Use Of Robotic Platform Research Articles

Current status, evolution, and future perspectives in robotic platform systems for prostate cancer treatment: a narrative review.

Robotic surgery has contributed greatly to the shift from traditional surgery to minimally invasive surgery. Urology is the major field of application of robotic surgery. Several urological procedures, especially radical prostatectomy, benefit from the use of robotic surgery. Non-systematic research of the literature was performed using "Robot-assisted radical prostatectomy" and "Robotic platforms" as keywords to understand the actual situation and the future perspectives of this technology in prostate cancer treatment. The robotic platform landscape is constantly evolving. DaVinci has always been the mainstay in this field, particularly after the advent of the new single port platforms. New platforms are emerging, providing an alternative option to the well-known DaVinci system. Since in literature, few studies compare the use of different robotic platforms, their application in urological procedures is not yet widely used, for both oncological and non-oncological procedures. Furthermore, artificial intelligence begins to play a role in this landscape and could be useful for future developments. So further studies are warranted to give a full comprehension of the whole scenario. This review aims to analyze the current state of the use of robotic platforms in urology, particularly in radical prostatectomy, and to understand the evolution.

Laparoscopic intra-peritoneal onlay mesh plus versus robotic transabdominal pre-peritoneal for primary ventral hernias: Our technique and outcomes.

Intra-peritoneal onlay mesh repair (IPOM) still remains the most common approach for laparoscopic repair of small to medium sized hernias worldwide. In this study, we compare our early outcomes of an established procedure, i.e. laparoscopic IPOM plus to robotic transabdominal pre-peritoneal (rTAPP) for small to medium sized primary ventral hernia. To compare laparoscopic IPOM plus with rTAPP in terms of pain score, time to ambulate, hospital stay, time to return to work as well as the expenses. This is a retrospective analysis of prospectively collected data at our centre between July 2021 and June 2022. Operative time including docking time was recorded. Cost analysis was done in both set of patients. Pain scores were assessed using Visual Analogue Scale (VAS) at regular intervals for up to 3 months and then at the end of 1 year. Time to ambulate, return of bowel function and return to work were documented. Any complication or recurrence during the study period was recorded. Mean operative time for IPOM plus and rTAPP groups was 59.00 and 73.55 min, respectively. Mean pain score for IPOM at 6, 12 and 24 h was 7.35, 6.81 and 5.77, while for rTAPP, it was 4.73, 3 and 2.55, respectively. VAS scores at 1 week, 1 month and 3 month also showed similar trends. Mean time to ambulate in minutes for IPOM and rTAPP group was 357.69 and 223.64, respectively. Mean hospital stay in days for IPOM and rTAPP was 2.12 and 1.18, respectively. Mean time to return to work in days was 11.77 and 8.45 for IPOM and rTAPP groups, respectively. Expenditure wise, cost of TAPP was more and statistically significant, owing to the use of robotic platform. The mean overall cost of laparoscopic IPOM plus and rTAPP in rupees was 187,177.69 and 245,174.55, respectively. Robotic TAPP appears an excellent alternative to laparoscopic IPOM plus. Larger studies with long-term follow-up data are further required to reinforce it.

The Contemporary Role of Salvage Radical Prostatectomy in the Management of Recurrent Prostate Cancer: An Up-to-Date Review.

Prostate cancer is the second most common cancer among men, with many treatment modalities available for patients, such as radical prostatectomy, external beam radiotherapy, brachytherapy, high-intensity focused ultrasound, cryotherapy, electroporation and other whole-gland or focal ablative novel techniques. Unfortunately, up to 60% of men with prostate cancer experience recurrence at 5 to 10 years. Salvage radical prostatectomy can be offered as an option in the setting of recurrence after a primary non-surgical treatment. However, the complexity of salvage radical prostatectomy is considered to be greater than that of primary surgery, making it the least popular treatment of choice. With the wide use of robotic platforms in urologic oncologic surgery, salvage radical prostatectomy has attracted attention again because, compared to past data, modern series involving salvage Robot-Assisted Radical Prostatectomy have shown promising results. In this narrative literature review, we comprehensively examined data on salvage radical prostatectomy. We investigated the correlation between the different types of primary prostate cancer therapy and the following salvage radical prostatectomy. Furthermore, we explored the concept of a robotic approach and its beneficial effect in salvage surgery. Lastly, we emphasized several promising avenues for future research in this field.

