Robot-assisted Technique Research Articles

Local recurrence of robot-assisted total mesorectal excision: a multicentre cohort study evaluating the initial cases

PurposeEvidence regarding local recurrence rates in the initial cases after implementation of robot-assisted total mesorectal excision is limited. This study aims to describe local recurrence rates in four large Dutch centres during their initial cases.MethodsFour large Dutch centres started with the implementation of robot-assisted total mesorectal excision in respectively 2011, 2012, 2015, and 2016. Patients who underwent robot-assisted total mesorectal excision with curative intent in an elective setting for rectal carcinoma defined according to the sigmoid take-off were included. Overall survival, disease-free survival, systemic recurrence, and local recurrence were assessed at 3 years postoperatively. Subsequently, outcomes between the initial 10 cases, cases 11–40, and the subsequent cases per surgeon were compared using Cox regression analysis.ResultsIn total, 531 patients were included. Median follow-up time was 32 months (IQR: 19–50]. During the initial 10 cases, overall survival was 89.5%, disease-free survival was 73.1%, and local recurrence was 4.9%. During cases 11–40, this was 87.7%, 74.1%, and 6.6% respectively. Multivariable Cox regression did not reveal differences in local recurrence between the different case groups.ConclusionLocal recurrence rate during the initial phases of implantation of robot-assisted total mesorectal procedures is low. Implementation of the robot-assisted technique can safely be performed, without additional cases of local recurrence during the initial cases, if performed by surgeons experienced in laparoscopic rectal cancer surgery.

Current and Future Applications of the Kambin's Triangle in Lumbar Spine Surgery.

Kambin’s triangle has become the anatomical location of choice when accessing the lumbar spine to treat degenerative spinal disorders. Currently, lumbar interbody fusion is the most common procedure utilizing this space; however, with the advent of the Kambin’s prism definition, advanced imaging modalities, and robotic-assisted techniques, lumbar spine surgery has become increasingly precise and less invasive. These technological and procedural advances have drastically reduced the rate of complications, improved patient outcomes, and expanded the use of the Kambin’s triangle to treat different pathologies utilizing cutting-edge techniques. In this review, the authors present the current uses of the Kambin’s triangle and the future application of this anatomical corridor in lumbar spine surgery.

Association of robot-assisted techniques with the accuracy rates of pedicle screw placement: A network pooling analysis

SummaryBackgroundTraditional paired meta-analyses have yielded inconsistent results for the safety and effectiveness of robotic-assisted pedicle screw placement due to the high heterogeneity within studies. This study evaluated the clinical effectiveness and safety of robotic-assisted pedicle screw placement.MethodsThe Embase, PubMed, and Cochrane Library databases were searched with no language limitations from inception to Jan 4, 2022. Odds ratio (OR), mean difference (MD), and 95% confidence interval (CI) were used to report results. The main outcomes were accuracy of pedicle screw placement, proximal facet joint violation, and complications. The study protocol was published in PROSPERO (CRD42022301417).Findings26 trials including 2046 participants evaluating robotic-assisted pedicle screw placement were included in this study. Our pooled results showed that Renaissance (OR 2.86; [95% CI 1.79 to 4.57]) and TiRobot (OR 3.10; [95% CI 2.19 to 4.40]) yielded higher rates of perfect pedicle screw insertion (Grades A) than the conventional freehand technique. Renaissance (OR 2.82; [95% CI 1.51 to 5.25]) and TiRobot (OR 4.58; [95% CI 2.65 to 7.89]) yielded higher rates of clinically acceptable pedicle screw insertion (Grades A+B). However, ROSA, SpineAssist, and Orthobot were not associated with higher perfect pedicle screw insertion and clinically acceptable pedicle screw insertion rates. Robot-assisted techniques were associated with low rates of proximal facet joint violation (OR 0.18; [95% CI 0.10 to 0.32]; I2:9.55%) and overall complications (OR 0.38; [95% CI 0.23 to 0.63]; I2:27.05%). Moreover, robot-assisted techniques were associated with lower radiation doses (MD –14.38; [95% CI –25.62 to –3.13]; I2:100.00%).InterpretationOur findings suggest that only Renaissance and TiRobot systems are associated with high accuracy rates of pedicle screw placement. Robotic-assisted techniques hold great promise in spinal surgery due to their safety and effectiveness.FundingThis work was supported by grants from the National Natural Science Foundation of China (No. 81871818), Tangdu Hospital Seed Talent Program (Fei-Long Wei) and Natural Science Basic Research Plan in Shaanxi Province of China (No.2019JM-265).

