Laparoscopic Platform Research Articles

Comparison of index and reoperative bowel resections in Crohn's disease.

There is a scarcity of literature describing outcomes of reoperative Crohn's disease. An in-depth knowledge of these outcomes is critical for managing patient expectations and optimal perioperative planning. We sought to examine outcomes in patients undergoing reoperative surgeries for Crohn's disease compared to index operations. A retrospective chart review of surgeries performed from 2018-2023 at a single tertiary care academic institution was performed. A subgroup analysis of index vs. reoperative ileocolic resections was performed to minimize confounding due to the heterogeneity of operations between the index and reoperative groups. Out of 119 patients, 70 (59%) underwent index operations, and 49 (41%) were reoperations. Overall complication rates (24.28% vs. 34.69%, P=0.224), EBL (189.5 vs. 193.4 mL, P=0.94), operative time (209 vs. 236 min, P=0.091), length of stay (mean: 7.24 vs. 10.08 days, P=0.0142), utilization of laparoscopy (92.85% vs. 65.3%, P=0.0002) and conversion to open technique (4.61% vs. 9.37%, P=0.392) favored index cases. The laparoscopic approach narrowed the gap in length of stay between the index and reoperative groups from 2.83 to 0.6 days. Subgroup analysis of ileocolic resections (Index: 50, reoperations: 26) also favored the index operations. The current study provides valuable insight into managing patient expectations and optimal perioperative planning for reoperative Crohn's disease. Reoperations were associated with longer stays, lower utilization of laparoscopic platforms, and a trend toward higher overall complication rates. Laparoscopy reduces the gap in length of stay between index and reoperations; however, it is associated with a higher reoperation conversion rate.

On-demand robotics—The best of both worlds for robotic-assisted laparoscopic surgery

A modular, combined use of robotic and laparoscopic platforms has been suggested to address challenges in optimal workspace utilization. The 3-arm on-demand open Dexter Robotic System was developed to combine the advantages of robot-assisted precision surgery in narrow spaces with the laparoscopic approach for frequent position changes in larger spaces. The system integrates 2 patient carts, a fully controllable endoscope arm, and a sterile surgeon open console, allowing for a rapid switch between robot-assisted surgery and laparoscopy. When switching, the robotic arms may be folded into a laparoscopic home position at any time during a procedure, allowing unrestricted access to the patient. Switches take 15–30 seconds, occurring seamlessly without redocking or recalibrating upon returning to the robotic mode. During oncologic colorectal resections, some procedure steps (eg, central vessel ligation and lymphadenectomy) are best suited for the robotic approach, providing advantages related to 3-dimensional vision, improved ergonomics, and improved dexterity within confined spaces. In contrast, the laparoscopic platform is better suited for procedure steps requiring frequent movements within a large workspace (eg, lateral to medial mobilization of the colon). The Dexter system provides a portfolio of 7 robotic instruments with monopolar and bipolar function operating with any existing available generator. Furthermore, existing operating room equipment, including insufflating devices, optics, and trocars can be used with the Dexter robotic platform. Recently, the first published clinical experience from the authors’ institution, involving 12 pilot cases, demonstrated the safety and feasibility for right colonic resections for benign and malignant indications and ventral mesh rectopexies.

Skill transference and learning curves in novice learners: a randomized comparison of robotic and laparoscopic platforms.