The role of RObotic surgery in EMergency setting (ROEM): protocol for a multicentre, observational, prospective international study on the use of robotic platform in emergency surgery

BackgroundRobotic surgery has gained widespread acceptance in elective interventions, yet its role in emergency procedures remains underexplored. While the 2021 WSES position paper discussed limited studies on the application of robotics in emergency general surgery, it recommended strict patient selection, adequate training, and improved platform accessibility. This prospective study aims to define the role of robotic surgery in emergency settings, evaluating intraoperative and postoperative outcomes and assessing its feasibility and safety.MethodsThe ROEM study is an observational, prospective, multicentre, international analysis of clinically stable adult patients undergoing robotic surgery for emergency treatment of acute pathologies including diverticulitis, cholecystitis, and obstructed hernias. Data collection includes patient demographics and intervention details. Furthermore, data relating to the operating theatre team and the surgical instruments used will be collected in order to conduct a cost analysis. The study plans to enrol at least 500 patients from 50 participating centres, with each centre having a local lead and collaborators. All data will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. Ethical considerations and data governance will be paramount, requiring local ethical committee approvals from participating centres.DiscussionCurrent literature and expert consensus suggest the feasibility of robotic surgery in emergencies with proper support. However, challenges include staff training, scheduling conflicts with elective surgeries, and increased costs. The ROEM study seeks to contribute valuable data on the safety, feasibility, and cost-effectiveness of robotic surgery in emergency settings, focusing on specific pathologies. Previous studies on cholecystitis, abdominal hernias, and diverticulitis provide insights into the benefits and challenges of robotic approaches. It is necessary to identify patient populations that benefit most from robotic emergency surgery to optimize outcomes and justify costs.

ASO Author Reflections: Expanding Minimally Invasive Options for Perihilar Cholangiocarcinoma: The Use of Robotic Platform in Biliovascular Reconstruction.

ASO Author Reflections: Expanding Minimally Invasive Options for Perihilar Cholangiocarcinoma: The Use of Robotic Platform in Biliovascular Reconstruction.

Initial 12 Cases of Robot-Assisted Gastrectomy for Gastric Cancer Using the Hinotori Surgical Robot System: Tips for the Efficient Introduction of a New Surgical Robot.

Introduction: The use of robotic platform for gastrectomy for gastric cancer is rapidly increasing. This study aimed to describe the perioperative outcomes of 12 patients who underwent robotic gastrectomy for gastric cancer using the hinotori™ surgical robot system (hinotori), a novel robot-assisted surgical platform, and compare the outcomes with the existing system, the da Vinci® Surgical System (DVSS). Methods: This study included 12 consecutive patients with gastric cancer who underwent robotic gastrectomy for gastric cancer using the hinotori between March 2023 and September 2023 at our institution. The comprehensive perioperative outcomes of these patients were retrospectively analyzed and compared to 11 patients who underwent robotic gastrectomy using the DVSS during the same period. Results: The median age and body mass index were 71 years (range: 56-86) and 22.7 kg/m2 (range: 16.1-26.7). Distal and total gastrectomy were performed in 8 and 4 patients, respectively. The median console time and operation times were 187 (range: 112-270) and 252 minutes (range: 173-339), respectively. The median blood loss was 3 mL (range: 2-5). No intra- or postoperative complications were observed. There were no significant differences in perioperative outcomes between the hinotori and the DVSS. Conclusions: Robotic gastrectomy for gastric cancer using the hinotori is a feasible procedure and achieved perioperative outcomes similar to that using the DVSS. Clinical Trial Registration number: 114167-1.

Robotic Approach to Paediatric Gastrointestinal Diseases: A Systematic Review.