Determination of parabens in wastewater samples via robot-assisted dynamic single-drop microextraction and liquid chromatography-tandem mass spectrometry.

Dynamic single-drop microextraction (SDME) was automatized employing an Arduino-based lab-made Cartesian robot and implemented to determine parabens in wastewater samples in combination with liquid chromatography-tandem mass spectrometry. A dedicated Arduino sketch controls the auto-performance of all the stages of the SDME process, including syringe filling, drop exposition, solvent recycling, and extract collection. Univariate and multivariate experiments investigated the main variables affecting the SDME performance, including robot-dependent and additional operational parameters. Under selected conditions, limit of detections were established at 0.3µg/L for all the analytes, and the method provided linear responses in the range between 0.6 and 10µg/L, with adequate reproducibility, measured as intraday relative standard deviations (RSDs) between 5.54% and 17.94%, (n=6), and inter-days RSDs between 8.97% and 16.49% (n=9). The robot-assisted technique eased the control of dynamic SDME, making the process more feasible, robust, and reliable so that the developed setup demonstrated to be a competitive strategy for the automated extraction of organic pollutants from water samples.

177: A 5-YEAR SINGLE CENTER EXPERIENCE IN ROBOTIC SURGERY FOR ESOPHAGEAL ACHALASIA IN A TERTIARY CENTER, WITH PERI-OPERATIVE TAILORED PROTOCOLS

Abstract Background and aim Esophageal achalasia is a rare benign disease with heavy impact on daily life. Laparoscopic Heller-myotomy as the gold standard surgical treatment. In recent years the robot-assisted (DaVinci, Intuitive Surgical Inc., CA) technique became widely used for its reported advantages in terms of vision, precision and motion. The aim of the study was to evaluate the supposed advantages of robot-assisted Heller myotomy compared to the standard laparoscopic approach in a single center experience. Methods We included the patients who underwent standard laparoscopic and robot-assisted Heller-myotomy with Dor fundoplicatio in the last 5 years in the Upper-GI division of the University Hospital of Verona. We assessed if the robot-assisted Heller-Dor myotomy was simplified in terms of the ease of the myotomy, especially on the gastric side and the following fundoplicatio, on the sharpness of the endoscope and on the precision of the movements. We also compared the operative times with the two techniques, and the overall morbidity and mortality rates, also with the introduction of new peri-operative protocols for standardized and enhanced recovery. Results We included 40 patients who underwent Heller-Dor, robot-assisted Heller-Dor approach was performed in 17 patients and standard laparoscopic approach in 23 patients. Based on the surgeons experience and judgment, robot-assisted Heller-myotomy seems to be easier than the laparoscopic procedure in terms of sharpness of vision, freedom of motion and consequently precision in the single-fibers dissection of the muscularis. The operative times were comparable between the robot-assisted procedures and the laparoscopic approach, as were morbidity and mortality rates; in-hospital stay was also similar in the two groups, with a slight decrease in the last 6 months, after the introduction of new post-operative protocols for enhanced recovery with mandatory contrast swallow on POD1. Conclusion Our study suggests that robot-assisted Heller-myotomy for achalasia is a valid alternative to the traditional laparoscopic approach, for the improvement of surgical precision and myotomy outcome, with apparently no deterioration of safety and surgical complications, in particular with dedicate personnel and standardized recovery protocols. It also suggests that the learning curve is negligible if supported by an adequate number of patients per-year, as in a tertiary center.

