Robot-assisted Laparoscopic Surgery Research Articles

A comparison of analgesic efficacy between oral pregabalin, gabapentin, and melatonin as non-opioid anaesthesia for robotic-assisted laparoscopic surgeries: A prospective randomized double-blinded clinical study

A comparison of analgesic efficacy between oral pregabalin, gabapentin, and melatonin as non-opioid anaesthesia for robotic-assisted laparoscopic surgeries: A prospective randomized double-blinded clinical study

057. The Comparative Efficacy of Robot-Assisted Versus Laparoscopic Surgery for Rectal Cancer: A Systematic Review and Meta-Analysis

Background: Background: Total mesorectal excision (TME) is the gold standard surgical intervention for rectal cancer, associated with effective local recurrence management and improved overall survival rates. Laparoscopic surgery for colon cancer is primarily recognised as a curative treatment. Nonetheless, laparoscopic surgery for rectal cancer presents technological limitations. Robot-assisted laparoscopic total mesorectal excision (TME) surgery for rectal cancer was established to address these technical difficulties. Our objective was to assess the clinical and oncological outcomes of robot-assisted surgery compared to laparoscopic surgery for rectal cancer. Methods: We searched PubMed, ScienceDirect, and CENTRAL to identify studies and trials published between 2014 and 2023. The outcomes of our study encompass operational duration, duration of hospital admission, and intra-operative haemorrhage. We employed Revman 5.4.2 to do the meta-analysis. Results: Seven trials were analysed, encompassing 1,231 patients, including 545 patients who underwent robotic-assisted surgery and 686 patients who received laparoscopic surgery. Our results demonstrate that robot-assisted surgery significantly reduced operation time (MD 74.04, 95% CI [28.12, 119.97], p = 0.002), hospital stay (MD -1.86, 95% CI [-2.68, -1.05], p < 0.00001), and intra-operative blood loss (MD 36.83, 95% CI [23.55, 50.11], p < 0.00001). Our study identified robot-assisted surgery as a viable option for rectal cancer treatment. Conclusion: Our study revealed that robot-assisted surgery correlated with decreased intra-operative blood loss, operative duration, and length of hospital stay. Further research is needed to corroborate these findings

Domestic single-port robot-assisted laparoscopic surgery for pyelotomy combined with shockwave lithotripsy: the first case report

Introduction and Importance: Kidney stones are a common condition treated in urology departments and rank first among hospitalized patients. Staghorn kidney stones are a particular type of kidney stone that fill or occupy most of the renal collecting system. They have a large stone load and are often associated with recurrent urinary tract infections and chronic renal insufficiency. Case presentation: The authors report a case of single-port robot-assisted laparoscopic pyelotomy combined with EMS (Electromagnetic Shockwave Lithotripsy) for surgical stone removal, and discuss and analyze it based on published literature. A 75-year-old woman visited our hospital in January 2024 due to right waist pain and hematuria. Computed Tomography (CT) indicated a stone ~6.1×5.8×3.5 cm in the right renal pelvis and calyces. Staghorn kidney stones are challenging to remove surgically, have a low stone clearance rate, and are prone to recurrence, making them one of the most difficult issues in urological surgery. Combined treatment effectively reduces the number of skin-renal passages, decreases the occurrence of injuries and complications, and improves the success rate of lithotripsy and the stone-free rate. Therefore, the patient underwent single-port robot-assisted laparoscopic pyelotomy combined with EMS surgical lithotomy and was discharged 7 days after the operation. There were no complications postoperation, and follow-up showed that the stones were completely cleared without any residue. Clinical discussion: The treatment of staghorn kidney stones requires a comprehensive approach to reduce the number of skin-renal passages and the occurrence of complications. Single-port robot-assisted pyelotomy combined with EMS lithotripsy can ensure the effectiveness of the surgery while reducing risks and enhancing patient recovery. Conclusion: For staghorn kidney stones, single-port robot-assisted pyelotomy combined with EMS stone removal is a safe and effective procedure with a beautiful incision, fewer complications, and excellent patient outcomes.

