of Da Vinci robotic surgical system-assisted and laparoscopy-assisted operations for gastrointestinal stromal tumor (GIST). Methods The retrospective cohort study was conducted. The clinical data of 98 patients with GIST who were admitted to the Lanzhou General Hospital of Chinese People′s Liberation Army from June 2016 to May 2018 were collected. Of 98 patients, 45 undergoing Da Vinci robotic surgical system-assisted surgery for GIST and 53 undergoing laparoscopy-assisted surgery for GIST were respectively allocated into the robotic group and laparoscopic group. The associate senior and above doctors performed the surgery. The wedge resection was applied to patients with diameter of gastric stromal tumor 5 cm or tumor located in the cardia and pylorus. Patients with intestinal stromal tumor underwent intestinal resection + end-to-side anastomosis. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence or metastasis up to July 2018. Measurement data with normal distribution were represented as ±s, and comparison between groups was done using the independent-sample t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using nonparametric test. Comparisons of count data were analyzed using chi-square test. Results (1) Surgical and postoperative situations: 98 patients underwent successful surgery. The operation time, volume of intraoperative blood loss, recovery time of gastrointestinal function, time of gastrointestinal decompression tube removal, time of abdominal drainage tube removal and duration of postoperative hospital stay were respectively (152±49)minutes, 100 mL (range, 10-300 mL), (2.6±0.6)days, (1.1±0.3)days, (5.7±1.2)days, (8.3±1.3)days in the robotic group and (201±62)minutes, 100 mL (range, 5-600 mL), (3.1±0.7)days, (2.1±1.5)days, (6.9±3.4)days, (11.6±7.0)days in the laparoscopic group, with statistically significant difference between groups (t=-3.983, Z=2.104, t=-3.776, -3.637, -2.018, -2.817, P<0.05). (2) Follow-up: 98 patients were followed up for 2-24 months, with a median time of 13 months. During the follow-up, there was no tumor recurrence or metastasis between groups. Conclusion Compared with laparoscopy-assisted surgery, Da Vinci robotic surgical system-assisted surgery for GIST is safe and feasible, with advantages of shorter operation time, faster postoperative recovery and shorter duration of hospital stay. Key words: Gastrointestinal stromal tumor; Surgical procedures, operative; Da Vinci robot; Laparoscopy; Efficacy

Nerve‐sparing in salvage robot‐assisted prostatectomy: surgical technique, oncological and functional outcomes at a single high‐volume institution

To show the feasibility, oncological and functional outcomes of neurovascular bundle (NVB) preservation during salvage robot-assisted radical prostatectomy (RARP). In the present institutional review board-approved retrospective analysis, between January 2008 and March 2016, 80 patients underwent salvage RARP, performed by a single surgeon (V.P), because of local recurrence after primary treatment. These patients were categorized into two groups depending on the degree of nerve-sparing (NS) performed: a good-NS group (≥50% of NVB preservation) and a poor-NS group (<50% of NVB preservation). A standard transperitoneal six-port technique, using the DaVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), was performed, and either an anterograde or a retrograde approach was used for NVB preservation. Validated questionnaires were used preoperatively (Sexual Health Inventory for Men [SHIM] and American Urological Association scores). Potency after salvage RARP was defined as the ability to achieve a successful erection with penetration >50% of the time, while full continence after salvage RARPwas defined as 0 pads used. The Kaplan-Meier method was used for survival and predictive estimations, and regression models were used to identify the predictors of potency, continence and biochemical failure (BCF). The potency rate at 12months was higher in the good-NS group (25.6% vs 4.3%; P = 0.036) regardless of previous SHIM score, and good NS tended to be predictive of potency after salvage RARP (P = 0.065). The full continence rate at 12months and BCF rate were similar in the two groups, and non-radiation primary treatment was the only predictor of continence at 12months after salvage RARP (P = 0.033). Our data support the feasibility and safety of NVB preservation for salvage RARP conducted in select patients in a high-volume institution and the subsequent better recovery of adequate erections for intercourse.

Robot-assisted laparoscopic resection of clinical T4b tumours of distal sigmoid and rectum: initial results.

