Robot-assisted Laparoscopic Procedures Research Articles

The Effect of Steep Trendelenburg Positioning on Retinal Structure and Function during Robotic-Assisted Laparoscopic Procedures.

Purpose Robotic-assisted laparoscopic radical prostatectomy (RALP) has become a standard treatment choice for localized prostate cancer. RALP requires a steep Trendelenburg position, which leads to a significant increase in intraocular pressure (IOP). This study evaluated the effect on the retinal structure and function in patients undergoing RALP. Methods Standard automated perimetry (SAP) and optical coherence tomography (OCT) were performed in 20 males scheduled for RALP at 1 month and 1 day before the operation and at 1 and 3 months after the operation. IOP measurements were made in the supine position at 5 min after intubation under general anesthesia (T1), at 6 discrete time points (5, 30, 60, 120, 180, and 240 min; T2-7), and at 5 min after returning to a horizontal supine position (T8). Serial retinal nerve fiber layer (RNFL) thicknesses and visual field progression were assessed using the guided progression analysis software program. RNFL thickness progression and visual field progression were evaluated by event analysis. Results Average IOP (mmHg) for each time point was as follows: T1 = 12.3 ± 2.6, T2 = 20.4 ± 4.2, T3 = 23.3 ± 3.8, T4 = 24.0 ± 3.2, T5 = 24.3 ± 3.4, T6 = 27.1 ± 7.2, T7 = 29.8 ± 8.7, and T8 = 20.1 ± 4.4. During RALP, IOP significantly increased. There was no progression of the visual field and RNFL thickness after surgery or any other ocular complications found. Conclusions Although IOP significantly increased during RALP, there were no significant changes in the retinal structure and function between the pre- and postoperation observations.

A Novel Vesicoscopic Bladder Wall Suture Fixation Technique to Aid Endoscopic Vesicostomy Button Insertion

Background: To describe a novel bladder fixation technique for use during endoscopic vesicostomy button insertion. Methods: After standard cystoscopic visualization of the bladder, a standard 18 G intravenous cannula was inserted into the bladder. A non-absorbable suture thread was placed through this intravenous cannula under cystoscopic vision. The proximal end of the suture was then removed using standard ureteroscopic grasping forceps (3 Fr) through another needle (15 G) inserted next to the initial puncture site (following a path at 30 degrees from the initial puncture tract) into the bladder. The suture ends were brought out of the bladder and tied at the skin level, 2 cm from the intended vesicostomy site. Sutures were removed on the second postoperative day. Results: This fixation technique allows for adequate fixation of the bladder dome to the anterior abdominal wall. These sutures also have less potential for cutaneous scarring and pain. No complications were reported. Conclusion: This simple fixation technique is easily performed using materials found in every urology suite. It also avoids the skills required with other previously reported fixation suture techniques, and can also be utilized for bladder fixation in cases of vesicoscopic laparoscopic or robotic assisted laparoscopic procedures.

Robot-Assisted Laparoscopic Suturing of a U-Shaped Ileal Neobladder with ENDOSEW

Abstract Introduction: ENDOSEW® is a new sewing device developed for the placement of running sutures during (robot-assisted) laparoscopic procedures.1,2 The study was conducted to evaluate the feasibility of a robot-assisted suturing of a U-shaped ileal neobladder with the ENDOSEW suturing device (KARL STORZ ENDOSKOPE, Tuttlingen, Germany) and the da Vinci System in an experimental setting.3,4 Materials and Methods: The length of the suturing unit is 300 mm with a diameter of 14 mm, so that it can be placed via a 15 mm trocar. Tissue up to 4 mm thickness can be sutured with a stitch overlap of 3 mm. Surgeon decides about the distance between two stitches (from 1.5 to 4 mm) by transporting the tissue more or less forward. An industrialized stitch (type 501) is created with only one threat by wrapping the threat around the tissue. The suturing device can place up to 38 stitches per minute (i.e., 120 mm/min). A polyglycolic acid 4.0 braided thread is used in applicators from 2.5 to 12.5 m. A 40 cm bovine in...

