Expertise In Robotic Surgery Research Articles

Impacts of completely endophytic renal masses on perioperative, oncologic, and functional outcomes in robot-assisted partial nephrectomy: a systematic review and meta-analysis.

The objective of this study was to perform a comprehensive pooled analysis aimed at comparing the efficacy and safety of robot-assisted partial nephrectomy (RAPN) between completely endophytic tumors (CERT) and non-completely endophytic tumors (non-CERT). This study adhered rigorously to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to conduct a systematic review and meta-analysis. We performed a systematic search in the PubMed, Embase, Web of Science, and Cochrane Library databases, focusing on studies published in English up to May 2024. Our analysis primarily evaluated key outcomes, specifically perioperative, functional, and oncological outcomes. A total of 2126 patients across six studies were included in the analysis. Compared to non-CERT, CERT was associated with significantly higher rates of major complications (Odds Ratio [OR]: 2.47; 95% CI: 1.14 to 5.34; p = 0.02), longer warm ischemia times (Weighted Mean Difference [WMD]: 3.27min; 95% CI: 0.61 to 5.39; p = 0.02), a greater decline in estimated glomerular filtration rate (eGFR) (WMD: 2.93 ml/min/1.73 m2; 95% CI: 0.75 to 5.11; p = 0.008), and relatively lower trifecta achievement rates (OR: 0.63; 95% CI: 0.41 to 0.96; p = 0.03). However, no statistically significant differences were observed between the two groups in terms of operative time, length of stay, blood loss, transfusion rates, intraoperative complications, overall complications, positive surgical margins, and local recurrence. Although CERT was associated with greater declines in eGFR and lower rates of trifecta achievement, it yielded perioperative, functional, and oncologic outcomes comparable to those of non-CERT in RAPN. Our findings suggest that RAPN for completely endophytic renal masses can achieve acceptable outcomes when performed in centers with substantial expertise in robotic surgery. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=555067, identifier CRD42024555067.

Characterizing robotic surgical expertise: An exploratory study of neural activation during mental imagery of robotic suturing

BackgroundMental imagery (MI) aids skill acquisition, however, it is unclear to what extend MI is used by experienced surgeons. The purpose of this study was to assess differences in MI of participants with varying surgical expertise in robotic surgery. MethodsStudents, residents, and surgeons completed the Mental Imagery Questionnaire to assess MI for robotic suturing. Participants then completed robotic simulator tasks, and imagined performing robotic suturing while being assessed with electroencephalogram (EEG). ResultsAttending surgeons reported higher MI for robotic suturing, and EEG revealed higher neural activation during imagery of robotic suturing than other groups. ConclusionsExperienced surgeons displayed higher MI ability for robotic suturing, and displayed higher cortical activity in the frontal and parietal areas of the brain, which is associated with more advanced motor imagery. MI appears to be a component of robotic surgery expertise.

Development of a Senior Medical Student Robotic Surgery Training Elective.

As robotic surgery has become more widespread, early exposure to the robotic platform is becoming increasingly important, not only to graduate medical education, but also for medical students pursuing surgical residency. In an effort to orient students to robotic technology and decrease the learning curve for what is likely to become an integral part of residency training, we created a formal, elective robotic surgery curriculum for senior medical students. Throughout this 2-week fourth year rotation, students completed online training modules and assessment; mastered exercises on the simulator system related to the console, camera, energy, dexterity, and suturing skills; attended didactics; utilized the dual console during one-on-one simulation lab sessions with attending robotic surgery experts; and translated new skills to biotissue anastomoses as well as bedside-assisting in the operating room. During cases, students were able to have more meaningful observation experiences, recognizing the significance of various robotic approaches employed and utilization of specific instruments. Future aims of this rotation will assess student experience as it impacts readiness for surgical residency.

Expert Consensus Recommendations for Robotic Surgery Credentialing.

To define criteria for robotic credentialing using expert consensus. A recent review of institutional robotic credentialing policies identified significant variability and determined current policies are largely inadequate to ensure surgeon proficiency and may threaten patient safety. Twenty-eight national robotic surgery experts were invited to participate in a consensus conference. After review of available institutional policies and discussion, the group developed a 91 proposed criteria. Using a modified Delphi process the experts were asked to indicate their agreement with the proposed criteria in three electronic survey rounds after the conference. Criteria that achieved 80% or more in agreement (consensus) in all rounds were included in the final list. All experts agreed that there is a need for standardized robotic surgery credentialing criteria across institutions that promote surgeon proficiency. Forty-nine items reached consensus in the first round, 19 in the second, and 8 in the third for a total of 76 final items. Experts agreed that privileges should be granted based on video review of surgical performance and attainment of clearly defined objective proficiency benchmarks. Parameters for ongoing outcome monitoring were determined and recommendations for technical skills training, proctoring, and performance assessment were defined. Using a systematic approach, detailed credentialing criteria for robotic surgery were defined. implementation of these criteria uniformly across institutions will promote proficiency of robotic surgeons and has the potential to positively impact patient outcomes.

