Robotic Surgery Group Research Articles

Who may benefit from robotic gastrectomy?: A subgroup analysis of multicenter prospective comparative study data on robotic versus laparoscopic gastrectomy

AimsRobotic gastrectomy for gastric cancer has been proven to be a feasible and safe minimally invasive procedure. However, our previous multicenter prospective study indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. This study aimed to identify which subgroups of patients would benefit from robotic gastrectomy rather than from conventional laparoscopic gastrectomy. MethodsA prospective multicenter comparative study comparing laparoscopic and robotic gastrectomy was previously conducted. We divided the patients into subgroups according to obesity, type of gastrectomy performed, and extent of lymph node dissection. Surgical outcomes were compared between the robotic and laparoscopic groups in each subgroup. ResultsA total of 434 patients were enrolled into the robotic (n = 223) and laparoscopic (n = 211) surgery groups. According to obesity and gastrectomy type, there was no difference in the estimated blood loss (EBL), number of retrieved lymph nodes, complication rate, open conversion rate, and the length of hospital stay between the robotic and laparoscopic groups. According to the extent of lymph node dissection, the robotic group showed a significantly lower EBL than did the laparoscopic group after D2 dissection (P = 0.021), while there was no difference in EBL in patients that did not undergo D2 dissection (P = 0.365). ConclusionPatients with gastric cancer undergoing D2 lymph node dissection can benefit from less blood loss when a robotic surgery system is used.

A novel robotic surgical technique for thyroid surgery: bilateral axillary approach (BAA).

Bilateral axillo-breast approach (BABA) robotic thyroidectomy (RT) is proven to be a feasible method for the treatment of well-differentiated thyroid cancers in terms of oncology as well as cosmesis. However, BABA RT causes postoperative sternal discomfort and needs an incision over the nipple areolar area. Here, we suggest a novel robotic surgical technique for thyroid surgery that does not need a breast incision-bilateral axillary approach (BAA). We recruited 51 patients who were willing to undergo the novel BAA robotic thyroid surgery. We performed a propensity score-matched analysis to compare the BAA robotic thyroid surgery group (BAA group) with the conventional open thyroid surgery group (open group). Mean operation time in the BAA group (129.7min) was significantly longer than that in the open group (103.1min) (p<0.001). However, no significant differences in the mean number of metastatic lymph nodes (LNs), mean number of retrieved LNs, vocal cord palsy, hypoparathyroidism, and mean stimulated thyroglobulin level were observed between the two groups. There was no case of postoperative bleeding or chyle leak. Of the 51 patients who had undergone the BAA procedure, 27 patients answered the questionnaire. The mean scale, ranging from 0 to 10, at postoperative 1day/2weeks was as follows: voice change score, 3.0/1.6; swallowing difficulty score, 4.0/2.0; anterior neck pain score, 4.6/3.6; anterior neck numbness score, 5.4/4.3; right chest pain score, 3.8/2.1; left chest pain score, 3.6/2.3; right chest numbness score, 3.2/2.8; left chest numbness score, 2.4/2.7; right breast pain score, 0.9/0; left breast pain score, 1.2/0; right breast numbness score, 1.7/0; and left breast numbness score, 2.6/0, respectively. BAA robotic thyroid surgery is a novel, safe, and feasible oncoplastic method, especially for patients who have fear of procedures around the nipple areolar complex.

Robotic-assisted vs traditional laparoscopic surgery for endometrial cancer: a randomized controlled trial

