Vinci Robotic Surgical System Research Articles

Behind the pattern: General surgery residsent autonomy in robotic surgery

ObjectiveRobotic surgery is increasingly utilized and common in general surgery training programs. This study sought to better understand the factors that influence resident operative autonomy in robotic surgery. We hypothesized that resident seniority, surgeon work experience, surgeon robotic-assisted surgery (RAS) case volume, and procedure type influence general surgery residents’ opportunities for autonomy in RAS as measured by percentage of resident individual console time (ICT). MethodsGeneral surgery resident ICT data for robotic cholecystectomy (RC), inguinal hernia (RIH), and ventral hernia (RVH) operations performed on the dual-console Da Vinci surgical robotic system between July 2019 and June 2021 were extracted. Cases with postgraduate year (PGY) 2–5 residents participating as a console surgeon were included. A sequential explanatory mixed-methods approach was undertaken to explore the ICT results and we conducted secondary qualitative interviews with surgeons. Descriptive statistics and thematic analysis were applied. ResultsResident ICT data from 420 robotic cases (IH 200, RC 121, and VH 99) performed by 20 junior residents (PGY2-3), 18 senior residents (PGY4-5), and 9 attending surgeons were extracted. The average ICT per case was 26.8 % for junior residents and 42.4 % for senior residents. Compared to early-career surgeons, surgeons with over 10 years' work experience gave less ICT to junior (18.2 % vs. 32.0 %) and senior residents (33.9 % vs. 56.6 %) respectively. Surgeons' RAS case volume had no correlation with resident ICT (r = 0.003, p = 0.0003). On average, residents had the most ICT in RC (45.8 %), followed by RIH (36.7 %) and RVH (28.6 %). Interviews with surgeons revealed two potential reasons for these resident ICT patterns: 1) Surgeon assessment of resident training year/experience influenced decisions to grant ICT; 2) Surgeons’ perceived operative time pressure inversely affected resident ICT. ConclusionsThis study suggests resident ICT/autonomy in RC, RIH, and RVH are influenced by resident seniority level, surgeon work experience, and procedure type, but not related to surgeon RAS case volume. Design and implementation of an effective robotic training program must consider the external pressures at conflict with increased resident operative autonomy and seek to mitigate them.

Da Vinci Robotic Surgical System: Early Experience from Pakistan.

To determine the outcomes of robotic surgeries using the Da Vinci robotic surgical system (DVSS) at Pakistan's largest urological tertiary healthcare system. Descriptive study. Place and Duration of the Study: Department of Minimally Invasive and Robotic Surgery, Division of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from March 2017 to December 2021. Hospital records of patients who underwent robotic urological surgeries were assessed for their outcomes in terms of blood loss, mortality, system malfunction, and conversion to open surgery. Descriptive statistics were determined. A total of 550 procedures were performed. The mean age recorded was 39.58±16.83 years. The mean blood loss recorded was 255.611±353.57 ml; there were 3 cases of malfunction. Forty cases were converted to open surgery, and the mortality rate was 1.1%. Minimally invasive surgical techniques have high precision, fewer complications, and lower morbidity rates. Using DVSS for surgical interventions is both effective and safe. Minimally invasive surgery, Da Vinci robotic surgical system, Robotic surgery.

IJCM_277A: Awareness, Perception and Attitude of Medical Interns and Graduates Towards Robotic Surgery: A Cross-Sectional Study