The use of partial nephrectomy in the treatment of patients with pT1/pT2 renal cell carcinoma: a trend analysis from a tertiary referral centre

In patients with localised renal cell carcinoma, the only curative treatment option is surgical tumour excision. Current national and European guidelines recommend partial nephrectomy in the form of an open or minimally-invasive procedure in case of small tumours. The aim of this study was to examine the use of radical (RN) or partial (PN) nephrectomy performed as open or minimally-invasive procedures in patients with pT1 /pT2 renal cell carcinoma at a tertiary referral centre. This retrospective study included a total of 758 patients with localised renal cell carcinoma (pT1/pT2), who underwent PN or RN between 01/2008 and 10/2014. Nephrectomy was either performed as an open (OPN, ORN), laparoscopic (LPN, LRN) or robot-assisted laparoscopic (RAPN) procedure. Out of 758 patients, 439 (57.9 %) underwent PN performed as an LPN in n = 254 (57.9 %) and OPN in n = 185 (42.1 %). 319 patients (42.1 %) underwent RN performed as an LRN in n = 250 (78.4 %) and ORN in n = 69 (21.6 %). Between 2008 and 2014, there was a trend towards the use of PN, especially in patients with pT1a and pT1b. The majority of patients with pT2 underwent RN, performed as an LRN in 40 - 53.9 %. The results of this trend analysis from a tertiary referral centre demonstrate an increased use of PN and minimally-invasive procedures over time, as recommend by national and European guidelines.

Robot-assisted versus conventional laparoscopic operation in anus-preserving rectal cancer: a meta-analysis

ObjectiveThe aim of this meta-analysis is to provide recommendations for clinical practice and prevention of postoperative complications, such as circumferential resection margin (CRM) involvement, and compare the amount of intraoperative bleeding, safety, operative time, recovery, outcomes, and clinical significance of robot-assisted and conventional laparoscopic procedures in anus-preserving rectal cancer.MethodsA literature search (PubMed) was performed to identify biomedical research papers and abstracts of studies comparing robot-assisted and conventional laparoscopic procedures. We attempted to obtain the full-text link for papers published between 2000 and 2016, and hand-searched references for relevant literature. RevMan 5.3 software was used for the meta-analysis.ResultsNine papers (949 patients) were eligible for inclusion; there were 473 patients (49.8%) in the robotic group and 476 patients (50.2%) in the laparoscopic group. According to the data provided in the literature, seven indicators were used to complete the evaluation. The results of the meta-analysis suggested that robot-assisted procedure was associated with lower intraoperative blood loss (mean difference [MD] −41.15; 95% confidence interval [CI] −77.51, −4.79; P=0.03), lower open conversion rate (risk difference [RD] −0.05; 95% CI −0.09, −0.01; P=0.02), lower hospital stay (MD −1.07; 95% CI −1.80, −0.33; P=0.005), lower overall complication rate (odds ratio 0.58; 95% CI 0.41, 0.83; P=0.003), and longer operative time (MD 33.73; 95% CI 8.48, 58.99; P=0.009) compared with conventional laparoscopy. There were no differences in the rate of CRM involvement (RD −0.02; 95% CI −0.05, 0.01; P=0.23) and days to return of bowel function (MD −0.03; 95% CI −0.40, 0.34; P=0.89).ConclusionThe Da Vinci robot was superior to laparoscopy with respect to blood loss, open conversion, hospital stay, and postoperative complications during anus-preserving rectal cancer procedures; however, conventional laparoscopy had an advantage regarding operative time. The remaining indicators (CRMs and recovery from intestinal peristalsis) did not differ.

Diffusion of robotic-assisted laparoscopic technology across specialties: a national study from 2008 to 2013.

