Traditional Laparoscopy Research Articles

V07-04 RESIDENT TRAINING FOR ROBOTIC RENAL SURGERY WITH A PORCINE MODEL

You have accessJournal of UrologyRenal Oncology I1 Apr 2018V07-04 RESIDENT TRAINING FOR ROBOTIC RENAL SURGERY WITH A PORCINE MODEL Niraj Badhiwala, Kefu Du, Steven Monda, Venkatesh Ramakrishna, Angelia DeClue, and Robert Figenshau Niraj BadhiwalaNiraj Badhiwala More articles by this author , Kefu DuKefu Du More articles by this author , Steven MondaSteven Monda More articles by this author , Venkatesh RamakrishnaVenkatesh Ramakrishna More articles by this author , Angelia DeClueAngelia DeClue More articles by this author , and Robert FigenshauRobert Figenshau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1763AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic surgery is critical for modern urologists. Despite the reduced difficulty of robotic surgery compared to traditional laparoscopy, a learning curve still exists. Due to increased demands on surgeon productivity and outcomes, residency robotics training is increasingly relying on simulations. We present a cost-effective model for realistic training for robotic partial nephrectomy. METHODS Using our surgical education center with a training Da Vinci Si robot, we set up a training platform with a porcine kidney obtained from a local butcher shop. Expired and unsterile instruments and equipment were used to reduce cost. A quarter-size circular area of the kidney is marked as the area of the “tumor”, and robotic partial nephrectomy is performed by the trainee in a standardized stepwise manner. Video recordings are obtained and uploaded for review by the trainees to provide constructive feedback to each other. These workshops are repeated several times through the academic year for the residents to practice and improve performance in the operating room. RESULTS Two residents participate in each training session. Average time for completion of each training session is less than 90 minutes. Average cost per session is under $20. Sliding-clip renorrhaphy was achieved without difficulty with tissue integrity. No significant difference in realism was noted between frozen and fresh specimen. CONCLUSIONS Porcine kidney for robotic partial nephrectomy is an inexpensive, realistic, and easily adoptable tool for resident training. Similar porcine models can be used for training for other surgical procedures. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e742 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Niraj Badhiwala More articles by this author Kefu Du More articles by this author Steven Monda More articles by this author Venkatesh Ramakrishna More articles by this author Angelia DeClue More articles by this author Robert Figenshau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

93: Difference in outcomes between traditional laparoscopy and robotic assisted surgery after uterosacral ligament suspension for pelvic organ prolapse

93: Difference in outcomes between traditional laparoscopy and robotic assisted surgery after uterosacral ligament suspension for pelvic organ prolapse

Costs of Robotic-Assisted Versus Traditional Laparoscopy in Endometrial Cancer.

The purpose of this study was to compare the costs of traditional laparoscopy and robotic-assisted laparoscopy in the treatment of endometrial cancer. A total of 101 patients with endometrial cancer were randomized to the study and operated on starting from 2010 until 2013, at the Department of Obstetrics and Gynecology of Tampere University Hospital, Tampere, Finland. Costs were calculated based on internal accounting, hospital database, and purchase prices and were compared using intention-to-treat analysis. Main outcome measures were item costs and total costs related to the operation, including a 6-month postoperative follow-up. The total costs including late complications were 2160 &OV0556; higher in the robotic group (median for traditional 5823 &OV0556;, vs robot median 7983 &OV0556;, P < 0.001). The difference was due to higher costs for instruments and equipment as well as to more expensive operating room and postanesthesia care unit time. Traditional laparoscopy involved higher costs for operation personnel, general costs, medication used in the operation, and surgeon, although these costs were not substantial. There was no significant difference in in-patient stay, laboratory, radiology, blood products, or costs related to complications. According to this study, robotic-assisted laparoscopy is 37% more expensive than traditional laparoscopy in the treatment of endometrial cancer. The cost difference is mainly explained by amortization of the robot and its instrumentation.

Robotic distal pancreatectomy and splenectomy: rationale and technical considerations.