Previous studies comparing robotic-assisted laparoscopic surgery to traditional laparoscopic or open surgery in gynecologic oncology have been retrospective. To our knowledge, no prospective randomized trials have thus far been performed on endometrial cancer. We sought to prospectively compare traditional and robotic-assisted laparoscopic surgery for endometrial cancer. This was a randomized controlled trial. From December 2010 through October 2013, 101 endometrial cancer patients were randomized to hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy either by robotic-assisted laparoscopic surgery or by traditional laparoscopy. The primary outcome measure was overall operation time. The secondary outcome measures included total time spent in the operating room, and surgical outcome (number of lymph nodes harvested, complications, and recovery). The study was powered toshow at least a 25% difference in the operation time using 2-sided significance level of .05. The differences between the traditional laparoscopy and the robotic surgery groups were tested by Pearson χ2 test, Fisher exact test, or Mann-Whitney test. In all, 99 patients were eligible for analysis. The median operation time in the traditional laparoscopy group (n= 49) was 170 (range 126-259) minutes and in the robotic surgery group (n= 50) was 139 (range 86-197) minutes, respectively (P < .001). The total time spent in the operating room was shorter in the robotic surgery group (228 vs 197 minutes, P < .001). In the traditional laparoscopy group, there were 5 conversions to laparotomy vs none in the robotic surgery group (P= .027). There were no differences as to the number of lymph nodes removed, bleeding, or the length of postoperative hospital stay. Four (8%) vs no (0%) patients (P= .056) had intraoperative complications and 5 (10%) vs 11 (22%) (P= .111) had major postoperative complications in the traditional and robotic surgery groups, respectively. In patients with endometrial cancer, robotic-assisted laparoscopic surgery was faster to perform than traditional laparoscopy. Also total time spent in the operation room was shorter in the robotic surgery group and all conversions to laparotomy occurred in the traditional laparoscopy group. Otherwise, the surgical outcome was similar between the groups. Robotic surgery offers an effective and safe alternative in the surgical treatment of endometrial cancer.

Comparison of perioperative and short-term outcomes between robotic and conventional laparoscopic surgery for colonic cancer: a systematic review and meta-analysis

PurposeReports from several case series have described the feasibility and safety of robotic surgery (RS) for colonic cancer. Experience is still limited in robotic colonic surgery, and a few meta-analysis has been conducted to integrate the results for colon cancer specifically. We conducted a systematic review of the available evidence comparing the surgical safety and efficacy of RS with that of conventional laparoscopic surgery (CLS) for colonic cancer.MethodsWe searched English databases (MEDLINE, Embase, and Cochrane Library), and Korean databases (KoreaMed, KMbase, KISS, RISS, and KisTi). Dichotomous variables were pooled using the risk ratio, and continuous variables were pooled using the mean difference (MD).ResultsThe present study found that the RS group had a shorter time to resumption of a regular diet (MD, –0.62 days; 95% CI, –0.97 to –0.28), first passage of flatus (MD, –0.44 days; 95% CI, –0.66 to –0.23) and defecation (MD, –0.62 days; 95% CI, –0.77 to –0.47). Also, RS was associated with a shorter hospital stay (MD, –0.69 days; 95% CI, –1.12 to –0.26), a lower estimated blood loss (MD, –19.49 mL; 95% CI, –27.10 to –11.89) and a longer proximal margin (MD, 2.29 cm; 95% CI, 1.11-3.47). However, RS was associated with a longer surgery time (MD, 51.00 minutes; 95% CI, 39.38–62.62).ConclusionWe found that the potential benefits of perioperative and short-term outcomes for RS than for CLS. For a more accurate understanding of RS for colonic cancer patients, robust comparative studies and randomized clinical trials are required.

Rheumatoid arthritis and Robotic radical surgery: Positioning and Anesthetic Challenges.

Robotic surgery is the future of minimally invasive surgery. Anaesthesiologists have to be prepared for the various challenges posed by robotic surgeries in terms of steep trendelenberg position, prolonged pneumoperitoneum and fluid restriction. Rheumatoid arthritis (RA) is a debilitating autoimmune inflammatory arthritis affecting almost every joint of the body. The various deformities due to RA can pose a challenge for proper positioning. It can also cause difficult venous cannulation, difficult airway, impaired respiratory function, multi-system involvement and propensity to cause neurovascular impingement. We present a case of severe rheumatoid arthritis with hypothyroidism posted for elective robotic radical hysterectomy and the anaesthetic challenges.

Robotic versus conventional laparoscopic colorectal operations: a-single center experience.