While well-established protocols direct laparoscopic training, there remains arelative paucity of guidelines for robotic education. Furthermore, it is unknown how exposure to one platform influences trainees' proficiency in the other. This study aimed to compare and quantify (1) learning curves and (2) transference of skill between the two modalities in novice learners. Thirty pre-clinical medical students were randomized into two groups. One group performed the peg-transfer task using the robot first, followed by laparoscopy, while the other group performed the same task laparoscopically first. Participants completed five repetitions with each methodology. Participants were timed and errors were recorded. We hypothesized that laparoscopic experience with the peg-transfer task would assist in completing the task robotically, and there would be a higher degree of skill transference from the laparoscopic to robotic platform. Peg-transfer task completion was consistently faster and more accurate with the robot compared to laparoscopy (p < 0.01). We observed a positive transference of skill from the laparoscopic to robotic platform. However, exposure to the robot-hindered students' ability to perform the task laparoscopically, evidenced by significantly increased time and errors when compared with baseline laparoscopic performance (p < 0.01). These findings encourage surgical residency programs to treat robotic and laparoscopic training as discrete entities and consider their unique learning curves and skill transference when designing an efficient curriculum. While these effects are observed in novices, future directions include uncovering the trends among resident trainees and practicing surgeons.

And then there was one … incision. First single-port pediatric robotic case series

In the past two decades, technology has advanced to augment an already minimally-invasive approach in laparoscopic surgery. Robotic-assisted laparoscopic platforms have now evolved to its 4th-generation product: a single-port system, first cleared through the FDA for urologic procedures last year. A single, 2.5cm incision allows for placement of a port that admits a fully-wristed camera as well as three fully-wristed instruments, all controlled by the surgeon at the console. We sought to document the feasibility of the single-port (SP) robotic platform in the first clinical series of pediatric patients, reporting use of this system for dismembered pyeloplasty and Mitrofanoff. Secondary aims were to report intraoperative details and perioperative outcomes. Seven patients underwent surgery using the da Vinci SP Surgical System (Intuitive Surgical, Sunnyvale, CA). Six patients, two girls and 4 boys, were diagnosed with ureteropelvic junction obstruction and underwent SP robotic-assisted dismembered pyeloplasty while one male patient with neurogenic bladder underwent SP robotic-assisted Mitrofanoff procedure. Patient's ages ranged from 22 months to 14 years. A 2.5-cm incision was made within the Pfannenstiel line in HIdES fashion for the pyeloplasties, while the previous gastrostomy tube site was used for the Mitrofanoff. Through this incision a 25-mm multichannel port was placed. The 12×10-mm articulating robotic camera and two 6-mm articulating robotic instruments were utilized. All surgeries were completed successfully through the single port without intraoperative complications, need for separate ports, or conversion. Median operative time was 120min, and all patients were dismissed in less than 24h, taking only acetaminophen and ibuprofen for pain control. There was no issue with instrumentation in older patients; however, shorter working distance in the 22-month-old pyeloplasty limited wristing of the instruments. We report the first cases utilizing the SP robotic platform in children. Despite their smaller size and limited workspace, we had no issues with instrument clashing or triangulation in older patients, completing the procedures in a similar timeframe as multiport robotic platforms. Use of the SP platform is not recommended if working distance will be<10cm from the end of the port as instrument movement is prohibitive. The HIdES approach of placing the port in the Pfannenstiel line gave additional working distance and kept the incision below the swimsuit line for excellent cosmesis (Figure1). Further study with additional cases will compare this approach with standard multiport robotics to analyze and compare operative data and outcomes.

Evaluation of laparoscopic skills in medical students.

To evaluate the laparoscopic skills of medical students and identify personal characteristics in terms of greater easiness in performing laparoscopic surgical procedures. This study included medical students in the 6th semester of a Medical School in Brazil who answered 10 questions concerning their habits and characteristics. A laparoscopic platform and an abdominal synthetic model were used to assess surgical skills comprising the three following surgical steps: to pass the needle through the trocar and to place it in the laparoscopic needle holder, to perform a laparoscopic simple stitch in synthetic liver parenchyma and, to perform a laparoscopic surgical knot. The duration of the activity was limited to four minutes and the procedure was monitored by a laparoscopic surgeon. The study included 50 students. Of these, 18% completed the three surgical stages. Steps 1 and 2 were completed by 94% and 88% of students, respectively. No statistically significant variables were found when characteristics of the groups with and without success in the three stages were compared. The group that finished the activity had a faster time completing step 2 than the group that failed (mean time of 115.3 seconds against 157.8 seconds, p=0.03). The minority of students could complete effectively all three surgical steps. No personal traits related to greater surgical skill were identified.