Minimally invasive distal pancreatectomy has had significant adoption in the United States over the past decade. Robotic distal pancreatectomy is a type of minimally invasive technique which affords greater dexterity and visualization compared to traditional laparoscopy. In addition to standard distal pancreatectomy procedures with or without splenectomy, the use of robotic surgical systems has been efficacious in performing more complex techniques such as radical antegrade modular pancreatosplenectomy (RAMPS) or spleen-preservation. There are important technical considerations to performing robotic distal pancreatectomy procedures which differ from other minimally invasive approaches. The purpose of this report is to describe the rationale and technical considerations for implementation of robotic distal pancreatectomy procedures in clinical practice.

Minimally invasive abdominal cerclage compared to laparotomy: a comparison of surgical and obstetric outcomes.

The objective of this study is to report surgical and obstetric outcomes of patients following abdominal cerclage placement through either minimally invasive or open techniques. Subjects of this retrospective cohort study were patients at two referral centers specializing in high-risk pregnancy and minimally invasive gynecologic surgery. Electronic medical records of all patients who underwent abdominal cerclage placement between December 2011 and December 2015 at Yale New Haven Hospital and Bridgeport Hospital were reviewed. The patients included were women who underwent abdominal cerclage placement either during pregnancy or prior to conception. One cohort of women had their abdominal cerclage placed using traditional laparoscopy or robotic-assisted laparoscopy. The other cohort consisted of women whose abdominal cerclage was placed through laparotomy. Electronic medical charts were reviewed to collect baseline demographic and pre-procedure obstetric information, as well as surgical and subsequent obstetric outcomes. Eleven minimally invasive and nine open abdominal cerclages were performed during the study period. Seven of the minimally invasive and two open cerclages were done outside of pregnancy. Average operative time was longer in the minimally invasive cohort. Estimated blood loss was typically lower in the minimally invasive group. Length of hospital stay was shorter in the minimally invasive group. Obstetric outcomes were similar between the two cohorts, with a total of nine live births in the minimally invasive group and seven live births in the open group. Minimally invasive abdominal cerclage is a safe alternative when performed by a surgeon with appropriate training and technical skills, and obstetric outcomes are comparable to those after open abdominal cerclage.

Arm reduced robotic-assisted laparoscopic hysterectomy with transvaginal cuff closure.

IntroductionThe use of robotics for benign etiology in gynecology has not proven to be more beneficial when compared to traditional laparoscopy. The major concern regarding robotic hysterectomy stems from its high cost.AimTo evaluate the clinical utility and effectiveness of one-arm reduced robotic-assisted laparoscopic hysterectomy as a cost-effective surgical option for total robotic hysterectomy.Material and methodsA sample population of 54 women who underwent robotic-assisted laparoscopic surgery for benign gynecologic indications was evaluated, and two groups were identified: (1) the two-armed robotic-assisted laparoscopic surgery group (n = 38 patients), and (2) the three-armed robotic-assisted laparoscopic surgery group (n = 16 patients).ResultsAn increased cost was observed when three-armed robotic surgery was employed for benign gynecologic surgery (p < 0.001). The cost reduction observed in the study group was primarily derived from one robotic arm reduction and vaginal closure of the cuff. This cost reduction was achieved without an increase in complication rates or undesirable postoperative outcomes. An estimated profit between $399.5 and $421.5 was made for each patient depending on the suture material chosen for cuff closure. Two-armed surgery resulted in an 18.6% reduction in procedure-specific costs for robotic hysterectomy.ConclusionsTwo-armed robotic-assisted laparoscopic hysterectomy appears to be a cost-effective solution for robotic gynecologic surgery. This surgical solution can be performed as effectively as classical three-armed robotic hysterectomies for benign indications without the risk of increased surgical-related morbidities. This approach has the potential to be a widely preferred surgical approach in medical communities where cost reduction is one of the primary determinants of surgery type.

Transvaginal, rather than traditional, laparoscopy should be used for the assessment of infertility: AGAINST: Practising specialists prefer traditional laparoscopy.

