Robot-assisted Laparoscopic Surgery Research Articles

The safety of robot-assisted surgery versus laparoscopic surgery for rectal tumor patients.

56 Background: Robotic assisted surgery for the rectum has dramatic increased. In addition to the magnifying effect of laparoscopic benefit, robot-assisted surgery has multi-joint function and 3D vision which allows more precise manipulation in the deep pelvic region and is thought to contribute significantly to perioperative safety. However, the superiority of robotic-assisted surgery still remains controversial. In this study, we compared the short-term results of laparoscopic and robotic-assisted surgery for rectal tumors. Methods: This study was a single-center, retrospective study. We included 273 rectal tumor patients who underwent surgery with anastomosis from 2017 to 2021. 169 patients underwent laparoscopic surgery (Lap group) and 104 patients underwent robotic-assisted surgery (Robot group). Postoperative complications were compared by matching using the propensity score based on the IPTW method with the maximum tumor diameter, cT, and cN stage as adjustment factors (SMD≤0.2 was defined as no difference between the groups). Results: Among the patient backgrounds, blood loss, LPLN dissection and tumor diameter showed significant difference. Moreover, rate of cT3-4, cN positive were significantly high in the Lap group. The rate of postoperative complications based on clavien-dindo classification (Lap group vs Robot group), grade II or higher in 29.6% vs 19.2%, grade III or higher in 11.2% vs 5.8% and anastomotic leakage (all grade) in 5.9% vs 4.8%. Adjusted by propensity score matching for all the factors of SMD≤0.2, though there was no significant difference in anastomotic leakage (OR 0.76, 95%CI 0.46-1.27, p=0.296), both postoperative complications of grade II or higher (OR 0.66, 95%CI 0.50-0.87, p=0.004) and grade III or higher (OR 0.29, 95%CI 0.16-0.53, p<0.001) were significantly lower in the Robot group. Conclusions: The results of this study showed better short-term outcomes which suggest that robotic-assisted surgery for rectal tumor is superior in safety than laparoscopic surgery.

Lung ultrasonography for detection of atelectasis in adults undergoing robot assisted laparoscopic pelvic surgeries

Introduction: Robot-assisted laparoscopic pelvic surgeries are minimally invasive techniques that require the patient to be placed in the steep Trendelenburg position. Pneumoperitoneum further increases the risk of postoperative pulmonary complications. We used lung ultrasound score (LUSS) to detect post-operative atelectasis in this subset of patients.
 Methodology: Patients aged 18 to 70 y with ASA physical status I/II undergoing robot assisted pelvic surgeries in steep Trendelenburg position were enrolled. Patients were mechanically ventilated with 50% oxygen in air with a tidal volume of 6 to 8 ml/kg in volume control mode to maintain an end tidal carbon dioxide at 35−45 mmHg with positive end-expiratory pressure (PEEP) of 5 cmH2O. Ultrasonographic assessment was done; before induction (A), after extubation (F), 12 h (G) and 24 h after surgery (H) by dividing chest into 12 regions.
 Results: A total of 1152 cine-loops acquired during the study period in 32 patients were analyzed. Incidence of postoperative atelectasis was 87.5% and each lung ultrasound examination required 12.35 ± 4.68 min. Statistically significant fall in PaO2 was recorded at extubation from baseline and intra-operative values (P < 0.0001). Statistically significant difference was established between change in baseline and post-extubation LUSS to the total volume of fluid given (P = 0.002).
 Conclusion: A high incidence (87.5%) of atelectasis in adults after robot assisted laparoscopic pelvic surgeries was detected using lung ultrasound score. Lung oxygenation decreased significantly after steep Trendelenburg position and extubation. The observed statistical difference in total IV fluids administered between patient subgroups who showed increased ultrasound signs of lung edema from the A period to the F period, although suggestive of association, is no evidence of causation.
 Abbreviations: ARISCOT- Assess Respiratory Risk in Surgical patients in Catalonia; LUS- Lung Ultrasound; LUSS- Lung Ultrasound Score; OR- Operating room; PEEP- Positive End-Expiratory Pressure
 Key words: LUSS; Lung ultrasound score; Pneumoperitoneum; Robotic Surgery; Ultrasonography
 Citation: Sethi S, Kathuria R, Samra T, Saini V, Toshkhani D, Kushal P. Lung ultrasonography for detection of atelectasis in adults undergoing robot assisted laparoscopic pelvic surgeries. Anaesth. pain intensive care 2023;27(4):573−578; DOI: 10.35975/apic.v27i4.1503
 Received: October 28, 2021; Reviewed: June 06, 2022; Accepted: September 17, 2022

