Robotic Operative Time Research Articles

Evolution and Adaptations of Robotic DIEP Flap Surgery: A Systematic Review.

The integration of robotic technology into surgical procedures has gained considerable attention for its promise to enhance a variety of clinical outcomes. Robotic deep inferior epigastric perforator (DIEP) flap harvest has emerged as a novel approach for autologous breast reconstruction. This systematic review aims to provide a comprehensive overview of the current techniques, outcomes, and complications of robotic DIEP flap surgery. A systematic literature search was conducted after PRISMA 2020 guidelines across databases including PubMed, Embase, Google Scholar, and Web of Science from 2000 to 2023. Articles exploring robotic DIEP flap harvest for breast reconstruction were assessed to compare operative techniques, clinical outcomes, and complications. The risk of bias was evaluated using ROBINS-I and the Newcastle-Ottawa scale. Fourteen studies involving 108 patients were included. Three studies used a totally extraperitoneal (TEP) technique, whereas 11 studies used a transabdominal preperitoneal (TAPP) approach. Preoperative planning utilized computed tomography angiography and magnetic resonance angiography imaging. The mean robotic operative time was 64 minutes, with total operative times averaging 574 minutes for TAPP and 497 minutes for TEP. The mean length of stay was 5 days, and the mean fascial incision length was 3cm. Overall complication rate was 14.9%, with no significant difference compared with conventional DIEP flap procedures. Robotic DIEP flap harvest is a promising technique that may reduce postoperative pain and limiting abdominal donor site morbidity. Potential limitations include longer operative times, variable hospital stays, and increased costs.

The impact of resident training on robotic operative times: is there a July Effect?

It is unknown whether the July Effect (a theory that medical errors and organizational inefficiencies increase during the influx of new surgical residents) exists in urologic robotic-assisted surgery. The aim of this study was to investigate the impact of urology resident training on robotic operative times at the beginning of the academic year. A retrospective chart review was conducted for urologic robotic surgeries performed at a single institution between 2008 and 2019. Univariate and multivariate mix model analyses were performed to determine the association between operative time and patient age, estimated blood loss, case complexity, robotic surgical system (Si or Xi), and time of the academic year. Differences in surgery time and non-surgery time were assessed with/without resident presence. Operative time intervals were included in the analysis. Resident presence correlated with increased surgery time (38.6 min (p < 0.001)) and decreased non-surgery time (4.6 min (p < 0.001)). Surgery time involving residents decreased by 8.7 min after 4 months into the academic year (July–October), and by an additional 5.1 min after the next 4 months (p = 0.027, < 0.001). When compared across case types stratified by complexity, surgery time for cases with residents significantly varied. Cases without residents did not demonstrate such variability. Resident presence was associated with prolonged surgery time, with the largest effect occurring in the first 4 months and shortening later in the year. However, resident presence was associated with significantly reduced non-surgery time. These results help to understand how new trainees impact operating room times.

Robotic intersphincteric resection of low rectal cancer versus laparoscopic intersphincteric resection of low rectal cancer

This systematic review evaluated and compared the two currently available intersphincteric resection techniques (robotic and laparoscopic intersphincteric resection) for low rectal cancer, with the final aim of comparing associated factors between the two techniques. The assessed factors included surgical duration, hospital stay, complications, overall survival, local recurrence, and low anterior resection syndrome (LARS). A literature search of the search engines “PubMed”, “SCOPUS”, and “Web of Science” was conducted, with a time interval set between 2015 and 2023. The initial search yielded 57 studies, of which 10 met the inclusion and exclusion criteria. Hence, data was extracted from only these 10 studies. The average reported robotic surgery time varied between 197 and 472 mins, while the laparoscopic surgery time varied between 240 and 325 mins. Conversely, the overall survival and local recurrence rates were 89.7% and 6.7% for robotic and 87.9% and 6.2% for laparoscopic resection, respectively. In addition, complications were reported in 16.5% and 18.2% of robotic and laparoscopic resection cases, respectively. This systematic review showed that although the surgery duration is longer in robotic resection compared to laparoscopic resection, the former technique is associated with lower rates of complications and local recurrence, and improved overall survival. In addition, few studies have reported on the prevalence of LARS; therefore, we recommend that this field be studied and included in the reported data of the upcoming studies to allow more conclusive evidence regarding prevalence of LARS among the two groups of intersphincteric resections.

Transferring Surgical Expertise: Analyzing the Learning Curve of Robotic Cardiac Surgery Operative Time Reduction When Surgeon Moves from One Experienced Center to Another.