Increased cost burden associated with robot-assisted rectopexy: do patient outcomes justify increased expenditure?

Robot-assisted surgical techniques have flourished over the years, with refinement in instrumentation and optics allowing for adaptation and increasing utilization across surgical fields. Transabdominal rectopexy with mesh for rectal prolapse may stand to benefit significantly from the use of a robotic platform. However, increased operative times and immediate associated costs of robotic surgery may provide a counterargument to widespread adoption. To determine which approach to the treatment of rectal prolapse, laparoscopic or robotic, is more cost effective and provides better outcomes with fewer complications, a retrospective review was performed at a single tertiary care academic institution from May 2013 to December 2020. Twenty-two patients underwent transabdominal mesh rectopexy through a robot-assisted DaVinci platform (Intuitive Sunnyvale, CA), and thirty through a laparoscopic platform. Main outcome measures included operative, hospital, and total cost as defined by total charges billed. Secondary outcomes included rate of recurrence, intra-operative complications, median operative time, post-operative complications, average hospital length of stay, inpatient pain medication usage, and post-operative functional outcomes. Cost analysis for robot-assisted versus laparoscopic rectopexy demonstrated operating room costs of $46,118 ± $9329 for the robotic group, versus $33,090 ± $15,395 (p = 0.002) for the laparoscopic group. Inpatient hospital costs were $60,723 ± $20,170 vs. $40,798 ± $14,325 (p = 0.001), and total costs were $106,841 ± $25,513 vs. $73,888 ± $28,129 (p ≤ 0.001). When secondary outcomes were compared for the robotic versus laparoscopic groups, there were no differences in any of the aforementioned outcome variables except for operative time, which was 79min longer in the robotic group (p ≤ 0.001). Robot-assisted mesh rectopexy demonstrated no clinical benefit over traditional laparoscopic mesh rectopexy, with significantly higher operative and hospital costs. A reduction in the acquisition and maintenance costs for robotic surgery is needed before large-scale adoption and implementation of the robotic platform for this procedure.

Laparoscopic versus Robotic Hepatectomy: A Systematic Review and Meta-Analysis.

This study aimed to assess the surgical outcomes of robotic compared to laparoscopic hepatectomy, with a special focus on the meta-analysis method. Original studies were collected from three Chinese databases, PubMed, EMBASE, and Cochrane Library databases. Our systematic review was conducted on 682 patients with robotic liver resection, and 1101 patients were operated by laparoscopic platform. Robotic surgery has a long surgical duration (MD = 43.99, 95% CI: 23.45–64.53, p = 0.0001), while there is no significant difference in length of hospital stay (MD = 0.10, 95% CI: −0.38–0.58, p = 0.69), blood loss (MD = −20, 95% CI: −64.90–23.34, p = 0.36), the incidence of conversion (OR = 0.84, 95% CI: 0.41–1.69, p = 0.62), and tumor size (MD = 0.30, 95% CI: −0–0.60, p = 0.05); the subgroup analysis of major and minor hepatectomy on operation time is (MD = −7.08, 95% CI: −15.22–0.07, p = 0.09) and (MD = 39.87, 95% CI: −1.70–81.44, p = 0.06), respectively. However, despite the deficiencies of robotic hepatectomy in terms of extended operation time compared to laparoscopic hepatectomy, robotic hepatectomy is still effective and equivalent to laparoscopic hepatectomy in outcomes. Scientific evaluation and research on one portion of the liver may produce more efficacity and more precise results. Therefore, more clinical trials are needed to evaluate the clinical outcomes of robotic compared to laparoscopic hepatectomy.