The use of minimally invasive surgery (MIS) for paediatric surgery has been on the rise since the early 2000s and is complicated by factors unique to paediatric surgery. The rise of robotic surgery has presented an opportunity in MIS for children, and recent developments in the reductions in port sizes and single-port surgery offer promising prospects. This study aimed to present a systematic overview and analysis of the existing literature around the use of robotic platforms in the treatment of paediatric gastrointestinal diseases. In accordance with the PRISMA Statement, a systematic review on paediatric robotic gastrointestinal surgery was conducted on Pubmed, Cochrane, and Scopus. A critical appraisal of the study was performed using the Newcastle Ottawa Scale. Fifteen studies were included, of which seven were on Hirschsprung's disease and eight on other indications. Included studies were heterogeneous in their populations, age, and sex, but all reported low incidences of intraoperative complications and conversions in their robotic cohorts. Only one study reported on a comparator cohort, with a longer operative time in the robotic cohort (180 vs. 152 and 156 min, p < 0.001), but no significant differences in blood loss, length of stay, intraoperative complications, postoperative complications, or conversion. Robotic surgery may play a role in the treatment of paediatric gastrointestinal diseases. There is limited data available on modern robotic platforms and almost no comparative data between any robotic platforms and conventional minimally invasive approaches. Further technological developments and research are needed to enhance our understanding of the potential that robotics may hold for the field of paediatric surgery.

Accessibility Evaluation of an Assistive Social Robotic Platform for Rehabilitation and Its Improvement by Means of Haptic Devices

The use of robotic platforms with social capabilities is becoming increasingly common to support people’s daily lives. Such systems are commonly referred to as Socially Assistive Robots (SAR). Many SARs focus on a human-machine interaction based on visual and sound information, which could limit access for users with sight, hearing, or cognitive impairments, as it is usual in health environments. In this paper, we report a qualitative evaluation of the accessibility of Inrobics Rehab platform, arehabilitation platform based on the NAO robot. From the main outcomes, we propose to augment communication channels in social rehabilitation robots with haptic devices. The main aim of this proposal is to increase the accessibility of the platforms by combining multimodal information provided by visual, sound, and tactil channels.

Robotic versus laparoscopic gastric bypass in bariatric surgery: a systematic review and meta-analysis on perioperative outcomes

BackgroundRobotic-assisted surgery has emerged as a compelling approach to bariatric surgery. However, current literature has not consistently demonstrated superior outcomes to laparoscopic bariatric surgery to justify its higher cost. With its mechanical advantages, the potential gains from the robotic surgical platform are likely to be apparent in more complex cases such as gastric bypass, especially revisional cases. ObjectiveThis systematic review and meta-analysis aimed to summarize the literature and evaluate the peri-operative outcomes of patients with obesity undergoing robotic gastric bypass versus laparoscopic gastric bypass surgery. SettingSystematic review. MethodsA literature search of Embase, Medline, Pubmed, Cochrane library, and Google Scholar was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing outcomes of robotic and laparoscopic gastric bypass for obesity were included. ResultsTwenty-eight eligible studies comprised a total of 82,155 patients; 9051 robotic bypass surgery (RBS) versus 73,104 laparoscopic bypass surgery (LBS) were included. All included studies compared Roux-en-Y gastric bypass. RBS was noted to have higher reoperation rate within 30 days (4.4% versus 3.4%; odds ratio 1.31 [95% CI, 1.04–1.66]; P = .027; I2 = 43.5%) than LBS. All other endpoints measured (complication rate, anastomotic leak, anastomotic stricture, surgical site infections, hospital readmission, length of stay, operative time, conversion rate and mortality) did not show any difference between RBS and LBS. ConclusionThis systematic review and meta-analysis showed that there was no significant difference in key outcome measures in robotic versus laparoscopic gastric bypass. RBS was associated with a slightly higher reoperation rate and there was no reduction in overall complication rate with the use of robotic platform.

AB124. SOH23ABS_087. Robotic transabdominal combined transvesical and extravesical repair of multiple bladder diverticulae: our technique

Background: Bladder diverticulum is one of the causes voiding dysfunction. Conventional open repair of multiple bladder diverticula can have significant morbidity which can potentially be minimised with minimally invasive surgery (MIS) with the use of robotic platform. We report our techniques and experience in a case of multiple bladder diverticulae which was repaired using a dual console da Vinci Xi surgical system.