Robotically assisted cardiac surgery is performed in a team setting and is well known to be associated with learning curves. Surgeon and operative team learning curves are distinct entities, with total operative time representing the entire operative team (surgery, anesthesia, nursing, and perfusion) and cross-clamp time representing mainly the surgical team. Little is known about how a team learning curve evolves when an experienced surgeon transitions from one surgical center to another. This study investigates the dynamics of the team learning curve expressed as total operative time in the case of a surgeon with previous experience transitioning to a new team. A retrospective analysis was conducted on robotic cardiac surgeries performed by a surgeon who transitioned from one experienced surgical center to another. Operative time data were collected and categorized to assess the evolution of the learning curve. Statistical analysis, including learning curve modeling and linear regression analysis, was used to evaluate changes in total time in the operating room per case. 103 cases were included in Weill Cornell Medicine (2019-2023). The median patient age was 63 years, 68% were males, 90.3% of cases were repaired for degenerative mitral valve disease, and the median body mass index was 23.87. Operative time (ORT) decreased from a median of 5.00 h [95%CI: 4.76, 6.00] in the first 30 cases to 4.83 [95%CI: 4.10, 5.27] thereafter, with the apparent curve plateauing indicative of the adaptation period to the new surgical environment (p = 0.01). Subgroup analysis among mitral cases (n = 93) showed a decrease in ORT from 5.00 [95%CI: 4.71, 5.98] in the first 26 cases to 4.83 [95%CI: 4.14, 5.30] (p = 0.045). There was no difference between the initial 30 cases and subsequent cases regarding cardiopulmonary bypass time, myocardial ischemia time, reoperation for bleeding, prolonged ventilation, reintubation, renal failure, need for an intra-aortic balloon pump, readmission to the ICU, reoperation for valvular dysfunction within 30 days, pneumonia, and deep venous thrombosis. Multivariate significant predictors of longer operative time were the first 30 cases, resection-based repairs, and MAZE as a concomitant procedure. Total operative time can be expected to decrease after about 30 cases when an experienced robotic surgeon moves between centers. Complications and cross-clamp times are less susceptible to a learning curve phenomenon in such a circumstance, as these depend primarily on the operating surgeon's level of experience. Understanding these dynamics can inform the planning and management of surgical transitions, ensuring optimal patient care and continued improvement in surgical outcomes.

Feasibility and Safety of Performing Day-Surgery Medial Unicompartmental Robotic Prostheses in the Italian Health Care System

Study Purpose: Our study analyzes the feasibility and safety of robotic-assisted medial unicompartmental prostheses performed in day surgery compared to the current standard for a minimum of two nights in the rules of the Italian National Health System, which is mandatory for Diagnosis Related Groups reimbursement of ordinary hospitalization. Two groups of patients undergoing robotic-assisted medial unicompartmental prostheses were compared, of which one group in ordinary hospitalization and one group in day surgery. All patients from both groups underwent Robot-assisted medial unicompartmental prosthesis surgery (RIO® MAKO Stryker surgical corporation). The terms of comparison between the two groups regarding feasibility and safety were: any complications, any transfusions, hospital readmissions, and ER accesses for prosthesis-related reasons within 7 days and within 3 months after surgery. Pain preoperatively, at discharge, 3 months and 1 year after surgery was quantified by Verbal Rating Scale (0 to 4). Method: At the ASL Toscana Sudest in Arezzo, a total of 280 robot-assisted Unicompartmental Knee Arthroplasty (UKA) surgeries were performed during the study period (2014-2018), 259 of which were medial surgeries. The surgical team was always the same with oversight by two experienced senior surgeons. In this study, 259 cases of medial UKA were taken into consideration, while lateral or patellofemoral types were left out. Of the 259 medial UKA, 30 patients were consecutively operated on in day surgery by waiting list progression without any exclusion. The other 229 were all operated on as inpatients. We collected the ASA (American Society of Anesthesiologists) value data of the 30 patients under study namely 9 patients with ASA 1, 19 patients with ASA 2, and 2 patients with ASA 3. The average time for robotic surgery between the first 30 patients operated in 2014 and the last 30 operated in 2018 was studied to evaluate the trend in reduction of operational time by showing improvement in the learning curve of robotic technique with statistically significant result of P&lt;0.01. We assessed patient satisfaction with the surgical course and outcomes of the 30 patients operated for UKA in day surgery, 3 and 12 months after surgery with Likert scale quantifying satisfaction from 1 to 5: 1 totally dissatisfied, 2 dissatisfied, 3 neutral, 4 satisfied, 5 completely satisfied. Results: No readmission to the emergency room or ward occurred within 7 and 90 days after surgery for minor or major complications in the two groups. In view of the pain treatment protocol adopted for all UKA operated patients, the results regarding pain were not statistically significant between the two groups. Therefore, there were no differences according to the two types of hospitalization. After 3 and 12 months, 80% and 76% of patients, respectively, in the day-surgery operated group expressed themselves with value 4 and 5 on the Likert scale of satisfaction. Conclusions: In our study, we found no differences between the two groups of 30 patients operated in day surgery and the 229 operated in ordinary hospitalization in terms of transfusions, complications or hospital readmissions within 7 days, nor minor or major complications within 90 days after surgery. We found no statistically significant differences in the VRS pain scale by comparing the two groups; we found a high satisfaction index of the 30 patients undergoing day surgery. The pain scale, compared with values between the same group of 30 patients before surgery and after 3 and 12 months, showed a decrease such that it was statistically significant for P&lt;0.05; an analogous result was obtained by comparing values between the same group of 229 patients for P&lt;0.05. Our study demonstrates that robotic medial UKA can be safely performed in day surgery. Being able to perform this surgery under the assumptions and characteristics of day surgery organization means reduction of surgery costs, of waiting lists, of hospitalization risks, and of patient stress. The resulting organizational proposal is to authorize Italian health facilities to perform partial prosthesis surgery in day surgery with equal DRG reimbursement. Economic savings would result from this opportunity by offsetting the higher cost of the same robotic surgery.