Background: Robotic surgery is a novel venture in medical sciences that uses robotic systems to assist and carry out surgical procedures and is one of the most discussed topics in surgery today. However, there is paucity of information regarding awareness, attitude and perceptions related to robotic surgery among the future surgical care providers (i.e., interns and postgraduates). Methodology: This cross-sectional study was carried out among all the Medical Interns and the Postgraduates posted in the surgical Departments of KMC Mangalore (General Surgery, OBG, ENT, Ophthalmology, Orthopedics and Anaesthesia) using Universal sampling technique and data were collected using a semi-structured, pre-validated questionnaire consisting of two sections. The collected data were analyzed using SPSS software version 25. The results were summarized as percentages, tables and figures. For comparison across the groups chi-square test was used and a value less than 0.05 was considered statistically significant. Results: One hundred sixty-nine Interns and surgical Postgraduates were included in total in the study with a mean age of 25 years. Among the study participants,57.3% (n=59) of Interns and 57.6% (n=38) of Postgraduates have seen robotic surgery being performed in the past. More than half of the study participants, 66%(n=68) interns and 72.7%(n=48) postgraduates were aware of the Da Vinci robotic surgical system. Among the challenges for mainstreaming robotic surgery, cost was the most important concern among 53.3% (n=57) interns and 53%(n=35) postgraduates. Conclusion: In our study majority of the participants, Interns (64.1%) and Post graduates (84.8%) had a positive outlook towards robotic surgery & believed cost (55.3 % Interns and 53% Post graduates) was one of the major constrains limiting its use

A narrative review of the Medtronic Hugo RAS and technical comparison with the Intuitive da Vinci robotic surgical system.

Medtronic launched the Hugo Robotic-Assisted Surgery (RAS) System in 2021, offering a modular alternative to the incumbent market leader in surgical robotics, the Intuitive da Vinci (dV) surgical system. A detailed technical review of the Hugo RAS was conducted to explore the strengths and weaknesses of this new robotic surgical system. Each component of the system-vision tower, arm cart, and surgeon console-was compared against the existing dV systems. The docking process, instrumentation, and external arm movement trajectories were analyzed. The modular Hugo RAS provides the possibility of operating using up to four arm carts. It has certain design features that are unique to itself, and others that have been implemented to address the shortcomings of the dV Si. While Medtronic's first-generation robot offers distinct advantages over the older Intuitive systems, the true test of its mettle will be its performance compared to the latest dV Xi.

Comparison of effectiveness and safety of Da Vinci robot's "3 + 1" and "4 + 1" modes of treatment for colorectal cancer.

To compare the effectiveness of the Da Vinci Surgical Robot System (DSRS) "3 + 1" and "4 + 1" models for colorectal cancer (CRC). A total of 107 patients with CRC admitted to our hospital from February 2021 to May 2022 were selected for the retrospective analysis. Of these, 57 patients underwent the DSRS "4 + 1" model (control group), while the rest 50 underwent the DSRS "3 + 1" model (research group). The operation time, intraoperative bleeding, number of lymph nodes detected, time of first postoperative urinary catheter removal, time of first feeding, time of first venting and hospitalization were compared between the two groups. The changes of white blood cell (WBC) and C-reactive protein (CRP) levels before and after surgery were detected, and patients' adverse effects and treatment costs between surgery and hospital discharge were counted. The Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS) were used to assess the psychological state of the patients. There was no difference in operative time, intraoperative bleeding, and number of lymph nodes detected between both groups (P > 0.05), while time to first postoperative urinary catheter removal, time to first feeding, time to first venting, length of stay (LOS), postoperative inflammatory factor levels, incidence of adverse events, and treatment costs were all lower in the research group than in the control group (P < 0.05). SAS and SDS scores decreased after treatment in both groups, but the decrease was more obvious in the research group (P < 0.05). Both DSRS "4 + 1" and "3 + 1" modes have better treatment effects for CRC. However, the "3 + 1" mode has higher safety and lower treatment cost, which can significantly improve the postoperative recovery process of patients and is more worthy to be promoted in clinical practice.

Robotic excision of posterior mediastinal neurogenic tumours: Technique and surgical outcomes.