Robotic-assisted procedures were frequently found to have similar outcomes and indications to their laparoscopic counterparts, yet significant variation existed in the acceptance of robotic-assisted technology between surgical specialties and procedures. We performed a retrospective cohort study investigating factors associated with the adoption of robotic assistance across the United States from 2008 to 2013. Using the Nationwide Inpatient Sample database, patient- and hospital-level variables were examined for differential distribution between robotic-assisted and conventional laparoscopic procedures. Multilevel logistic regression models were constructed to identify independent factors associated with robotic adoption. Furthermore, cases were stratified by procedure and specialty before being ranked according to proportion of robotic-assistance adoption. Correlation was examined between robotic-assistance adoption and relative outcome in comparison with conventional laparoscopic procedures. The national robotic case volume doubled over the five-year period while a gradual decline in laparoscopic case volume was observed, resulting in an increase in the proportion of procedures performed with robotic assistance from 6.8 to 17%. Patients receiving robotic procedures were more likely to be younger, males, white, privately insured, more affluent, and with less comorbidities. These differences have been decreasing over the study period. The three specialties with the highest proportion of robotic-assisted laparoscopic procedures were urology (34.1%), gynecology (11.0%), and endocrine surgery (9.4%). However, no significant association existed between the frequency of robotic-assistance usage and relative outcome statistics such as mortality, charge, or length of stay. The variation in robotic-assistance adoption between specialties and procedures could not be attributable to clinical outcomes alone. Cultural readiness toward adopting new technology within specialty and target anatomic areas appear to be major determining factors influencing its adoption.

Robotic-assisted laparoscopic artificial urinary sphincter and MACE procedure on a pediatric patient

To describe robotic-assisted laparoscopic artificial urinary sphincter (RAL-AUS) placement and a Malone antegrade continent enema (MACE) procedure on a 6-year-old girl. Our patient is a 6-year-old girl with myelomeningocele. She was totally incontinent of urine and chronic constipated despite aggressive bowel regimen. Preoperative workup included renal and bladder ultrasound showing normal findings. Video-urodynamics was also obtained showing low leak point pressure (25cm H2O) with no reflux. RAL-AUS was performed totally intra-corporally with no complications. The total operative time was 5h 42min. Estimated blood loss was minimal. The patient was discharged on postoperative day 4 with the AUS deactivated. Follow-up cystoscopy and activation of the AUS was done 6 weeks later. At 3-month follow-up, the patient was fully recovered and remained completely dry between voids. Also her bowel movements improved significantly with the MACE. Both patient and family appeared comfortable in using the AUS. To our knowledge, this is the first case described of RAL-AUS placement in the pediatric population. We believe this can be safely accomplished with good outcomes. The robotic approach provides an advantage in performing deep pelvic surgeries and facilitates concomitant intra-abdominal procedures.

Feasibility of Transvesical Robotic VVF Repair in Porcine Model.

Extraperitoneal transvesicoscopic vesicovaginal fistula (VVF) repair has received limited use because of its narrow working space, longer operation time, and technical difficulty. The present study describes the feasibility of robotic-assisted transvesicoscopic VVF repair in an animal model. Two Yorkshire swine underwent robotic-assisted laparoscopic (RAL) VVF repair. With the 4 trocars, an artificial VVF was made in the supratrigonal area and VVF repair was performed in 3 layers as in open VVF repair methods. The mean operation time was 108 minutes. The operation time was prolonged in 1 case due to weak fixation of bladder to anterior abdominal wall. Equipment interference did not occur. Tissue manipulation and suturing were easy. The results of this study suggest that extraperitoneal RAL procedures for VVF repair may be an effective minimally invasive modality with reduced morbidity. A shorter operation time and easy suturing technique were the distinct merits of the extraperitoneal RAL technique.