Robotic surgery was first introduced in 2000 especially to overcome the limitations of low rectum cancer surgery. There is still no consensus regarding the standard method for colorectal surgery. The aim of this study was to compare robotic surgery with laparoscopic colorectal surgery. This is a retrospective study. Data of patients with a diagnosis of colon or rectal cancer were analyzed for robotic colorectal surgery and laparoscopic colorectal surgery. The cost of robotic surgery group was statistically higher than the laparoscopic surgery group (p=0.032). The average operation duration was 178 minutes in the laparoscopic surgery group and 228 minutes in the robotic surgery group, and this difference was statistically significant (p=0.044). There was no statistically significant difference between the groups regarding other parameters. Disadvantages of robotic surgery seem to be its higher cost and longer operation duration as compared to laparoscopic surgery. We claim that an increase in the number of cases and experience may shorten the operation time while the increase in commercial interest may decrease the cost disadvantage of robotic surgery.

Single Incision Trans-Umbilical Total Hysterectomy: Robotic or Laparoscopic?

Objective: The aim of this study was to compare the early surgical outcomes in patients who underwent total hysterectomy with laparoendoscopic single-site surgery (LESS-TH) versus robotic single-site total hysterectomy (RSS-TH). Methods: Twenty-four patients who underwent RSS-​TH and thirty-four patients who underwent LESS-TH were retrospectively evaluated. Patient characteristics, operation time, intraoperative data (conversions, complications, estimated blood loss, etc.) and postoperative pain scores were compared. Results: The total operation time was significantly longer in the robotic surgery group, with a time of 98.5 vs. 86 min (p = 0.013), while vaginal closure time was significantly higher in the laparoscopic surgery group (p = 0.011). Intraoperative outcomes and postoperative pain scores were similar in the two groups. Conclusion: RSS-TH helps surgeons to overcome the technical disadvantages of LESS-TH, particularly vaginal cuff closure, ergonomics and instrument crowding and clashing. Early surgical outcomes are comparable in the two groups, and both techniques are safe and feasible.

Single Incision Trans-Umbilical Total Hysterectomy: Robotic or Laparoscopic?

Objective: The aim of this study was to compare the early surgical outcomes in patients who underwent total hysterectomy with laparoendoscopic single-site surgery (LESS-TH) versus robotic single-site total hysterectomy (RSS-TH). Methods: Twenty-four patients who underwent RSS-​TH and thirty-four patients who underwent LESS-TH were retrospectively evaluated. Patient characteristics, operation time, intraoperative data (conversions, complications, estimated blood loss, etc.) and postoperative pain scores were compared. Results: The total operation time was significantly longer in the robotic surgery group, with a time of 98.5 vs. 86 min (p = 0.013), while vaginal closure time was significantly higher in the laparoscopic surgery group (p = 0.011). Intraoperative outcomes and postoperative pain scores were similar in the two groups. Conclusion: RSS-TH helps surgeons to overcome the technical disadvantages of LESS-TH, particularly vaginal cuff closure, ergonomics and instrument crowding and clashing. Early surgical outcomes are comparable in the two groups, and both techniques are safe and feasible.

Cerebral tissue O2 saturation during prolonged robotic surgery in the steep Trendelenburg position: an observational case series in a diverse surgical population.