Active constrained motion control for a robot-assisted endoscope manipulator in pediatric minimal access surgery.

Robot-assisted laparoscopic surgery has three main system requirements: safety, simplicity, and intuitiveness. However, accidental movement of the endoscope due to body fatigue and misunderstanding of the verbal orders between the surgeon and assistant will contribute to highly unexpected tool-tissue interactions, particularly in pediatric minimal access surgery with restricted working space. This study introduces a compact, lightweight endoscope manipulator with a mechanical remote-center-motion function. Using a custom-designed human-machine interface, the surgeon can intuitively control the movement of the endoscope manipulator over their view. In addition, an active constrained motion control algorithm is proposed to generate a forbidden-region constraint for avoiding collisions between the endoscope tip and surrounding organs in a pediatric abdominal cavity with restricted space. Simulations and experiments demonstrate the performance of the proposed compact endoscope manipulator and the active constrained surface tracking control scheme.

Transfusion Risk in Open, Laparoscopic, and Robotic-Assisted Surgery: A Propensity Score Matched Case-Control Study across Surgical Disciplines

Introduction: Robotic-assisted surgery is increasingly performed in various surgical disciplines demonstrating improved oncological and functional outcomes compared to conventional surgery. Objective: Unclear is how robotic-assisted surgery affects perioperative anemia and the need for blood products. Methods: In this case-control study, 15,009 matched patient pairs undergoing urological, visceral, or thoracic surgery were included. Pairwise comparisons between robotic-assisted surgery, laparoscopic surgery, and open surgery were performed with propensity score matching. Results: Robotic-assisted surgery compared to open surgery was associated with a risk reduction of allogeneic red blood cell transfusion by RR: 0.32 (95% CI: 0.27–0.37) and a limited reduction of perioperative hemoglobin (perioperative hemoglobin difference of 0.40 g/dL, 95% CI: 0.31–0.49). Robotic-assisted surgery was associated with a shorter length of hospital stay by 4.29 days (95% CI: 3.74–4.84). Compared to laparoscopic surgery, robotic-assisted surgery had no significant effect on red blood cell transfusions (RR: 0.94, 95% CI: 0.75–1.18), perioperative hemoglobin (0.27 g/dL, 95% CI: 0.16–0.38), or length of hospital stay 0.53 days (95% CI: −0.14–1.19). Conclusions: Robotic-assisted and laparoscopic procedures are associated with reduced blood transfusions compared to open surgery and, thus the advancement of minimally invasive procedures constitutes an important measure to improve patient outcomes.

Comparison of the effectiveness of open, laparoscopic, and robotic-assisted radical prostatectomies based on complication rates: a retrospective observational study with administrative data from Switzerland

BackgroundRadical prostatectomies can be performed using open retropubic, laparoscopic, or robot-assisted laparoscopic surgery. The literature shows that short-term outcomes (in particular, inpatient complications) differ depending on the type of procedure. To date, these differences have only been examined and confirmed in isolated cases based on national routine data.MethodsThe data was based on the Swiss Medical Statistics from 2016 to 2018 from a national survey of administrative data from all Swiss hospitals. Cases with the coded main diseases neoplasm of the prostate (ICD C61) and the main treatments of laparoscopic (CHOP 60.5X.20) or retropubic (CHOP 60.5X.30) radical prostatectomies were included, resulting in a total sample size of 8,593 cases.ResultsA procedure-related complication occurred in 998 cases (11.6%). By surgical procedure, complication rates were 10.1% for robotic-assisted laparoscopic radical prostatectomy 9.0% for conventional laparoscopic radical prostatectomy and 17.1% for open retropubic radical prostatectomy (p < 0.001). Conventional and robotic-assisted laparoscopic radical prostatectomies had a significantly lower risk of complications than retropubic procedures. Moreover, the risk of a procedure-related complication was almost twice as high in cases operated on retropubically; however, no significant difference was found between conventional and robotic-assisted laparoscopic cases.DiscussionThe use of a surgical robot showed no advantages in radical prostatectomies regarding procedure-related during the hospital stay. However, both conventional and robotic-assisted laparoscopically operated radical prostatectomies show better results than open retropubic procedures. Further studies on the long-term course of patients based on claims data are needed to confirm the inherent benefits of surgical robots in tandem with them being increasingly employed in hospitals.