Transvaginal laparoscopy (TVL) was introduced in 1998 (Gordts et al. Hum Reprod 1998;13:99–103) but its uptake has been slow. Globally, very few centres offer it as an alternative to traditional laparoscopy. There are reasons for this. First, the diagnostic capability of TVL is inferior to that of traditional laparoscopy. It cannot visualise the uterovesicle pouch, the superior aspects of the ovary and the abdominal cavity. Moreover, the greater degree of distension achieved with carbon dioxide in the case of traditional laparoscopy permits movement of mobile structures such as the uterus, ovary, Fallopian tubes and bowel by the use of a palpiteur to enable a more thorough inspection of these structures. Second, the therapeutic capability of TVL is limited to a few simple operations compared with the much wider range of operations permitted by traditional laparoscopy such as ovarian cystectomy, myomectomy, salpingostomy, salpingectomy, tubal anastomosis, excision of peritoneal endometriotic lesions and suturing, all of which are not possible with TVL. As a consequence, it is more difficult for TVL to implement a see-and-treat policy. Third, although it is still unclear if there is any significant difference in complication rate between the two types of laparoscopy, when complication does occurs, it is far easier to deal with using traditional laparoscopy than TVL. Haemostasis during TVL relies exclusively on a small bipolar diathermy instrument whereas a wider range of management options are available during traditional laparoscopy, namely mono- or bipolar diathermy, suturing and the application of haemostatic agents such as Floseal (Watrowski Arch Gynecol Obstet 2014;290:411–15). Neither traditional laparoscopy nor TVL is indicated in the routine, initial investigation of women presenting with infertility. Refined imaging techniques such as three-dimensional ultrasonography in conjunction with hystero-salpingo contrast or saline infusion sonography have emerged as noninvasive and less expensive alternative options that have largely replaced hysterosalpingography and endoscopic examination as the initial investigations of choice to assess pelvic anatomy. Neither TVL nor traditional laparoscopy should be employed as a screening test for subtle lesions (such as fimbrial cyst and accessory fimbriae), as the possible benefit, if any, of diagnosing and treating these subtle lesions has not yet been confirmed by clinical trials. Endoscopic examination of the pelvis is considered necessary only when either symptoms, clinical findings on examination, or initial investigation by the use of one of the currently available imaging techniques suggest that pelvic pathology is likely to be present. The choice of traditional laparoscopy or TVL will depend on the likely pathology to be encountered and whether traditional laparoscopy is deemed desirable for a more thorough examination of the pelvic and abdominal cavity and necessary to complete the required surgical treatment. Second, it will depend on the local availability of necessary equipment to support TVL. In the end, local practice including the expertise and preference of the specialist providing the care will influence the final decision. Given the above considerations, it is no wonder why the vast majority of practicing specialists prefer traditional laparoscopy to TVL. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Exploring the umbilical and vaginal port during minimally invasive surgery.

This article focuses on the anatomy, literature, and our own experiences in an effort to assist in the decision-making process of choosing between an umbilical or vaginal port. Umbilical access is more familiar to general surgeons; it is thicker than the transvaginal entry, and has more nerve endings and sensory innervations. This combination increases tissue damage and pain in the umbilical port site. The vaginal route requires prophylactic antibiotics, a Foley catheter, and a period of postoperative sexual abstinence. Removal of large specimens is a challenge in traditional laparoscopy. Recently, there has been increased interest in going beyond traditional laparoscopy by using the navel in single-incision and port-reduction techniques. The benefits for removal of surgical specimens by colpotomy are not new. There is increasing interest in techniques that use vaginotomy in multifunctional ways, as described under the names of culdolaparoscopy, minilaparoscopy-assisted natural orifice surgery, and natural orifice transluminal endoscopic surgery. Both the navel and the transvaginal accesses are safe and convenient to use in the hands of experienced laparoscopic surgeons. The umbilical site has been successfully used in laparoscopy as an entry and extraction port. Vaginal entry and extraction is associated with a lower risk of incisional hernias, less postoperative pain, and excellent cosmetic results.

Subtotal hysterectomy by natural orifice transluminal endoscopic surgery.

Study objective:To introduce the innovative surgical procedure of treating benign uterine pathology with subtotal hysterectomy by natural orifice transluminal endoscopic surgery (NOTES).Design:Prospective observational study.Setting:Tertiary referral medical center.Methods:From June 2014 to May 2016, three patients with benign uterine diseases who were eligible for laparoscopic subtotal hysterectomy were recruited to undergo transvaginal NOTES at a tertiary referral medical center. Intraoperative and postoperative surgical outcomes were measured.Results:Subtotal hysterectomy by transvaginal NOTES was successfully completed in all patients without any conversion to conventional laparoscopy. The operative time was 144 ± 4.5 (138–149) minutes with an average estimated blood loss of 133 ± 62 (50–200) mL. None of the patients required an intraoperative blood transfusion. The mean specimen weight was 140 ± 59 (56–188) g. The final histology reports were uterine leiomyoma and adenomyosis in these three cases. There were no intraoperative or postoperative complications. No case required intraoperative or postoperative blood transfusion. No cases were converted to traditional laparoscopy or laparotomy.Conclusion:Our preliminary results showed the safety and feasibility of subtotal hysterectomy by transvaginal NOTES in selected patients. It is one of the most minimally invasive surgeries and results in invisible scars.