Comment on the Paper by Mondzelewski and Colleagues: “Intraocular Pressure During Robotic-assisted Laparoscopic Procedures Utilizing Steep Trendelenburg Positioning.” J Glaucoma. 2015;24(6):399–404

Comment on the Paper by Mondzelewski and Colleagues: “Intraocular Pressure During Robotic-assisted Laparoscopic Procedures Utilizing Steep Trendelenburg Positioning.” J Glaucoma. 2015;24(6):399–404

Reduction in surgical fog with a warm humidified gas management protocol significantly shortens procedure time in pediatric robot-assisted laparoscopic procedures

The adoption of robot-assisted laparoscopic (RAL) procedures in the field of urology has occurred rapidly, but is, to date, without pediatric-specific instrumentation. Surgical fog is a significant barrier to safe and efficient laparoscopy. This appears to be a significant challenge when adapting three-dimensional 8.5-mm scopes to use in pediatric RAL surgery. The objective of the present study was to compare matched controls from a prospectively collected database to procedures that were performed utilizing special equipment and a protocol to minimize surgical fog in pediatric RAL procedures. A prospectively collected database of all patients who underwent RAL pediatric urology procedures was used to compare: procedure, age, sex, American Society of Anesthesiologists score, weight, console time, number of times the camera was removed to clean the lens during a procedure, length of hospital stay, and morphine equivalents required in the postoperative period. A uniquely developed protocol was used, it consisted of humidified (95% relative humidity) and warmed CO2 gas (95°F) insufflation via Insuflow® on a working trocar, with active smoke evacuation via PneuVIEW®XE on the opposite working trocar with a gas pass through of 3.5-5 l/min. The outcomes were compared with matched controls (Summary Fig). The novel gas protocol was utilized in 13 procedures (five pyeloplasties, two revision pyeloplasties, three ureteroureterostomies (UU), three nephrectomies) and compared with 13 procedures (six pyeloplasties, one revision pyeloplasty, three UU, three nephrectomies) prior to the protocol development. There was no statistical difference in age (P=0.78), sex (P=0.11), ASA score (P=1.00) or weight (P=0.69). There were no open conversions, ≥Grade 2 Clavien complications, or readmissions within 30 days in either group. This novel gas protocol yielded a statistically significant reduction in procedure time, by decreasing the number of times the camera was required to be pulled during the case by more than five occurrences, and saved approximately 35min on average per case.

Risk factors for postoperative complications in robotic general surgery.

The feasibility and safety of robotically assisted procedures in general surgery have been reported from various groups worldwide. Because postoperative complications may lead to longer hospital stays and higher costs overall, analysis of risk factors for postoperative surgical complications in this subset of patients is clinically relevant. The goal of this study was to identify risk factors for postoperative morbidity after robotic surgical procedures in general surgery. We performed an observational monocentric retrospective study. All consecutive robotic surgical procedures from November 2001 to December 2013 were included. One thousand consecutive general surgery patients met the inclusion criteria. The mean overall postoperative morbidity and major postoperative morbidity (Clavien >III) rates were 20.4 and 6%, respectively. This included a conversion rate of 4.4%, reoperation rate of 4.5%, and mortality rate of 0.2%. Multivariate analysis showed that ASA score >3 [OR 1.7; 95% CI (1.2-2.4)], hematocrit value <38 [OR 1.6; 95% CI (1.1-2.2)], previous abdominal surgery [OR 1.5; 95% CI (1-2)], advanced dissection [OR 5.8; 95% CI (3.1-10.6)], and multiquadrant surgery [OR 2.5; 95% CI (1.7-3.8)] remained independent risk factors for overall postoperative morbidity. It also showed that advanced dissection [OR 4.4; 95% CI (1.9-9.6)] and multiquadrant surgery [OR 4.4; 95% CI (2.3-8.5)] remained independent risk factors for major postoperative morbidity (Clavien >III). This study identifies independent risk factors for postoperative overall and major morbidity in robotic general surgery. Because these factors independently impacted postoperative complications, we believe they could be taken into account in future studies comparing conventional versus robot-assisted laparoscopic procedures in general surgery.