Gender Differences in the Adoption and Utilization of Robotic-assisted Laparoscopic Surgery Among Practicing Urologists: A Study of American Board of Urology Case Logs From 2012-2022

ObjectiveTo evaluate the differential activity in robotic-assisted laparoscopic surgery (RALS) by urologic surgeon gender. MethodsThis was a retrospective study of American Board of Urology surgical case logs from 2012-2022. The CPT-coded laparoscopic procedures included were: Partial Nephrectomy (50543), Radical Nephrectomy (50545, 50546, 50548), Pyeloplasty (50544), and Sacrocolpopexy (57425). Robotic-assisted cases were co-coded with CPT S2900. Univariate analysis and multiple logistic regression analyzed the roles of physician gender and other factors on RALS utilization. A separate analysis was performed for Robotic-Assisted Laparoscopic Prostatectomy (RALP) (55866). ResultsWomen performed 10.8% of all procedures and 9.02% of robotic cases. General Urology and Urogynecology and Reconstructive Pelvic Surgery (URPS) had higher concentrations of women. Of the CPT procedures analyzed, women performed the highest percentage of sacrocolpopexies (39.2% of total), 8.09% of which were robotic. In multivariate regression, women surgeons had significantly lower odds of performing a robotic case compared to men (OR 0.803, p<0.001). Endourology, Oncology, Pediatric Urology, and URPS subspecialties were associated with RALS. Upward trends were depicted across all physicians (0.012, [0.007, 0.018], p<0.001) and for men (0.019, [0.010, 0.029], p=0.001). Women showed no significant increase in robotic usage over time (p=0.463). ConclusionsWomen have lower odds of participating in robotics, primarily specialize in URPS and their involvement in RALS is skewed toward sacrocolpopexy. As robotics continues to dominate surgical urology, ensuring equitable training opportunities is essential. Research into the roles of mentorship in residency, same gender patient-physician concordance, practice setting, and recent graduates’ referral patterns is warranted.

Preoperative 3D Planning and Intraoperative Navigation in Robot-Assisted Laparoscopic Surgery for Complex Pheochromocytoma.

To evaluate the value of preoperative 3D planning and intraoperative navigation in robot-assisted laparoscopic surgery for complex pheochromocytoma. Observational study. Place and Duration of the Study: Department of Urology, The Affiliated Hospital of Hebei University, from July 2022 to July 2023. Sixty patients with complex pheochromocytoma were divided into the study group (n = 30) and the control group (n = 30) according to the treatment method. The study group was treated with robot-assisted laparoscopic surgery, with preoperative 3D printing-based planning, and intraoperative 3D navigation, and the control group underwent conventional retroperitoneal robot-assisted laparoscopic surgery. Surgical-related indicators and intraoperative and postoperative complication rates between the two groups were compared. The operation time, postoperative hospital stay, and drainage tube retention time in the study group were significantly shorter than in the control group (p <0.001), and the intraoperative blood loss in the study group was significantly less than in the control group (p <0.001). The study group exhibited a significantly lower incidence of intraoperative haemodynamic instability (HI), use of vasoactive drugs, and postoperative ICU transfer rate than the control group (p <0.05). The incidence of surgical complications in the study group was significantly lower than in the control group (p = 0.04). The non-recurrence rate in the study and control groups after 1-year follow-up was 96.7% and 90%, respectively (χ2= 2.77, p = 0.10). Robot-assisted surgery, performed through renal surface, has the advantages of less bleeding, shorter surgical time, faster recovery, fewer complications related to chromaffin cell inflammation and postoperative complications, and is safe and effective in treating complex pheochromocytoma. 3D planning and navigation, Robot-assisted surgery, Complex pheochromocytoma.