The first experience of robot-assisted vental mesh rectopexy using the Senhance® system in the treatment of patients with obstructive defecation syndrome

Aim: to assess primary results of robot-assisted ventral mesh procedure using the new Senhance® robotic system for obstructive defecation syndrome.Patients and Methods: the prospective cohort study included patients who underwent robot-assisted ventral mesh rectopexy with the Senhance® system for obstructive defecation syndrome caused by rectocele and/or rectal prolapse and/or internal intussusception. The optimal trocar sites, the location of robotic arms, operation time and intraoperative blood loss were evaluated, as well as post-op morbidity rate (Clavien-Dindo scale), pain intensity (VAS scale) and recurrence rate.Results: the study included 22 patients. Operation time was 87.1 ± 24.3 minutes. The intraoperative blood loss was 19.8 ± 9.6 ml. No conversion to open or laparoscopic approach occurred, no morbidity occurred. Pain intensity on day 1 was 0.255 mm according to VAS. No anatomical recurrence was revealed. The median follow-up period was 20.4 months (7–22 months).Conclusion: robotic-assisted ventral rectopexy using the Senhance® system is effective and safe. The results are similar to laparoscopic ones. However, the use of the Senhance® system is cost effective compared to other robotic systems.

Comparison of short-term outcomes of robotic-assisted radical colon cancer surgery using the Kangduo Surgical Robotic System and the Da Vinci Si Robotic System: a prospective cohort study.

Robotic surgery has been a revolution for colon cancer (CC) patients, with the increasing availability of different competitive robotic systems, but evidence of relevant oncologic outcomes is indeed scarce. Our goal was to compare the surgical quality and short-term oncologic outcomes of the Kangduo Surgical Robotic System and the da Vinci Si Robotic System in patients with CC. These are results from a subcohort of a multicenter randomized controlled noninferiority trial performed in three centers in China. Enrolled patients were randomly assigned to undergo surgery using either the KD-SR-01 system (KD group) or the da Vinci Si (DV) robotic system (DV group). Neither investigators nor patients were masked to treatment allocation, but assessment of pathological outcomes was masked to treatment allocation. The primary endpoint was surgical success rate. The secondary endpoints were surgical outcomes, pathologic outcomes, and postoperative outcomes. The study is registered at www.chictr.org.cn (ChiCTR2200063172). Although the long-term follow-up results were not a predefined endpoint for this study, late-stage work is in progress. A total of 58 CC patients were included in this study, 28 in the KD group and 30 in the DV group. All patients were successfully operated without any intermediate open/conventional laparoscopic surgery and the success rate of surgery was 100%. Assessment of equipment docking task load and intraoperative operating sensation score were similar between the two groups. Adverse events and Clavien-Dindo grade II or higher grade complication rates were comparable between the two groups. Device arm docking time, robotic arm operation time, and intraoperative bleeding were not significantly different between the two groups. Similar results were obtained from postoperative pathological outcomes and internal environment indexes. The efficacy and safety of the Kangduo Robotic Surgical System has been proved, operation of the Kangduo Robotic System by experienced surgeons for CC is not less effective than the da Vinci robotic System.