Factors Associated with Inpatient Narcotic Medication Usage after Robotic-assisted Laparoscopy

Describe factors that contribute to an increased narcotic medication use after robotic-assisted laparoscopic (RAL) surgery. A retrospective cohort. A teaching hospital. All patients undergoing RAL surgery by gynecologist oncologists at St. Joseph's Hospital and Medical Center over a 3-year period. RAL by gynecologist oncologists. Using retrospective chart review, patients who underwent RAL surgery from 2012 to 2015 in the division of gynecologic oncology were identified; 757 patients were eligible for inclusion in the study. Total narcotic use during the postoperative hospital stay was converted to oral morphine milligram equivalents (OME). Bivariate correlations of total OME narcotics to multiple variables were evaluated using Spearman's rho. The average age, body mass index, and length of stay were 53.76 years (17-92), 31.75 kg/m2 (17-56), and 1.56 days (range, 0-19), respectively. Increased OME correlated positively with body mass index (Spearman's rho=.077, p=.036), any intraoperative complication (Spearman's rho=.05, p=.886), any postoperative complication (Spearman's rho=.16, p <.0001), length of stay in days (Spearman's rho=.282, p <.0001), procedure time (Spearman's rho .023, p=.52), and total anesthesia time (Spearman's rho, .032). Total OME narcotics were correlated negatively with age of 65 years or older (Spearman's rho, -.144, p <.0001) and use of patient-controlled analgesia (Spearman's rho, -.185, p <.0001). Age younger than 65 years seems to be a predictor for increased requirement of total morphine equivalent medication after RAL surgery, whereas patient-controlled analgesia use had a negative association.

SINGLE-INCISION LAPAROSCOPY VERSUS STANDARD LAPAROSCOPY FOR COLORECTAL SURGERY : A SYSTEMATIC REVIEW

Background: Colorectal cancer (CRC) is the third most prevalent malignancy worldwide. Only surgical resection is curative for colorectal cancer. Recent advances in surgical techniques, such as robot-assisted laparoscopic surgery (RALS), single-incision laparoscopic surgery (SILS), and natural orifice transluminal endoscopic surgery (NOTES), etc., have benefited colorectal cancer patients tremendously. The aim: This study aims to compare single-incision laparoscopy and conventional laparoscopy for colorectal surgery. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 201 articles, whereas the results of our search on SagePub brought up 119 articles. The results of the search conducted for the last year of 2013 yielded a total 54 articles for PubMed and 23 articles for SagePub. In the end, we compiled a total of 16 papers, 11 of which came from PubMed and 5 of which came from SagePub. We included six research that met the criteria. Conclusion: Previous studies have consistently shown that complications within 30 days postoperatively and incision size in patients with single port are better than patients with multiport. Perioperative outcome and long-term survival rates were similar between the two groups.

Safety Issues in the Development of an Innovative Medical Parallel Robot Used in Renal Single-Incision Laparoscopic Surgery.

Robotic-assisted single-incision laparoscopic surgery (SILS) is becoming an increasingly widespread field worldwide due to the benefits it brings to both the patient and the surgeon. The goal of this study is to develop a secure robotic solution for SILS, focusing specifically on urology, by identifying and addressing various safety concerns from an early design stage. Starting with the medical tasks and protocols, the technical specifications of the robotic system as well as potential; hazards have been identified. By employing competitive engineering design methods such as Analytic Hierarchy Process (AHP), Risk assessment, and Failure Mode and Effects Analysis (FMEA), a safe design solution is proposed. A set of experiments is conducted to validate the proposed concept, and the results strongly support the development of the experimental model. The Finite Element Analysis (FEA) method is applied to validate the mechanical architecture within a set of simulations, demonstrating the compliance of the robotic system with the proposed technical specifications and its capability to safely perform SILS procedures.

Evolving trends in the surgical therapy of patients with endometrial cancer in Germany: analysis of a nationwide registry with special emphasis on perioperative outcomes.