Extraperitoneal robotic approach to the uretero-vesical junction in children: Initial experience and a step-by-step video presentation

The use of transperitoneal robotic-assisted procedures for ureterovesical junction (UVJ) anomalies in pediatric patients is increasing. However, the extra-peritoneal approach potentially less invasive, remains underexplored with robotic approach in pediatric patients. We present our experience of robot-assisted extra-vesical laparoscopic extra-peritoneal UVJ surgery. Extraperitoneal access was made through a 1,5cm horizontal incision below the umbilicus. Digital dissection was performed under the rectus fascia to the pubic symphysis. The space was further developed under direct vision with laparoscope. The Da Vinci Xi platform was docked after the placement of 4 robotic 8mm-trocars and an 8mm assistant port. We performed extraperitoneal robot-assisted laparoscopic UVJ surgery in 3 patients: - Case 1: 9-year-old boy: left-sided ureterectomy, UV reimplantation (UVR) with psoas hitch for a symptomatic mega-ureter. - Case 2: 13-year-old girl: right-sided VUR on a duplex system treated with an extravesical Lich-Gregoir antireflux plasty. - Case 3: 8-year-old boy: left-sided bladder diverticulectomy with UVR. There is no complication above Clavien 2 and no recurrence of febrile UTI during the follow-up period (from 6 to 17 months). Extra-peritoneal robotic approach for UVJ surgery further for UVR in pediatric urology seems feasible with good short-term result even for the complex ones.

On-demand robotics—The best of both worlds for robotic-assisted laparoscopic surgery

A modular, combined use of robotic and laparoscopic platforms has been suggested to address challenges in optimal workspace utilization. The 3-arm on-demand open Dexter Robotic System was developed to combine the advantages of robot-assisted precision surgery in narrow spaces with the laparoscopic approach for frequent position changes in larger spaces. The system integrates 2 patient carts, a fully controllable endoscope arm, and a sterile surgeon open console, allowing for a rapid switch between robot-assisted surgery and laparoscopy. When switching, the robotic arms may be folded into a laparoscopic home position at any time during a procedure, allowing unrestricted access to the patient. Switches take 15–30 seconds, occurring seamlessly without redocking or recalibrating upon returning to the robotic mode. During oncologic colorectal resections, some procedure steps (eg, central vessel ligation and lymphadenectomy) are best suited for the robotic approach, providing advantages related to 3-dimensional vision, improved ergonomics, and improved dexterity within confined spaces. In contrast, the laparoscopic platform is better suited for procedure steps requiring frequent movements within a large workspace (eg, lateral to medial mobilization of the colon). The Dexter system provides a portfolio of 7 robotic instruments with monopolar and bipolar function operating with any existing available generator. Furthermore, existing operating room equipment, including insufflating devices, optics, and trocars can be used with the Dexter robotic platform. Recently, the first published clinical experience from the authors’ institution, involving 12 pilot cases, demonstrated the safety and feasibility for right colonic resections for benign and malignant indications and ventral mesh rectopexies.