Designing and implementing a multi-function board to increase the operation time of mobile robots using solar panels

Today, the use of mobile robots and autonomous vehicles has increased due to their use in various industries, and their performance and duration of operation largely depend on the amount of energy consumed and their batteries. One of the ways to increase the operation time of robots is the use of solar panels that can charge their batteries while moving, but the amount of energy received from solar panels reduces their efficiency due to factors affecting them, such as the angle of the sun, weather conditions, and their use in mobile robots alone is not recommended. In this research, we introduce an electric circuit with very low losses to increase the received power of solar panels and increase their efficiency, which is able to supply the power of the robot through solar panels when the sunlight and the angle of radiation are suitable and charge the batteries through the maximum power point controller (MPPC), and by reducing the amount of energy received from the panels by changing the energy source to the battery, the duration of the system’s dependence on the battery has decreased, which increases the duration of the mobile robots.

V01-01 UTILITY OF 3-D MODELING IN COMPLEX UPPER TRACT RECONSTRUCTION: ROBOTIC-ASSISTED URETEROPELVICOSTOMY OF NATIVE URETER TO TRANSPLANT RENAL PELVIS

You have accessJournal of UrologyCME1 Apr 2023V01-01 UTILITY OF 3-D MODELING IN COMPLEX UPPER TRACT RECONSTRUCTION: ROBOTIC-ASSISTED URETEROPELVICOSTOMY OF NATIVE URETER TO TRANSPLANT RENAL PELVIS Bridget L. Findlay, Jayson P. Kemble, Elizabeth N. Bearrick, Katherine T. Anderson, and Boyd R. Viers Bridget L. FindlayBridget L. Findlay More articles by this author , Jayson P. KembleJayson P. Kemble More articles by this author , Elizabeth N. BearrickElizabeth N. Bearrick More articles by this author , Katherine T. AndersonKatherine T. Anderson More articles by this author , and Boyd R. ViersBoyd R. Viers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 3-D models have been used successfully in oncologic planning, however there are limited data supporting their use and efficacy in complex genitourinary reconstructive cases. Due to complex and variable regional anatomy with transplant vasculature and collecting system, surgical planning requires an individualized approach based on anatomic relationships. Herein, we aim to illustrate the novel utility of 3-D modeling in surgical planning for complex upper tract reconstruction, and to describe an alternative approach to transplant proximal ureteral stricture reconstruction. METHODS: The index patient is a 17-year-old male with a history of bilateral grade 4 vesicoureteral reflux (VUR) who developed end stage renal disease despite ureteroneocystostomies in childhood. He underwent a living-unrelated donor renal transplantation in November 2021, complicated by a focal proximal ureteral stricture. His anatomy was further complicated due to prior ligation of his native distal right ureter and intraperitoneal location of his transplant kidney. Therefore, a 3-D printed anatomical model was created to aid in surgical planning. RESULTS: The 3-D model highlighted a complex trajectory of the proximal transplant ureter and area of stricture directly posterior to the renal hilar vessels. Additionally, the native right ureter ligation was noted distal to the transplant renal pelvis and was not amenable for use in reconstruction. Given these anatomic considerations, the patient underwent an uncomplicated robotic-assisted ureteropelvicostomy between his native left proximal ureter and transplant renal pelvis. Total robotic operative time was 2 hours 17 minutes. He was dismissed on postoperative day (POD) 1 with a creatinine nadir near his post-transplant baseline level at 10-week follow-up. CONCLUSIONS: 3-D printed models have utility in select cases with complex anatomy. These models facilitate accurate regional and spatial anatomy of critical structures to enable effective operative planning. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e79 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bridget L. Findlay More articles by this author Jayson P. Kemble More articles by this author Elizabeth N. Bearrick More articles by this author Katherine T. Anderson More articles by this author Boyd R. Viers More articles by this author Expand All Advertisement PDF downloadLoading ...

