Use Of Robotic Surgical System Research Articles

Improved Nodal Yields in Laparoscopic Right Hemicolectomy Using Intracorporeal Technique—A Comparative Study

AbstractRight-sided colon cancer is now commonly treated by laparoscopic right hemicolectomy (LRH). The best procedure for mesentery dissection and nodal harvesting is still being debated. The purpose of this study is to compare precise intra-corporeal mesentery dissection (ICMD) with extra-corporeal mesentery dissection (ECMD) approaches and assess their impact on nodal harvest during LRH. This paper is also aimed at providing a detailed account of the customised intracorporeal dissection technique. A retrospective analysis of 78 operative cases was performed. The patients were divided into two groups: those with ICMD (n = 30) and those with ECMD (n = 48). The total number of lymph nodes extracted was the primary outcome. The number of positive lymph nodes, length of hospital stay, and surgical complications were some of the secondary objectives. The total number of lymph nodes extracted in the ICMD was considerably higher (p = 0.02). Cancers located in the ascending colon were associated with more lymph nodes than tumours located in the cecum or hepatic flexure (p = 0.001). This study demonstrates that ICMD provides improved nodal yield compared to ECMD in LRH for right-sided colon cancer. The anatomical location of cancer also impacts the nodal number, with tumours in the ascending colon having the highest yield. The findings underscore the importance of precise dissection technique selection to optimise oncological outcomes, suggesting potential further enhancements with the use of robotic surgical systems in accessing challenging anatomical locations.

Console and bedside surgeon fused robot-assisted thoracic surgery.

In the last decade, even thoracic surgery has seen an increase in the use of robotic surgical systems, and robot-assisted thoracic surgery (RATS) is considered one of the main issues. While RATS is associated with solo manipulative freedom and high-definition optical systems, several disadvantages, such as the lack of tactile sensation and difficult learning curves for the whole team, have been raised. Therefore, to overcome these issues, we developed a 'fusion surgery' approach combining a robotic procedure with manual maneuvers, where the table surgeon retracts the lung and staples the pulmonary vasculature and bronchus. Herein, we introduce our 'fusion surgery' procedure and elaborate on its advantage from technical and educational perspectives.

Robotic Rectus Abdominis Harvest for Pelvic Reconstruction after Abdominoperineal Resection.

The use of robotic surgical systems to perform abdominoperineal resection (APR) has recently become more prevalent. This minimally invasive approach produces fewer scars and potentially less morbidity for the patient. The rectus abdominis muscle is often used for reconstruction after APR if primary closure is not feasible or the surgical site is at high risk of wound complications. Since the traditional open harvest of this flap creates large incisions that negate the advantages of minimally invasive APR, there has been growing interest in harvesting the rectus abdominis in a similarly robotic fashion. This article reviews the technique, benefits, and limitations of this robotic technique. Compared to the traditional open harvest, robotic harvest of the rectus abdominis leaves smaller scars, provides technical benefits for the surgeon, and offers possible morbidity benefits for the patient. These advantages should be weighed against the added expense and learning curve inherent to robotic surgery.

A single institution experience: Robotic-assisted laparoscopic renal calyceal diverticulectomies, heminephrectomy and bladder diverticulectomies

Introduction: The use of a robotic surgical system has transformed modern urological surgeries. There is little reported, however, on the use of robotic surgical systems in the management of benign urological diseases. We aim to report our experience in robotic-assisted surgery in renal calyceal diverticulectomies, heminephrectomy and bladder diverticulectomies. Methodology: We retrospectively collected the data of patients who had robotic-assisted surgery in our institution from 1 January 2014 to 31 December 2019. Results: Over the last five years, our institution has performed over 1500 robotic-assisted urological surgeries. In this five-year period, four robotic surgeons have performed a total of 25 robotic assisted operations to treat benign urological diseases including three renal calyceal diverticulectomies, one heminephrectomy and two bladder diverticulectomies. All patients were satisfied with the outcomes of their surgery when reviewed at their follow up consultations. Conclusion: We report a very positive experience in using robotic surgical systems in managing our series of benign urological conditions in our hospital. We should not restrict the use of this tool to cancer surgery, but consider the technology in our surgical armamentarium for all aspects of our urological practice.