Endometrial cancer (EC) is the most common gynecological malignancy in women, with increasing incidence in the last decades. Surgical therapy is the mainstay of the initial management. The present study analyzed the evolving trends of surgical therapy in Germany in patients diagnosed with EC recorded in a nationwide registry. All patients with the diagnosis of EC undergoing open surgery, laparoscopic surgery, and robotic-assisted laparoscopic surgery between 2007 and 2018 were identified by international classification of diseases (ICD) or specific operational codes (OPS) within the database of the German federal bureau of statistics. A total of 85,204 patients underwent surgical therapy for EC. Beginning with 2013, minimal-invasive surgical therapy was the leading approach for patients with EC. Open surgery was associated with a higher risk of in-hospital mortality (1.3% vs. 0.2%, p < 0.001), of prolonged mechanical ventilation (1.3% vs. 0.2%, p < 0.001), and of prolonged hospital stay (13.7 ± 10.2days vs. 7.2 ± 5.3days, p < 0.001) compared to laparoscopic surgery. A total of 1551 (0.04%) patients undergoing laparoscopic surgery were converted to laparotomy. Procedure costs were highest for laparotomy, followed by robotic-assisted laparoscopy and laparoscopy (8286 ± 7533€ vs. 7083 ± 3893€ vs. 6047 ± 3509€, p < 0.001). The present study revealed that minimal-invasive surgery has increasingly become the standard surgical procedure for patients with EC in Germany. Furthermore, minimal-invasive surgery had superior in-hospital outcomes compared to laparotomy. Moreover, the use of robotic-assisted laparoscopic surgery is increasing, with a comparable in-hospital safety profile to conventional laparoscopy.

Robot-assisted surgery versus laparoscopic surgery of ureteropelvic junction obstruction in children: a systematic review and meta-analysis.

The clinical effectiveness and safety of robot-assisted laparoscopic pyeloplasty (RP) compared with laparoscopic pyeloplasty (LP) have not been clearly established in ureteropelvic junction obstruction (UPJO) children and require review. We searched in the Cochrane, MEDLINE, EMBASE, Web of Science, and CNKI database on 30 June 2022. This systematic review and meta-analysis were performed in RevMan 5.4 based on studies comparing RP versus LP in children with UPJO and subgroup analysis in children < 2years of age has been performed. The Newcastle-Ottawa Scale was used to evaluate the studies. We included one RCT, and eighteen cohort studies, a total involving 3370 children. Compared with LP, RP showed higher surgical success rates (OR 2.57, 95%CI (1.24, 5.32), P < 0.05), lower postoperative complication rates (OR 0.61, 95%CI (0.38, 0.99), P < 0.05), shorter hospital stay (MD - 1.04, 95% CI (- 1.6, - 0.47), P < 0.05) as well as operative time (MD - 22.11, 95%CI (- 35.91, - 8.31), P < 0.05). No significant differences were detected for intraoperative complication rates or conversion to open surgery rates. RP is an alternative to UPJO with higher success rates, and less postoperative complications. Evidence on the effectiveness and safety of RP compared with LP for UPJO children is of low certainty. More quality evidence in the form of randomized controlled trials is needed to obtain more reliable analysis results.

Single-port robotic-assisted ureteral reconstruction for management of strictures after renal transplantation

Ureteral strictures are a common and often challenging complication of renal transplantation. The use of single-port (SP) robotic-assisted laparoscopic surgery is a novel approach in the management of these patients. Here we describe 3 patients with stricture of the transplant ureter causing hydronephrosis and allograft dysfunction, whose ureteral reconstructions were successfully performed using the SP robotic-assisted laparoscopic approach. Two patients underwent transplant-to-native ureteroureterostomy and 1 patient underwent ureteroneocystostomy. We demonstrate that the use of concurrent ureteroscopy and near-infrared fluorescence enables safe and rapid identification of native and transplant ureters. In addition, side-to-side anastomosis of transplant-to-native ureters allows for preservation of ureteral vasculature. In this limited series, the SP robotic platform demonstrates great promise in simplifying and streamlining our approach to ureteral strictures in this patient population.

Technical Aspects and Clinical Outcomes of Robotic Ureteroscopy: Is It Ready for Primetime?