Utility of 3D Modeling in Complex Upper Tract Reconstruction: Robot-Assisted Ureteropelvicostomy of Native Ureter to Transplant Renal Pelvis

Clinical History: The case is a 17-year-old boy with a history of bilateral grade 4 vesicoureteral reflux and end-stage renal disease who underwent a living-unrelated donor renal transplantation in November 2021. He presented in June 2022 with vague abdominal pain and creatinine 4.3 mg/dL. Physical Examination: Transplant biopsy showed no evidence of acute rejection. Antegrade nephrostogram at the time of nephrostomy tube placement demonstrated hydronephrosis and a focal stricture of the proximal transplant ureter. His anatomy was further complicated because of prior ligation of his native distal right ureter at the time of transplant and intraperitoneal location of his transplant kidney through a peritoneal window. Diagnosis: Focal proximal stricture of transplant ureter. Intervention: Given the complex anatomy, a 3D-printed anatomical model was created to facilitate surgical planning. The 3D model highlighted a complex trajectory of the proximal ureter and strictured segment directly posterior to the transplant hilar vessels. In addition, the transplant kidney was directly overlying the dome of the bladder because of its intraperitoneal location. Given these anatomic considerations, the patient underwent an uncomplicated robot-assisted ureteropelvicostomy between his native left ureter and transplant renal pelvis. Follow-Up/Outcomes: Total robotic operative time was 2 hours 17 minutes. He was dismissed on postoperative day 1 with a creatinine nadir equivalent to his post-transplant baseline at 10-week follow-up. 3D-printed models have utility in select cases with complex anatomy. These models facilitate accurate regional and spatial anatomy of critical structures to enable effective operative planning. No competing financial interests exist. Patient consent statement: Patient consented to the use of nonidentifiable intraoperative photography and video recording for the purpose of medical education and publication in professional journals. Source of 3D model: Mayo clinic 3D Anatomic Modeling Laboratory. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. No funding was received for this article. Music: All music was from Pixabay.com, royalty free. Runtime of video: 04 mins 58 secs

Preliminary Experience of Partial Nephrectomy Through a New Single-Port Surgical Robot System.

Purpose: To explore the preliminary safety and efficacy of the Shurui single-port (SP) surgical robot in partial nephrectomy (PN). Methods: This study prospectively enrolled patients with T1a renal tumors who met the inclusion criteria from February to July 2022 in The First Affiliated Hospital School of Medicine Zhejiang University. The operative outcomes and perioperative data, including clinical and histological data, were prospectively collected and analyzed. Results: A total of 13 patients were included in this study, including 7 males and 6 females. The median age was 53 (33-74) years, and the average body mass index was 24.9 ± 4.2 kg/m2. There were 6 cases of left kidney tumors and 7 cases of right kidney tumors in the 13 patients. The average tumor diameter was 1.9 ± 0.9 cm. In all operations, the diseased tissue was removed according to the established surgical plan. The average warm ischemia time was 26.2 ± 9.7 minutes; the average device docking time was 3.6 ± 1.8 minutes; and the average robotic arm operation time was 124.7 ± 40.4 minutes. All operations were successfully completed; there was no conversion to open surgery during the operation; and no operation holes were added. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) score was 26.3 ± 2.6 points, and no device-related adverse events occurred during the operation. The median time to discharge was 6 days (range, 4-11 days). Postoperative pathological examination showed that all tumor margins were negative. There were no Clavien grade ≥3 surgical complications in any of the patients during the perioperative period or at the 1-month postoperative follow-up. Conclusion: The new SP surgical robot system is safe, effective, flexible, and stable for application in PN.

Permanent-Magnetically Amplified Robotic Gripper With Less Clamping Width Influence on Compensation Realized by a Stepless Width Adjustment Mechanism

Machines such as robotic grippers use powerful actuators or gearboxes to exert large loads at the expense of energy consumption, volume, and mass. We propose a stepless force amplification mechanism that assists clamping by a pair of permanent magnets, in which the external control force required to adjust their distance, and thus the output force, is suppressed by compensation springs. For further sophistication, we invented a new width adjuster using a lever. By separating the actuation of fingers and compensated magnets temporarily, the adjuster eliminated the nonlinear influence of the object width on the clamping force. The prototype gripper for proof of concept revealed that the adjuster successfully linearized the width-force characteristic with an inclination of 0.15 N/mm, which is sufficiently insignificant compared to the major output force of approximately 50 N. The force amplification effect coexisted with this phenomenon, such that the clamping force was amplified to 137.5% while maintaining the energy consumption of a DC motor, and the force-energy efficiency was multiplied by 1.39. Thus, able to be driven by a weaker, smaller, and lighter actuator, the gripper contributes to extension of the operation time of robots with limited power.