Demands associated with the Trendelenburg position (TP) are well known yet there is little attention given to regional cerebral tissue O2 saturation (SctO2) in those undergoing robotic surgery in the TP with CO2 insufflation (C-INSF). This is the first study to report on SctO2 in a wide range of patients undergoing lengthy TP and robotic surgery. We measured SctO2 during robotic surgery in patients in the TP with C-INSF, as well as a control robotic thyroid surgery group who were supine with no C-INSF. We recorded relevant variables and periods of cerebral desaturation (CD). We studied 42 patients in 25°-45° of TP for ≥125 min. Management was at the providers' discretion. The INVOS(®) 5100C Cerebral Oximeter (Covidien, Boulder, CO) recorded SctO2. CD was defined as a >20 % decrease from baseline SctO2 or a value ≤55 % for ≥10 min. Patients were assessed for adverse outcome. The sample consisted of 13 males and 29 females aged 22-73, BMI 22-36 had general (N = 3), urological (N = 14) and gynecological (N = 25) surgery; two patients had CD lasting 150 and 190 min and two had episodic CD lasting 10-35 min. The four were female aged 22-60 in 38°-45° of TP. Eleven cases had multiple episodic CD for ≤15 min, 27 TP cases had no CD. Other observations included a consistent fall in SctO2 with phenylephrine; an increased SctO2 with ephedrine; and FiO2 and EtCO2 being generally strong, direct modifiers of SctO2. High MAP was inconsistently associated with high SctO2. BMI had no observed effect on SctO2. Pulse oximetry was ≥97 % in all cases. We observed no adverse cerebral events on follow-up. Additional clinical studies are warranted.

Robotic Splenectomy: What is the Real Benefit?

The advancement of technology may take one of several forms. Some products are a result of ongoing quest to solve existing problems—a gradual evolution of previous, more primitive versions. Other products create a revolution, by inventing a new category and providing capabilities we didn’t even know we needed, but now can’t live without (the iPhone comes to mind). Another type of invention includes extremely sophisticated technologies that nevertheless fail to provide a real advantage over the existing tools. Some may call them ‘‘white elephants.’’ Is robotic surgery such an elephant? Robotic surgery promised an easy-to-use platform to perform difficult surgical tasks with greater accuracy. Intuitively, this should translate to better surgical care. Yet, the ultimate criterion by which we should measure the usefulness of a surgical tool—the eventual clinical outcome—was found to be surprisingly difficult to demonstrate, even after several years of widespread robotic integration into the clinical surgery world. Yes, safe (despite some rare mishaps...) and feasible (despite humongous costs)—we know this already, but we are still waiting for hard data to show that the surgeon’s ease and fun-to-use experience is translated into a real advantage to the patient. It may be that the robot’s advantage is less pronounced than initially seemed, but this doesn’t mean that there are no significant advantages in some specific situations, and all we need now is to find the problems that the robot is here to solve. In this issue of the World Journal of Surgery, Giza et al. [1] suggests such situation, with their impressive experience with splenectomy—more than 400 splenectomies performed over almost 18 years. With more than 200 laparoscopic and nearly 80 robotic splenectomies retrospectively analyzed, they managed to define ‘‘simple’’ vs. ‘‘difficult’’ splenectomies and show that the assistance of the robotic system in difficult splenectomies translated into shorter operating time and five times less blood loss. Conversion rate was lower in the robotic surgery group, but postoperative complication rate was no different. It may be sensible to assume that shorter operations with less bleeding would result in better postoperative outcome, but we have no real support for this hypothesis in this study. So, despite having a nice study showing ‘‘some’’ advantage in ‘‘some’’ of the cases of splenectomy, I am not sure that such a retrospective analysis provides a good enough reason to switch to robotic surgery, if you’re doing it well enough laparoscopically. We will continue to wait for data, and wait for future (and cheaper, and less cumbersome) versions of ‘‘vision and motion-enhancing systems’’ (as this is what essentially the da Vinci system is). In case you already own such a machine, please continue to use it, and try to define its real role in modern surgery. At the same time, you will continue to please your management by justifying the costly purchase and satisfy the public who is eager to undergo ‘‘surgery of the future.’’

Gland-preserving robotic surgery for benign submandibular gland tumours: a comparison between robotic and open techniques

Benign tumours of the submandibular gland are usually treated surgically. Gland-preserving techniques, which can be used to completely remove the tumour, preserve the function of the gland and reduce complications, but conventional open operations result in obvious scars on the neck. We aimed to investigate the feasibility and efficacy of gland-preserving robotic surgery using a hairline approach. We compared robotic with open techniques for gland-preserving operations to remove benign tumours of the submandibular gland. Patients were matched for age and sex (4 in each group). All patients in the robotic surgery group had their tumours removed successfully through hairline approaches. No patient had operative complications or postoperative functional nerve deficit, and an aesthetically pleasing outcome was achieved by concealing the scars within the hairline. Robotic operations took longer than open operations. No recurrence was noted during follow-up. Gland-preserving robotic surgery is a feasible alternative to conventional techniques and has potential advantages for safety and aesthetic outcome.