Effectiveness of Mechanical Bowel Preparation before Robot-Assisted Laparoscopic Gynecologic Surgery: A Randomized, Single-Blind, Controlled Trial

Objective: The objective of this randomized controlled trial was to compare the effect of bowel preparation using only oral polyethylene glycol electrolyte (PEG) solution versus oral PEG solution combined with mechanical sodium phosphate (NaP) enema on the surgical field visualization in patients undergoing robot-assisted laparoscopic gynecologic procedures. Methods: Participants were randomized to either a single oral PEG solution or an oral PEG solution combined by mechanical NaP enema. The intraoperative visualization of the surgical field, the ease of manipulation of the bowels, and overall difficulty level of the surgery were evaluated by the surgeon using a self-administered questionnaire. After the surgery, the patients completed a survey assessing postoperative gastrointestinal discomfort. Results: A total of 114 women were enrolled and randomized to oral PEG solution-only group (n = 48), and oral PEG plus mechanical NaP enema group (n = 66). Forty-two women in oral PEG-only group and 59 oral PEG plus NaP enema group completed the study. There was no difference in intraoperative visualization or overall difficulty of the operation between the two groups, and bowel manipulation was easier in the oral PEG-only group. Also, there was no difference in operating time between the groups. The patients’ level of gastrointestinal discomfort after the surgery was not significantly different between the two groups. Conclusion: Routine use of mechanical NaP enema before robot-assisted laparoscopic gynecologic surgery is not recommended, because it has no additional benefit regarding intraoperative visualization or the surgical level of difficulty over oral bowel preparation methods.

A systematic review and meta-analysis compared the safety and effectiveness of the AirSeal system with traditional pneumoperitoneum systems in robot-assisted laparoscopic urologic surgery.

This study aimed to analyze perioperative results in robot-assisted laparoscopic urological surgeries, comparing the AirSeal system with traditional pneumoperitoneum systems. This study adhered to the PRISMA guidelines for conducting systematic reviews and meta-analyses. Extensive searches were conducted in PubMed, EMBASE, and Google Scholar, including randomized controlled trials (RCTs) and cohort studies up to June 15, 2024. A combined examination of the studies found that the AirSeal system had superior results in terms of surgery duration, end-tidal carbon dioxide levels, and tidal volume compared to the traditional pneumoperitoneum system. During robotic-assisted partial nephrectomy, the AirSeal team experienced a notable decrease in surgical time, ETCO2, and VT. In addition, the occurrence of SCE was lower in the AirSeal group. However, there were no significant differences observed between the groups regarding EBL, LOHS, overall complications, and major complications. Compared to conventional pneumoperitoneum systems, the AirSeal system offers several advantages in robot-assisted laparoscopic urological surgery: reduced operative time, lower end-tidal CO2 pressure, and decreased tidal volume. Furthermore, implementing the AirSeal system does not lead to higher rates of complications, estimated blood loss, or lengthier hospital stays.

Is It the Best Option? Robotic Surgery for Endometriosis.

Endometriosis is a chronic condition affecting approximately 10% of women of reproductive age, leading to significant physical and emotional stress. Treatments include medical management and surgical interventions, with laparoscopic surgery being the gold standard for removing endometrial tissue. The advent of robotic-assisted laparoscopic surgery (RALS) has enabled more complex procedures to be performed minimally invasively, increasing its use in high-difficulty surgeries. Developed in the late 20th century, systems like the Da Vinci Surgical System have revolutionized surgery by enhancing precision, dexterity, and visualization. The latest models, including the Da Vinci Xi and SP, offer advanced features such as enhanced arm mobility, fluorescence imaging, and single-port capabilities. Comparative studies of RALS and conventional laparoscopy (LPS) for endometriosis show mixed results. While some studies indicate no significant differences in complications or recovery outcomes, others highlight longer operative times and hospital stays for RALS. Despite these drawbacks, RALS is not inferior to LPS overall. The clinical benefits of RALS include greater precision and accuracy, reduced surgeon fatigue, and a faster learning curve, facilitated by advanced ergonomic and control systems. However, the high costs and extensive infrastructure requirements limit the accessibility and availability of robotic surgery, particularly in smaller or rural hospitals. The absence of tactile feedback remains a challenge, though upcoming advancements aim to address this. Continued research and development are essential to make robotic surgery more cost-effective and broadly accessible, ensuring its benefits can reach a wider patient population. This abstract encapsulates the key aspects of robotic surgery's development, comparative studies with conventional methods, and its clinical benefits and limitations, highlighting the need for ongoing improvements and research.