Robot-Assisted Partial Nephrectomy with a New Robotic Surgical System: Feasibility and Perioperative Outcomes.

Purpose: The aim of this study was to evaluate the feasibility and safety of a novel robotic system (KD-SR-01) for partial nephrectomy. Methods: Seventeen patients with small renal masses (SRMs) (≤4 cm) underwent KD-SR-01 robotic partial nephrectomy (KD-RPN) from December 2020 to March 2021 in our institution. The operative outcomes and perioperative data, including clinical and histological data, were prospectively collected and analyzed. Results: In total, 10 men and 7 women, with a median age of 51 years, underwent KD-RPN. Four transperitoneal procedures and 13 retroperitoneal procedures were performed without conversion to open or conventional laparoscopic surgery. The docking time and robotic operative time were 3.3 and 68.6 minutes, respectively. The warm ischemia time was 16.9 minutes. No major intraoperative or postoperative complications (Clavien grade ≥III) occurred. The duration of postoperative hospital stay was 5 days. Pathologic examination revealed nine clear cell carcinoma, two papillary cell carcinoma, one oncocytoma, and five angiomyolipoma cases. All surgical margins were negative. The estimated glomerular filtration rate (eGFR) on the first postoperative day was significantly decreased compared with the preoperative eGFR (91.7 ± 12.9 mL/min vs 97.9 ± 10.7 mL/min, p = 0.036). However, no significant difference was observed between the preoperative eGFR and the value on the fourth postoperative day (95.7 ± 13.4 mL/min vs 97.9 ± 10.7 mL/min, p = 0.427). Conclusions: KD-RPN was safe and feasible for treatment of SRM. The early oncologic and functional outcomes were promising. Long-term follow-up and well-designed prospective comparative studies with the da Vinci® platform are needed to corroborate these findings.

Robotic versus laparoscopic transabdominal preperitoneal (TAPP) approaches to bilateral hernia repair: a multicenter retrospective study using propensity score matching analysis

BackgroundSince the introduction of minimally invasive surgery, new techniques like transabdominal preperitoneal (TAPP) repair have progressively gained acceptance for the treatment of groin hernia. Laparoscopic TAPP (LTAPP) is recommended for bilateral repairs. Likewise, the introduction of robotic platforms has promised additional surgical benefits for robotic TAPP (RTAPP), which are yet to be confirmed. This study compared multicenter data obtained from patients undergoing bilateral inguinal hernia repair with RTAPP, performed during the preliminary learning curve period, versus conventional LTAPP.Materials and methodsAll consecutive bilateral inguinal hernia patients from four Italian centers between June 2015 and July 2020 were selected. A propensity score model was used to compare patients treated with LTAPP versus RTAPP, considering sex, age, body mass index, current smoking status, overall comorbidity, hernia classification (primary or recurrent), and associated procedures as covariates. After matching, intraoperative details and postoperative outcomes were evaluated.ResultsIn total, 275 LTAPP and 40 RTAPP were performed. After matching, 80 and 40 patients were allocated to the LTAPP and RTAPP cohorts, respectively. No intraoperative complications or conversion to open surgery occurred. However, a longer operative time was recorded in the RTAPP group (79 ± 21 versus 98 ± 29 min; p < 0.001). Postoperative visual analog scale (VAS) pain scores (p = 0.13) did not differ and complication rates were similar. There were no clinical recurrences in either group, with mean follow-up periods of 52 ± 14 (LTAPP) and 35 ± 8 (RTAPP) months. A statistical difference in length of hospital stay was found between the groups (1.05 ± 0.22 vs 1.50 ± 0.74 days; p < 0.001).ConclusionIn this patient population, outcomes for bilateral inguinal hernia repair appear comparable for RTAPP and LTAPP, except for a shorter recovery after laparoscopic surgery. A longer operative time for robotic surgery could be attributable to the learning curve period of each center.

