Robotic Suturing Research Articles

FLUORESCENCE CYSTOSCOPY WITH HEXAMINOLEVULINATE IN THE DIAGNOSIS OF BLADDER CANCER: OUR EXPERIENCE

physical therapy. He received adjuvant chemotherapy and is alive without evidence of disease recurrence at 1 year. CONCLUSIONS: There is a risk of obturator nerve injury during pelvic lymph node dissection. Hem-o-lock clips may be removed with the use of a clip remover or harmonic instrument. If transected and recognized, immediate apposition of the nerve is necessary to yield recovery. Robotic suturing of the transected nerve was technically feasible in this case.

LapED® 4-In-1 Silicone Training Aid for Practicing Laparoscopic Skills and Tasks: A Preliminary Evaluation

We developed a simple, inexpensive model to simulate four reconstructive laparoscopic procedures: pyeloplasty, vesicourethral anastomosis, bladder injury repair, and partial nephrectomy. Liquid silicone was applied in layers to a mold to create the 4-in-1 model. A questionnaire evaluating its face and content validity was distributed to postgraduate urologists participating in a mini-residency program at the University of California-Irvine (UCI), and in the 2006 American Urological Association Hands-On course on reconstructive laparoscopic pyeloplasty. A total of 56 postgraduate urologists used the model and completed an evaluation questionnaire. Ninety-four percent (51/54) and 96% (48/50) agreed that the model was helpful for practicing laparoscopic pyeloplasty and urethrovesical anastomosis, respectively. Urologists who were experienced in either performing laparoscopic pyeloplasty (n = 6) or robot-assisted and/or laparoscopic prostatectomy (n = 11) would recommend this model to surgeons in training. Overall, 94% (48/51) and 96% (50/52) of the respondents would recommend this model for postgraduate surgeons and residents, respectively. We present a versatile model for practicing laparoscopic and robotic suturing and knot-tying skills in four reconstructive urologic procedures. Our results support the face and content validity of this model for performing pyeloplasty and vesicourethral anastomoses.

Robotic Technology—Probably a Safe Tool for Development of Completely Endoscopic Coronary Revascularization Procedures

: Totally endoscopic coronary artery bypass grafting (TECAB) requires telemanipulation technologies because attempts using conventional thoracoscopic instrumentation have completely failed. These complex operations require individual and team learning curves and necessitate a stepwise approach. The aim of this study is to assess risk adjusted outcome in robotically assisted coronary artery bypass grafting (CABG) after the first 6 years of application. : From 2001 to 2007, 177 CABG procedures were performed using the da Vinci system. A low risk patient population [age 59 (31-76) years, EuroSCORE 1 (0-7)] was treated. The following procedures were carried out: endoscopic internal mammary artery takedown in minimally invasive direct coronary artery bypass, Off-pump coronary artery bypass, and CABG (n = 26); robotic suturing of left internal mammary artery to left anterior descending artery anastomoses through sternotomy (n = 32); TECAB on the arrested heart (n = 108); TECAB on the beating heart (n = 11). : There was no hospital mortality, and cumulative risk adjusted mortality plots showed that 2.76 predicted events did not occur. Given 177 event free procedures Clopper Pearson estimations revealed a 95% confidence interval between 0.0% and 2.3% for perioperative mortality. : Introduction of robotic TECAB grafting appears to meet current CABG safety standards. Initial application in low risk patients and a stepwise approach towards completely endoscopic versions of the operation are worthwhile. Despite a high grade of innovation and despite learning curves, perioperative mortality may be lower than predicted.