Accuracy and safety of robot-assisted cortical bone trajectory screw placement: a comparison of robot-assisted technique with fluoroscopy-assisted approach

ObjectiveTo compare the safety and accuracy of cortical bone trajectory screw placement between the robot-assisted and fluoroscopy-assisted approaches.MethodsThis retrospective study was conducted between November 2018 and June 2020, including 81 patients who underwent cortical bone trajectory (CBT) surgery for degenerative lumbar spine disease. CBT was performed by the same team of experienced surgeons. The patients were randomly divided into two groups—the fluoroscopy-assisted group (FA, 44 patients) and the robot-assisted group (RA, 37 patients). Robots for orthopedic surgery were used in the robot-assisted group, whereas conventional fluoroscopy-guided screw placement was used in the fluoroscopy-assisted group. The accuracy of screw placement and rate of superior facet joint violation were assessed using postoperative computed tomography (CT). The time of single screw placement, intraoperative blood loss, and radiation exposure to the surgical team were also recorded. The χ2 test and Student’s t-test were used to analyze the significance of the variables (P < 0.05).ResultsA total of 376 screws were inserted in 81 patients, including 172 screws in the robot-assisted group and 204 pedicle screws in the fluoroscopy-assisted group. Screw placement accuracy was higher in the RA group (160, 93%) than in the FA group (169, 83%) (P = 0.003). The RA group had a lower violation of the superior facet joint than the FA group. The number of screws reaching grade 0 in the RA group (58, 78%) was more than that in the FA group (56, 64%) (P = 0.041). Screw placement time was longer in the FA group (7.25 ± 0.84 min) than in the RA group (5.58 ± 1.22 min, P < 0.001). The FA group had more intraoperative bleeding (273.41 ± 118.20 ml) than the RA group (248.65 ± 97.53 ml, P = 0.313). The radiation time of the FA group (0.43 ± 0.07 min) was longer than the RA group (0.37 ± 0.10 min, P = 0.001). Furthermore, the overall learning curve tended to decrease.ConclusionsRobot-assisted screw placement improves screw placement accuracy, shortens screw placement time, effectively improves surgical safety and efficiency, and reduces radiation exposure to the surgical team. In addition, the learning curve of robot-assisted screw placement is smooth and easy to operate.

Minimally Invasive and Open Donor Nephrectomy: Lessons Learned From a French Multicenter Experience

We evaluated different techniques of donor nephrectomy. Outcomes of 4 surgical approaches (open surgery [OS], standard laparoscopy [SL], hand-assisted laparoscopy [HAL], and robot-assisted la`paroscopy [RAL]) were compared. A total of 264 nephrectomies were performed: 65 in the OS group, 65 in the SL group, 65 in the HAL group, and 69 in RAL group. Operative time was longer for the RAL group (P < .001) with a mean time of 202 minutes (RAL), 182 minutes (OS), 173 minutes (SL), and 157 minutes (HAL). Complications (P=.002) and consumption of morphine derivates (P=.31) were lower for the RAL group (P=.0002). The visual analog scale pain scores (P=.002), hospital stay (P=.023), and time to return to full activities (P=.79) were higher for OS. The 4 different nephrectomy surgical approaches had similar favorable results. The robot-assisted technique presented as an alternative option, with low incidence of complications, less pain, and results comparable to the other techniques.

Care of the Patient Undergoing Robotic-Assisted Brain Biopsy With Stereotactic Navigation: An Overview.