Laparoscopic guided liposomal bupivacaine injection compared to transversus abdominus plane block for postoperative pain after robotic gynecologic oncology surgery

ObjectiveThe purpose of this study was to determine if laparoscopically guided transversus abdominis plane block (Lap-Tap) with liposomal bupivacaine provides superior postoperative pain control when compared to ultrasound-guided block (US-Tap) with liposomal bupivacaine at the time of robotic surgery for gynecology oncology patients. MethodsThis was a prospective randomized controlled trial assigning patients to one of two cohorts: Cohort 1 consisted of US-Tap administered before the procedure using liposomal bupivacaine, Cohort 2 consisted of Lap-Tap administration with laparoscopic visualization using the medication above. Primary outcomes were pain scores and total opioid use in Oral Morphine Equivalents (OME) during the first 72 h after surgery. Secondary outcomes were postoperative pain satisfaction and oral narcotic requirements. ResultsThere was a significant increase in oral narcotic use in the first 24 h in the US-Tap cohort compared to the Lap-Tap cohort: Lap-Tap mean = 6.73 ± 8.22 OME versus US-Tap mean = 12.69 ± 12.94 p = 0.018 OME. The increase was equivalent to one additional Hydrocodone-Acetaminophen 7.5 mg/325 mg in the first 24 h after surgery. However, total oral narcotic use over the first 72 h was not significantly different between the two cohorts: Lap-Tap mean = 21.73 ± 19.83 OME, US-Tap mean = 32.50 ± 29.47, p = 0.062 OME. In addition, there was no significant difference in satisfaction or pain scores between the US-Tap and Lap-Tap groups at 24, 48, or 72-hours. ConclusionsLap-Taps are comparable to US-Tap for postoperative analgesia during the first 72-h after surgery when performing robotic-assisted gynecologic oncology surgery.

Ten-year experience of robotic latissimus muscle flap reconstructive surgery at a single institution

Robotic reconstructive surgery has been performed since 2012 at our institution. The purpose of this study was to report our 10-year experience with robot-assisted reconstructive surgery and compare the clinical outcomes of different robotic models. Medical records of 41 patients who had chest or breast reconstruction during October 2012 ∼ May 2021 were reviewed retrospectively. Different robotic models were evaluated and compared in terms of surgical technique, demographic variables, postoperative complication, and operative parameters. esthetic assessments were performed by four plastic surgeons to evaluate symmetry, scar formation, and general esthetic features based on patients' photographs. Overall, out of 41robot-assisted reconstructive surgeries, 13were performed with the Da Vinci Si model, 18with the Da Vinci Xi model, and 10with the Da Vinci Sp model. The docking time, robot operation time, and hospitalization time were shorter for surgeries, which used the Da Vinci Sp model than other models. All other complications and operative parameters showed no significant difference. Improved esthetic outcome was achieved for all patient groups. Group Sphad the most favorable score, followed by Group Xi and Group Si, although there were no statistical implications. Ever since the introduction of the Da Vinci model in 2012, we have successfully implemented the robot-assisted reconstructive surgery. Surgical technique improved over the last 10 years. With the introduction of the Sp model, we are now at the stage of further developing the surgical technique and establishing the robotic reconstructive surgery.

Single-Port Transaxillary Robot-Assisted Latissimus Dorsi Muscle Flap Reconstruction for Poland Syndrome: Concomitant Application of Robotic System to Contralateral Augmentation Mammoplasty.

Currently, robot-assisted latissimus dorsi muscle flap (RLDF) surgery is used in treating patients with Poland syndrome and for breast reconstruction. However, conventional RLDF surgery has several inherent issues. We resolved the existing problems of the conventional system by introducing the da Vinci single-port system in patients with Poland syndrome. Overall, three patients underwent RLDF surgery using the da Vinci single-port system with gas insufflation. In the female patient, after performing RLDF with silicone implant, augmentation mammoplasty was also performed on the contralateral side. Both surgeries were performed as single-port robotic-assisted surgery through the transaxillary approach. The mean operating time was 449 (335–480) minutes; 8.67 (4–14) minutes were required for docking and 59 (52–67) minutes for robotic dissection and LD harvesting. No patients had perioperative complication and postoperative problems related to gas inflation. The single-port robot-assisted surgical system overcomes the drawbacks of previous robotic surgery in patients with Poland syndrome, significantly shortens the procedure time of robotic surgery, has superior cosmetic outcomes in a surgical scar, and improves the operator's convenience. Furthermore, concurrent application to another surgery demonstrates the possibility in the broad application of the robotic single-port surgical system.

Robotic Foregut Surgery in the Veterans Health Administration: Increasing Prevalence, Decreasing Operative Time, and Improving Outcomes.