Robotic surgery in urology has already been widely employed in robotic-assisted laparoscopic surgery for minimally invasive procedures (MIS). We wanted to analyse rapidly developing robotic ureteroscopy (RoboURS) for the treatment of renal stone disease. A comprehensive literature review was performed for technical aspects and clinical outcomes of RoboURS. RoboURS has made significant breakthroughs with each model proving that this technology improves ergonomics and supports surgeon and instrument longevity while minimising musculoskeletal issues in retrograde intra-renal surgery (RIRS). Further randomised controlled trials are required to compare the efficacy of RoboURS vs manual flexible ureteroscopy (FURS). The cost-effectiveness will also need to be assessed prior to widespread acceptance into urological infrastructure and mainstream practice. RoboURS continues to evolve despite the limitations of infrastructure and cost-effectiveness. It holds the promise of a better future for surgeon longevity, reduced peri-operative morbidity and better workplace environment.

Effect of internal jugular vein catheterization on intracranial pressure and postoperative cognitive function in patients undergoing robot-assisted laparoscopic surgery.

We aimed to evaluate the effects of internal jugular vein (IJV) catheterization on intracranial pressure (ICP) and postoperative delirium (POD) during robot-assisted laparoscopic surgery by measuring the optic nerve sheath diameter (ONSD). Data from a prospective single-center cohort study, conducted from October 2021 to February 2022, were used. Forty out of 80 patients scheduled for laparoscopic radical hysterectomy or prostatectomy were assigned to the group receiving IJV catheterization (Group I), and the other 40 only received peripheral venous cannulation (Group C) according to clinical need of patients. Ultrasonography of ONSDs, the proportion of regurgitation time in a cardiac cycle, and hemodynamic parameters were measured at four time points: immediately after induction of anesthesia in the supine position (T0), 30 min (T1), 60 min (T2) after orienting to the Trendelenburg position, and before returning to the supine position at the end of surgery (T3). Time to eye opening and emergence stay, POD, and QoR-15 were compared. The ONSDs increase gradually as the surgery progressed. Group I showed a higher value of ONSD at T1 (4.72 ± 0.29 mm vs. 4.5 ± 0.33 mm, p = 0.0057) and T3 (5.65 ± 0.33 mm vs. 5.26 ± 0.31 mm, p < 0.0001). The proportions of the regurgitation time of IJVV were greater in Group I than those in Group C at T1 (14.95, 8.5%-18.9% vs. 9.6%, 0%-17.2%, p < 0.0001) and T3 (14.3, 10.6%-18.5% vs. 10.4%, 0%-16.5%, p = 0.0003). Group I had a delayed time to eye opening (10.7 ± 1.72 min vs. 13.3 ± 2.35 min, p < 0.0001) and emergence stay (32.2 ± 5.62 min vs. 39.9 ± 6.7 min, p < 0.0001). There were no significant differences in POD and QoR-15 between the two groups on day three. IJV cannulation may not be the preferred approach in robot-assisted laparoscopic surgery as it was risk factor for IJVV regurgitation, ICP elevation, emergence delayed.

Robotic surgery implementation in an isolated overseas territory – The case of Reunion Island

In February 2020, robotic surgery was introduced in University Hospital of St Pierre in Reunion Island. The aim of this study was to evaluate the implementation of robotic assisted surgery in the hospital and its impact on operating times and patient outcomes. Data was prospectively collected on patients undergoing laparoscopic robotic assisted surgery between February 2020 and February 2022. Information included patient demographics, type of surgery, operating times and length of stay. Over the two-year study period, 137 patients underwent laparoscopic robotic assisted surgery performed by 6 different surgeons. 89 of the surgeries were in gynecology, including 58 hysterectomies, 37 were in digestive surgery, and 11 in urology. The installation and docking times decreased across all specialties and were found to be significantly reduced when comparing the first and last 15 hysterectomies: mean installation time decreased from 18.7 to 14.5 minutes (p=0.048), mean docking time decreased from 11.3 to 7.1 minutes (p=0.009). The implementation of robotic assisted surgery in an isolated territory such as Reunion Island was slow due to a lack of trained surgeons, supply difficulties and Covid crisis. Despite these challenges, the use of robotic surgery allowed for technically more challenging surgeries and demonstrated similar learning curves to other centers.

Advantages and disadvantages of robotic-assisted urologic surgery vs. laparoscopic surgery in the COVID-19 Pandemic

Advantages and disadvantages of robotic-assisted urologic surgery vs. laparoscopic surgery in the COVID-19 Pandemic

ANESTHETIC MANAGEMENT OF A PATIENT UNDERGOING ROBOTIC ASSISTED LAPAROSCOPIC NEPHRECTOMY FOR NON-FUNCTIONING LEFT KIDNEY.