Up-to-date comparison of robotic-assisted versus open distal pancreatectomy: A PRISMA-compliant meta-analysis.

Although robot-assisted distal pancreatectomy (RADP) has been successfully performed since 2003, its advantages over open distal pancreatectomy (ODP) are still uncertain. The objective of this meta-analysis is to compare the clinical and oncologic safety and efficacy of RADP vs ODP. Multiple databases (PubMed, Medline, EMBASE, Web of Science, and Cochrane Library) were searched to identify studies that compare the outcomes of RADP and ODP (up to February, 2020). Fixed and random effects models were applied according to different conditions. A total of 7 studies from high-volume robotic surgery centers comprising 2264 patients were included finally. Compared with ODP, RADP was associated with lower estimated blood loss, lower blood transfusion rate, lower postoperative mortality rate, and shorter length of hospital stay. No significant difference was observed in operating time, the number of lymph nodes harvested, positive margin rate, spleen preservation rate, rate of severe morbidity, incidence of postoperative pancreatic fistula, and severe postoperative pancreatic fistula (grade B and C) between the 2 groups. With regard to perioperative outcomes, RADP is a safe and feasible alternative to ODP in centers with expertise in robotic surgery. However, the evidence is limited and more randomized controlled trials are needed to further clearly define this role.

Proving the Effectiveness of the Fundamentals of Robotic Surgery (FRS) Skills Curriculum: A Single-blinded, Multispecialty, Multi-institutional Randomized Control Trial.

To demonstrate the noninferiority of the fundamentals of robotic surgery (FRS) skills curriculum over current training paradigms and identify an ideal training platform. There is currently no validated, uniformly accepted curriculum for training in robotic surgery skills. Single-blinded parallel-group randomized trial at 12 international American College of Surgeons (ACS) Accredited Education Institutes (AEI). Thirty-three robotic surgery experts and 123 inexperienced surgical trainees were enrolled between April 2015 and November 2016. Benchmarks (proficiency levels) on the 7 FRS Dome tasks were established based on expert performance. Participants were then randomly assigned to 4 training groups: Dome (n = 29), dV-Trainer (n = 30), and DVSS (n = 32) that trained to benchmarks and control (n = 32) that trained using locally available robotic skills curricula. The primary outcome was participant performance after training based on task errors and duration on 5 basic robotic tasks (knot tying, continuous suturing, cutting, dissection, and vessel coagulation) using an avian tissue model (transfer-test). Secondary outcomes included cognitive test scores, GEARS ratings, and robot familiarity checklist scores. All groups demonstrated significant performance improvement after skills training (P < 0.01). Participating residents and fellows performed tasks faster (DOME and DVSS groups) and with fewer errors than controls (DOME group; P < 0.01). Inter-rater reliability was high for the checklist scores (0.82-0.97) but moderate for GEARS ratings (0.40-0.67). We provide evidence of effectiveness for the FRS curriculum by demonstrating better performance of those trained following FRS compared with controls on a transfer test. We therefore argue for its implementation across training programs before surgeons apply these skills clinically.

First case of robotic laparoendoscopic single-site radical prostatectomy with single-site VesPa platform

This study aimed at reporting our first experience with robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with single-site VesPa platform (Intuitive Surgical Inc.).A 68-year-old-man presenting with a cT1c adenocarcinoma Gleason Score 3+4=7 in 4/12 bilateral cores underwent a transperitoneal robotic LESS-RP with a single-site Vespa platform. Initial PSA, prostate weight, and body mass index (BMI) were 4.4ng/ml, 45g, and 25, respectively. Instruments and camera cross within the Single-Site port; the da Vinci System software detects and reassigns the user's hands with the instruments position. The single-site port is inserted through a 2-cm intraumbilical incision. The robotic 8.5mm scope and two surgical curved instruments (fenestrated bipolar forceps and cautery hook) are introduced through the ports and used for most of the procedure, whereas a wristed needle driver on the right hand is used for the reconstructive steps. An additional 12mm port (Air Seal, SurgiQuest) is placed in a midline between the umbilicus and the right iliac spine in order to facilitate table assistance during surgery and to place a drain at the end of the procedure.Operative time and blood loss were 300min and 400mL, respectively. The postoperative course was uneventful. The drain and the catheter were removed on days 1 and 6, respectively. The patient experienced a temporary mild stress incontinence (one pad at sixth month) and erectile dysfunction.Our first robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with the single-site VesPa platform was associated with acceptable operative times and perioperative outcome. This procedure is feasible without complications, provided that a proper patient selection has occurred. Limited movements together with the lack of the fourth robotic arm require a considerable expertise in robotic surgery. Some tricks can help overcome technical limitations. The Robotic LESS-RP reduces in some measure the limitations of conventional LESS RP, although further refinement of the robotic instruments is necessary.