Initial Japanese Experience of Laparoscopic Cholecystectomy Using a New Robot-Assisted System

The object of this paper is to clarify the feasibility and safety of robot-assisted laparoscopic cholecystectomy. Acute or chronic cholecystitis is the most common disease in patients, caused by cholecystolithiasis. Minimally invasive laparoscopic surgery is often performed for treatment of cholelithiasis. We performed robot-assisted laparoscopic cholecystectomy for the treatment of 5 patients with cholecystolithiasis. The patient underwent laparoscopic cholecystectomy using the ViKY Endo-Control System (ViKY, EndoControl, Grenoble, France). The robot-controlled laparoscopic holder was placed at the right axilla. The laparoscopic operation was performed via conventional 4-port access using the ViKY system with voice activation. All patients were treated successfully by this robot-assisted laparoscopic procedure, without any complications. Mean docking time using the ViKY was 16 minutes, mean resection time of the gallbladder was 62.2 minutes, operative time was 94.6 minutes, and the mean amount of the blood loss was minimal. Our initial experience demonstrated that robot-assisted laparoscopy was feasible and safe in patients with cholecystolithiasis, providing patient advantages. We also discuss the advantages and disadvantages of robot-assisted laparoscopic surgery.

Single-port Robotic Pelvic Bulky Lymph Node Resection: A Case Report

Study ObjectiveTo report the feasibility of bulky pelvic lymph node resection with robotic-assisted single-port laparoscopy in a patient with cervical cancer before chemoradiation therapy. DesignResection of pelvic bulky lymph nodes with a narrated video of da Vinci single-port platform surgery (Intuitive Surgical, Sunnyvale, CA) (Canadian Task Force classification III). SettingAlthough not enough evidence exists to reveal that single-site surgery is better than traditional endoscopic surgery, several studies have suggested that single-site robotic surgery has certain advantages such as less postoperative analgesic use, shorter hospital stay, and quicker recovery. Furthermore, robotic single-site surgery has evolved single-site procedures. Compared with the single-port laparoendoscopic procedure, the robotic-assisted single-port laparoscopic procedure offers some advantages to minimally invasive surgery such as greater dexterity, 3-dimensional visualization, and fewer instrument clashes. These advantages make robotic single-port surgery more preferable; nevertheless, the lack of articulating instruments and the low quality of optical exposure are still challenges. Robotic single-port pelvic lymphadenectomy was first described by Tateo et al [1] in an endometrial carcinoma patient. We present a robotic single-port pelvic bulky lymph node resection in an advanced cervical cancer patient. Even though current data are controversial about removing bulky lymph nodes in patients with advanced cervical cancer, some studies have recommended that debulking of tumor-involved lymph nodes before chemoradiation may be benefical for these patients (Leblanc et al [2], Marnitz et al [3]). In our case, the patient underwent robotic-assisted single-port laparoscopy using the da Vinci Single-Site platform. The abdominal cavity was insufflated from a 3-cm umblical incision, and a 5-lumen single port was inserted. Then, an 8.5-mm 3-dimensional camera was inserted through the port, and for dissection and resection 5-mm bipolar fenestrated forceps and a monopolar hook were used. After resection, the bulky lymph nodes were taken out with an endoscopic bag through the assistant port lumen. Additionally, it is important to remember that single-site procedures are not approved by the Food and Drug Administration for lymphadenectomy. PatientsA 46-year-old patient diagnosed with advanced-stage cervical cancer (Fédération Internationale de Gynécologie et d'Obstétrique stage IIIB) presented with bilateral pelvic lymph node metastasis revealed by pelvic magnetic resonance imaging. The patient had no history of prior surgery or comorbidity. We decided to perform resection of the pelvic lymph nodes with a robotic-assisted single-site laparoscopic procedure before chemoradiation threapy. InterventionsExcision of pelvic bulky lymph nodes using robotic-assisted single-port laparoscopy. Measurements and Main ResultsThe total operating time was 170 minutes (from docking to the end of the extubation), the estimated blood loss was 30 mL, and no complications occurred. The patient was discharged the day after surgery. The histopathologic examination revealed squamous cell carcinoma metastasis. ConclusionRobotic-assisted single-port surgery seems to be an applicable and alternative technique to perform the resection of bulky pelvic lymph nodes in patients with advanced cervical cancer before chemoradiation therapy.

Uterine Conservation During Prolapse Repair: 9-Year Experience at a Single Institution.