Robotic-assisted versus conventional laparoscopic surgery for endometrial cancer: long-term results of a randomized controlled trial

BackgroundRobotic-assisted laparoscopic surgery (RALS) has become a widely and increasingly used modality of minimally invasive surgery in the treatment of endometrial cancer (EC). Due to its technical advantages, RALS offers benefits, such as a lower rate of conversions compared to conventional laparoscopy (CLS). Yet, data on long-term oncological outcomes after RALS is scarce and based on retrospective cohort studies only. ObjectivesThis study aimed to assess overall survival (OS), progression-free survival (PFS), and long-term surgical complications in EC patients randomly assigned to RALS or CLS. Study DesignThis randomized controlled trial was conducted at the Department of Gynecology and Obstetrics of Tampere University Hospital, Finland. Between 2010 and 2013, 101 patients with low-grade EC scheduled for minimally invasive surgery were randomized preoperatively 1:1 either to RALS or CLS. All patients underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. A total of 97 patients (49 in the RALS group and 48 in the CLS group) were followed up for a minimum of 10 years. Survival was analyzed using Kaplan-Meier curves, log-rank test, and Cox proportional hazard models. Binary logistic regression analysis was used to analyze risk factors for trocar site hernia. ResultsIn the multivariable regression analysis, OS was favorable in the RALS group (HR 0.39; 95% CI, 0.15–0.99, p=.047) compared to the CLS group. There was no difference in PFS (log-rank test, p=.598). The three-, 5- and 10-year OS were 98.0% (95% CI, 94.0–100) vs. 97.9% (93.8–100), 91.8% (84.2–99.4) vs. 93.7% (86.8–100), and 75.5% (64.5–87.5) vs. 85.4% (75.4–95.4) in the CLS and the RALS group, respectively. Trocar site hernia developed more often in the RALS group compared to the CLS group 18.2% vs. 4.1% (OR 5.42, 95% CI, 1.11–26.59, p=.028). The incidence of lymphocele, lymphedema, or other long-term complications did not differ between the groups. ConclusionsThe results of this RCT suggest a minor OS benefit in EC after RALS compared to CLS. Hence, the use of RALS in the treatment of EC seems safe, but larger RCTs are needed to confirm the potential survival benefit of RALS. No alarming safety signals were detected in the RALS group since the rate of long-term complications differed only in the incidence of trocar site hernia.

Meta-analysis of the efficacy and safety of robot-assisted comparative laparoscopic surgery in lateral lymph node dissection for rectal cancer.

A meta-analysis was conducted on the perioperative and oncological outcomes of robot-assisted and laparoscopic lateral lymph node dissection in rectal cancer. There are few articles and reports on this topic, and a lack of high-quality research results in unreliable research conclusions. This study includes prospective and retrospective studies to obtain more reliable findings. Databases were searched, including PubMed, EMBASE, Cochrane, and Web of Science. The search was conducted from the time of database construction to March 2024. The quality of the literature was evaluated using the NOS scoring system. Meta-analysis was performed using R language software. Statistical heterogeneity was assessed using the I2 statistic, and sensitivity analysis was performed. Six relevant literatures that met the criteria were finally included, and 652 patients were included, including 316 (48.5%) in the robot-assisted lateral lymph node dissection for rectal cancer group (RLLND) and 336 (51.5%) in the laparoscopic lateral lymph node dissection for rectal cancer group (LLLND). Analysis of the results showed that compared with the laparoscopic group, the robotic group had less mean intraoperative blood loss (MD = -22, 95% CI -40.03 to -3.97, P < 0.05), longer operative time (MD = 51.57, 95%CI 7.69to95.45, P < 0.05), and a shorter mean hospital stay (MD = -1.25, 95%CI -2.46 to -0.05, P < 0.05), a low rate of urinary complications (OR 0.39, 95%CI 0.23to0.64, P < 0.01), a low overall rate of postoperative complications (OR 0.6, 95%CI 0.42to0.87, P < 0.01), and a high number of lateral lymph node dissection (MD = 1.18, 95% CI 0.14to2.23, P < 0.05), and there was no statistically significant difference between the two groups in terms of postoperative anastomotic leakage, postoperative intestinal obstruction, and total number of lymph nodes obtained (P > 0.05). Compared with laparoscopy, robotic lateral lymph node dissection for rectal cancer reduces intraoperative blood loss, shortens the average length of hospital stay, reduces urologic complications, decreases overall postoperative complications, and collects more lateral lymph nodes. However, the surgical time is prolonged.