Radical resection by multivisceral resection of colorectal T4 tumours is important to reduce local recurrence and improve survival. Oncological safety of laparoscopic resection of T4 tumours is controversial. However, robot-assisted resections might have advantages, such as 3D view and greater range of motion of instruments. The aim of this study is to evaluate the initial results of robot-assisted resection of T4 rectal and distal sigmoid tumours. This is a cohort study of a prospectively kept database of all robot-assisted rectal and sigmoid resections between 2012 and 2017. Patients who underwent a multivisceral resection for tumours appearing as T4 cancer during surgery were included. Rectal and sigmoid resections are routinely performed with the DaVinci robot, unless an indication for intra-operative radiotherapy exists. 28 patients with suspected T4 rectal or sigmoid cancer were included. Most patients (78%) were treated with neoadjuvant chemoradiotherapy (n = 19), short course radiotherapy with long waiting interval (n = 2) or chemotherapy (n = 1). En bloc resection was performed with the complete or part of the invaded organ (prostate, vesicles, bladder, abdominal wall, presacral fascia, vagina, uterus, adnex). In 3 patients (11%), the procedure was converted to laparotomy. Twenty-four R0-resections were performed (86%) and four R1-resections (14%). Median length of surgery was 274min (IQR 222-354). Median length of stay was 6 days (IQR 5-11). Twelve patients (43%) had postoperative complications: eight (29%) minor complications and four (14%) major complications. There was no postoperative mortality. Robot-assisted laparoscopy seems to be a feasible option for the resection of clinical T4 cancer of the distal sigmoid and rectum in selected cases. Radical resections can be achieved in the majority of cases. Therefore, T4 tumours should not be regarded as a strict contraindication for robot-assisted surgery.

Research progress of the robot-assisted ophthalmology surgery

Surgical robots have the advantages of high precision, high flexibility, high repeatability, and merging with minimally invasive surgery to solve the shortcomings of traditional minimally invasive surgery, and gradually into all fields of medicine.Foreign scholars have extensive research on medical surgical robots.Currently, Da Vinci surgical robots are the most widely used and most mature surgical robot system.Although our scholars started later, they also successfully developed a corneal transplant robot, MiaoShou-A robot, robotic vitreoretinal microsurgery system and so on.At present, Robot-assisted surgery are widely used in various medical fields, which has also been used in ophthalmology.Robot-assisted surgery can reduce the physiological tremor of the surgeon; improve surgical stability and accuracy; shorten the learning curve and so on.At present, Da Vinci surgical robots can perfectly complete the ocular surface surgery such as suturing of the corneal laceration, corneal whole-layer transplantation, amniotic membrane transplantation and pterygium excision.The corneal transplantation microsurgery robot developed by our country can also complete corneal looping incision and suturing of the corneal.As Da Vinci surgical robots have some limitations and can't be well used in complex intraocular surgery such as vitreoretinal surgery.Handheld robot system, steady-hand robot system, master-slave robot system and various kinds of robots based on these systems are used in intraocular surgery.The pars plana vitrectomy(PPV), retinal foreign body Removal, retinal vascular sheath sclerosis, retinal vascular cannulation had successfully performed in harvested porcine eyes and endolaser for retinal photocoagulation was done in Irish rabbit.It offers the possibility for future intraocular surgery with robot-assisted.At the same time, wider application research of robotic surgery and improvement of a robotic system should be continued. Key words: Robot; Ophthalmology; Research progress

Application of the whole process quality control in the Da Vinci surgical instruments cleaning

Objective To explore the application effect of the whole process quality control on the Da Vinci surgical instruments cleaning. Methods Using objective sampling method, 312 Da Vinci surgical instruments handled from July 2016 to September 2016 were selected as the control group, while 513 instruments handled from October 2016 to December 2016 were recruited into the observation group. The control group used routine cleaning and sterilization method. Meanwhile, the observation group received the whole process quality control. The rate of re-cleaning for Da Vinci surgical instruments were compared between two groups. Results The rate of re-cleaning for Da Vinci surgical instruments was 3.8% in the control group, which was higher than that (1.8%) in the observation group. The difference between two groups was statistically significant (χ2=3.423, P<0.05) . Conclusions The application of the whole process quality control on the Da Vinci surgical instruments cleaning can improve the service quality of central sterile supply and guarantee the smooth process of Da Vinci-assisted surgery. Key words: Robotics; Da Vinci; Whole process quality control; Cleaning quality

Preliminary experience in laparoscopic resection of hepatic hydatidectocyst with the Da Vinci Surgical System (DVSS): a case report

BackgroundAt present, Da Vinci robotic assisted hepatectomy has been routinely carried out in conditional units. But there is no report concerning the use of Da Vinci robots for hepatic hydatid cystectomy and experience on this aspect is seldom mentioned before. This study was to summarize the preliminary experience in laparoscopic resection of hepatic hydatidectocyst with the Da Vinci Surgical System (DVSS).Case presentationA 29-year-old female diagnosed as hepatic hydatid in the right anterior lobe of liver was treated with laparoscopic resection by the DVSS under general anesthesia. Appropriate disposal of tumor cell in vascular system and disinfection of surgical field with hypertonic saline were conducted. The hepatic hydatidectocyst was resected completely with an operation time of 130 min, an intraoperative blood loss of 200 ml and a length of hospital stay for five days. The vital signs of patient were stable and no cyst fluid allergy occurred after operation.ConclusionsOur result showed that laparoscopic resection of hepatic hydatidectocyst by using the DVSS is safe and feasible on the basis of hospitals have rich experience in treatment of cystic echinococcosisliver, resection with DVSS and laparoscopic excision.