Robotic assisted laparoscopic surgeries are a recent advancement in minimal access surgeries that guarantee faster recovery and minimal life altering choices to the patients. However, the advent of robotic laparoscopic surgeries has placed and increasing amount of responsibility on the anaesthesiologist to maintain intra-operative stability as robotic procedures have a unique set of general consideration and their own plethora of physiological changes in the patient. This case repost describes the anaesthetic management of a 57-year-old Female patient who underwent Robotic assisted laparoscopic nephrectomy of a non-functioning left kidney

V05-04 APPLICATIONS OF 3-DIMENSIONAL VIRTUAL REALITY MODELS IN UROLOGIC ROBOTIC SURGERY

You have accessJournal of UrologyCME1 Apr 2023V05-04 APPLICATIONS OF 3-DIMENSIONAL VIRTUAL REALITY MODELS IN UROLOGIC ROBOTIC SURGERY Michael Emmerling, Hung Jui Tan, Joseph Shirk, and Marc Bjurlin Michael EmmerlingMichael Emmerling More articles by this author , Hung Jui TanHung Jui Tan More articles by this author , Joseph ShirkJoseph Shirk More articles by this author , and Marc BjurlinMarc Bjurlin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Virtual Realtiy (VR) technologies have developed increasing relevance and implementation in the field of medicine, and more specifically in the realm of surgical management for Urologic cancers. Certain VR technologies can develop three-dimensional (3D) digital models from standard computed tomography (CT) and magnetic resonance imaging (MRI) scans to facilitate surgical planning and intra-operative guidance. Use of 3D VR models has been linked to improved patient outcomes. Specifically, the use of 3D VR technology in robotic assisted laparoscopic partial nephrectomy has led to reduced operative times, shorter hospital stay, reduced clamp time, and minimized blood loss. In this video, we will highlight the impact of 3D VR technology on intra-operative planning for patients undergoing partial nephrectomy for renal masses. METHODS: In this video abstract, we explore the use of 3D VR technology in 5 patients undergoing robotic-assisted laparoscopic partial nephrectomy for renal masses. We review the CT findings and subsequently rendered 3D VR images to highlight the impact of VR on clinical decision making regarding partial versus radical nephrectomy, transperitoneal versus retroperitoneal approach, optimal vascular control mechanisms, selective versus global clamping, and depth of tumor resection. RESULTS: The use of 3D VR software impacted operative planning in each of patient undergoing robotic assisted laparoscopic surgery for a renal mass. Pre-operative and intra-operative use of 3D VR software allowed the surgeon to individualize the operative approach for each patient based on specific anatomic considerations that were highlighted or augmented with 3D VR technology. CONCLUSIONS: VR models applied to robotic partial nephrectomy appear to demonstrate improvement in clinical outcomes, surgical planning, and preoperative and intraoperative guidance. The technology is evolving, and cost remains a consideration. Future challenges will be to adopt artificial Intelligence and machine learning to account for tissue deformation, organ mobility, and anatomical changes during dissection. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e425 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Emmerling More articles by this author Hung Jui Tan More articles by this author Joseph Shirk More articles by this author Marc Bjurlin More articles by this author Expand All Advertisement PDF downloadLoading ...