Robotic Versus Traditional Laparoscopy in Benign Hysterectomy: A Single Institution Experience [13H

INTRODUCTION: Robotic-assisted laparoscopy in benign hysterectomy remains controversial, and current evidence suggests similar outcomes when compared to traditional laparoscopic hysterectomy. This study sought to compare clinical outcomes between the two types of procedures at a single academic institution. METHODS: The electronic medical records of 133 women treated with robotic hysterectomy (RH) and 69 patients treated with traditional laparoscopic hysterectomy (TLH) for benign indications between September 2011 and December 2014 were reviewed. Clinical outcomes were compared using univariate and multivariate analyses. RESULTS: Patients undergoing RH were older (median 57 vs 48 years, P &lt; .001) and less likely to be obese (18.8 vs 34.8%, P=.017). Operative time was similar for RH and TLH (203.0 vs 204.5 minutes, P=.973), despite a higher rate of concomitant procedures in robotic cases (32.3 vs 7.2%, P &lt; .001). TLH was associated with higher rates of conversion to laparotomy (11.6 vs 1.5%, P=.003), blood loss greater than 1,000 mL (5.8 vs 0.8%, P=.047), and hospital stay greater than 2 days (21.7 vs 7.5%, P=.004). There were no significant differences in intraoperative or postoperative complications between groups. Multivariate logistic regression controlling for body mass index and specimen weight found total operative time (P=.006), estimated blood loss (P=.002), and TLH (P=.04) to be independent predictors of conversion to laparotomy. CONCLUSION: In our population, robotic-assisted hysterectomy was associated with lower rates of intraoperative hemorrhage, conversion to laparotomy, and extended hospital stay when compared to traditional laparoscopy. Such data support the utilization of robotic assistance in laparoscopic hysterectomy for benign indications.

Laparoscopy vs. Robotic Surgery for Endometriosis (LAROSE): a multicenter, randomized, controlled trial

To determine whether the use of the robot for surgical treatment of endometriosis is better than traditional laparoscopy in terms of operative length, perioperative parameters, and quality of life outcomes. Multicenter, randomized clinical trial. University teaching hospitals. Women aged >18years with suspected endometriosis who elected to undergo surgical management. Randomization to conventional or robot-assisted laparoscopic removal of endometriosis. The primary outcome measured was operative time. Secondary outcomes were perioperative complications and quality of life. The mean operative time for robotic vs. laparoscopic surgery for endometriosis was 106.6 ± 48.4minutes vs. 101.6 ± 63.2 minutes. There were no differences in blood loss, intraoperative or postoperative complications, or rates of conversion to laparotomy in the two arms. Both groups reported significant improvement on condition-specific quality of life outcomes at 6weeks and 6months. There were no differences in perioperative outcomes between robotic and conventional laparoscopy. NCT01556204.

Comparison of single incision laparoscopic cholecystectomy with conventional laparoscopic cholecystectomy using conventional laparoscopic instrument: a prospective observational study