Clinical efficacy of transanal specimen extraction in modified Da Vinci robot-assisted anterior resection of rectosigmoid tumor

Objective To explore the clinical efficacy of transanal specimen extraction in modified Da Vinci robot-assisted anterior resection of rectosigmoid tumor. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 47 patients who underwent Da Vinci robot-assisted anterior resection of rectosigmoid tumor using transanal specimen extraction in the Second Xiangya Hospital of Central South University from March to October 2016 were collected. Excisional intestinal canal was intraoperatively taken out from the anus instead of abdominal minor incision. Observation indicators: (1) operation and postoperative recovery; (2) postoperative pathological examination situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients and tumor recurrence or metastasis up to June 2017. Measurement data with normal distribution were represented as ±s. Results (1) Operation and postoperative recovery: 47 patients underwent successful operations, without conversion to open surgery. Of 47 patients, 8 underwent coloanal ultralow anastomosis, 3 underwent prophylactic terminal ileum stoma fistulization and 1 underwent intersphincteric resection after turning inside out resectable specimen. Operation time, volume of intraoperative blood loss, time for out-of-bed activity, time to anal exsufflation and time of postoperative drainage-tube removal were (222±73)minutes, (21±9)mL, (1.7±0.8)days, (2.3±1.0)days and (6±5)days, respectively. Among 3 patients with postoperative complications, 2 with anastomotic fistula were cured by conservative treatment, and 1 with urinary retention removed urethra catheter at 4 weeks postoperatively. All the 47 patients had good recovery, and duration of hospital stay was (10±4)days. (2) Postoperative pathological examination situations: number of lymph node dissected was 15±7, with R0 resection. Tumor pathological diagnosis: rectosigmoid adenocarcinoma was detected in 38 patients (1 with high-differentiated tumor, 32 with moderate-differentiated tumor and 5 with low-differentiated tumor), mixed carcinoma in 4 patients, tubulovillous adenoma in 2 patients, mucinous adenocarcinoma in 1 patient, neuroendocrine carcinoma in 1 patient and focal carcinoma in 1 patient. The maximum diameter of tumor was (3.5±1.5)cm. Postoperative pathological T stage: 4, 9, 18 and 14 patients were detected in stage T1, T2, T3 and T4a. Postoperative pathological N stage: 30, 8 and 7 patients were detected in stage N0, N1 and N2. Postoperative pathological TNM stage: stage Ⅰ, Ⅱ and Ⅲ were respectively in 11, 19 and 15 patients. There was no clinical stage in 2 patients with tubulovillous adenoma. (3) Follow-up: of 47 patients, 42 were followed up for 7-15 months, with a median time of 11 months. During the follow-up, 38 patients had tumor-free survival, 3 had tumor recurrence or metastases and 1 died. Conclusion Transanal specimen extraction is safe and feasible in modified Da Vinci robot-assisted anterior resection of rectosigmoid tumor, with minimal invasion and satisfactory short-term outcomes. Key words: Colorectal neoplasms; Da Vinci robot surgical system; Radical resection; Transanal; Specimen

Robotic paraesophageal hernia repair: a single-center experience and systematic review

Robotic Surgery is becoming increasingly used in general surgery. The objective of this study is to evaluate the safety, effectiveness and short-term (less than 1year) outcomes of Robotic Paraesophageal Hernia (RPEH) Surgery using the DaVinci Surgical Robot system (Intuitive Surgical, CA) in a large community hospital. This is a retrospective cohort study of 28 consecutive patients who underwent robotic paraesophageal hernia repair January 2011-March 2013 in this institution. Data and outcomes collected for analysis include patient demographics, operating times, conversion, complications, mortality and recurrence. The mean age of the patients was 68.7+/-12.7years, 82% were females and the mean BMI was 29+/-6.3. The mean operative time, including the robot docking time, was 83.6+24min. The average length of hospital stay (LOS) was 2.8+/-1.9days. There were no conversions to open or laparoscopic procedures. Postoperative complications were noted in 3 patients (10.7%), including one mortality (3.4%). One symptomatic recurrence (3.4%) was noted during the 12-month follow-up period. Robotic Paraesophageal repair is a safe (similar rate of complication and mortality to literature for laparoscopic procedure) and an effective (paraeshopageal hernia repaired without high recurrence) procedure with acceptable complication rates even in older patients with high operative risks.