Robotic surgery compared with laparotomy for high-grade endometrial cancer.

High-grade endometrial cancer often presents with occult metastatic disease and this presentation pattern can be considered a contraindication to minimally invasive surgery. We sought to compare the surgical and oncologic outcomes of patients with high-grade endometrial cancer who underwent surgical management/staging via the robotic approach versus the traditional open approach. A retrospective analysis was performed of patients with high-grade endometrial cancer who were treated at a single institution from January 2008 through December 2011. High-grade endometrial histology was defined as FIGO grade 2 or 3 endometrioid, serous, clear cell or uterine carcinosarcoma. Pre-operatively, all patients had clinical stage I disease based on a combination of physical examination and imaging studies. Baseline patient demographics, operative results, complications and oncologic outcomes were analyzed. Eighty consecutive patients were included. Forty-seven patients underwent surgical management using the robotic approach and 33 patients underwent a traditional operation via laparotomy. The groups were well matched in terms of age, body mass index, medical co-morbidities, stage and histology. The average hospital stay for patients who underwent open surgery was significantly longer than for those who underwent a robotic approach [5.6 versus 1.4days (p=0.0001)]. Of the patients who underwent robotic surgery, 7/47 (15%) experienced an operative complication versus 18/33 (55%) in the open surgery cohort (p=0.002). The average number of pelvic lymph nodes retrieved in each cohort was 12. The average number of para-aortic lymph nodes retrieved in each group was 4. On final pathologic analysis, 20 patients in the robotic surgery arm were found to have disease that had spread beyond the uterus (43%), compared to 14 in the traditional surgery group (42%). There were 11/47 (23%) recurrences in the robotic surgery group during the study period, compared to 8/33 (24%) in the laparotomy group. There were no significant differences in progression-free or overall survival between the two cohorts. Robotic surgery is safer than laparotomy for patients with high-grade endometrial cancer. The oncologic outcomes appear similar. Minimizing morbidity in this patient population is important since many are elderly and will require adjuvant therapy.

Differences in self-reported outcomes of open prostatectomy patients and robotic prostatectomy patients in an international web-based survey

ObjectivesTo compare patient reported outcomes between robotic assisted surgery and non-robotic assisted surgery. MethodsThis was an international web-based survey based on a qualitative research and literature review, an internet-based questionnaire was developed with approximately 70 items. The questionnaire included both closed and open-ended questions. ResultsResponses were received from 193 men of whom 86 had received either open (OP) or robotic (RALP) surgery. A statistically significant (p=0.027), ranked analysis of covariance was found demonstrating higher recent distress in the robotic (RALP) surgery group. Although not statistically significant, there was a pattern of men having robotic (RALP) surgery reporting fewer urinary and bowel problems, but having a greater rate of sexual dysfunction. ConclusionsMen who opt for robotic surgery may have higher expectations for robotic (RALP) surgery, when these expectations are not fully met they may be less likely to accept the consequences of this major cancer surgery. Information regarding surgical choice needs to be tailored to ensure that men diagnosed with prostate cancer are fully informed of not only short term surgical and physical outcomes such as erectile dysfunction and incontinence, but also of potential issues with regards to masculinity, lifestyle and sexual health.

Treatment of colorectal cancers with minimally invasive surgical techniques at a dedicated cancer center.