MP68-13 THE PREVALENCE OF PORT-SITE INCISIONAL HERNIA AFTER UROLOGIC ROBOT-ASSISTED LAPAROSCOPIC SURGERY: A SINGLE-CENTER RETROSPECTIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP68-13 THE PREVALENCE OF PORT-SITE INCISIONAL HERNIA AFTER UROLOGIC ROBOT-ASSISTED LAPAROSCOPIC SURGERY: A SINGLE-CENTER RETROSPECTIVE STUDY Lek Hong Tan, Guan Heng Chen, Chao Hsiang Chang, Chi Rei Yang, Chi Ping Huang, and Hsi Chin Wu Lek Hong TanLek Hong Tan More articles by this author , Guan Heng ChenGuan Heng Chen More articles by this author , Chao Hsiang ChangChao Hsiang Chang More articles by this author , Chi Rei YangChi Rei Yang More articles by this author , Chi Ping HuangChi Ping Huang More articles by this author , and Hsi Chin WuHsi Chin Wu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Port-site incisional hernia is a rare but potentially dangerous complication following laparoscopic surgery. However, only sporadic studies reported this complication after robotic surgery. Therefore, this study investigates the prevalence of port-site incisional hernia after urologic robot-assisted laparoscopic surgery. METHODS: This is a retrospective, single-center, observational study. Medical records were reviewed for 1295 patients who underwent urologic robot-assisted laparoscopic surgery from September 2013 to September 2021. The prevalence of port-site incisional hernia of robot-assisted radical prostatectomy (RARP), robot-assisted partial nephrectomy (RAPN), robot-assisted radical cystectomy (RARC), and robot-assisted radical nephroureterectomy with bladder cuff excision (RANUBCE) was computed. In addition, the association between uremic status and the post-operative port-site incisional hernia was shown with an odd ratio (OR) against a reference group. RESULTS: Among 527 patients who underwent RARP, 9 patients suffered from port-site incisional hernia (1.71%; 95% CI: 0.90%, 3.22%), 1 out of 154 patients in RAPN (0.65%; 95% CI: 0.11%, 3.59%), 4 out of 46 patients in RARC (8.70%; 95% CI: 3.44%, 20.33%), and 4 out of 136 patients in RANUBCE (2.94%; 95% CI: 1.15%, 7.32%). For all 4 patients who suffered from port-site incisional hernia after undergoing RARC, their neobladders were constructed extracorporeally, of which 2 performed ileal conduit, Studer pouch in 1 patient, and another one underwent J-pouch construction. The average time to occurrence of port-site incisional hernia was 366 days and the longest time to occurrence was 1129 days. Most of the incisional hernia occurred at the camera port site (70.59%; 95% CI: 46.87%, 86.72%), and uremic status is associated with a higher tendency to suffer from port-site incisional hernia (OR= 3.68, p<0.05). CONCLUSIONS: RARC has a higher prevalence rate of port-site incisional hernia, among other types of urologic robot-assisted surgery. Incisional hernia tends to occur in RARC with extracorporeal neobladder construction. In addition, the port-site incisional hernia is associated with the larger port size and the uremic status of the patients. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e958 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lek Hong Tan More articles by this author Guan Heng Chen More articles by this author Chao Hsiang Chang More articles by this author Chi Rei Yang More articles by this author Chi Ping Huang More articles by this author Hsi Chin Wu More articles by this author Expand All Advertisement PDF downloadLoading ...

Pediatric robotic urologic procedures: Indications and outcomes.

Robotic-assisted laparoscopic surgery (RALS) has revolutionized minimally invasive surgery in pediatric urology. The robotic platform allows surgeons to maintain the benefits of laparoscopic surgery while having enhanced three-dimensional view, dexterity, range of motion, and control of high-resolution cameras. In this review, we summarize the indications and recent outcomes for various pediatric urologic RALS procedures to illustrate the current state of robotics in pediatric urology. We systematically searched the PubMed and EMBASE databases. We extrapolated and summarized recent evidence on RALS in pediatric urology patients, with an emphasis on indications and outcomes, with regard to the following procedures and search terms: pyeloplasty, kidney stone surgery, partial nephrectomy, nephroureterectomy, ureteral reimplantation, appendico-vesicostomy, augmentation cystoplasty, bladder neck reconstruction, and Malone antegrade continence enema. Additional Medical Subject Headings terms used to augment the search included "Treatment Outcome" and "Robotic Surgical Procedures." Increasing usage of RALS has shown many benefits in perioperative and postoperative outcomes. In addition, there is growing evidence that robotic procedures in pediatric urology result in similar or better surgical outcomes when compared to the standard of care. RALS has shown considerable effectiveness in pediatric urologic procedures and may achieve surgical outcomes comparable to the standard approaches of open or laparoscopic surgery. However, larger case series and prospective randomized controlled trials are still necessary to validate the reported outcomes, in addition to cost analyses and studies on the surgical learning curve. We believe that the continuous evolution of robotic platforms will allow for enhanced care and quality of life for pediatric urology patients.