Robotic surgeries: an initial experience in a multispeciality hospital

Background: The use of robotic surgical systems is an expanding technology in the world. Robot-assisted surgery overcomes some limitations of laparoscopy. Aim was to evaluate a single surgeon’s experience with safety, feasibility, complications, and short- and long-term outcomes for robotic assisted procedures.Methods: It was a prospective study of 39 patients operated by robotic assistance performed 39 surgeries from November 2018 to June 2020 in three departments with follow up of 2 years. The surgeries performed included gastroenterology, gynecological and urological system.Results: It was a prospective, analytical and descriptive study. In total 39 cases in present study followed up for 3 years. Most of the patients in study are in >65 years age group, and females have been operated mostly. Surgeries in our hospital done with robotic assistance ware 13 cases (33.3%) in gastroenterology department, gynecological department with total 17 cases (42.5%) and in urology department it was 9 cases (23.2%). Gastroenterology surgeries took less time of 100 minutes. Blood loss in gynecological surgeries was more compared to other departments with 103 ml followed by urology 98 ml. Hospital stay in present study was less for gynecological surgeries with one day of admission. All over complications are around 2.5%. Success rate in our study was 97.5%.Conclusions: It was concluded that robotic surgery offers an effective and safe alternative in the surgical treatment.

Advancements in Robotic Living Donor Hepatectomy, Review of Literature and Single-Center Experience

To highlight the use of robotic surgical system in live liver donor hepatectomy. Our early experience with 175 robotic donor hepatectomies showed that the procedure is safe, feasible, and reproducible in the hands of an experienced surgeon. The robotic surgical system has added more benefits to the minimal invasive surgery rather than laparoscopy; it offers better visualization, better ergonomics, better range of movements, and reduced physiological tremors. Moreover, the amplified 3D view with steady instrumental movements ensured meticulous tissue handling; this encouraged many transplant centers to use the technique in live liver donor hepatectomy. Here, in this review, we highlight the pre-requisites of robotic liver donor program and our early outcome in 175 liver donor hepatectomies.

Laparoscopic and robot-assisted procedures in patients with gastrointestinal stromal tumors (GIST) of stomach

To analyze the results of minimally invasive surgical procedures in patients with gastric GIST. The study included 30 patients aged 52.2±9.8 years. ASA grade II (44%), III (26%) and I (23%) were predominant. Lesion of stomach body was noted in 17 (56%) patients, antrum - in 8 (27%), fundus - in 2 (7%) and cardia - in 3 (10%) patients. GIST was located on the anterior wall of stomach in 56% of patients. Exophytic growth was observed in 16 (53%) patients, endophytic - in 12 (40%), transmural growth - in 2 (7%) cases. T2 grade of tumor was noted in 67% of cases (TNM 8). All patients underwent laparoscopic or robot-assisted ('daVinci Si') partial resection of the stomach. Radical resection (R0) without injury of pseudocapsule of tumor was made in all patients. Laparoscopic procedures were performed in 25 (83%) patients, robot-assisted - in 5 (17%). Early postoperative complications (Clavien-Dindo II) were observed in 3 patients. Spindle cell structure of tumors (93%) with low mitotic activity (63%) prevailed. Tumor stage I was observed in 56% of patients. Patients with high mitotic tumor index (44%) were directed to targeted therapy. Recurrence and/or metastasis in long-term period were absent in 26 (87%) patients. Laparoscopic surgery for gastric GIST is safe and characterized by the absence of significant postoperative complications and long-term recurrence-free period. The use of robotic surgical system is effective and justified for anatomically difficult localization of GIST.

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.

Robotic-Assisted Esophageal Surgery.

The adoption of minimally invasive approaches to the management of esophageal disease has been slow, except for the laparoscopic management of gastroesophageal reflux disease. However, the advent of new surgical technologies - in particular, robotic-assisted surgical systems - has revolutionized esophageal surgery. The literature was systematically reviewed using the keywords "robotic," "esophageal surgery," "esophagectomy," "fundoplication," and "esophageal myotomy." The reference lists from these articles were then also analyzed. Forty-nine studies were included in our comprehensive review of robotic-assisted esophageal surgery, and they consisted of literature reviews, case reports, retrospective and prospective case series, and randomized controlled trials. Robotic-assisted esophageal surgery is a safe and effective way of treating esophageal disorders, including gastroesophageal reflux disease, achalasia, leiomyomas, and cancer. The use of robotic surgical systems has many benefits for managing disorders of the esophagus, but more studies, including randomized controlled trials, are necessary.

Comparison of Single and Dual Console Systems in the Robotic Surgical Training of Graduating Obstetrics and Gynecology Residents in the United States [103

INTRODUCTION: The use of robotic surgical systems in gynecologic surgery is continuing to increase. The dual console system has the potential to improve resident participation and training in robotic-assisted surgeries. The goal of this study is to compare obstetrics and gynecology residents' self-assessment of surgical training on single and dual console robotic systems. METHODS: An anonymous survey was designed using Qualtrics web-based survey software. The survey link was sent to all graduating obstetrics and gynecology residents and program directors in the United States by e-mail. RESULTS: A total of 39 program directors and 34 residents completed the survey. Thirty-one (70%) program directors and 26 (70%) residents reported that the dual console is being utilized in their institution. Thirty-six percent of program directors report that residents performed more than 20 robotic-assisted total laparoscopic hysterectomy cases in the dual console group compared with only 13% in single console group (P=.111), whereas 30% of residents in the dual console group report performing more than 20 robotic-assisted total laparoscopic hysterectomies compared with none in single console group (P=.124). Programs with a dual console had higher rates of providing training certificates at graduation: 52% (dual console group) compared with 22% (single console group) reported by program directors (P=.148) compared with 43% (dual console group) compared with 0% (single console group) reported by graduating residents (P=.032). CONCLUSION: Dual consoles are utilized in 70% of obstetrics and gynecology residency programs that completed the survey. Utilization of a dual console significantly increased the rate of obtaining training certificates as reported by residents. Utilization of a dual console did not significantly increase the number of robotic-assisted total laparoscopic hysterectomy cases performed by residents as reported by residents and program directors.