MP51-19 MULTI-COMPONENT VIDEO-BASED FEEDBACK USING ADDITIONAL WEBCAM INPUTS IMPROVES DAVINCI SURGICAL SKILLS SIMULATOR (DVSSS) PERFORMANCE

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment I1 Apr 2017MP51-19 MULTI-COMPONENT VIDEO-BASED FEEDBACK USING ADDITIONAL WEBCAM INPUTS IMPROVES DAVINCI SURGICAL SKILLS SIMULATOR (DVSSS) PERFORMANCE Scott Quarrier, Aisha Siebert, and Ahmed Ghazi Scott QuarrierScott Quarrier More articles by this author , Aisha SiebertAisha Siebert More articles by this author , and Ahmed GhaziAhmed Ghazi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1628AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ergonomics is the study of the efficient movement in working environments. The da Vinci operating system is unique in that it consists of a separate human-machine interface at the operating console including master controls, camera pedal, and clutch. However, current robotic training approaches lack the ability to deliver specific feedback addressing each component. We demonstrate the use of additional web-camera inputs, offering multi-component summative feedback to improve virtual reality (VR) daVinci surgical skills simulator (DVSSS) training. METHODS 18 medical students were enrolled in a study on a VR DaVinic surgical skills curriculum. They were randomized into three groups: Group A (n=6, control), no performance feedback; Group B (n=6, standard formative expert feedback), Group C (n=6, summative expert feedback using multicomponent video feedback of the VR task + webcam feedback of master controls and foot pedal). Each trainee completed each task six times. 4 tasks (Peg Board 2, Camera targeting 2, Ring walk 3 & Suture sponge 3) were chosen. Simulator-measured performance metrics included differences in total score, time and economy of motion over the five trials. Data were analyzed using SPSS version 15. RESULTS A learning curve was observed across the five trials in all groups. A significant difference was seen between the three groups for change in overall score across the five trials. Ergonomic metric assessment showed that Groups B and C performed better than Group A (P .002 and P .000, respectively) and that the multicomponent feedback was more effective in tasks involving the use of multiple controls (Camera targeting & Ring walk). CONCLUSIONS Multi-component summative feedback (combination of task, master control, and camera pedal) is effective in significantly shortening the learning curve in the robotic training process, especially in complex tasks. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e701-e702 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Scott Quarrier More articles by this author Aisha Siebert More articles by this author Ahmed Ghazi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Laparobotic Duodenal Diverticulectomy: A Case Series and Operative Technique

Objective: Duodenal diverticulum is not uncommon but most are asymptomatic. Surgery is recommended only for the patients with symptoms. Although laparoscopic diverticulectomy can be done, it is often with significant difficulties due to inherent limitations of the laparoscopic technique and posterior location of the lesion. The advent of the robotic surgical technology with superior imaging and instrumentation may provide an alternative minimally invasive approach for this situation. We herein report our case series utilizing the daVinci Surgical System (dVSS) for duodenal diverticulectomy. Methods: We retrospectively reviewed our robotic database for all duodenal procedures performed at a single institution (the Valley Hospital: VH). Only patients who underwent laparobotic duodenal diverticulectomy (LRDD) were included and their recorded videos reviewed. Data analyzed were patients’ demographic, perioperative outcomes, and technical details. We used the daVinci Si (Intuitive Surgical Inc. Sunny Vale, Calif.) for all cases. Results: 4 female patients underwent LRDD. All presented with abdominal pain. Diagnosis was made by CT scans or MRI with or without EGD. 3 patients had diverticula located in the second part of the duodenum (75%). Concomitant procedures (choledochoduodenostomy and CBD exploration) were performed in two patients. Mean operative time was 142.5 min. There was one complication but no mortality. Average length of stay was 4 days. Conclusion: LRDD is feasible, efficient, and safe. The dVSS provides the surgeon improved visualization and enhanced dexterity to perform complex procedure.

Detection and Localization of Robotic Tools in Robot-Assisted Surgery Videos Using Deep Neural Networks for Region Proposal and Detection.