The primary aim is to compare safety and long-term outcomes between uterine-sparing prolapse procedures performed using 4 different surgical routes over a 9-year period. This is a retrospective cohort study of women who underwent uterine-sparing prolapse procedures performed by 10 female pelvic medicine and reconstructive surgeons between January 2003 and December 2011. Demographic information, operative characteristics, complications (intraoperative and postoperative), and prolapse recurrence were obtained by chart review. Additional information collected included subsequent uterine or cervical pathology, procedures, and pregnancies. Two hundred forty uterine-sparing prolapse procedures were performed in the 9-year period. One hundred two patients (42.5%) underwent a vaginal procedure, 95 patients (39.6%) underwent a conventional laparoscopic procedure, 28 patients (11.7%) underwent a robotic-assisted laparoscopic procedure, and 15 patients (6.3%) underwent an abdominal procedure. Median follow-up time and interquartile range for abdominal, vaginal, laparoscopic, and robotic surgical routes were 16.4 (3.9-23.9), 14 (3.3-36.4), 22.6 (2.9-64.5), and 6.1 (3-24.4) months, respectively. Prolapse recurrence rates were similar for all groups (abdominal 13.3%, vaginal 14.7%, laparoscopic 11.6%, robotic 3.6%; P = 0.39). Intraoperative, postoperative, and long-term complications rates were similar between all groups (P = 0.63, P = 0.43, P = 0.10). The rate of benign gynecologic conditions encountered after surgery was similar among all groups, with an overall rate of abnormal uterine bleeding/postmenopausal bleeding of 5.4% and overall rate of cervical dysplasia of 0.8%. Two pregnancies were reported, both undergoing cesarean delivery at term. Uterine-sparing prolapse procedures appear to have good long-term safety and a low risk of future gynecologic pathology.

PD40-11 TRENDS AND PREDICTORS OF URETERAL INJURIES IN THE ERA OF LAPAROSCOPIC AND ROBOTIC SURGERY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion III1 Apr 2016PD40-11 TRENDS AND PREDICTORS OF URETERAL INJURIES IN THE ERA OF LAPAROSCOPIC AND ROBOTIC SURGERY Vinay Patel, Kristian Stensland, Rajiv Jayadevan, Karl Coutinho, Simon Hall, and Michael Palese Vinay PatelVinay Patel More articles by this author , Kristian StenslandKristian Stensland More articles by this author , Rajiv JayadevanRajiv Jayadevan More articles by this author , Karl CoutinhoKarl Coutinho More articles by this author , Simon HallSimon Hall More articles by this author , and Michael PaleseMichael Palese More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1543AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteral injury is a major concern for abdominal and pelvic surgeries, particularly as laparoscopic and other minimally invasive procedures gain popularity. We aimed to identify and describe trends in and predictors of ureteral injury requiring repair during index admission. METHODS The New York State SPARCS comprehensive inpatient database was queried for urologic, general surgery, and OB/GYN surgical procedures performed from 1983-2012. Index procedures extracted using relevant ICD9 codes included hysterectomy, ovarian/fallopian procedures, c-section, and colectomy. Laparoscopic (including robotic) coded procedures, ureteral repairs, and catheterizations were extracted using relevant ICD9 codes. Logistic regression was utilized to identify predictors of ureteral injury requiring repair. RESULTS The absolute incidence of ureteral repair increased slightly from 1983 to 2012, with an average of 44 repairs/year from 1983-1987 compared to 58 repairs/year from 2008-2012. The greatest increase in rate of ureteral repair was a 5-fold increase in ureteral repairs for ovarian/fallopian operations, compared to 2.5 and 3-fold increases for colectomy and hysterectomy, respectively. Concurrently, the rate of ureteral catheterization for all procedures increased 7-fold overall. Catheterization rates in hysterectomy, colectomy, and ovarian/fallopian procedures increased 3-fold, 6-fold and 3-fold, respectively. The increased rate of catheterization far outstretched the rate of ureteral repair. Considering only years where both open and laparoscopic coded procedures were performed, open procedures were more likely associated with ureteral repair than laparoscopic coded procedures on both univariate and multivariate analysis (hysterectomy 0.084% vs 0.035%, p < 0.001; colectomy 0.15% vs. 0.017%, p = 0.001). On logistic regression, common demographic variables including age, sex, and insurance status were not associated with ureteral injury requiring repair. CONCLUSIONS Laparoscopic and robotic-assisted laparoscopic procedures are associated with fewer ureteral repairs than open procedures. Despite increased rates of ureteral catheterization in index procedures, rates of ureteral repair during index admission are increasing, though not as quickly as the rate of ureteral catheterization. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e939 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Vinay Patel More articles by this author Kristian Stensland More articles by this author Rajiv Jayadevan More articles by this author Karl Coutinho More articles by this author Simon Hall More articles by this author Michael Palese More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Robot-assisted laparoscopic (RAL) procedures in general surgery.