Brain tumors can cause pressure, swelling, and functional changes to the surrounding tissue and lead to sensorimotor symptoms. Such tumors are either benign or malignant and their origin can be primary or metastatic. Although diagnostic studies (eg, computed tomography and magnetic resonance imaging) can reveal a mass and provide information on its location, size, and relationship to surrounding structures, the most definitive way to make a diagnosis requires a brain biopsy tissue sample. The robotic-assisted technique with stereotactic navigation allows the neurosurgeon to merge preoperative scans with a computer program to provide a map of the planned surgical trajectory and use the robot to obtain the biopsy. The robotic-assisted brain biopsy with navigation provides improved accuracy with small incisions that may not be possible using non-robotic-assisted techniques. This article provides background information and an overview of the nursing considerations for patients undergoing robotic-assisted brain biopsy procedures.

Full subcostal subxiphoid robotic-assisted radical thymectomy: preclinical cadaveric study for optimizing patient positioning, table settings, and port configuration.

Robotic subxiphoid transthoracic thymectomy showed several surgical advantages. Nevertheless, the intercostal insertion of trocars may lead to nerve injury with enhanced post-operative pain. Moreover, the dissection of peri-diaphragmatic mediastinal fat may result challenging, in particular on left side, where the presence of the heart precludes the optimal visualization. We describe a preclinical cadaveric study of a novel full subcostal robotic-assisted technique to overcome these limitations. A total subcostal robotic-assisted radical thymectomy was evaluated on a cadaver model using the da Vinci Xi system. The exploratory procedure was divided in two steps: (a) dissection of the thymus gland, except the left mediastinal epi-diaphragmatic fat pad; (b) dissection of the left diaphragmatic mediastinal fat pad avoiding heart compression while perfectly visualizing the left phrenic nerve. Five different setups were explored based on camera and trocars insertions, patient's positioning and table's settings. Both the tasks were accomplished using the novel technique. The subxiphoid insertion of the camera and the position of two robotic arms about 8cm distally on the subcostal made the most part of mediastinal dissection straightforward. Left peri-diaphragmatic fat pad can be better visualized and dissected positioning the camera in the left subcostal port shifting the instruments on the right side. This may permit a better control of the left phrenic nerve reducing heart compression. Full subcostal robotic-assisted thymectomy resulted feasible in cadaveric model. Clinical trial should be performed to confirm the translational use of this novel technique and the speculated advantages in living model.

Robot-assisted radical cystectomy for bladder cancer: single-center experience

Abstract Objective Radical cystectomy remains the most effective treatment for patients with localized, invasive bladder cancer and recurrent noninvasive disease. Recently some surgeons have begun to describe outcomes associated with less invasive surgical approaches to this disease, such as laparoscopic or robotic assisted techniques. We report our maturing experience with 100 consecutive cases of robotic assisted laparoscopic radical cystectomy regarding perioperative results, pathological outcomes, and surgical complications. Methods A total of 100 consecutive patients (73 male and 27 female) underwent robotic radical cystectomy with intracorporeal urinary diversion at our institution from February 2018 to February 2021 for clinically localized bladder cancer. Outcome measures evaluated included operative variables, hospital recovery, pathological outcomes, and complication rate. Results The mean age of this cohort was 60.4 years (range 38 to 82). Ninety-five patients underwent ileal conduit diversion, 5 received a neobladder). The mean operating room time for all patients was 184 min (min time was 160 min) and mean surgical blood loss was 286 ml. On surgical pathology, 2% of the cases were pT1, 35% were pT2, 51+12% were pT3/T4 disease and 17% were node positive. The mean number of lymph nodes removed was 16 (range 10 to 40). In no case was there a positive surgical margin. The mean days to flatus were 2.6, bowel movement 2.8 and discharge home 8.2. There were 21 postoperative complications in 20 patients with 4% having a major complication (Clavien grade 3 or higher) and 15% being readmitted within 30 days after surgery. At a mean follow-up of 12 months 3 patients had disease recurrence and died 4 of disease. Conclusions We report a relatively large cohort and maturing experience with robotic radical cystectomy for the treatment of bladder cancer, providing acceptable surgical and pathological outcomes. These results support continued efforts to refine the surgical management of muscle-invasive bladder cancer.