Is There a Scope for an Open Source Philosophy in Robotic Joint Replacement?: Why and How to Make Robotic Platforms Common and Universal for All Implants !

Standardisation and open source technologies has transformed our world by levelling the field for innovation and improvisation. In the field of arthroplasty, we are seeing robotic technology make giant strides in terms of wide spread adoption across geographies. The benefits of consistency, reduced intra-surgeon and inter-surgeon variability as well as decreased dependence on complex instrumentation sets and large implant inventories, is a step in the right direction. However they suffer from a very significant drawback; today's robotic systems are essentially closed systems and do not offer cross platform and cross implant compatibility. This point of view dwells on why it is important that robotics become open source and how this can be achieved. A universal system of implant sizing and nomenclature is proposed. This may enable the use of Robotic platform across various commercially available implants seamlessly. As of today, scientific literature and also the marketing literature provides no verifiable rationale for use of varied implant sizing terminology. The proposed universal implant sizing and nomenclature can be based on the Anteroposterior and mediolateral size data obtained from various anthropometric studies down across varied races. TBy building a consensus on the universal implant sizing nomenclature, the field of arthroplasty will achieve a major milestone. It will have benefits including easier documentation, storage and transmission of data. Most importantly, it will be the right step in direction of making the Robotic Technology - open source and thus making it available, accessible and affordable to all.

No prostate? No problem: robotic inguinal hernia repair after prostatectomy.

Traditional teaching suggests that prior pelvic operations, including prostatectomy, are a contraindication to laparoscopic inguinal hernia repair. Despite the growing use of robotic platforms in inguinal hernia repair, there are few studies describing robotic-assisted inguinal hernia repairs (RIHR) in this patient population. This study aims to demonstrate that RIHR is safe and effective in repairing inguinal hernias in patients who had previously undergone prostatectomy. We retrospectively reviewed RIHR cases performed from March 2017 to October 2021 by a single surgeon at our university-affiliated community hospital. Cases were reviewed for preoperative considerations, operative times and complications, and postoperative outcomes. A total of 30 patients with prior prostatectomy underwent transabdominal preperitoneal (TAPP) RIHR with mesh. Sixteen of the 30 patients had undergone robot-assisted laparoscopic prostatectomy (RALP), while 14 patients underwent open resection. Seven of the patients had received post-resection radiation and 12 had previous non-urologic abdominal operations. When compared to all RIHRs performed over the same period, duration of surgery was increased. There were no conversions to open surgery. Postoperatively, one patient developed a repair site seroma which resolved after 1month. Mean follow-up time was 8.0months. At follow-up, one patient reported experiencing intermittent non-debilitating pain at the repair site and one patient developed an inguinoscrotal abscess of unknown relation to the repair. No patients reported hernia recurrences nor mesh infection. This review suggests that TAPP RIHR can be a safe and effective approach to inguinal hernia repair in patients who have previously undergone prostatectomy, including those who received radiation and those who underwent either open or robotic resections.

Comparison of laparoscopic vs. robotic paraesophageal hernia repair: a systematic review.

In both clinical practice and residency training, the use of robotic platforms in surgery is becoming more common. The aim of this study was to perform a systematic review of the perioperative outcomes of robotic and laparoscopic paraesophageal hernia (PEH) repair. The PRISMA statement guidelines were used to perform this systematic review. We conducted a database search which included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. There were 384 articles discovered in the initial search using various keywords. From those 384 articles, after duplicates were removed and publications were eliminated based on eligibility criteria, 7 publications were then chosen for analysis. Risk of bias was assessed using Cochrane Risk of Bias Assessment Tool. Narrative synthesis of results has been provided. When compared to standard laparoscopic approaches, robotic surgery for large PEHs may offer benefits in terms of decreased conversion rate and shorter hospital stay. Some studies found a decrease in need for esophageal lengthening procedures and fewer long-term recurrences. The perioperative complication rate is similar between the two techniques in most studies; however, one large study of nearly 170,000 patients in the early years of robotics adoption demonstrated a higher rate of esophageal perforation and respiratory failure in the robotic group (2.2% increase in absolute risk). Cost is another disadvantage of robotic repair when compared to laparoscopic repair. Our study is limited by the non-randomized and retrospective nature of the studies. More studies into recurrence rates and long-term complications are needed to determine the efficacy of robotic versus laparoscopic PEHs repair.