Portable laparoscopy 3D measurement system by using Raspberry Pi

Minimally invasive techniques have become the standard for a variety of surgeries in all surgeries. Specially، there has been a recent move to integrate low-cost and more efficient technology into standard laparoscopy and endoscopy. Surgery to design portable laparoscopy device and improve visual field stability using, a low cost laparoscopic camera, the portable device differ from conventional in equipment (number, size, Wight, ..). The scope of the control room of the inserted laparoscopic platform system receives increasing attention from researchers, surgeons, and also patients. Although many prototype by using Raspberry pi embedded system laparoscopes have been introduced with a built-in platform smart touch screen system, few of them eliminate the blocked cable. It is suggested to Hardware architecture for integrated system Endoscopic camera design fully modern dynamic platform, facilitating installation without fully connected cables laparoscopic surgical robotic camera with adequate in-vivo motility. Modular design and preliminary test on board.

Wound Retractor Laparoscopic Port System for Laparoscopic Ovariectomy in Panthera leo.

Simple SummaryThe procedures are carried out using three portals, with a retractor platform at the umbilical port and cannulas inserted 3–4 cm cranial and caudal to the device at the midline. We evaluated the procedure’s duration as well as the intraoperative and early postoperative complications. The extraction of dissected ovarian tissue and annexes went off without complications. It is feasible and without intraoperative difficulties to employ a laparoscopic platform during three-portal operations for laparoscopic ovariectomy in adult obese lionesses. Because of the retractor, the 25 mm mini-laparotomy posed no entry-related issues. It also made retrieving thick ovaries and swiftly re-establishing the pneumoperitoneum simpler.The aim of this study was to assess the feasibility and intraoperative complications of performing ovariectomies in African lionesses (Panthera leo) using a wound retractor laparoscopic platform. Six lionesses (n = 6) were included. The surgical procedures were carried out through three portals, with a retractor platform positioned at the umbilical port and cannulas placed 3–4 cm from the cranial and caudal regions to the device at the level of the midline. An ovariectomy was performed with a vessel-sealing device. We evaluated the surgery time and the intraoperative and early postoperative complications. The mean weight was 172.83 kg. The total surgery time was 49.33 min. The installation step took a mean of 10.33 min to complete. The mean ovariectomy time was 20 min. Controlled bleeding was observed at the tip of the uterine horn in two cases due to excessive tissue thickness. The retrieval of dissected ovarian tissue and annexes was easily performed. No other complications were observed. The use of the laparoscopic platform during three-portal surgeries for laparoscopic ovariectomy in adult overweight lionesses is feasible and without intraoperative problems. The retractor meant that there were no entry-related issues due to the 25 mm mini-laparotomy. It also made it simpler to extract thick ovaries and promptly re-establish the pneumoperitoneum.

Robotic Laparoscopic Transdiaphragmatic Repair of Large Hiatal Hernias

Introduction: Although laparoscopic Nissen fundoplication is the most common procedure for the repair for hiatal hernia (HH) repair, HH recurrence due to breakdown of the hiatoplasty has been reported as a common mechanism of failure after primary repair. Left transthoracic anatomic and physiologic repair (AFR) of HH is associated with lower incidence of leak and reoperation but greater morbidity. Adopting the transthoracic approach to a robotic laparoscopic platform may represent the ideal approach to the repair of HH. This study reviews the results of this technique. Methods: A retrospective review was performed on patients who had robotic AFR (RAFR) of large HH. All patients received the previously validated Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) questionnaire preoperatively and postoperatively. Objectively, symptoms were graded using the Visick Scale. Recurrence was defined as greater than 2 cm or 10% of the stomach above the diaphragm detected by either CT, esophagogram or endoscopy. The preoperative data was compared to the results at 2 years. Results: 396 patients underwent RAPR. The Median GERD-HRQL score was 42 (range 38 - 45) preoperatively and 6 (range 0 - 14) at two years (p Conclusion: RAFR of HH is associated with excellent symptom relief and low recurrence rate. RAFR should be considered when deciding on what operation to perform in patients with large paraesophageal hiatal hernias.