Neurogenic tumours are the most common tumours of the posterior mediastinum and account for 75% of the tumours in this region. Till recently, open transthoracic approach has been the standard of care for their excision. Thoracoscopic excision of these tumours is being commonly employed because of lesser morbidity and shorter hospital stay. The robotic surgical system offers a potential advantage over conventional thoracoscopy. We herein report our technique and surgical outcomes of excision of posterior mediastinal tumours using the Da Vinci Robotic Surgical System. We retrospectively reviewed 20 patients who underwent Robotic Portal-Posterior Mediastinal Tumour (RP-PMT) Excision at our centre. The demographic data, clinical presentation, characteristics of the tumour, operative and post-operative variables including, total operative time, blood loss, conversion rate, duration of the chest tube, hospital stay and complications were noted. Twenty patients underwent RP-PMT Excision and were included in the study. The median age was 41.2 years. The most frequent presentation was chest pain. Schwannoma was the most common histopathological diagnosis. There were two conversions. The total operative time was 110 min with an average blood loss of 30 mL. Two patients developed complications. The postoperative hospital stay was 2.4 days. With a median follow-up of 36 months (6-48 months), all except patients are recurrence-free, except the patient with malignant nerve sheath tumour who developed local recurrence. Our study demonstrates the feasibility and safety of robotic surgery for posterior mediastinal neurogenic tumours with good surgical outcomes.

Perioperative Patient Management in Mammary Coronary Bypass Surgery Using Da Vinci Surgical System

Introduction . Minimally invasive surgical techniques, including robot-assisted ones, on the one hand, allowed indications for surgery to be expanded, but on the other hand, generated a number of specific problems associated with technical aspects of minimally invasive treatment. The latter has led to a new consideration of the influence of surgical aggression on patients and showed a clear need for adequate anaesthetic support in order to correct homeostasis changes and ensure safety of patients. Aim. To improve the patient safety in mammary coronary bypass surgery using the Da Vinci robotic surgical system. Materials and methods. The study enrolled 12 patients who underwent robot-assisted endoscopic isolation of the left internal mammary artery, followed by an anastomosis of the anterior descending branch via a mini-thoracotomy in the fifth intercostal space under single lung sevoflurane inhalation anesthesia with continuous ESP analgesia. Results and discussion . No lethal outcomes or serious complications such as myocardial infarction and acute cerebrovascular accident were reported. Discharge or transfer to the rehabilitation unit was carried out on the 5th–7th day. Conclusion . Minimally invasive techniques, including robot-assisted ones, require that the intensivists and cardiac surgeons be aware of the pathophysiological factors that affect the cardiovascular and respiratory systems, and have the ability to predict the course of events and take actions to prevent complications.

Efficacy and safety of robotic-assisted versus median sternotomy for cardiac surgery: results from a university affiliated hospital.

We aimed to report the experience of robotic-assisted cardiac surgery (RACS) using the Da Vinci robotic surgical system, meanwhile its efficacy and safety was also evaluated by comparing with traditional open-heart surgery (TOHS), thus to provide evidence for a broader application of RACS in clinical practice. From July 2017 to May 2022, a total of 255 patients who underwent cardiac surgery assisted by Da Vinci robotic surgery system in the First Affiliated Hospital of Anhui Medical University, which included 134 males with an average age of 52.6±6.3 years and 121 females with an average age of 51.8±5.4 years. They were defined as the RACS group. By searching the hospital's electronic medical record information system, 736 patients with the same disease types who underwent median sternotomy and had complete data in the same period were selected as the TOHS group. Intra- and postoperative clinical results of the both groups were compared, and we focused the following indices including surgery time, reoperation rate for postoperative bleeding, length of intensive care unit (ICU) stay, postoperative hospitalization day, the number of died and withdrawing treatments, and the time of patients back to normal daily activities after discharge. In RACS group, 2 patients were scheduled to undergo mitral valvuloplasty (MVP), but they had to change to mitral valve replacement (MVR) due to unsatisfactory results; furthermore, 1 patient who received atrial septal defect (ASD) repair experienced abdominal hemorrhage because a rupture of abdominal aorta which were induced by the femoral arterial cannulation, and this patient eventually died of invalid rescue. As for the comparison of clinical results between both groups, there were no significant statistical differences in reoperation rate for postoperative bleeding, and the number of died and withdrawing treatments between both groups. However, length ICU stay, postoperative hospitalization day, and the time of patients back to normal daily activities after discharge was lower in RACS group in addition to the surgery time. Compared with TOHS, RACS is safe and effective in clinical and is worthy of promotion in an appropriate place.