Interview: Juan Gómez Rivas

Why did you decide to pursue a career in urology, and what continues to motivate you today? Urology is one of the medical specialties with the highest involvement in new technologies. From endoscopic surgery to laparoscopic robot-assisted surgery, we are one of the leaders in disruptive technologies in the medical field. Also, urology combines surgical with clinical-medical activity, covering many subtopics from benign diseases to oncology. My field of interest is genitourinary tumours. Lately there has been a big change in the management of genitourinary tumours, with novel drugs, targeting agents, and tailored medicine. Nowadays, motivation in the clinical aspect comes from patient satisfaction, and for the academic part, in leading a team of young and enthusiastic people and pushing forward to increase the academic level in Europe. This team is the Young Academics Urologists (YAU) of the European Association of Urology (EAU).1 What experience did you gain from your role as Chairman of the European Society of Residents in Urology (ESRU), and are there any notable achievements that come to mind from your time in this position? I was part of the ESRU for 5 years, and I learned multiple soft skills such as leadership, communication, and teamwork. In these 5 years, we published many papers about the actual status of urology training in Europe, raising awareness of the lack of confidence, lack of training in major surgery, and amount of surgical simulators, among others. Also, we found that although the residents present their work at congresses, this does not translate into scientific publications, so there is a lack of academic-scientific motivation, and it mainly depends on going abroad or getting into a PhD programme. Nowadays, the EAU is working hard to make urological education reachable at all levels in Europe. Having participated in multiple international congresses and collaborated on more than 250 published scientific papers, what will you be focusing on next as an educator? The natural pathway of doctors should be to achieve proficiency in their field of interest, and deliver this knowledge to the next generations. In the YAU, we are working on building an open academic curriculum for everyone. This curriculum should be Pan-European, unbiased, and high-level, covering the latest updates in research, and led by experts. Drawing upon your experience as a clinical observer, are there any innovations on the horizon in the fields of laparoscopy and focal therapy techniques for prostate cancer? Prostate cancer is living a revolution in terms of diagnosis and treatment. There are novel imaging techniques such as MRI, prostate-specific membrane antigen, and micro-ultrasound, among others, which allow us to see, diagnose, and control a tumour that we were not able to see a few decades ago. Focal therapy and robotic surgery allow us to deliver tailored treatments with good oncological results, without harbouring the quality of life. New energies to deploy inside the prostate are coming, and new robots are in the field, so the future is promising. How is the EAU, with whom you have several positions of involvement, educating healthcare professionals and trainees in the field of urology? The EAU offers numerous resources and programmes for optimal learning in urology for doctors at any stage of their urological careers. The educational arm of the EAU is the European School of Urology (ESU). The ESU aims to stimulate, coordinate, and organise all postgraduate teaching and education activities of the EAU at the highest level possible. Therefore, all teaching activities organised by the ESU are open to constant evaluation. No matter what stage you are in your career, the EAU-ESU can offer you valuable learning resources, designed to prepare the frontrunners in urology, including masterclasses, courses, hands-on training, webinars, on-demand activities, e-courses, and podcasts, among others. There are educational platforms with the latest findings on clinical trials, insights from meeting reports, and interviews with key opinion leaders called UROONCO2 and UROLUTS.3 Furthermore, urologists can be part of scholarships and exchange programmes at reputable European institutions from an early stage, and team up with experts in clinical and experimental research via the European Urological Scholarship Programme (EUSP). You recently co-authored the study, ‘Augmented reality’ applications in urology: a systematic review’. What were the key findings from this investigation? Augmented reality applied to surgical procedures refers to the superimposition of pre-operative or intraoperative images into the operative field. Augmented reality has been increasingly used in a myriad of surgical specialties, including urology, and its advances have led to increasing registration accuracy, as well as increased ability to identify anatomic landmarks, and improve outcomes during urologic procedures, such as robot assisted radical prostatectomy and partial nephrectomy.

Multi-Institutional Trends in Gynecological Robotic Surgery in India: A Real-World Scenario.