O-BN04 Laparoscopic assisted robotic Heller’s cardiomyotomy in achalasia: a 12-year experience

Abstract Background Heller’s cardiomyotomy (HC) using a computer-enhanced (robotic) laparoscopic platform allows for a more precise dissection. This is achieved by utilizing the superior optics of a 3D camera and greater degrees of freedom provided by robotic instrumentation. Our aim was to assess short to long term outcomes in terms of mucosal integrity, hospital stay and symptom improvement and quality of life. Methods A retrospective review of prospectively collected data was performed of patients who underwent robotic HC between July 2009- May 2021. HC was performed using a Da Vinci robot S and Xi (Intuitive Surgical Inc.) with 4 laparoscopic ports and liver retractor. Anterior mobilization of the oesophagus was performed leaving the posterior component of phreno-oesophageal ligament intact. A longitudinal myotomy was made extending into the proximal stomach. An anti-reflux procedure (ARP) was not routinely performed. Data collected including demography, Eckardt symptom score, Quality of Life (QoL) with SF-36, surgical technical data and surgical outcome (post-op morbidity, mortality, hospital stay). Results Fifty-seven patients underwent surgery (28 males). Median age was 46 years (18-71). Two had surgery for recurrent dysphagia following laparoscopic HC elsewhere. Median length of myotomy was 8cm (5-11). No mucosal breaches were identified at surgery, but one had postoperative leak. Median length of hospital stay was 2 days (1-148). One had chest infection and another DVT. Median follow-up was 61 months (2- 86). There was no mortality. Three patients (5%) needed oesophageal dilatation during follow-up. There was a significant improvement in Eckardt score from 10 (9-12) to 2 (0-6), and in all components of QoL (p &amp;lt; 0.05). Conclusions Heller’s myotomy can be performed very precisely using a Da Vinci Robot. It minimises the risk of mucosal breach reflecting in the low leak rate. No patient had developed troublesome reflux which may well be due to the preservation of the posterior component of the phreno-oesophageal ligament. It also improves symptoms and quality of life for many years. Robotic HC may become the standard treatment for achalasia in the very near future.

The learning curve in robotic colorectal surgery compared with laparoscopic colorectal surgery: a systematic review.

The learning curve has implications for efficient surgical training. Robotic surgery is perceived to have a shorter learning curve than laparoscopy; however, detailed analysis is lacking. The aim of this work was to analyse studies comparing robotic and laparoscopic colorectal learning curves. Simulation studies comparing novices' learning curves were analysed in order to surmise applicability to colorectal surgery. A systematic search of Medline, PubMed, Embase and the Cochrane Library identified colorectal papers (from 1 January 2000 to 3 March 2021) comparing robotic and laparoscopic learning curves where surgeons lacked laparoscopic colorectal experience. Simulation studies comparing learning curves were also included. The learning curve was defined as the period of ongoing improvement in speed and/or accuracy. From 576 abstracts reviewed, three operative and 16simulation studies were included. The robotic learning curve for right colectomy was significantly faster in one study (16 vs. 25 cases) and equal for anterior resection in two studies (44 vs. 41 cases and 55 vs. 55). One study showed fewer complications for robotic patients (14.6% vs. 0%, p =0.013). Ten simulation studies reported faster times and eight recorded error rates favouring robotic surgery. Seven studies measured the learning curve. Four favoured laparoscopic surgery, but operating times were faster using the robotic platform. Operating times for robotic surgery may be faster than laparoscopy when surgeons are inexperienced with both platforms. This may be related to a superior baseline performance rather than a shorter learning curve. Whether a shorter learning curve on the laparoscopic platform will persist for long enough to enable skills to overtake robotic ability needs further investigation.