Sequential endoscopic and robot-assisted surgical solutions for a rare fungal spondylodiscitis, secondary lumbar spinal stenosis, and subsequent discal pseudocyst causing acute cauda equina syndrome: a case report

BackgroundFungal spondylodiscitis is a rare infectious disease. The secondary lumbar spinal stenosis and postoperative discal pseudocyst were even rarer. The surgical interventions were disputed, yet endoscopic and robot-assisted techniques may be helpful under different circumstances.Case presentationA 62-year-old female was diagnosed as infectious spondylodiscitis at the L4/5 level and a posterolateral endoscopic debridement was performed after invalid conservative therapy. Causative organism culture revealed a rare fungus, Candidatropicalis. A secondary spinal stenosis with refractory radiculopathy occurred almost 3 years after the first surgery and a successful endoscopic surgery was implemented aiming to decompress the nerve in a minimally invasive way. However, 2 months later, the patient manifested severe acute cauda equina syndrome and radiological examinations suggested a rare postoperative discal pseudocyst. A laminectomy followed by a pseudocystectomy was applied to achieve thorough decompression. An innovative double trajectory system (simultaneous traditional pedicle screw and cortical bone trajectory screw) accompanied by posterolateral fusion was designed and executed by the professional robot-assisted system.ConclusionEndoscopic and robot-assisted techniques may provide alternative solutions for fungal spondylodiscitis and accompanied sequelae.

Robot Surgery for Midline Cysts of the Prostate With Hypospadias in the Pediatric Population

To summarize the experience of using robotic surgery to treat midline cysts (MLC) of the prostate in pediatric patients with hypospadias, and to introduce and evaluate the initial outcome of seminal passage reconstruction via robot-assisted laparoscopy during the removal of symptomatic MLCs. We included a case series of 17 symptomatic MLCs with hypospadias. All patients received both genetic and fertility evaluation. MLCs were removed via robot-assisted laparoscopy and the seminal passage was reconstructed in 7 patients. Five patients were assessed as fertile as adults, while the other 12 were assessed as infertile. All 17 patients received robot-assisted laparoscopic surgery to remove MLCs, and 7 patients received reconstruction of the seminal passage. Patients were followed-up for 5-24 months; there were no serious adverse events except for 1 patient who experienced a single occurrence of epididymitis 7 months after reconstruction of the seminal passage. There were no significant cystic remnants in any of the patients upon ultrasonography and/or urethrography after surgery. Urethroscopy and vasography were performed in 2 patients after reconstruction; in both cases, unobstructed seminal passages were indicated. Reconstruction of the seminal passage is practical when carried out by robot-assisted techniques. Initial results indicated that the reconstruction operations were able to restore patency in the seminal duct in some of the patients. Fertility is the goal of this technique, and long-term follow-up is needed.

Urinary continence and erectile dysfunction results in robot-assisted radical prostatectomy with endopelvic fascia preservation