V06-09 ROBOT-ASSISTED NEPHRON-SPARING MANAGEMENT OF URETERAL TUMORS: PATIENT-TAILORED APPROACH WITH DEMONSTRATION OF FOUR DIFFERENT TECHNIQUES

You have accessJournal of UrologyCME1 Apr 2023V06-09 ROBOT-ASSISTED NEPHRON-SPARING MANAGEMENT OF URETERAL TUMORS: PATIENT-TAILORED APPROACH WITH DEMONSTRATION OF FOUR DIFFERENT TECHNIQUES Sumit Saini, Timothy O'Rourke, and Ashok Hemal Sumit SainiSumit Saini More articles by this author , Timothy O'RourkeTimothy O'Rourke More articles by this author , and Ashok HemalAshok Hemal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Need for renal function preservation may influence the decision to take a nephron sparing approach of segmental ureterectomy for localized ureteral tumors, as an alternative to radical nephroureterectomy. In this video we demonstrate four different individualized surgical techniques tailored according to patient’s disease. METHODS: All the surgeries were performed by single surgeon (AKH) using da Vinci (Si/Xi) robotic surgical system. For distal ureteral tumors, distal ureterectomy with bladder cuff excision/partial cystectomy with pelvic lymph node dissection (PLND) and uretero-neo-cystostomy was performed in 11 patients. Proximal ureteral tumors were addressed with segmental ureterectomy and uretero-ureterostomy in 5 patients and another patient underwent augmented anastomotic ureteroplasty using free circumferential ileal patch. Regardless of the surgical approach adopted, complete preoperative evaluation was carried out with cross sectional imaging and other investigations (renogram, retrograde pyelogram & nephrostogram) as indicated. These procedures were considered in carefully selected patients with unifocal disease associated with medical co-morbidities, advancing age, and compromised renal function. Intraoperative fluoroscopy guided navigation and/or molecular imaging using indocyanine green (intraluminal or intravascular) are also helpful. RESULTS: In this video, we have demonstrated four such techniques, including our novel approach of augmented anastomotic ureteroplasty with free circumferential ileal patch to bridge a significant defect following segmental ureterectomy. We have also highlighted our novel technique of intra-corporeal JJ stent placement. No intra or post operative complications were noted, and all the surgical margins were negative. JJ Stents was removed in about 4 weeks post-operatively. CONCLUSIONS: Robot-assisted patient-tailored approach for ureteral tumors may be effectively employed in appropriately selected patients of ureteral tumors with excision and end to end anastomosis, augmented anastomosis or uretero-neo-cystotomy with psoas hitch as an alternative to radical nephroureterectomy to salvage the ipsilateral kidney. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e511 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sumit Saini More articles by this author Timothy O'Rourke More articles by this author Ashok Hemal More articles by this author Expand All Advertisement PDF downloadLoading ...

Prospects and challenges of robotic hernia surgery in China: A narrative review

Abstract The Da Vinci surgical robotic system has revolutionized the field of robotic surgery and has become one of the most ubiquitous and recognized systems in the robotic surgery era. The rapid rise in China’s economy will provide crucial support for the promotion and application of robotic surgical systems in the country’s surgical field. At present, approximately 1.2 million inguinal hernia repairs are performed annually in China. However, many of these surgeries are performed via traditional open repair or laparoscopy methods. Using the purported benefits of robotic surgery system to benefit hernia patients should become a future direction for Chinese hernia surgeons.

A Time Trend Analysis of 5,000 Robotic Thyroidectomies via Bilateral Axillo-Breast Approach.