Route of Hysterectomy: Robotic

The annual percentage of hysterectomies performed with robotic-assisted laparoscopy has steadily increased since the U.S. Food and Drug Administration (FDA) approved the platform for gynecologic surgery in 2005. The rapid adoption and continued expansion of this technique are due to many factors, including 3-dimensional cameras with better visualization, instrumentation enabling precise movements with tremor control, and better ergonomics for surgeons. Residency training, with decreased numbers of minimally invasive techniques using vaginal and laparoscopic approaches, likely contributes to this trend as well. Despite these ever-increasing numbers, gynecologic societies have yet to determine and outline a standardized credentialing process. The robotic-assisted laparoscopic platform enables challenging cases, which previously would have been relegated to laparotomy, to be addressed in a minimally invasive platform. Obese patients and those with enlarged uteri or with significant adhesive disease have benefited from this unique technology. Hysterectomies performed with the robotic platform have consistently had lower surgical blood loss and shorter lengths of hospital stays. Complication rates between robotic-assisted laparoscopy and standard laparoscopy for hysterectomies appear to be similar; however, the robotic platform has longer operative times. This could be balanced by the demonstrated overall shorter hospital stay, compared to standard laparoscopic hysterectomy, and by a lower conversion rate to laparotomy. Advantages of the robotic platform appear to be magnified when surgeons have greater experience. Costs associated with purchase and use of robotic platforms continue to cause concern. It is hoped that competition with alternative robotic systems will decrease these costs. However, they must be viewed within the context of improved surgical and perioperative outcomes.

The TransEnterix European Patient Registry for Robotic-Assisted Laparoscopic Procedures in Urology, Abdominal, Thoracic, and Gynecologic Surgery (“TRUST”)

Introduction: Robotic surgery was first introduced in the mid-1980s, and at the end of the '90s, the da Vinci® System (Intuitive Surgical Inc., Sunnyvale, California) was introduced in Europe and held a monopoly for years afterward. In 2016, Senhance™ digital laparoscopic platform (Asensus Surgical, Durham, North Carolina) came to the market. This new platform is based on laparoscopic movements and is designed for laparoscopic surgeons. This study shows the surgical outcomes of patients after different visceral, colorectal, gynecological, and urological surgical procedures done with the Senhance™ digital laparoscopic platform with a focus on safety. Materials and Methods: The study population consists of 871 patients who underwent robotic surgery with the Senhance™ platform. The most common procedures were hernia repairs (unilateral and bilateral), cholecystectomies, and prostatectomies. The procedures were performed in five centers in Europe between February 2017 and July 2020 by experienced laparoscopic surgeons. Results: 220 (25.3 %) out of 871 patients had a unilateral hernia repair, 70 (8.0%) a bilateral hernia repair, 159 (18.3%) underwent a cholecystectomy, and 168 (19.3%) a prostatectomy. The other procedures included visceral, colorectal, and gynecological surgery procedures. The median docking time was 7.46 minutes for the four most common procedures. The duration of surgery varied from 32 to 313 minutes, the average time was 114.31 minutes. Adverse events were rare overall. There were 48 (5.5 %) adverse events out of 871 patients, 24 of them (2.8 % of all cases) were severe. Out of all 24 severe adverse events, five events (20.8%) were likely related to the robot, 17 events (70.8%) were unlikely related to the robot, and two events (8.3%) could not be categorized. Regarding complications following unilateral hernia repairs, data from 212 patients was available. Thirteen (6.1%) complications occurred, and six of those (2.8%) were serious. Out of 68 patients with a bilateral hernia repair, six patients (8.8%) developed complications, three of which were severe (4.4%). The complication rate was 2.8% in the patients following a cholecystectomy (4/144); two of them serious. After prostatectomy, six out of 141 patients (4.3 %) had complications; one serious (0.7%) No mortality was observed. Data about unplanned conversions to laparoscopic surgery could be collected from 761 patients which is a rate of 3.7%. There were 12 conversions out of 760 procedures to open surgery (1.6%). Conclusions: Our series shows these procedures are safe and reproducible. The findings suggest that the surgical results after robotic surgery with the Senhance™ system are promising. Long-term data regarding complication rates should be the subject of future studies.