Introduction: Radical prostatectomy is the treatment of choice for patients with organ-confined prostate cancer due to its oncological benefits and survival. With the advancement of technology, surgical techniques have been modified, and robot-assisted radical prostatectomy (RARP) is currently the procedure with the most advanced technology. Due to its multiple advantages, such as short-term functional and surgical results, shorter hospital stay and minimal invasiveness, it constitutes a valid therapeutic option to consider for this group of cancer patients.&#x0D; Objective: To compare the results obtained in urinary continence and erectile dysfunction after RARP with a standard da Vinci® system with 4 arms, between a group of 43 patients who underwent said procedure, without preservation of the endopelvic fascia in 2018, and 68 patients who underwent the same procedure with endopelvic fascia preservation, between January 2019 and February 2021, all at the Hospital Carlos Andrade Marín, in Quito.&#x0D; Methodology: A retrospective longitudinal descriptive observational study was made, with the comparison of 68 prostate cancer patients who underwent radical surgery with endopelvic fascia preservation at the Hospital Carlos Andrade Marín, between January 2019 and February 2021, and 43 patients who had the same surgery but without endopelvic preservation, in the year 2019.&#x0D; Results: One hundred eleven surgeries for prostate cancer with the robot-assisted radical prostatectomy technique were performed. Forty-three (37.8%) surgeries were made without endopelvic fascia preservation, and 68 (61.3%) were made with endopelvic fascia preservation.&#x0D; At the first month of follow-up, 25 (58%) patients of the RARP without endopelvic fascia preservation group, presented with severe erectile dysfunction, 11 (26%) with moderate erectile dysfunction, 6 (14%) with moderate to mild erectile dysfunction, and 1 (2%) with mild erectile dysfunction. At 6 months follow-up, of the 25 patients with severe dysfunction, 2 presented with moderate dysfunction and 23 remained with severe dysfunction. Of the patients who underwent RARP with endopelvic fascia preservation, 54 (80%) presented with mild incontinence, and 3 (4%) were completely continent making use of this technique. Furthermore, at 9 months follow-up, 90% of the patients had complete continence and 10% mild incontinence. Fifty six percent of the RARP patients with endopelvic fascia preservation presented severe sexual dysfunction at the first postoperative month. However, after pharmacological treatments, only 19% remained with erectile dysfunction.&#x0D; Conclusion: RARP is a safe and minimally invasive technique, it improves surgical and functional results, in the short and long terms, with respect to continence and sexual function. Endopelvic fascia preservation could improve results in the long term for continence and erectile dysfunction.

Endovascular Rescue for Renal Artery Pseudoaneurysms following Minimally Invasive Robot-Assisted Partial Nephrectomy—A Case Series

AbstractNephron sparing surgery or partial nephrectomy has been employed ever since in cases of renal tumors with an aim to preserve the function of residual kidney. Lately, there has been increasing adoption in robot-assisted techniques for partial nephrectomy. However, renal surgeries of any kind have always been a hazard for postoperative vascular complications owing to high vascularity of the renal tissues, of which renal artery pseudoaneurysm is one of the most fatal complications. We present a case series where highly super-selective embolization rescues the patient and augments the nephron sparing nature of the precise robot-assisted partial nephrectomy.

Robot-assisted versus conventional laparoscopic adrenalectomy: Results from the EUROCRINE Surgical Registry

BackgroundAdrenalectomy is routinely performed via the minimally invasive approach. Safety of adrenalectomy using the robot-assisted technique has been widely demonstrated by several series, but the literature is scarce regarding the comparison of conventional laparoscopic versus robot-assisted approach. We decided to carry out a multicenter study to compare clinical and surgical outcomes between laparoscopic and robotic adrenalectomy. MethodsThis is a retrospective case-control study, including data from centers affiliated to the Surgical Registry EUROCRINE. Patients undergoing laparoscopic surgery for adrenal tumors and registered between 2015 and 2018 were included. Robot-assisted versus laparoscopic adrenalectomy was compared. All comparisons were carried out in terms of complication rate, conversion rate and duration of stay. ResultsA total of 1,005 patients from 46 clinics underwent robotic or conventional laparoscopic adrenalectomy. Median age was 55 (interquartile range: 45−65) years. Robotic adrenalectomy was performed in 189 (18.8%) patients. According to Clavien-Dindo classification, complication rate was lower in the robotic surgery group (1.6% vs 16.5%, P < .001). Laparoscopic surgery and active hormonal status were significantly correlated with complications, both in univariate and multivariate analysis. There was no significant difference between laparoscopic and robotic surgery groups, in terms of conversion rate (2.1% vs 0.5%, respectively, P = .147). Duration of stay was shorter in the robotic adrenalectomy group (82.1% vs 28.8%, P < .001). ConclusionAnalysis of the EUROCRINE database supports that robotic adrenalectomy resulted in a lower complication rate and shorter duration of stay, compared with laparoscopic adrenalectomy. Granular data to support this is warranted.