Introduction of Robotic Surgery into a Community Hospital Setting: A Prospective Comparison of Robotic and Open Colorectal Resection for Cancer

Purpose: The aim of this study was to compare robotic colorectal surgery (RCS) performed by a team having limited expertise in robotic surgery with open colorectal surgery (OCS) performed by experienced colorectal surgeons. Methods: This was a prospective comparative nonrandomized study. Results: Between March 2013 and June 2015, 79 patients with colon and rectal adenocarcinoma were enrolled into the study. Of these, 41 patients underwent OCS and 38 underwent RCS. The groups were comparable in terms of demographics and type of procedure. The RCS took significantly longer in the operating room than the OCS (222 vs. 141 min, p < 0.001). The rate of major complications was similar for both RCS and OCS (5.3 vs. 9.8%, p = 0.454). Wound infections were less frequent in the RCS group (10.5 vs. 29.3%, p = 0.039). The mean hospital stay was 1 day shorter in the RCS group than in the OCS group (5.7 vs. 6.7 days, p = 0.176). The lymph nodes harvested was comparable (14.7 RCS vs. 15.5 OCS, p = 0.596). Conclusions: This study confirmed that the surgical team with limited expertise in minimally invasive surgery can still safely introduce robotic surgery into their colorectal practice. When compared to the open approach, the robotic approach reduces hospital stay, as well as the rate of surgical site infection.

Predictive Validity of a Training Protocol Using a Robotic Surgery Simulator

Robotic surgery simulation may provide a way for surgeons to acquire specific robotic surgical skills without practicing on live patients. Five robotic surgery experts performed 10 simulator skills to the best of their ability, and thus, established expert benchmarks for all parameters of these skills. A group of credentialed gynecologic surgeons naive to robotics practiced the simulator skills until they were able to perform each one as well as our experts. Within a week of doing so, they completed robotic pig laboratory training, after which they performed supracervical hysterectomies as their first-ever live human robotic surgery. Time, blood loss, and blinded assessments of surgical skill were compared among the experts, novices, and a group of control surgeons who had robotic privileges but no simulator exposure. Sample size estimates called for 11 robotic novices to achieve 90% power to detect a 1 SD difference between operative times of experts and novices (α = 0.05). Fourteen novice surgeons completed the study-spending an average of 20 hours (range, 9.7-38.2 hours) in the simulation laboratory to pass the expert protocol. The mean operative times for the expert and novices were 20.2 (2.3) and 21.7 (3.3) minutes, respectively (P = 0.12; 95% confidence interval, -1.7 to 4.7), whereas the mean time for control surgeons was 30.9 (0.6) minutes (P < 0.0001; 95% confidence interval, 6.3-12.3). Comparisons of estimated blood loss (EBL) and blinded video assessment of skill yielded similar differences between groups. Completing this protocol of robotic simulator skills translated to expert-level surgical times during live human surgery. As such, we have established predictive validity of this protocol.

Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries

We conducted this study to investigate how physical and cognitive ergonomic workloads would differ between robotic and laparoscopic surgeries and whether any ergonomic differences would be related to surgeons' robotic surgery skill level. Our hypothesis is that the unique features in robotic surgery will demonstrate skill-related results both in substantially less physical and cognitive workload and uncompromised task performance. Thirteen MIS surgeons were recruited for this institutional review board-approved study and divided into three groups based on their robotic surgery experiences: laparoscopy experts with no robotic experience, novices with no or little robotic experience, and robotic experts. Each participant performed six surgical training tasks using traditional laparoscopy and robotic surgery. Physical workload was assessed by using surface electromyography from eight muscles (biceps, triceps, deltoid, trapezius, flexor carpi ulnaris, extensor digitorum, thenar compartment, and erector spinae). Mental workload assessment was conducted using the NASA-TLX. The cumulative muscular workload (CMW) from the biceps and the flexor carpi ulnaris with robotic surgery was significantly lower than with laparoscopy (p<0.05). Interestingly, the CMW from the trapezius was significantly higher with robotic surgery than with laparoscopy (p<0.05), but this difference was only observed in laparoscopic experts (LEs) and robotic surgery novices. NASA-TLX analysis showed that both robotic surgery novices and experts expressed lower global workloads with robotic surgery than with laparoscopy, whereas LEs showed higher global workload with robotic surgery (p>0.05). Robotic surgery experts and novices had significantly higher performance scores with robotic surgery than with laparoscopy (p<0.05). This study demonstrated that the physical and cognitive ergonomics with robotic surgery were significantly less challenging. Additionally, several ergonomic components were skill-related. Robotic experts could benefit the most from the ergonomic advantages in robotic surgery. These results emphasize the need for well-structured training and well-defined ergonomics guidelines to maximize the benefits utilizing the robotic surgery.