Conventional and robotic transanal minimally invasive surgery for rectal neoplasia

The treatment of rectal cancer is evolving at a rapid pace in parallel with advancements in surgical technique. One such advancement is the application of the laparoscopic platform to the transanal approach, coined transanal minimally invasive surgery (TAMIS). TAMIS overcomes many of the shortcomings of the traditional transanal approach to the local resection of rectal neoplasia, offering greater visualization and access to the middle and upper rectum with improved oncologic outcomes. Following the introduction of conventional TAMIS, the robotic platform was introduced and applied in analogous fashion. Over the past decade, data have accumulated enabling the comparison of the two approaches most notably with regard to patient morbidity, mortality, and oncologic outcomes. This review discusses the most recently available outcomes regarding conventional and robotic TAMIS and provides a comparison of the two platforms in the treatment of rectal neoplasia. While randomized controlled trials comparing the two platforms are lacking, important differences have been identified. Conventional TAMIS is the more cost-effective approach while advancements in the robotic platform allow the surgeon to be seated and ergonomically optimized, allowing greater visualization and ease of suturing. Differences in oncologic outcomes between the two platforms have not been identified. Head-to-head randomized controlled trials are required to determine if any differences in functional or oncologic outcomes exist.

Shortening surgical training through robotics: randomized clinical trial of laparoscopic versus robotic surgical learning curves.

BackgroundMinimally invasive surgery is the standard technique for many operations. Laparoscopic training has a long learning curve. Robotic solutions may shorten the training pathway. The aim of this study was to compare laparoscopic with robotic training in surgical trainees and medical students.MethodsSurgical trainees (ST group) were randomized to receive 6 h of robotic or laparoscopic simulation training. They then performed three surgical tasks in cadaveric specimens. Medical students (MS group) had 2 h of robotic or laparoscopic simulation training followed by one surgical task. The Global Rating Scale (GRS) score (maximum 30), number of suture errors, and time to complete each procedure were recorded.ResultsThe median GRS score for the ST group was better for each procedure after robotic training compared with laparoscopic training (total GRS score: 27·00 (i.q.r. 22·25–28·33) versus 18·00 (16·50–19·04) respectively, P < 0·001; 10 participants in each arm). The ST group made fewer errors in robotic than in laparoscopic tasks, for both continuous (7·00 (4·75–9·63) versus 22·25 (20·75–25·25); P < 0·001) and interrupted (8·25 (6·38–10·13) versus 29·50 (23·75–31·50); P < 0·001) sutures. For the MS group, the robotic group completed 8·67 interrupted sutures with 15·50 errors in 40 min, compared with only 3·50 sutures with 40·00 errors in the laparoscopic group (P < 0·001) (10 participants in each arm). Fatigue and physical comfort levels were better after robotic compared with laparoscopic operating for both groups (P < 0·001).ConclusionThe acquisition of surgical skills in surgical trainees and the surgically naive takes less time with a robotic compared with a laparoscopic platform.

Short- and long-term outcomes for single-port risk-reducing salpingo-oophorectomy with and without hysterectomy for women at risk for gynecologic cancer

IntroductionRisk-reducing salpingo-oophorectomy has been established as one of the most effective strategies in risk reduction for ovarian and breast cancers among women at increased genetic risk. However, there are limited...

A Low-Cost Platform for Laparoscopic Simulation Training.