Autonomous Robotic Inspection for Remote Inspection Technique Systems: A Review

Due to the harsh environment and heavy use that modern marine vessels are subjected to, they are required to undergo periodic inspections to determine their current condition. The use of autonomous remote inspection systems can alleviate some of the dangers and shortcomings associated with manual inspection. While there has been research on the use of robotic platforms, none of the works in the literature evaluates the current state of the art with respect to the specifications of the classification societies, who are the most important stakeholders among the end users. The aim of this paper is to provide an overview of the existing literature and evaluate the works individually in collaboration with classification societies. The papers included in this review are either directly developed for, or have properties potentially transferable to, the marine vessel inspection process. To structure the review, an expertise-engineering separation is proposed based on the contributions of the individual paper. This separation shows which part of the inspection process has received the most attention, as well as where the shortcomings of each approach lay. The findings in this review indicate that while there are promising approaches, according to our metrics there is still a gap between the classification societies’ requirements and the state of the art. Our results indicate that, even though there is a lot of quality work in the literature, there is a lack of integrated development activities that achieve a level of completeness sufficient for the classification societies to confidently use them.

ANN-Based Optimization of Human Gait Data Obtained From a Robot-Mounted 3D Camera: A Multiple Sclerosis Case Study

Assessment of gait consistency requires testing over a long walking distance. Robot-mounted 3D cameras represent a cost-effective, markerless technology of human gait analysis that can be applied for this purpose. However, the use of robotic platforms for gait analysis is limited by the low accuracy of 3D cameras. The aim of this study is to improve the accuracy of kinematic and spatio-temporal estimations obtained from a robot-mounted 3D camera by applying a supervised learning process, and then to verify the effectiveness of the proposed method for clinical use. Artificial neural networks have been trained using the reference data provided by a Vicon system, which lead to improved estimations. Then, gait characteristics in Multiple Sclerosis patients has been measured. Significant differences respect to Healthy Controls have been found mainly for hip flexion, pelvis tilt, pelvis rotation and stride length. The improvement of robot-mounted 3D camera estimations and their application to the analysis of gait impairment in a natural environment show the flexibility and adaptability that this setup can provide.

Automating DUID methods using robotics for rapid high throughput sample preparation – Analysis of Delta-9-Tetrahydrocannabinol and its major metabolite Delta-9-tetrahydrocannabinol acid in whole blood

To fully automate, using liquid-handling robotics, a liquid chromatography tandem mass spectrometry method for the analysis of delta-9-tetrahydrocannabinol (THC) and delta-9-tetrahydrocannabinol acid (THC-A) in whole blood. Uptake in usage of ultra-high performance liquid chromatography (UHPLC) has led to development of methods with very fast (typically < 5 minutes) chromatographic run times used in the forensic toxicology laboratory. Nevertheless, use of whole blood for quantitative analysis continues to present challenges for delivering high throughput methods with rapid analysis times. Whole blood requires the use of solid phase extraction (SPE) for sample pre-treatment and preparation, which is time consuming and labour intensive. Recent developments in SPE technologies have produced 96-well format platforms that are used to extract greater number of samples in parallel and are ideally suitable for automated liquid handlers. With recent sensitivity increases in mass spectrometers, smaller volumes (< 250 μL per aliquot of blood) can be used for extraction in 96-well plates. This facilitates the use of robotic platforms together with rapid liquid chromatography tandem mass spectrometry (LC-MS/MS) methods to give truly high throughput and fast analytical methods, increasing method efficiencies, reducing human intervention and errors. Here we present the development, validation and implementation of a fully automated robotic sample preparation method for whole blood for analysis of THC and THC-A in UK driving under the influence of drugs (DUID) cases. Aliquots (200 μL) of blank blood and casework samples previously dispensed into 96-well plates by a robotic system (BRAND) were prepared by the liquid handling system (Hamilton). Casework samples and blank blood were spiked with internal standard and blank blood samples were further spiked to produce calibrants and quality controls. The plate is then mixed with the addition of a cell lysis solution and the aliquots transferred to a protein/lipid depletion (PPT) plate (Waters). A positive pressure manifold was used to draw the solution through the PPT plate into a collection plate where the precipitate was dried. The precipitate was reconstituted and loaded by the Hamilton onto a C18 microelution SPE plate (Waters). Following extraction, the samples are reconstituted and the collection plate is placed in the autosampler for analysis. The LC-MS/MS method consists of a 2.1 mm × 50 mm, 1.7 μm, C18 column running a 4 minute gradient of water and acetonitrile with 0.1% formic acid. The method was successfully validated, with LLOQs for THC and THC-A of 1 μg/L and 5 μg/L, respectively. Precision (%CV) for THC was < 8% and < 6% for THC-A. Accuracy was within 15% of the spiked concentration for THC and THC-A across all validation batches ( n = 11). The robotic platform was able to undertake sample pre-treatment and extraction in 3.5 hours. A batch of 40 casework samples can be completed in 13 hours including the LC-MS/MS run time. The introduction of this method to our laboratory has resulted in a significant increase in the speed for a sample to be processed and results obtained. We can prepare and extract double the amount of samples in less than half the time taken by our manual method. We have reduced the amount of sample used and decreased our turnaround times all for our customer's benefit. Full automation of the sample preparation of whole blood samples using liquid handling robots can significantly improve laboratory throughput and capacity and efficiently utilise high speed chromatography providing rapid analysis from start to finish.