This study aimed to investigate the time trends of surgical outcomes in patients who underwent bilateral axillo-breast approach robotic thyroidectomy (BABA RT) over the last 14years. From February 2008 to September 2021, we conducted a retrospective medical chart review of 5,011 consecutive patients who underwent BABA RT at three Seoul National University-affiliated hospitals. The patients were divided into three groups based on the main model of the da Vinci robotic surgical system to evaluate trends in surgical treatment strategies and outcomes after BABA RT. Of the 5,011 patients (4,706 malignant and 305 benign), the most common histological subtype was papillary thyroid carcinoma (n = 4,584; 97.4%). The mean tumor size significantly increased from 0.8cm to 1.2cm (p < 0.05). The mean numbers of metastatic and harvested lymph nodes from the central neck dissection and the lateral neck dissection showed a significant difference and tendency to increase (from 0.9 to 1.6, 4.7 to 6.2, p < 0.05, and from 0.6 to 3.9, 5.3 to 17.9, p < 0.05), respectively, throughout the study period. Permanent hypoparathyroidism decreased from 3.4 to 2.9%. The rate of transient and permanent vocal cord palsy decreased from 15.2 to 2.7% and from 0.7 to 0.2%, respectively. With advancements in robotic surgical systems and improvements in the BABA RT technique, surgical indications have expanded to include more advanced thyroid diseases, and surgical outcomes have improved over the last 14years.

Application of da Vinci surgery in hepatectomy

The first laparoscopic hepatectomy was performed over 30 years ago, and its safety and short-term and long-term outcomes are comparable to those of traditional laparotomy. Minimally invasive surgery is important for liver surgery. However, due to the limitations of its instruments and technology, laparoscopic surgery still has certain challenges in the field of liver resection, which is also an important reason for the relatively slow implementation of laparoscopic liver resection. The advent of the da Vinci robotic surgical system has helped to overcome the shortcomings of laparoscopy, such as the difficulty in exposing some special liver segments and performing sutures and reconstruction. Based on the experience of the authors’ surgical team, this paper explores the application value and breakthrough of the da Vinci robot in minimally invasive hepatectomy from the aspects of perioperative evaluation, lesion localization, bleeding control, surgical approaches, and precautions for complications.

Schwannoma Originating From the Lingual Nerve Radiologically Mimicking a Submandibular Gland Tumor

Schwannoma, also known as neurilemmoma, is a slowly growing benign neurogenic tumor, originating from the Schwann cells of the nerve sheath. Schwannoma can arise from various nerves such as cranial nerves, spinal nerves, autonomic nerves, and is most common in the head and neck area. However, Schwannoma originating from the lingual nerve is very rare and the clinical findings are non-specific. Therefore, when it occurs in the submandibular space, it is difficult to differentiate them from other tumors, making it difficult to accurately diagnose before surgery. Therefore, by reporting a case of Schwannoma originating from the lingual nerve that was misdiagnosed for a submandibular gland tumor, we intend to understand the characteristics and radiological findings of Schwannoma originating from the lingual nerve. The tumor was successfully treated without complications by using the da Vinci robotic surgical system, which provides a wide field of view and wrist joint structure.

A retrospective comparative cohort study on the efficacy and safety of bi-port robotic-assisted lobectomy and multi-port robotic-assisted lobectomy.

BackgroundThe pursuit of less surgical incisions brings better postoperative experience of patients and earns extensive popularity recently. As the update to the da Vinci robotic surgical system has reduced the size of the robotic arm, a new surgical method with fewer ports has become feasible. We performed 20 cases of robotic surgery with only 2 ports and compared the efficacy and safety between bi-port robotic-assisted lobectomy and multi-port robotic-assisted lobectomy.MethodsTo compare the efficacy and safety of the different surgery strategies, we retrospectively reviewed 20 cases of bi-port robotic-assisted thoracic surgery (RATS) and 40 cases of multi-port RATS which were performed at the Shanghai Chest Hospital Between February 2021 and May 2021. The baseline characteristics and their perioperative data were collected and analyzed. Chest tube drainage, chest tube removal time, lymphadenectomy outcomes, operation duration were collected to compare the efficacy of the two groups and blood loss, perioperative complications were recorded to value the safety.ResultsA total of 60 surgeries in the 2 groups were successfully completed. The baseline characteristics in terms of sex, age, health statues were comparable (P≥0.05). The maximum diameter of the tumor in the bi-port surgery group was 0.5–3.6 cm (2.0±1.0) vs. 0.5–4.0 cm (1.9±0.9) cm in the control group. No significant difference was discovered in terms of tumor location, tumor maximum diameter, tumor histology. The intraoperative blood loss was 60.0±20.5 mL and the average operation time was 95.6±21.4 min in the bi-port surgery group compared to 65.0±30.4 mL and 101.4±25.0 min in the control group. An average of 6.0±1.4 lymph nodes were collected in the bi-port surgery group with a mean diameter of 1.2±0.4 cm, and in the control group, an average of 6.1±1.6 lymph nodes were collected with a mean diameter was 1.2±0.5 cm. The average time of chest drainage was 4.3±1 vs. 5.1±1.3 days in the bi-port surgery group and control group. No statistical significance was found between the two groups (P>0.05).ConclusionsCompared to multi-port RATS, Bi-port robotic-assisted lobectomy was safe and showed promising efficacy in patients with early staged operable lung cancer.