Background: Laparoscopic surgery is one of the most significant surgical advances of twentieth century. Laparoscopic cholecystectomy is criterion standard for the treatment of benign gall bladder diseases, and it is the most common laparoscopic surgery worldwide. The aim of the study was to compare the intra-operative and post-operative complication, conversion rate and outcome of single incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy on short term follow up.Methods: This prospective analytical observational design study was carried out in Tertiary Health care centre. As per convenience sampling 60 consecutive patients of cholelithiasis. Data obtained was analyzed and inferences were drawn regarding the outcomes of the SILC in terms of cosmesis, post-operative pain and any other complications and compare the outcomes against the conventional four port laparoscopic cholecystectomy.Results: In our study we found the mean operating time for SILC was 90.5±16.37 minutes, whereas the mean operating time for CLC was 74±17.83 (p = 0.0004). Intra-operative blood loss for SILC and CLC was comparable and statistically insignificant. Pain in the SILC group was found to be significantly low than CLC group (p ≤0.0001). The median cosmetic scale score for SILC group was 20 with range 13-21 and in conventional laparoscopic cholecystectomy group it was 16 with range 12-18 (p &lt;0.0001).Conclusions: The major advantage of SILC is cosmetic satisfaction, while the disadvantages of SILS are longer operative time. There was no statistically significant difference in the intra-operative blood loss and conversion rate, and complications in both the techniques. Single incision laparoscopic cholecystectomy (SILC) was developed with the aim of reducing the invasiveness of traditional laparoscopy.

Application of da Vinci surgical robotic system in hepatobiliary surgery

The development of minimally invasive surgery has brought a revolutionary change to surgery techniques, and endoscopic surgical robots, especially Da Vinci robotic surgical system, has further broaden the scope of minimally invasive surgery, which has been applied in a variety of surgical fields including hepatobiliary surgery. Today, the application of Da Vinci surgical robot can cover most of the operations in hepatobiliary surgery which has proved to be safe and practical. What’s more, many clinical studies in recent years have showed that Da Vinci surgical system is superior to traditional laparoscopy. This paper summarize the advantage and disadvantage of Da Vinci surgical system, and outlines the current status of and future perspectives on the robot-assisted hepatobiliary surgery based on the cases reports in recent years of the application of Da Vinci surgical robot.

Minimally Invasive Radical Hysterectomy for Cervical Cancer Is Associated With Reduced Morbidity and Similar Survival Outcomes Compared With Laparotomy

Study ObjectiveTo assess outcomes of women with cervical cancer undergoing upfront radical hysterectomy (RH) via a minimally invasive surgery (MIS) or a traditional laparotomy (XL) approach at 2 large US academic institutions to determine whether the mode of surgery affects patient outcomes. DesignRetrospective cohort study (Canadian Task Force classification II-1). SettingTwo academic medical institutions in the United States. PatientsWomen undergoing upfront RH for cervical cancer between 2000 and 2013. InterventionMinimally invasive techniques (laparoscopic and robotic) for RH compared with XL. Measurements and Main ResultsA total of 383 women met the eligibility requirements. Of these, 101 underwent an MIS (i.e., traditional laparoscopy, laparoendoscopic single site, or robotic) approach, and 282 underwent an XL approach. Overall survival (median not reached; p = .29) was not different between the 2 groups. Recurrence was rare and equivalent in the 2 groups, affecting 5.0% of patients in the MIS group and 6.4% of those in the XL group (p = .86). Pelvic lymph nodes were dissected in 98% of patients in the MIS group and 97% of those in the XL group (p > .99) and were found to be positive in 10.9% and 8.5% of those patients, respectively (p = .55). The mean number of pelvic lymph nodes retrieved was higher in the MIS group (19.4 vs 16.0; p < .001). There was no between-group difference in the rate of postoperative chemotherapy (p = .32) or radiation therapy (p = .28). Surgical margins were positive in 5.0% of specimens in the MIS group and in 4.6% of specimens in the XL group (p = .54). Although there was no difference in the overall rate of complications (15.1% and 17.2%, respectively; p = .87), laparotomy was associated with a higher median estimated blood loss (EBL) (50 cm3 vs 500 cm3) and a higher rate of perioperative blood transfusion (3.0% vs 26.2%; p < .001). Length of perioperative hospital stay was significantly shorter in the MIS group (1.9 days vs 4.9 days; p < .001). ConclusionMIS RH does not compromise patient outcomes, including overall survival, rate of recurrence, and the frequency of pelvic lymph node dissection or positivity. Morbidity was decreased in the MIS group, including decreased EBL, fewer blood transfusions, and shorter hospital stay.

Risk Factors and Outcomes for Conversion to Laparotomy of Laparoscopic Hysterectomy in Benign Gynecology.