Propensity Score–Matched Analysis Comparing Robotic and Laparoscopic Right and Extended Right Hepatectomy

Laparoscopic and robotic techniques have both been well adopted as safe options in selected patients undergoing hepatectomy. However, it is unknown whether either approach is superior, especially for major hepatectomy such as right hepatectomy or extended right hepatectomy (RH/ERH). To compare the outcomes of robotic vs laparoscopic RH/ERH. In this case-control study, propensity score matching analysis was performed to minimize selection bias. Patients undergoing robotic or laparoscopic RH/EHR at 29 international centers from 2008 to 2020 were included. Robotic vs laparoscopic RH/ERH. Data on patient demographics, tumor characteristics, and short-term perioperative outcomes were collected and analyzed. Of 989 individuals who met study criteria, 220 underwent robotic and 769 underwent laparoscopic surgery. The median (IQR) age in the robotic RH/ERH group was 61.00 (51.86-69.00) years and in the laparoscopic RH/ERH group was 62.00 (52.03-70.00) years. Propensity score matching resulted in 220 matched pairs for further analysis. Patients' demographics and tumor characteristics were comparable in the matched cohorts. Robotic RH/ERH was associated with a lower open conversion rate (19 of 220 [8.6%] vs 39 of 220 [17.1%]; P = .01) and a shorter postoperative hospital stay (median [IQR], 7.0 [5.0-10.0] days; mean [SD], 9.11 [7.52] days vs median [IQR], 7.0 [5.75-10.0] days; mean [SD], 9.94 [8.99] days; P = .048). On subset analysis of cases performed between 2015 and 2020 after a center's learning curve (50 cases), robotic RH/ERH was associated with a shorter postoperative hospital stay (median [IQR], 6.0 [5.0-9.0] days vs 7.0 [6.0-9.75] days; P = .04) with a similar conversion rate (12 of 220 [7.6%] vs 17 of 220 [10.8%]; P = .46). Robotic RH/ERH was associated with a lower open conversion rate and shorter postoperative hospital stay compared with laparoscopic RH/ERH. The difference in open conversion rate was associated with a significant decrease for laparoscopic but not robotic RH/ERH after a center had mounted the learning curve. Use of robotic platform may help to overcome the initial challenges of minimally invasive RH/ERH.

Use of Robotic Platforms as a Tool to Support STEM and Physical Education in Developed Countries: A Descriptive Analysis.