Robot-assisted versus conventional laparoscopic surgery for rectal cancer.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of robot-assisted surgery for rectal cancer resection.

Oncological outcomes after laparotomic, laparoscopic, and robot-assisted laparoscopic staging for early high–intermediate or high-risk endometrial cancer

ObjectivesTo compare oncological outcomes in patients with early-stage high–intermediate or high-risk endometrial cancer undergoing surgical staging by laparotomy, conventional laparoscopy, or robot-assisted laparoscopy.MethodsPatients diagnosed between 2015 and 2021 with stage...

Impact of Preoperative Gum Chewing on Postoperative Anti-Emetic Use in Robot-Assisted Laparoscopic Surgery for Benign Ovarian Masses: A Prospective, Single-Blinded Randomized Controlled Trial.

Background and Objectives: Postoperative nausea and vomiting (PONV) is a common issue for females undergoing gynecological surgeries, including those assisted by robotic systems. Despite available prophylactic measures, the incidence of PONV remains high, negatively impacting recovery and increasing healthcare costs. This study evaluates whether preoperative gum chewing reduces the need for anti-emetic drugs in females undergoing robot-assisted laparoscopic surgery for benign ovarian mass. Materials and Methods: This prospective, single-blinded, randomized controlled trial enrolled 92 adult females scheduled for robot-assisted laparoscopic surgery to treat benign ovarian mass. Following exclusions, the remaining participants were randomly assigned to either a gum-chewing group or a no-gum-chewing group. The gum-chewing group chewed sugar-free gum for 15 min in the holding area before surgery. The primary outcome measured was the need for anti-emetics to control PONV during the first hour in the post-anesthesia care unit (PACU). Secondary outcomes included the number of anti-emetic requests. No preemptive anti-emetics were administered during surgery. Results: Out of the initial 92 patients, 88 were included in the final analysis, with 44 in each group. The incidence of PONV requiring anti-emetics in the PACU was significantly lower in the gum-chewing group (79.5%) compared to the no-gum-chewing group (95.5%). Additionally, the number of anti-emetic requests was higher in the no-gum-chewing group. No postoperative complications such as tooth or jaw pain/injury or gastric content regurgitation were reported. Conclusions: Preoperative gum chewing for 15 min immediately before surgery significantly reduced the incidence of PONV in females undergoing robot-assisted laparoscopic surgery for benign ovarian mass. This simple, non-pharmacological intervention improved patient comfort and reduced the need for anti-emetic medications without any adverse effects. Further studies are needed to confirm these findings and to develop guidelines for incorporating preoperative gum chewing into clinical practice.

Laparoscopic Surgery During Pregnancy: A Meta-Review and Quality Analysis Using the Assessment of Multiple Systematic Reviews (AMSTAR) 2 Instrument.