549 Background: Laparoscopic (LS) and robotic surgery (RS) for colorectal cancer provides a new perspective of the deep pelvis. Our goal was to identify the role of LS and RS for patients with sigmoid and rectal cancer. Methods: We retrospectively analyzed 53 patients treated from 2007-2012. Resection type, previous surgery, neoadjuvant and adjuvant therapy, timing of surgery, lymph nodes (LN) harvested, estimated blood loss (EBL), operative time (OT), complications, and pathology were reviewed. Results: Of 53 patients, 32 underwent LS, and 18 RS. There were 47 patients with adenocarcinoma, 5 with unresectable polyps and 1 with anal melanoma. 62% of patients underwent a recto-sigmoid resection, 23% rectal, and 8% sigmoid. 32% had prior surgery. Neoadjuvant treatment (NAT) was initiated in 31 patients; 3 received chemotherapy without radiation, and 1 short course radiation. An average of 12.8 and 8.4 LN were harvested in the LS and RS groups respectively, with a mean of 9.9 LN after NAT, and 13.9 without. EBL was 155ml (20-650) with LS and 178ml (25-600) with RS. 3 LS cases were converted to an open procedure. Median OT was 270 and 302 minutes for LS and RS groups. Using the Clavien grading system, 12 patients had grade 1-2 complications, 5 grade 3, and 2 grade 4’s within 30 days. Radial margins were positive in 2 patients; one received NAT for a fungating anal adenocarcinoma, and the other had chemotherapy alone. One patient had a positive proximal margin with no prior therapy. Rate of complete pathological response (pCR) was 35%, and 71% were down staged. The mean interval between completion of NAT and resection was 8 weeks (range 4-12), and surgery to adjuvant therapy was 8 weeks (range 4-22). Conclusions: LS and RS surgery for colorectal cancer can be safely performed in conjunction with neoadjuvant and/or adjuvant chemotherapy. NAT should not preclude adoption of these techniques, as we achieved a 35% pCR with minimal operative morbidity allowing patients to proceed to adjuvant chemotherapy in a timely fashion. [Table: see text]

The Impact of Robotic Surgery for Mid and Low Rectal Cancer

The objective of this study was to clarify the impact of robotic surgery (RS) in the management of mid and low rectal cancer in comparison with open surgery (OS) and laparoscopic surgery (LS). The benefits of RS in the treatment of rectal cancer have not yet been clearly described. Using propensity scores for adjustment of sex, age, body mass index, tumor stage, and tumor height, a well-balanced cohort with 165 patients in each group, was created by matching each patient who underwent RS as the study group with one who underwent OS or LS as the control group (RS:OS = 1:1, RS:LS = 1:1 match). Pathological results, morbidity, perioperative recovery, and short-term oncological results were compared between the 3 groups. In RS and LS, the time to first flatus and resumed soft diet and length of hospital stay were significantly shortened compared with OS. Robotic surgery showed better recovery outcomes than LS with regard to time to resumed soft diet and length of hospital stay. The visual analog scale was significantly lower in the RS than in the OS and LS from postoperative days 1 to 5. The voiding problem and circumferential resection margin involvement rate were significantly lower in the RS group than in the OS group. No significant difference in 2-year disease-free survival was observed among the 3 groups. Robotic surgery may be an effective tool in the effort to maximize the advantages of minimally invasive surgery in the management of mid to low rectal cancer.

Ovarian remnant syndrome: comparison of laparotomy, laparoscopy and robotic surgery

To compare laparotomy, laparoscopy and robotic surgery in the management of ovarian remnant syndrome. Retrospective comparative study. Mayo Clinic Arizona and Mayo Clinic Rochester, USA. Women who underwent surgical treatment for ovarian remnant syndrome. The clinical records of 223 patients with histologically documented residual cortical ovarian tissue excised at Mayo Clinic by laparotomy, laparoscopy or a robotic approach, from January 1985 through February 2009, were reviewed. Data collected included the patient's age, body mass index, previous medical and surgical history, symptoms, prior management of ovarian remnant syndrome, preoperative imaging study, intraoperative details, postoperative course, complications and follow-up data. Intraoperative and postoperative outcomes. One hundred and eighty-seven patients (83.9%) were operated by laparotomy, 19 (8.5%) by laparoscopy and 17 (7.6%) by a robotic approach. Estimated blood loss and length of stay were significantly lower in the robotic and laparoscopic groups compared with laparotomy (p < 0.01). After a mean follow-up of 21.1 ± 32.4 months, the rate of pain improvement was 93.1, 94.4 and 71.4% for the laparotomy, laparoscopy and robotic surgery group, respectively. Robotic and laparoscopic surgery for the treatment of ovarian remnant syndrome offer advantages over laparotomy in terms of reduced blood loss, lower postoperative complications and shorter length of stay.