The lack of interest of children at school is one of the biggest problems that Mexican education faces. Two important factors causing this lack of interest are the predominant methodology used in Mexican schools and the technology as a barrier for attention. The methodology that institutions have followed has become an issue because of its very traditional approach, with the professor giving all the theoretical material to the students while they listen and memorize the contents, and, if we add the issue of the growing access to technological devices for students, children carrying a phone are more likely to be distracted. This study aims to integrate technology through assistive robots as a beneficial tool for educators, in order to improve the attention span of students by making the learning process in multiple areas of the Mexican curriculum more dynamic, therefore obtaining better results. To prove this, four different approaches were implemented; three in elementary schools and one in higher education: the LEGO® robotic kit and the NAO robot for STEM (science, technology, engineering, and mathematics) teaching, the NAO robot for physical education (PE), and the PhantomX Hexapod, respectively. Each of these technological approaches was applied by considering both control and experimental groups, in order to compare the data and provide conclusions. Finally, this study proves that the attention span is indeed improved as a result of implementing robotic platforms during the teaching process, allowing the children to become more motivated during their PE class and become more proactive and retain more information during their STEM classes.

635 ROBOTIC REDO FUNDUPLICATION FOR A TWO TIME RECURRENT HIATAL HERNIA. HOW WE DO?

Abstract In the video we perform the crural robotic reinforcement with de use of biosynthetic mesh (Gore Bio-A) without any funduplication in a 37 years-old woman with a two time hernia hiatal recurrence. Although laparoscopic surgery to treat primary hiatal hernias (HHs) is the gold standard approach, the use of robotic platforms seems to gain weight. This video aims to show the step-by-step in a redo hiatal surgery and the benefits of robotic surgery. Methods Here in the video we present a 37-year old woman patient who underwent previously two laparoscopic Nissen fundoplication because of hiatal hernia and gastroesophageal reflux disease. The first surgery was done in 2015 and the patient needed a laparoscopic redo due to hiatal relapse, done in 2019 with nonabsorbable mesh reinforcement. Posteriorly, the patient visited our clinic for epigastric pain and vomits. The proper study with gastroscopy, CT scan and barium swallow was ruled out, pointing a new relapse. With this results, the patient was purposed a redo cruroplasty with robotic approach. Results In the video we perform the crural robotic reinforcement with de use of biosynthetic absorbable mesh (Gore Bio-A) without any funduplication. This video aims to show the step-by-step in a redo hiatal surgery and the benefits of robotic surgery. In our short experience and according to the related publications we believe the robotic platform is feasible, safe and effective. Conclusion Although laparoscopic surgery to treat primary hiatal hernias (HHs) is the gold standard approach, the use of robotic platforms in complicated procedures such as relapsed hiatal hernias or gastroesophageal reflux disease (GERD) recurrence seems to gain weight. This is because of robotic approach may help in demanding surgeries with fibrosis and modified anatomy so it provides more precision with the articulating arms and better visualisation due to a 3D view and stable camera. Video https://drive.google.com/file/d/1BjwLWiEaNZWv6ULO9p-rec1LgSopfb1f/view?usp=sharing

Robotic Transanal Surgery. Initial Experience in a Developing Country

Abstract Background Transanal minimally invasive surgery (TAMIS) is a surgical technique used for the excision of rectal neoplasia that gained popularity during the last decade.Due to the technical difficulty (non-articulated instruments, reduced workspace) and the long learning curve associated with this technique, the use of robotic platforms to improve resection results has been suggested and reported, at the same time that the learning curve decreases and the procedure is facilitated Materials and Methods From March 2017 to December 2019, all patients with rectal lesions eligible for TAMIS were offered the possibility to receive a robotic TAMIS (R-TAMIS). We used a transanal GelPoint Path (Applied Medical Inc., Santa Margarita, CA, USA) in the anal canal to be able to do the Da Vinci Si (Intuitive Surgical, Sunnyvale, CA, USA) robotic platform docking, which we used to perform the excision of the rectal lesion as well as the resection site defect. Results Five patients between 34 and 79 years of age underwent R-TAMIS. The mean distance to the anal verge was 8.8 cm. There were no conversions. The mean surgery time was 85 minutes, and the mean docking time was 6.6 minutes. Conclusions Robotic TAMIS is a feasible alternative to TAMIS, with a faster learning curve for experienced surgeons in transanal surgery and better ergonomics. Further studies are needed to assess the cost-benefit relationship.