Accumulation of experience with minimally invasive surgery over the last three decades has rendered laparoscopic surgery the mainstay of management for surgical pathology during pregnancy. In the present meta-review, we compiled the available evidence on the safety of laparoscopic and robotic-assisted surgeries during pregnancy, based on relevant systematic reviews (SR) and meta-analyses (MA). A systematic review was performed for articles published until February 2024 in English using PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) and Google Scholar based on predefined selection and exclusion criteria.We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included SRs and MAs examining women of childbearing age (population) who had undergone laparoscopic surgery or robotic-assisted laparoscopic surgery during pregnancy (intervention).The presence of comparison to open surgery was desirable but not mandatory (comparator).The included studies should necessarily report on fetal loss (outcome), and optionally on other metrics of fetal, maternal, or operative performance. We considered SRs/MAs analyzing randomized trials, observational studies,case reports, and case series (study design).The methodological quality of SRs/MAs not exclusively including case reports and case series was assessed with the Assessment of Multiple Systematic Reviews (AMSTAR) 2 instrument. A total of 1229 articles were screened, of which 78 were potentially eligible.Of these, 33 articles met our inclusion criteria, 18 containing SRs only and 15 SRs with MA.The examined disciplines were laparoscopic appendectomy (10 studies, 30.3%), laparoscopic cerclage for cervical insufficiency (eight studies, 24.2%), adnexal-ovarian laparoscopic surgery (five studies, 15.2%), laparoscopic cholecystectomy and biliary tree exploration (three studies, 9.1%), laparoscopic myomectomy (two studies, 6.1%), and one study each for laparoscopic surgery regarding pancreatic indications, adrenal indications, and bariatric complications (3.0%).The odds ratio/relative risk for fetal loss rate ranged from 0-1.9, with variable statistical significance depending on the discipline.Twenty-three out of the 33 studies were submitted to quality evaluation with the AMSTAR 2 instrument, with three being of "low quality" (13.0%) and the remaining 20 of "critically low quality" (87.0%).In conclusion, the widespread acceptance of laparoscopic surgery for treating surgical pathology during pregnancy is substantiated by heterogeneous and low-quality evidence.Literature mainly revolves around laparoscopic appendectomy, whereas other disciplines that may commonly arise during pregnancy, such as cholecystectomy and the acute abdomen following bariatric surgery, are underrepresented in the literature.Factors such as anatomical alterations that may affect surgical access, surgeon's expertise, and the biological course of the underlying pathology should be taken into consideration when selecting the appropriate mode of operating during pregnancy.

Perioperative optic nerve sheath diameter variations in patients with end-stage renal failure undergoing robotic-assisted kidney transplant: a prospective observational study.

Patients with chronic kidney disease (CKD) who undergo hemodialysis are predisposed to interstitial cerebral edema. Robotic-assisted laparoscopic surgery can increase optic nerve sheath diameter (ONSD) and intracranial pressure. The impact of robotic-assisted kidney transplant (RAKT) on ONSD is complicated by the presence of CKD, the administration of furosemide and mannitol, and the manipulation of hemodynamics. We examined ONSD variations in patients undergoing RAKT over a 1-year period at our institution. Furthermore, we attempted to identify any perioperative hemodynamic factors influencing these changes. This prospective study included 20 patients undergoing RAKT. ONSD, heart rate, central venous pressure, systolic blood pressure, diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured following intubation (T1), after assuming the steep Trendelenburg position (T2), 1 hour after docking (T3), upon reperfusion (T4), after transition to the supine position (T5), and 3 hours postextubation (T6). Repeated measures analysis of variance with post hoc Bonferroni correction was employed to compare variables at each time point. Pearson correlation analysis was utilized to assess relationships between variables. P-values ≤0.05 were considered to indicate statistical significance. ONSD (in mm) increased from T1 (3.60±0.44) to T3 (4.06±0.45, P=0.002) and T4 (3.99±0.62, P=0.046), before falling to its lowest value at T6 (3.42±0.64, P=0.002). Pearson correlation analysis revealed significant correlations (P<0.05) between changes in ONSD at T3 and both DBP (r=0.637) and MAP (r=0.522). During RAKT with open ureteric anastomosis, ONSD initially increased, then decreased following reperfusion. DBP and MAP displayed positive correlations with ONSD changes at T3.