Single-Port Robotic Cholecystectomy

To report our results from a first human use clinical study with the da Vinci Surgical single-site instrumentation in patients with gallbladder disease and to perform a retrospective comparison with traditional multiport laparoscopic cholecystectomy. Ten patients underwent robotic single-port cholecystectomy performed with the da Vinci Si robot and novel da Vinci single-site instrumentation. Outcomes and operative times were compared with patients undergoing traditional multiport laparoscopic cholecystectomy during the same period. Tertiary care Veterans Administration hospital. Outpatients older than 18 years with an American Society of Anesthesiologists class of 1 to 3, no prior upper abdominal surgery, and diagnosis of noninflammatory biliary disease. Single-site robotic cholecystectomy. Operative time, complications up to 30 days, pain scores, and overall satisfaction. Nine of 10 patients had completion of robotic single-site cholecystectomy. Average operating room time was 105.3 minutes compared with an average of 106.1 minutes in the standard laparoscopic group. There were no serious adverse events in the robotic surgery group, with an average follow-up of 3 or more months. Robotic single-port cholecystectomy is feasible and comparable with standard laparoscopic cholecystectomy in the Veterans Administration medical center setting.

Robotic Gastrectomy as an Oncologically Sound Alternative to Laparoscopic Resections for the Treatment of Early-Stage Gastric Cancers

To evaluate the comparative safety and efficacy of robotic vs laparoscopic gastrectomy for early-stage gastric cancer. Retrospective analysis. Tertiary hospital. Eight hundred twenty-seven patients with gastric cancer. Between July 2005 and April 2009, 827 patients with gastric cancer underwent 236 robotic and 591 laparoscopic radical gastrectomies with curative intent. The patients' data were prospectively collected and retrospectively analyzed. We performed a comparative analysis between the robotic surgery group and laparoscopic surgery group for preoperative patient characteristics, intraoperative factors, and postoperative morbidity and mortality. The robotic group was younger than the laparoscopic group, but other preoperative patient characteristics did not differ. The mean operative time for the robotic group (219.5 minutes) was on average 49 minutes longer than the laparoscopic group (170.7 minutes) (P < .001), while mean blood loss was significantly less in the robotic group (91.6 mL vs 147.9 mL; P = .002). The robotic group had mortality of 0.4% and morbidity of 11.0%, comparable with those of the laparoscopic group (P > .05). The number of lymph nodes retrieved per level was adequate in both groups and did not differ significantly. Robotic D1+α (n = 5), D1+β (n = 126), and D2 (n = 105) dissections retrieved 27.2, 36.7, and 42.4 mean numbers of lymph nodes, respectively. Except for 3 cases in the laparoscopic group, all specimens had negative margins. Our largest comparative study demonstrates robotic gastrectomy to have better short-term and comparable oncologic outcomes compared with laparoscopic gastrectomy. A robotic approach to gastric cancer is a promising alternative to laparoscopic surgery.