With the new requirement for Fundamentals of Laparoscopic Surgery certification among graduating obstetrics and gynecology residents, there has been an increased interest in simulation training. The Fundamentals of Laparoscopic Surgery curriculum uses a commercial laparoscopic box trainer to practice and assess laparoscopic skills. We created a low-cost, space-efficient, portable and versatile training platform that allows for the breakdown of complex tasks, and we studied its user acceptability. A rectangular piece of pine wood purchased at a hardware store was used as a base; metal eye hooks were used as ports, and a blueprint was created to simulate placement of Fundamentals of Laparoscopic Surgery inserts. In addition to the Fundamentals of Laparoscopic Surgery skills, this platform can be used for any laparoscopic task (such as hysterectomy or cuff closure). Additionally, this platform can be used with or without a camera to allow for task breakdown into simpler components for faster learning. A usability and acceptability survey was administered to a convenient sample of faculty and trainees. Trainees and faculty responded favorably to the model. Residents, fellows, and attendings felt that the laparoscopic platform closely simulated the feel of performing live laparoscopy surgery. This is a novel low-cost laparoscopic platform to add to the gynecologic surgical education simulation toolkit.

Outcomes in Bariatric and Metabolic Surgery: an Updated 5-Year Review.

Knowledge regarding postoperative outcomes after bariatric and metabolic surgery continues to evolve. This review highlights key findings in outcomes research over the last 5years related to weight loss, remission of obesity-related disease, reflux, revisional surgery, robotic-assisted surgical platforms, and adolescent populations. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) produce similar weight loss patterns at 5years, while duodenal switch (BPD/DS) and related procedures are associated with maximal weight loss overall and optimal resolution of obesity-related comorbidities. Remission of type 2 diabetes mellitus (T2DM) following surgery is more likely in patients who are not insulin dependent prior to surgery. Bariatric and metabolic surgery offers a significant protective effect against coronary artery disease (CAD) and associated interventions in both diabetic and nondiabetic patients, as well as heart failure (HF). Gastroesophageal reflux disease (GERD) and dysphagia following SG are common, and routine endoscopic surveillance for Barrett's esophagus may be of significant utility. Robotic-assisted laparoscopic platforms concur similar outcomes to laparoscopic intervention, with a potential benefit in high BMI patients. Revisional surgery is most commonly performed for weight regain and/or inadequate weight loss following an index procedure, or reflux, and generally characterized by higher postoperative complication rates and longer inpatient lengths of stay (LOS). Surgical intervention in adolescent populations has similar weight loss and postoperative complication profiles to those seen in adult populations, with improved outcomes related to T2DM. Bariatric and metabolic surgery continues to evolve as a treatment for obesity and obesity-related comorbidities. While effective for weight loss and remission of obesity-related disease, SG is associated with high rates of postoperative GERD.

Glove single-port laparoscopy-assisted transanal total mesorectal excision for low rectal cancer: a preliminary report

PurposeGlove single-port laparoscopy-assisted transanal total mesorectal excision (TaTME) has been successfully carried out in our medical center. The purpose of this study is to evaluate the feasibility of this emerging operation.MethodsThis technique was performed by self-made glove single-port laparoscopic platform to radically resect low rectal cancer. Short-term postoperative results, including complications, length of hospital stay, and follow-up results were collected and analyzed statistically.ResultsThere are five consecutive patients (three males, two females) who underwent this surgery and included in this study. The mean distance from the tumor to the anal verge was 4.8 cm (range 4.0–6.0). The surgery was completed in all cases, and the rectal tumor was removed successfully without conversion; circumferential margins of all the excised specimens were negative. The mean time of operation was 338.00 min (range 280–400). The average number of lymph node dissection was 12.20. The average postoperative hospital stay was 8.60 days. During the follow-up (14.80 ± 1.92 months), all preventive ileostomies were successfully closed in about 3 months after the surgery, all patients had satisfactory anal function, and no tumor recurrence was found.ConclusionGlove single-port laparoscopy-assisted TaTME has a significant effect in specific patients with low rectal cancer, with rapid recovery and high safety. Prospective randomized studies involving more case counts and long-term follow-up results, especially oncologic outcomes, are needed to validate this technique.