Robotic suturing: Technique and benefit in advanced laparoscopic surgery

Suturing is one of the main tasks in advanced laparoscopic surgery, but limited degrees of freedom, 2D vision, fulcrum and pivoting effect make it difficult to perform. Robotic systems provide corresponding solutions as three‐dimensional (3D) view, intuitive motion and additional degrees of freedom. This review evaluates these benefits for their impact on suturing in experimental and clinical studies. The Medline database was searched for “robot*, telemanipulat* and laparoscop*”. A total of 1150 references were found and further limited to “suturing” for experimental evaluation, finding 89 references. All references were considered for information on robotic suturing in advanced laparoscopy. Further references were obtained through cross‐referencing the bibliography cited in each work. In experimental studies current robotic systems have proven their superior suturing capabilities compared to conventional laparoscopic techniques, mainly attributed to 3D visualization and full seven degrees of freedom. In clinical studies these benefits have not yet been sufficiently reproduced. Robotic systems have to prove the benefits shown in experimental studies for suturing tasks in clinical applications. Robotic devices shorten the learning curve of laparoscopic procedures. Further clinical trials focusing on anastomosis time are needed to assess this question.

Prior Video Game Exposure Does Not Enhance Robotic Surgical Performance

Prior research has demonstrated that counterintuitive laparoscopic surgical skills are enhanced by experience with video games. A similar relation with robotic surgical skills has not been tested. The purpose of this study was to determine whether prior video-game experience enhances the acquisition of robotic surgical skills. A series of 242 preclinical medical students completed a self-reported video-game questionnaire detailing the frequency, duration, and peak playing time. The 10 students with the highest and lowest video-game exposure completed a follow-up questionnaire further quantifying video game, sports, musical instrument, and craft and hobby exposure. Each subject viewed a training video demonstrating the use of the da Vinci surgical robot in tying knots, followed by 3 minutes of proctored practice time. Subjects then tied knots for 5 minutes while an independent blinded observer recorded the number of knots tied, missed knots, frayed sutures, broken sutures, and mechanical errors. The mean playing time for the 10 game players was 15,136 total hours (range 5,840-30,000 hours). Video-game players tied fewer knots than nonplayers (5.8 v 9.0; P = 0.04). Subjects who had played sports for at least 4 years had fewer mechanical errors (P = 0.04), broke fewer sutures (P = 0.01), and committed fewer total errors (P = 0.01). Similarly, those playing musical instruments longer than 5 years missed fewer knots (P = 0.05). In the extremes of video-game experience tested in this study, game playing was inversely correlated with the ability to learn robotic suturing. This study suggests that advanced surgical skills such as robotic suturing may be learned more quickly by athletes and musicians. Prior extensive video-game exposure had a negative impact on robotic performance.

Robotic dexterity: evaluation of three-dimensional monitoring system and non-dominant hand maneuverability in robotic surgery.

There has been great progress in robotic surgical technology in recent years. The aim of this study was to objectively quantify robot-enhanced dexterity. To evaluate three-dimensional monitoring and non-dominant hand maneuverability using the da Vinci Surgical System, five surgeons were asked to thread the needle through all 11 holes on the model with handling robotic instrument. Three types of suturing were carried out. In task 1, sutures were placed using the dominant hand under 3D imaging; in task 2, suturing was performed using the dominant hand under 2D imaging; and in task 3, suturing was done with the non-dominant hand under 3D imaging. Each surgeon placed three sutures in completing each task. The time to successful completion, accuracy, and the opinion of the level of difficulty were recorded. All 45 tasks were completed. The time required to place each suture (mean ± SD) was as follows: 211.7 ± 50.5 s for task 1, 331.1 ± 121.2 s for task 2, and 237.1 ± 95.7 s for task 3. Task 1 took less time than task 2 (P = 0.02). There were no differences in the times between task 1 and task 3 (P = 0.19). Robotic suturing under 3D imaging is significantly faster than under 2D imaging, and robotic suturing using the non-dominant hand does not need significantly more time than with the non-dominant hand. Technology for robotic surgery could increase the manipulative abilities.