Background Robot-assisted laparoscopic surgery in gynecology has grown exponentially compared to laparoscopic surgery. The probable reasons for the increased uptake of robotics are a shorter learning curve, three-dimensional vision, and increased dexterity compared to laparoscopic surgery, and precise surgery as compared to open surgery. This study compares the time trends of various parameters in robotic gynecological surgery in India over a decade. Material and methods In India, a retrospective analysis of all robot-assisted laparoscopic surgery for gynecologic diseases in five tertiary care hospitals was conducted between July 2011 and June 2021. Data were collected regarding demographic profiles, clinical and disease characteristics, and indications for surgery. Details related to surgery were collected, such as the number of ports, console and docking time, the procedure performed, total operative time, average blood loss, blood transfusion, and length of hospital stay. All the parameters collected were grouped into five years, and a comparison was made between the first five years (2011-2015) and the second five years (2016-2021). Statistical analysis, including descriptive statistics and trend analysis, was performed. Results During the 10 years, the total number of cases included was 1,501, out of which 764 were benign cases and 737 were pre-malignant/malignant cases. The common indications were uterine leiomyoma (31.2%) and carcinoma endometrium (28%). The mean age for benign cases was significantly lower than that for malignant cases (40.84 years and 55.42 years, respectively). Mean blood loss was significantly lower for benign indications (97.48 mL) than for oncological surgery (184.67 mL) and needed fewer transfusions. The mean length of stay (LOS) for benign (2.07 days) and malignant/ pre-malignant cases (2.32 days) and the mean BMI for benign (28.40) and for oncological patients (28.47) were similar in both groups. The docking time reduced significantly in the last five years. Conclusion The current retrospective study demonstrates an increasing uptake of robotic technology in gynecological surgery in India. Of the total cohort of cases, 70.9% of patients underwent gynecological robotic surgery in the last five years. A burst of adaptability happened for malignant cases in 2017 and benign cases in 2018, probably due to the increased availability of robotic platforms and improved awareness of technology and training among medical professionals. The number of cases has grown exponentially over the last five years in both benign and malignant/ pre-malignant scenarios; however, there has been a downward trend in the robotic surgery performed in the previous couple of years due to the uncertainty of the COVID pandemic.

The urinary and sexual outcomes of robot-assisted versus laparoscopic rectal cancer surgery: a systematic review and meta-analysis.

To compare the urinary and sexual outcomes between robot-assisted rectal cancer (RC) surgery (RRCS) and laparoscopic RC surgery (LRCS) using a meta-analysis, searches were conducted of the Embase, PubMed, Cochrane Library, CNKI, and Wanfang databases. The International Prostate Symptom Score (IPSS) was the primary outcome. Eleven studies (790 patients with RRCS and 888 with LRCS) were included. The IPSS scores were significantly lower for RRCS than LRCS from baseline to 3months (weighted mean difference [WMD] = - 1.21, 95% confidence interval [CI]: - 1.8,-0.62, I2 = 89.9%), to 6months (WMD = - 1.13, 95% CI: - 1.74, - 0.52, I2 = 93.3%), and to 12months (WMD = - 0.93, 95% CI: - 1.59, - 0.26, I2 = 93.8%). The International Index of Erectile Function (IIEF) scores were significantly higher for RRCS than LRCS from baseline to 3months (WMD = 3.36, 95% CI: 1.28, 5.44, I2 = 92.7%). The female sexual function index (FSFI) scores were significantly higher for RRCS than LRCS from baseline to 3months (WMD = 1.31, 95% CI: 0.87, 1.76, I2 = 0), to 6months (WMD = 2.36, 95% CI: 1.93, 2.79, I2 = 24.3%), and to 12months (WMD = 1.67, 95% CI: 0.41, 2.93, I2 = 90.9%). RRCS also achieved a better recovery of the urological and sexual function than LRCS for patients with RC. Larger-scale prospective randomized control trials are needed to verify these results.

New technologies in the surgical management of endometriosis

Introduction: Endometriosis is a very common disease that affects up to 10% of the female population. Although medical therapy represents the first-line treatment for endometriosis, it does not always manage to control symptoms. Laparoscopy represents the standard surgical treatment in endometriosis. Robotic-assisted laparoscopy is an innovative mini-invasive surgical technique. Its application in gynecological surgery and in endometriosis has increased in the last decade. Our purpose is to offer an overview of the role of robotic-assisted laparoscopy in the surgical treatment of endometriosis. Methods: We evaluated studies dealing with the new technique in surgery for endometriosis with a focus on robotic surgery. We performed a compressive literature research on PubMed and the Cochrane Library in December 2022. Expert opinion: Robotic-assisted surgery is a feasible and safe approach to endometriosis surgery and is superimposable to laparoscopy in terms of complication rate, blood loss, hospitalization, and long-term improvement of symptoms. The effect of robotic-assisted surgery on operative time is still contradictory and needs to be further investigated. Robotic-assisted laparoscopic surgery can provide particular benefit in the management of women with severe endometriosis secondary to its advantage in surgical precision and ergonomics. Indocyanine green fluorescence angiography could be useful to assist in the vascularization of ureters and bowel anastomosis, to prevent postoperative complication and leakage.