To estimate the incidence and factors for conversion to laparotomy in women scheduled for laparoscopic hysterectomy for benign gynecologic indications and to examine the effect of conversion on patient outcomes. A retrospective cohort study of a Michigan multicenter prospective database was abstracted from January 1, 2013, through July 2, 2014. Participants were collected from an all-payer quality and safety database maintained by the Michigan Surgical Quality Collaborative. Women with a preoperative indication of cancer or obstetric indications were excluded. A logistic regression model was used to calculate odds of conversion using patient preoperative and intraoperative attributes. During the study period, 6,992 women underwent an attempted laparoscopic hysterectomy with 3.93% (n=275) converted to laparotomy. After adjusting for socioeconomic differences, hysterectomy indication, and intraoperative factors, there were decreased odds of conversion to laparotomy with use of robotic-assisted laparoscopy compared with traditional laparoscopy (adjusted odds ratio [OR] 0.14, 95% confidence interval [CI] 0.07-0.25) with a predicted risk of conversion of 0.8% compared with 5.4% (P<.001). High-volume surgeons were less likely to convert to laparotomy compared with low- and medium-volume surgeons (adjusted OR 0.66, 95% CI 0.47-0.92) with a predicted risk of conversion of 1.4% compared with 2.25% (P=.015). Conversion was associated with moderate or severe adhesive disease and increasing specimen weight. Conversion was associated with increased rates of surgical site infection, blood transfusion, severe sepsis, and reoperation. This analysis demonstrates that conversion to laparotomy is associated with increased odds of postoperative morbidity, and robotic assistance and surgeon volume are strongly associated with decreased odds of conversion.

Single-incision laparoscopic surgery increases the risk of unintentional thermal injury from the monopolar "Bovie" instrument in comparison with traditional laparoscopy.

Single-incision laparoscopic surgery (SILS) places multiple instruments in close, parallel proximity, an orientation that may have implications in the production of stray current from the monopolar "Bovie" instrument. The purpose of this study was to compare the energy transferred during SILS compared to traditional four-port laparoscopic surgery (TRD). In a laparoscopic simulator, instruments were inserted via SILS or TRD setup. The monopolar generator delivered energy to a laparoscopic L-hook instrument for 5-s activations on 30-Watts coag mode. The primary outcome (stray current) was quantified by measuring the heat of liver tissue held adjacent to the non-electrically active 10-mm telescope tip and Maryland grasper in both the SILS and TRD setups. To control for the potential confounder of stray energy coupling via wires outside the surgical field, the camera cord and active electrode wires were oriented parallel or completely separated. SILS and TRD setups create similar amounts of stray current as measured by increased tissue temperature at the non-electrically active telescope tip (41±12 vs. 39±10°C; p=0.71). Stray current was greater in SILS compared to TRD at the tip of the non-electrically active Maryland forceps (38±9 vs. 20±10°C; p<0.01). Separation of the active electrode and camera cords did not change the amount of stray energy in the SILS orientation for either telescope (39±10°C bundled vs. 36±10°C separated; p=0.40) or grasper (38±9°C bundled vs. 34±11°C separated; p=0.19) but did in the TRD orientation (41±12 bundled vs. 24±10 separated; p<0.01). When SILS was compared to TRD with the cords separated, SILS increased stray energy at both the telescope tip and grasper tip (36±10 vs. 24±10°C; p<0.01 and 34±11 vs. 17±8°C; p<0.01). SILS increases stray energy transfer nearly twice as much as TRD with the use of the monopolar instrument. Strategies to mitigate the amount of stray energy in the TRD setup such as separation of the active electrode and camera cords are not effective in the SILS setup. These practical findings should enhance surgeons using the SILS approach of increased stray energy that could result in injury.

The use of robotic surgery in abdominal organ transplantation: A literature review.

Minimally invasive surgical approaches in transplantation are gaining increasing interest, and many centers are reporting their, mainly laparoscopic, experiences. Robotic surgery (RS) has some hypothetical advantages over traditional laparoscopy and has been successfully applied, although infrequently to organ transplantation. Our goal was to review and critique the publications reporting RS use in organ transplantation. Most of the RS experience has been with living renal donor organ procurement and, to a lesser extent, with RS procedures in the transplant recipient. The available literature suggests that RS appears to be a safe surgical alternative to standard open procedures. RS in living liver donor surgery remains limited, and more experience is required before commenting on RS-related outcomes RS in pancreatic transplantation is exceedingly rare. The enhanced precision and ergonomics of RS may expand its applicability to liver living donation and pancreas transplantation at some point in the future.