Application of a Robotic Telemanipulator to Perform Posterior Pharyngeal Flap Surgery

The instrumentation used during surgery to address velopharyngeal dysfunction has changed little over the past century. Recent advances in the use of robotic surgical systems in transoral surgery have expanded the use of these instruments beyond their traditional laparoscopic applications. The purpose of this study was to evaluate the feasibility of performing superiorly based, "Hogan"-style posterior pharyngeal flaps using a robotic surgical telemanipulator system. The authors hypothesize that use of this surgical platform provides equivalent safety, improved exposure, and more comfortable surgeon ergonomics compared with traditional methods of flap harvest and inset. A pilot study was performed using three fresh cadaveric human heads. Superiorly based posterior pharyngeal flaps were successfully performed in all specimens. The technical aspects of the procedure, including telemanipulator setup, positioning, surgical instrumentation, and timing, are described in detail. All three subjects underwent successful transfer of posterior pharyngeal flaps. Mean surgical time was 113 minutes. Using a 30-degree angled endoscope, the area of the operative field was nearly doubled, and this allowed for easy visualization of the flap ports, an advantage when tailoring the flap. Technically, the learning curve for using the robot telemanipulator was steep, and both operating surgeons (J.M.S. and J.A.T.) felt that the instrumentation and setup were ergonomic. There was no damage to adjacent structures. Transoral robotic surgery for velopharyngeal dysfunction is feasible and may offer improved exposure and ergonomics compared with traditional methods. As the use of robotic surgical systems becomes more widespread, their use in intraoral cleft surgery warrants further investigation.

Current status of robotic rectal cancer surgery

SUMMARY After the introduction of robotic surgery for rectal cancer, the safety and feasibility of robotic rectal cancer surgery was demonstrated. However, early comparative studies between laparoscopic and robotic surgery did not show a significant postoperative benefit. Recently, it was reported that robotic rectal surgery showed better postoperative outcomes than laparoscopic surgery with regard to postoperative recovery, pain and function preservation. In addition, robotic transanal specimen extraction was safely performed while maintaining a lower level of postoperative pain and recovery time. All of these findings should be validated with well-designed comparative studies. As robotic technology advances and continues to be studied, the use of robotic surgical systems will become more common among colorectal surgeons.

Robotics — The answer to the Achilles’ heel of VATS pulmonary resection

During the past decade, robotic surgical systems have been increasingly utilized to perform highly complex surgical procedures. In fact, the robotic-assisted approach to the treatment of many gynecological and urological surgical procedures has become the standard-of-care. The use of robotic surgical system in thoracic surgery is in its early development. Video-assisted thoracoscopic surgery (VATS) was propelled forward in the early 1990’s without full appreciation for long-term consequences, increased cost or therapeutic benefit. The trend in robotic-assisted thoracic surgery is projected to surpass the adoption of VATS and to mirror that of other robotic surgical subspecialties.

Robotics - The answer to the Achilles' heel of VATS pulmonary resection.

During the past decade, robotic surgical systems have been increasingly utilized to perform highly complex surgical procedures. In fact, the robotic-assisted approach to the treatment of many gynecological and urological surgical procedures has become the standard-of-care. The use of robotic surgical system in thoracic surgery is in its early development. Video-assisted thoracoscopic surgery (VATS) was propelled forward in the early 1990’s without full appreciation for long-term consequences, increased cost or therapeutic benefit. The trend in robotic-assisted thoracic surgery is projected to surpass the adoption of VATS and to mirror that of other robotic surgical subspecialties.

Robot-assisted pediatric surgery

Computer-enhanced robotic surgical systems have been increasingly used to facilitate complex minimal access surgical procedures. In adult patients, such systems have been used to perform a wide variety of operations including coronary artery bypass grafting, mitral valve repair, Roux-en-Y gastric bypass, colon resection, nephrectomy, and radical prostatectomy. In the field of pediatric surgery, the experience with robotic surgical systems has been more limited. However, with improvements in robotic technology, interest and experience with robotic pediatric surgery have grown rapidly. The purpose of this article is to review the current experimental and clinical literature regarding the use of robotic surgical systems in the pediatric patient population.