A comparison of robotic, laparoscopic, and hand-sewn intestinal sutured anastomoses performed by residents

Background Robotic surgery offers all the advantages of laparoscopy with additional increased accuracy. The use of robotic surgery has increased in the past 5 years. It has proven particularly useful in complex surgical procedures such as intracorporeal intestinal anastomosis. As the prevalence of robotic surgery increases, so will the need for residents to be able to perform surgery using the robotic system. Our goal was to compare hand-sewn, laparoscopic, and robotic suturing techniques performed by midlevel residents using a porcine intestinal model. Methods Fifteen residents unfamiliar with the robotic suturing technique participated in performing an initial hand-sewn suture line and then were randomized with cross-over to laparoscopic or robotic suturing. Completion time, leak pressure, number of sutures per cm, and difficulty level were assessed. Results The mean leak pressure for hand-sewn, laparoscopic, and robotic suturing was 9.5, 3.2, and 11.4 mm Hg, respectively. The laparoscopic group had 6 and the robotic group had 1 suture line that was inadequate for testing. Suture breakage was common in the robotic group. The anastomosis was considered hard by 92% in the laparoscopic group versus 17% in the robotic group. The time it took to complete 1 cm of anastomosis was .9, 8.7, and 8.3 minutes for hand-sewn, laparoscopic, and robotic suturing, respectively. Conclusion The robotic suture line performed by midlevel residents was superior to laparoscopy, although the time for anastomosis was equivalent.

Teaching robotic surgery: a stepwise approach

After an initial institutional experience with 50 robot-assisted laparoscopic Roux-en-Y gastric bypass procedures, a curriculum was developed for fellowship training in robotic surgery. Thirty consecutive robotic gastric bypasses were performed using the Zeus robotic surgical system to fashion a two-layer gastrojejunostomy. For teaching purposes, performance of the anastomosis was divided into three discrete tasks. Robotic suturing tasks were assigned to the trainee in cumulative order in ten-case increments. Our patient population averaged 44 years of age and 47 kg/m(2) in BMI. Patients were predominantly female (87%). The robotic training experience of the fellow defines the increases in surgical responsibility over the series of cases. Statistical analysis revealed no significant differences in task times or total robotic operative time as participation of the trainee in performing the gastrojejunostomy increased. No adverse robotic events or surgical complications occurred throughout this series. The learning curve of the fellow compared favorably with the initial experience of the institution. Robotic surgery training may be safely implemented in a minimally invasive surgery training program. A gradual introduction of robotic technique appears to maximize the learning experience and minimize the potential for adverse outcomes.

Virtual reality simulator training equals mechanical robotic training in improving robot-assisted basic suturing skills

This study aimed to investigate the effect of a virtual reality simulator on the learning of basic robotic suturing skills. Two randomized groups of students underwent a controlled training program. Both groups completed an identical test before and after training. The increase in the number of stitches placed during the pretest and posttest was used as an objective measure of the training effect. To evaluate the subjective feeling of understanding and mastering, the students indicated this on a visual analog scale. Both groups showed a significant increase in the number of stitches placed during the posttest, and an increase in subjective feeling of understanding and mastering. The increase did not differ between the groups, indicating that the virtual reality simulator equaled the mechanical trainer in training of robotic suturing technique. Training in basic robot-assisted suturing skills using a virtual reality simulator without additional training equaled training using a mechanical simulator.

Robotic-assisted laparoscopic microsurgical tubal anastomosis: a human pilot study

Objective: To evaluate the feasibility and safety of a robotic device to perform a laparoscopic tubal anastomosis. Design: Prospective pilot study. Setting: Tertiary care medical center. Patient(s): Ten patients with previous tubal ligations underwent laparoscopic tubal ligation reversal using a robotic suturing device. Intervention(s): Tubal surgery was performed with a robotic system. A two-layered closure was used for all tubes. Four stitches of 8-0 polygalactin sutures were used for each layer. Main Outcome Measure(s): Tubal patency; secondary measures were pregnancy rates, complications, and operative time. Result(s): The procedure was completed successfully in all 10 patients. No patient required conversion to an open procedure. The mean time (±SD) required to complete the anastomosis of both tubes was 159 ± 33.8 minutes. Chromotubation at the end of the procedure showed patency in all tubes anastomosed. A postoperative hysterosalpingogram 6 weeks after surgery demonstrated patency in 17 of the 19 (89%) tubes anastomosed. There have been five pregnancies so far. There were no complications. Conclusion(s): Robotic technology can be used safely to create laparoscopic microsurgical anastomoses with adequate patency rates. Robotic technology has the potential to make laparoscopic microsuturing easier.