Optimal use and outcomes of orthotopic neobladder reconstruction in men and women

Urethra-sparing has become a standard in patients undergoing radical cystectomy for bladder cancer showing excellent oncologic outcome in large retrospective studies. However, data on functional outcome and quality of life are still conflicting. This review aims to summarize recent data on oncologic and functional outcome of patients undergoing orthotopic urinary diversion. Orthotopic urinary diversion can be performed safely in patients with negative urethral resection margins in frozen section analysis. Minimally invasive cystectomy shows short-term and long-term oncologic outcomes comparable with open cystectomy. In the meantime, more than 150 cases of total intracorporeal diversion have been published demonstrating promising perioperative results. However, only few data exist on functional outcome of this procedure. For open neobladder substitution, there is still a broad variability in continence rates, voiding function and health-related quality of life between different studies. However, the number of studies using validated tools for assessment of functional outcome is constantly increasing showing promising long-term outcomes of the procedure. Both in men and in women, orthotopic neobladder should be considered as standard-of-care with excellent long-term oncologic and functional outcome. Due to lack of long-term functional and oncologic data, total intracorporeal diversion should be limited to selected patients and centers with broad expertise in robotic surgery.

Roboterassistierte laparoskopische Cardiomyotomie

Robot-assisted laparoscopic surgery is an expanding field of medicine. In endoscopic microsurgery particularly, difficult maneuvers such as intracorporeal hand-sewn anastomoses or a narrow operating field are ideal indications for use of an operation robot. Six patients, four men and two women, underwent robot-assisted laparoscopic cardiomyotomy for achalasia at a tertiary referral center with substantial expertise in robotic surgery. A detailed description of the operation technique is provided, together with a review of the literature. Robot-assisted laparoscopic cardiomyotomy was feasible without any particular problem and the postoperative course of all six patients was uneventful. The operation time was 236 (220-316) minutes, plus 38 (25-47) minutes for setup-time of the robot. At follow-up six months postoperatively, five of the six patients were free of significant dysphagia and all were free of reflux symptoms. There are several published reports, series and trials on robot-assisted laparoscopic cardiomyotomy. The general conclusion is that in experienced hands this operation is easy to perform, with a significantly lower rate of mucosal perforations, but that overall costs are higher, including a longer operation time during the learning curve. The avoidance of mucosal lacerations and their possible consequences has to be weighed against higher overall costs. Laparoscopic cardiomyotomy is the first standard laparoscopic operation where a clear advantage for use of an operation robot has been proven. Thus, wherever an operation robot is available it should be used for this procedure.

Robotic-assisted laparoscopic radical prostatectomy: initial 15 cases in Japan.

Recently, we have introduced robotic-assisted laparoscopic radical prostatectomy (RALP) in Japan. This article describes the details of a training program to shorten the learning curve in the absence of an urologist with expertise in robotic surgery. Five months after a 2-day training course of robotic surgery, RALP was first performed in Japan, and a total of 15 cases were performed in the subsequent 4 months. Our training program consisted of: (1) image training using surgical operation videos, (2) dry lab training using a sham pelvic cavity model, and (3) intraoperative mentoring. The operative procedure was divided into five consecutive stages, and time required to complete each stage was recorded. Robotic radical prostatectomy was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-h operation had been imposed by the ethics committee. The mean console time and the mean intraoperative blood loss (including urine) reduced from 264.2min and 459.4ml, respectively, in the first 11 cases, to 151min and 133.3ml, respectively, in the last three cases. With direct intraoperative guidance by the mentor during cases 13 and 14, the operation time was reduced at all five stages of the operative procedure. Our training program proved remarkably effective in reducing the learning curve of RALP in Japan, where there is no person with expertise in robotic surgery.