Does robotic-assisted computer navigation improve acetabular cup positioning in total hip arthroplasty for Crowe III/IV hip dysplasia? A propensity score case-match analysis.

Total hip arthroplasty (THA) in patients with hip-dislocation dysplasia remains challenging. This study aims to evaluate whether these patients may benefit from robotic-assisted techniques. We reviewed 135 THAs (108 conventional THAs and 27 robotic-assisted THAs) for Crowe type III or IV from January 2017 to August 2019 in our institution. Robotic-assisted THAs were matched with conventional THAs at a 1:1 ratio (27 hips each group) using propensity score matching. The accuracy of cup positioning and clinical outcomes were compared between groups. The inclination of the cup for conventional THAs and robotic THAs was 42.1 ± 5.7 and 41.3 ± 4.6 (p = 0.574), respectively. The anteversion of the cup for conventional THAs was significantly greater than that of robotic THAs (29.5 ± 8.1 and 18.0 ± 4.6; p < 0.001), respectively. The ratio of the acetabular cup in the Lewinnek safe zone was 37% (10/27) in conventional THAs and 96.3% (26/27) in robotic THAs (p < 0.001). Robotic THAs did not achieve better leg length discrepancy than that of conventional THAs (- 0.4 ± 10.9mm vs. 0.4 ± 8.8mm, p = 0.774). There was no difference in Harris Hip Score and WOMAC Osteoarthritis index between groups at the 2-year follow-up. No dislocation occurred in all cases at the final follow-up. Robotic-assisted THA for patients with high dislocation improves the accuracy of the implantation of the acetabular component with respect to safe zone.

Robot-assisted bronchial sleeve left upper lobectomy for locally advanced bronchopulmonary squamous cell carcinoma after neoadjuvant chemotherapy: a case report

: For patients with central bronchopulmonary malignancies, sleeve lobectomy serves as an alternative to pneumonectomy. In recent years, robotic-assisted technique has been innovatively developed and applied in sleeve lobectomy. Here, we introduce a patient treated with chemotherapy who received robotic bronchial sleeve lobectomy without pulmonary vessel anastomosis in our department. The patient was a 53-year-old male smoker, who had suffered irritable cough for 6 months. During surgery we found that the tumor was tightly adhered to the pulmonary artery. Robotic scissors were used to separate the tumor from the surface of the pulmonary artery. Finally, the tumor was removed along with the relevant bronchus, and the pulmonary artery remained intact. The tumor margins were verified as negative by fast frozen pathology during the procedure. This experience in our department demonstrates the advantages of robot-assisted bronchial lobectomy in preserving pulmonary vessels in patients with pulmonary arterial adventitia involvement.

Robot-assisted techniques in vascular and endovascular surgery.

For thousands of years, robots have inspired the imagination of humans, but it was only about 35 years ago that a robot was used for the first time in medicine. Since then, robot-assisted procedures have become increasingly popular in urology, general surgical specialties, and gynecology. Robot-assisted vascular surgery was first introduced in 2002 and was thought to overcome the limitations of laparoscopy. However, it did not gain widespread popularity, and its usage is still limited to a few centers worldwide. Robot-assisted endovascular procedures, on the other hand, while still in its infancy, have become a promising alternative to existing techniques. The improvements of the robotic systems promote better surgical performance and reduce occupational hazards for vascular and endovascular surgeons. A comprehensive review of literature was performed using the search terms “robotic,” “robot assisted,” “vascular surgery,” and “aortic” for surgical procedures or “robotic,” “robot assisted,” and “endovascular” for endovascular procedures. Full text articles that were published between January 1990 and March 2021 were included. This review summarizes the development of the techniques for robot-assisted vascular and endovascular surgery in recent years, its outcomes, advantages, disadvantages, and perspectives.