Historically, robotic surgery incurs longer operative times, higher costs, and nonsuperior outcomes compared with laparoscopic surgery. However, in areas of limited visibility and decreased accessibility such as the gastroesophageal junction, robotic platforms may improve visualization and facilitate dissection. This study compares 30-day outcomes between robotic-assisted foregut surgery (RAF) and laparoscopic-assisted foregut surgery in the Veterans Health Administration. This is a retrospective review of the Veterans Affairs Quality Improvement Program database. Patients undergoing laparoscopic-assisted foregut surgery and RAF were identified using CPT codes 43280, 43281, 43282, and robotic modifier S2900. Multivariable logistic regression and multivariable generalized linear models were used to analyze the independent association between surgical approach and outcomes of interest. A total of 9,355 veterans underwent minimally invasive fundoplication from 2008 to 2019. RAF was used in 5,392 cases (57.6%): 1.63% of cases in 2008 to 83.41% of cases in 2019. After adjusting for confounding covariates, relative to laparoscopic-assisted foregut surgery, RAF was significantly associated with decreased adjusted odds of pulmonary complications (adjusted odds ratio [aOR] 0.44, p < 0.001), acute renal failure (aOR 0.14, p = 0.046), venous thromboembolism (aOR 0.44, p = 0.009) and increased odds of infectious complications (aOR 1.60, p = 0.017). RAF was associated with an adjusted mean ± SD of 29 ± 2-minute shorter operative time (332 minutes vs 361 minutes; p < 0.001). Veterans undergoing RAF ascertained shorter operative times and reduced complications vs laparoscopy. As surgeons use the robotic platform, clinical outcomes and operative times continue to improve, particularly in operations where extra articulation in confined spaces is required.

679 Introduction of A Robotic Rectopexy Programme with Benchmarking to International Standards in Published Randomised Controlled Trials

Abstract Aim With the evolution of robotic surgery, the adoption of a robotic approach to perform rectopexy, in particular ventral mesh repair (VMR), is gaining popularity. We aimed to audit clinical outcomes following introduction of a robotic rectopexy (RR) programme and compare outcomes to internationally published randomised controlled trials (RCTs). Method Consecutive patients undergoing RR from July to December were included. The daVinci Xi surgical system (Intuitive, California) was used for all procedures using a modified left lower abdominal approach. Where VMR was performed, a 4 x 18cm Permacol mesh was used as standard and posterior fixation using ethibond. We compared operative times and 30-day clinical outcomes to international data. Results Over a six-month period, thirteen RR were performed (n = 1 sutured, n = 2 resection sutured, n = 10 VMR). All patients were female with a mean age of 60.4 years (SD 14.12). Mean time from 1st consultation to surgery was 10.7 months. Three patients had an external rectal prolapse and ten patients a rectocoele confirmed on dynamic MRI. Seven patients had co-existing urinary symptoms impacting on quality of life. Median docking time was 23 minutes and median robotic operative time was 194 minutes (156 minutes reported). There were no conversions (2.5% reported). Average length of stay was 5 days (4 days reported) and there were no 30-day morbidities (8.6% reported) or readmissions. Conclusions Robotic rectopexy can be performed with appropriate operative times and clinical outcomes and offers a superior operative platform for critical operative steps including rectal mobilisation and VMR mesh placement and suturing.

Surgical and oncological outcomes of transoral robotic total laryngectomy: A case series

ObjectiveTo evaluate the oncological, functional and voice rehabilitation outcomes of transoral robotic surgery for total laryngectomy (TORS-TL). MethodsA retrospective chart review of patients treated by TORS-TL was conducted at a single academic medical center. The following outcomes were studied: indication; average robotic set-up and operative times; mean estimated blood loss; postoperative complications; re-feeding features; mean hospital stay; need of adjuvant therapy and voice rehabilitation type. ResultsTORS-TL was performed in 10 patients for the following indications: nonfunctional larynx (N = 2); low-grade cricoid chondrosarcoma (N = 3) and recurrent laryngeal cancer after (chemo) radiation (N = 5). Two patients were excluded because the larynx was not exposable. Average robotic set-up and operative times were 20 and 278 min, respectively. The mean estimated blood loss was 50 mL. The mean hospital stay was 13.9 days (8–28 days). There was no local recurrence in patients operated for cancer recurrence (N = 5) 5 years after the surgery. Distant metastases occurred in one patient. A patient with laryngeal chondrosarcoma experienced local failure 3 years after TORS-TL. The voice rehabilitation consisted of esophageal voice (N = 2) and tracheoesophageal prosthesis (Provox®, N = 8). The main reasons for prosthesis replacement were transprosthetic (79%) and periprosthetic leaks (21%). The median lifespan of prostheses was 81 days. ConclusionTORS-TL may be a safe and effective surgical approach for selected surgical indications. Future controlled studies are needed to determine additional indications and limitations of this procedure.