Exploring the Benefits of Robotic Surgery in the Management of Severe Endometriosis

Robotic surgery has not been shown to be superior to laparoscopy in benign gynaecology conditions, including in endometriosis, which is often an underdiagnosed or a misdiagnosed condition. Our patient is a 41 yo G3P2 woman with persistent pelvic pain despite vaginal hysterectomy, who presented with an endometrioma and severe endometriosis. This video demonstrates the application of robotic surgery in severe and deep infiltrating endometriosis, in terms of its specific characteristics and benefits. There may be many additional advantages to using robotic-assisted laparoscopy in the surgical management of severe endometriosis, compared to traditional laparoscopy.

Laparoscopic and Robotic Skills Are Transferable in a Simulation Setting: A Randomized Controlled Trial

BACKGROUND: Residents are increasingly being trained on robotic techniques instead of traditional laparoscopy. Although simulation training does provide an effective supplement for traditional surgical training, less is known if skills are transferable between the laparoscopic and robotic platforms. METHODS: In a randomized single-blinded controlled trial of 40 simulation-skill-naive medical students, participants completed a baseline evaluation on a robotic pegboard-transfer task (Mimic dV-Trainer) and laparoscopic peg-transfer task (Fundamentals of Laparoscopic Surgery). Skills were evaluated using validated objective and subjective global rating scales (GRS) by two blinded expert surgeons. Participants were randomized to practice on either the robotic (N=20) or laparoscopic (N=20) task. After practice, participants were reevaluated performing both tasks. RESULTS: At baseline, there were no significant differences in objective measures (time to task completion, motion metrics) or composite GRS scores on both tasks between the groups. Participants performed their respective tasks faster (P&lt;.001, P&lt;.003), more efficiently (P&lt;.001) and with a higher percent improvement in composite GRS scores (P&lt;.001). The laparoscopic group improved their robotic performance with an increase in mean composite GRS scores of 15–20 but this change did not reach statistical significance (P=.091). Participants who practiced robotically significantly improved their laparoscopic performance with an increase in mean composite GRS scores of 15–19 (P&lt;.02). DISCUSSION: Skills learned on either the robotic or laparoscopic platform appear to be transferable; however, robotic skills appear to be more transferable to the laparoscopic platform, than vice versa.

3D Laparoscopy in Neonates and Infants.

This study focuses on the successful application of three-dimensional (3D) laparoscopic surgeries in the treatment of congenital anomalies and acquired diseases in the young pediatric population. The purpose of this scientific work consists in highlighting the spectrum, indications, applicability, and effectiveness of 3D endosurgery in children. Our experience is based on 110 endosurgical procedures performed in neonates and infants in the 3D format between January 2014 and May 2015. Depending on the type of operations, all patients were divided into the following groups: (1) inguinal herniorrhaphy (IH)-63 patients; (2) Nissen fundoplication (NF)-22 patients; (3) pyeloureteral anastomosis (PUA)-15 patients; (4) nephrectomy (NE)-5 patients; and (5) ovarian cystectomy (OC)-5 patients. The patients of the first three groups were compared with babies who underwent standard laparoscopic surgery, performed in the two-dimensional (2D) format during the same time period. The groups were organized according to patient demographics, operative report, and postoperative parameters. The patients were similar in terms of demographics and other preoperative parameters. There were significant differences in mean operative time between 3D and 2D procedures in the groups of patients with hydronephrosis and gastroesophageal reflux, which used manipulation with internal sutures (NF-37.95 minutes versus 48.42 minutes, P = .014; PUA-61.31 minutes versus 78.75 minutes, P = .019), but not in group after IH (15.88 minutes versus 15.57 minutes, P = .681). Postoperative parameters such as length of hospital stay and the number of complications were equivalent between groups. In this study, we demonstrated the success of 3D laparoscopy in small babies with inguinal hernia, gastroesophageal reflux, hydronephrosis, ovarian cyst, and multicystic kidney. Laparoscopy in 3D format lessens the duration of complex procedures, which utilize the use of the suture technique into the abdominal cavity. The perception of depth and the presence of tactile feedback make 3D laparoscopic surgery more acceptable when compared to traditional laparoscopy.