Robotic-assisted, laparoscopic, and open radical cystectomy: surgical data of 1400 patients from The Italian Radical Cystectomy Registry on intraoperative outcomes.

IntroductionThe Italian Radical Cystectomy Registry (Registro Italiano Cistectomie – RIC) aimed to analyse outcomes of a multicenter series of patients treated with radical cystectomy (RC) for bladder cancer.Material and methodsAn observational, prospective, multicenter, cohort study was performed to collect data from RC and urinary diversion via open (ORC), laparoscopic (LRC), or robotic-assisted (RARC) techniques performed in 28 Italian Urological Departments. The enrolment was planned from January 2017 to June 2020 (goal: 1000 patients), with a total of 1425 patients included. Chi-square and t-tests were used for categorical and continuous variables. All tests were 2-sided, with a significance level set at p <0.05.ResultsOverall median operative-time was longer in RARCs (390 minutes, IQR 335–465) than ORCs (250, 217–309) and LRCs (292, 228–350) (p <0.001). Lymph node dissection (LND) was performed more frequently in RARCs (97.1%) and LRCs (93.5%) than ORCs (85.6%) (p <0.001), with extended-LND performed 2-fold more frequently in RARCs (61.6%) (p <0.001). The neobladder rate was significantly higher (more than one-half) in RARCs. The median estimated blood loss (EBL) rate was lower in RARCs (250 ml, 165–400) than LRCs (330, 200–600) and ORCs (400, 250–600) (p <0.001), with intraoperative blood transfusion rates of 11.4%, 21.7% and 35.6%, respectively (p <0.001). The conversion to open rate was slightly higher in RARCs (6.8%) than LRCs (4.3%). Intraoperative complications occurred in 1.3% of cases without statistically significant differences among the approaches.ConclusionsData from the RIC confirmed the need to collect as much data as possible in a multicenter manner. RARCs proves to be feasible with perioperative complication rates that do not differ from the other approaches.

Комплексная профилактика кавернозного фиброза после перенесенной радикальной нервосберегающей простатэктомии

Advances in laboratory and radiation diagnostics have improved the detection of early prostate cancer in patients aged 45 to 60 years who are sexually active and interested in preserving their erectile function after surgery. Objective: to improve sexual rehabilitation of patients after nerve-sparing robot-assisted radical prostatectomy (NS-RARP). Patients and methods. This study was conducted at the Medical Research and Educational Center of Lomonosov Moscow State University and included 32 patients who had undergone NS-RARP. Their mean age was 58 ± 6.4 years. Mean PSA level at diagnosis was 7.07 ± 2.9 ng/mL. The stages of prostate cancer were distributed as follows: 3 cases of T1bN0M0 (9%), 17 cases of T1cN0M0 (53%), 7 cases of T2aN0M0 (22%), and 5 cases of T2bN0M0 (16%). All patients were operated on by the same surgeon; neurovascular bundles were preserved using the intrafascial technique. Conclusion. Implementation of the robot-assisted technique reduced the frequency of postoperative erectile dysfunction. It is well known that even a successful standard prostatectomy is likely to result in erectile dysfunction due to partial denervation and ischemia of the cavernous bodies in the early postoperative period and cavernous fibrosis in the late postoperative period causing venogenic erectile dysfunction. Prophylaxis of cavernous fibrosis with phosphodiesterase type 5 inhibitors does not always ensure normal erection: 75% of patients have complaints of erectile dysfunction one year postoperatively. Comprehensive prevention (pharmacotherapy plus physiotherapy) of cavernous fibrosis in the early postoperative period significantly improved erectile function as demonstrated by the International Index of Erectile Function (IIEF). It was also confirmed by better hemodynamic parameters and increased stiffness of cavernous tissue in the patients studied.