Robotics was introduced in clinical practice more than two decades ago, and it has gained remarkable popularity for a wide variety of laparoscopic procedures. We report our results of robot-assisted laparoscopic surgery (RALS) in the most commonly applied general surgical procedures. Ninety seven patients underwent RALS from 2009 to 2012. Indications for RALS were cholelithiasis, gastric carcinoma, splenic tumors, colorectal carcinoma, benign colorectal diseases, non-toxic nodular goiter and incisional hernia. Records of patients were analyzed for demographic features, intraoperative and postoperative complications and conversion to open surgery. Forty six female and 51 male patients were operated and mean age was 58,4 (range: 25-88). Ninety three out of 97 procedures (96%) were completed robotically, 4 were converted to open surgery and there were 15 postoperative complications. There was no mortality. Wide variety of procedures of general surgery can be managed safely and effectively by RALS. Copyright © 2015 John Wiley & Sons, Ltd.

The Risk of Developing Postoperative Chronic Pain After Abdominal and Robot-Assisted Laparoscopic Hysterectomy: A Cross-Sectional Study

Abstract Objective: The two main objectives were to investigate and compare the following: (1) the development of chronic postoperative pain after robot-assisted laparoscopic hysterectomy and abdominal hysterectomy and (2) potential risk factors for developing chronic postoperative pain after hysterectomy. Design: Questionnaire-based cross-sectional study. Materials and Method: Patients having abdominal or robot-assisted laparoscopic hysterectomy procedures performed at Aalborg University Hospital, Denmark, in the period from January 2010 to December 2012. The Danish Gynecologic Cancer Database was used to identify and collect clinical data from women who had undergone total hysterectomy for endometrial cancer. Questionnaires were mailed to the included women with a response time of 5 weeks. Results: A total of 228 women received the questionnaire, and 177 (77.6%) responded. No significant difference was found in the prevalence of chronic postoperative pain between abdominal and robot-assisted laparoscopi...

A virtual reality training program for improvement of robotic surgical skills.

The purpose of this study was to use a simulated virtual reality environment for training of surgical skills and then to identify if the learning that occurred was transferable to a real world surgical task. The virtual surgical tasks consisted of bimanual carrying, needle passing and mesh alignment. In this ongoing study, the experimental group (n = 5) was trained by performing four blocks of the virtual surgical tasks using the da Vinci surgical robot. Pre and post training, all subjects were tested by performing a suturing task on a "life-like" suture pad. The control group (n = 5) performed only the suturing task. Significantly larger pre and post differences were revealed in time to task completion (p < 0.05) and total distance travelled by the dominant side instrument tip (p < 0.01) in the experimental group as compared to the control group. These differences were specific to the suture running aspect of the surgical task. In conclusion, virtual reality surgical skills training may produce a significant learning effect that can transfer to actual robot-assisted laparoscopic procedures.

The Swedish uterus transplantation project: the story behind the Swedish uterus transplantation project.

The Swedish uterus transplantation project: the story behind the Swedish uterus transplantation project.

Patient Understanding, Attitudes, and Perceptions of Laparoscopic and Robotic-Assisted Laparoscopic Gynecologic Procedures

Patient Understanding, Attitudes, and Perceptions of Laparoscopic and Robotic-Assisted Laparoscopic Gynecologic Procedures