1981 QUALITY OF LYMPHADENECTOMY IS EQUIVALENT IN ROBOTIC AND OPEN CYSTECTOMY USING AN EXTENDED TEMPLATE

You have accessJournal of UrologyBladder Cancer: Metastatic Disease1 Apr 20111981 QUALITY OF LYMPHADENECTOMY IS EQUIVALENT IN ROBOTIC AND OPEN CYSTECTOMY USING AN EXTENDED TEMPLATE Ronney Abaza, Kamal Pohar, and Robert Bahnson Ronney AbazaRonney Abaza Columbus, OH More articles by this author , Kamal PoharKamal Pohar Columbus, OH More articles by this author , and Robert BahnsonRobert Bahnson Columbus, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2207AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Relative to lesser templates, extended lymph node dissection (eLND) more accurately assigns nodal stage, removes more positive lymph nodes, and may have greater survival benefit. Minimally-invasive techniques for radical cystectomy have been criticized due to concerns over ability to adequately perform eLND. We determined whether the quality of lymphadenectomy in robotic and open cystectomy is comparable using an extended template by assessing node yield and positivity. METHODS Extended lymph node dissection (eLND) was performed in 120 open and 35 robotic cystectomy patients by a dedicated open or dedicated robotic surgeon. Extended lymphadenectomy was strictly defined as thorough skeletonization of anatomical structures in each nodal group below the aortic bifurcation, including common iliac, external iliac, obturator, hypogastric, and presacral node chains. The hypogastric nodes included skeletonization of the triangle of Marcille (presciatic space). Lymph nodes were identified by palpation without fat clearing techniques or solvents. Nodes from robotic cases were extracted and submitted en bloc or as a maximum of two specimens while open surgery allowed nodes to be submitted as packets from each of the 5 nodal basins. RESULTS The mean lymph node count in the open group was 36.9 ± 14.8 (range, 11 to 87). Only 12 of 120 patients (10%) had a total node count of less than 20. In the robotic group, the mean node yield was 37.5 ± 13.2 (range, 18 to 64) with only 2 of 35 patients (6%) having less than 20 nodes. In the open group, 36 patients (30%) had lymph node metastasis, and in the robotic group, 11 patients (31%) had involved nodes. Open eLND identified 80% and 90% confidence of accurate staging as pN0 when 23 and 27 nodes were obtained, respectively. A total lymph node count of 23 or 27 was achieved in 104 (87%) and 92 (77%) of the open surgery patients and in 32 (91%) and 29 (83%) patients who had robotic surgery. Among open surgical patients, 36% of patients received neoadjuvant chemotherapy as compared with 31% in the robotic surgery group. CONCLUSIONS No difference was identified in the total number of lymph nodes removed and the number of node-positive patients when comparing open and robotic cystectomy with extended lymphadenectomy. Local recurrence and disease specific survival data will be required to confirm whether the two techniques are oncologically equivalent. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e793 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ronney Abaza Columbus, OH More articles by this author Kamal Pohar Columbus, OH More articles by this author Robert Bahnson Columbus, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparison of robotic-assisted surgery outcomes with laparotomy for endometrial cancer staging in Turkey

To compare the results of patients on whom staging was applied by robotic-assisted laparoscopic surgery and laparotomy for endometrial cancer. The study included 10 patients who had undergone robotic-assisted endometrial staging (group 1) and 12 patients staged by open surgery (group 2). Demographical characteristics and operative outcomes of all patients were compared. Body mass index, age, previous abdominal surgeries, histopathologic characteristics, performed operative procedure, operation time, complications, hospitalization duration, estimated blood loss and number of resected lymph nodes were recorded for all patients. Mean age of the patients in the robotic surgery group was 55.7 years (37-66) and in the laparotomy group 56.4 years (47-75). Body mass index was calculated as 32.7 kg/m² (24.5-40.3) in group 1 and 30.3 kg/m² (25.9-35.8) in group 2. Total duration of operation was 234.6 min (137-300) and 168.5 min (102-232) in group 1 and 2, respectively. Mean duration of hospitalization in group 1 was 2.8 days (2-5) and in group 2 was 8.8 days (6-13). Estimates of blood loss were 95 ml (20-210 ml) in the robotic surgery group and 255 ml (80-420) in the other group. The mean number of resected lymph nodes was 42 (13-86) and 46.5 (26-107) in the robotic-assisted surgery group and laparotomy group, respectively. None of the cases in the robotic-assisted endometrial staging group required transition to laparotomy. Robotic surgery may be preferred over laparotomy with respect to the advantages observed in the duration of hospitalization, estimated amount of blood loss and complications. There was no significant difference between the two methods in terms of number of resected lymph nodes. Despite the limited number of patients in this study, these results are important as they represent the first data on robotic surgery in Turkey.