Video understanding of robot-assisted surgery (RAS) videos is an active research area. Modeling the gestures and skill level of surgeons presents an interesting problem. The insights drawn may be applied in effective skill acquisition, objective skill assessment, real-time feedback, and human-robot collaborative surgeries. We propose a solution to the tool detection and localization open problem in RAS video understanding, using a strictly computer vision approach and the recent advances of deep learning. We propose an architecture using multimodal convolutional neural networks for fast detection and localization of tools in RAS videos. To the best of our knowledge, this approach will be the first to incorporate deep neural networks for tool detection and localization in RAS videos. Our architecture applies a region proposal network (RPN) and a multimodal two stream convolutional network for object detection to jointly predict objectness and localization on a fusion of image and temporal motion cues. Our results with an average precision of 91% and a mean computation time of 0.1 s per test frame detection indicate that our study is superior to conventionally used methods for medical imaging while also emphasizing the benefits of using RPN for precision and efficiency. We also introduce a new data set, ATLAS Dione, for RAS video understanding. Our data set provides video data of ten surgeons from Roswell Park Cancer Institute, Buffalo, NY, USA, performing six different surgical tasks on the daVinci Surgical System (dVSS) with annotations of robotic tools per frame.

P1.08-049 CT Guided Labeling with Indocyanine Green of Small Lung Nodules for Sublobar Resection Utilizing Robotic Assisted Thorascopic Surgery (RATS)

Localization of deep and small pulmonary lung nodules undergoing a wedge or sublobar resection may be challenging during thoracoscopy, and may necessitate greater resection or conversion to thoracotomy. Particularly in robotic surgery, with the absence of tactile feedback. Percutaneous CT guided Indocyanine Green injection provides a means to pinpoint these nodules. A retrospective study of 40 consecutive patients who underwent preoperative CT-guided localization of solitary pulmonary nodules with ICG. Nodules ≤ 15mm were 21/40 (52.5%), ≤ 20mm 30/40 (75%), and ≤ 30mm 38/40 (95%). A 22-gauge spinal needle (BD, NJ) or Chiba needle (Cook, IA) was positioned into or adjacent to the nodule. 0.4cc Indocyanine Green was injected and the inner stylet withdrawn. The Xi daVinci robot (Intuitive Surgery, CA) was docked and the firefly filter of the 8mm camera was activated, and the nodule illuminates in a fluorescence green color. A wedge or sublobar resection was performed, with progression to lobectomy when indicated. CT guidance successfully localized the nodules in 100% of 40 patients employing this technique. Success was measured in nodule illumination as seen by the surgeon upon activation of the camera filter and confirmed on frozen and permanent section by pathology. Initial wedge resection for diagnosis prior to lobectomy and sublobar resection for decreased PFTs or decrease cardiac function were performed by Robotic Assisted Thoracoscopy (RATS). There were no conversions to thoracotomy. Diagnosis were adenocarcinoma in 18 patients (45%), squamous cell carcinoma in 7 patients (17.5%), carcinoid in 1 patient (2.5%), metastatic in 8 patients (20%), and benign in 6 patients (15%). There were no 30 or 90 day mortalities. A chest tube reinsertion in one patient for pneumothorax. Economically the cost for the vial of ICG is $79.56 compared to a fiducil marker at a cost of $128.00. Thoracic Surgery has access to CT scanners, without an extra cost, electromagnetic navigation systems come with significant added costs. Percutaneous CT guided labeling with ICG is quick and economical for the localization of small and deep nodules undergoing RATS wedge or sublobar resection. This technique may be supportive in preserving lung parenchyma and reduce the need for conversion to thoracotomy, maintaining minimal invasive thoracic surgery, especially where palpation or tactile feedback is absent.

Robot Assisted Nephron Sparing Surgery in a L-Shaped Fused Ectopic Pelvic Kidney: Reproducibility of the Procedure and Technical Considerations

Crossed fused ectopia of the kidneys is a rare anomaly and tumours arising in them are rarer still. We report a case of a renal cell carcinoma arising in an L shaped crossed fused ectopic kidney in a 38 year old man for whom a robot assisted nephron sparing surgery was done. Our report highlights the importance of preoperative contrast enhanced computerized tomography (CECT) with arterial 3D reconstruction for preoperative surgical planning and the use of daVinci robot (Intuitive Surgical Inc., Sunnyvale, CA, USA) in performing the heminephrectomy with utmost precision. We have earlier reported the use of the robot for heminephrectomy in a patient with chromophobe renal cell carcinoma in a crossed fused ectopic kidney and this report highlights the technical aspects of the surgical procedure and establishes the reproducibility of the same.