Retropharyngeal lymph node dissection in head and neck cancers treated with transoral robotic surgery

Objective: To evaluate the indications, safety, feasibility, and surgical technique for patients with head and neck cancers undergoing transoral robotic retropharyngeal lymph node (RPLN) dissection. Methods: The current study enrolled 12 consecutive head and neck cancer patients (seven males and four females) who underwent transoral robotic RPLN dissection with the da Vinci surgical robotic system at the Sun Yat-sen University Cancer Center from May 2019 to July 2020. Seven patients were diagnosed as nasopharyngeal carcinoma with RPLN metastasis after initial treatments, 4 patients were diagnosed as thyroid carcinoma with RPLN metastasis after initial treatments, and one patient was diagnosed as oropharyngeal carcinoma with RPLN metastasis before initial treatments. The operation procedure and duration time, intraoperative blood loss volume and complications, nasogastric feeding tube dependence, tracheostomy dependence, postoperative complications, and hospitalization time were recorded and analyzed. Results: All patients were successfully treated by transoral robotic dissection of the metastatic RPLNs, none of which was converted to open surgery. RPLNs were completely resected in 10 patients, and partly resected in 2 patients (both were nasopharyngeal carcinoma patients). The mean number of RPLN dissected was 1.7. The operation duration time and intraoperative blood loss volume were (191.3±101.1) min and (150.0±86.6) ml, respectively. There was no severe intraoperative complication such as massive haemorrhage or adjacent organ injury during surgery. Nasogastric tube use was required in all patients with (17.1±10.6) days of dependence, while tracheotomy was performed in 8 patients with (11.6±10.7) days of dependence. The postoperative hospitalization stay was (8.5±5.7) days. Postoperative complications occurred in 4 patients, including 2 of retropharyngeal incision and 2 of dysphagia. During a follow-up of (6.5±5.1) months, disease-free progression was observed in all patients, 10 patients were disease-free survival and other 2 patients were survival with tumor burden. Conclusions: The transoral robotic RPLN dissection is safety and feasible. Compared with the traditional open surgical approach, it is less traumatic and safer, has fewer complications and good clinical application potentiality. The indications for transoral robotic RPLN dissection include thyroid carcinoma, oropharyngeal carcinoma, and some selected nasopharyngeal carcinoma and other head and neck cancers. Metastatic RPLNs from some nasopharyngeal carcinoma with incomplete capsule, unclear border and adhesion to the surrounding vessels are not suitable for transoral robotic RPLN dissection.

Prospective Pilot Study of Robotic-Assisted Harvest of the Latissimus Dorsi Muscle: A 510(k) Approval Study with U.S. Food and Drug Administration Investigational Device Exemption.

There are no U.S. Food and Drug Administration (FDA)-approved indications for robotic plastic surgery. This study was designed to demonstrate safety and efficacy of the robotic latissimus dorsi harvest for FDA approval. This prospective, single-arm study was conducted under an investigational device exemption through the FDA for obtaining 510(k) approval. The primary safety endpoint was adverse events attributable to harvest. Primary efficacy endpoints included muscle viability after harvest and conversion to open technique. Secondary endpoints included postoperative pain and upper extremity function. Fifteen patients enrolled, with a mean age of 50 ± 10 years and a mean body mass index of 25 ± 4 kg/m2. There were no adverse events, all muscles were viable after harvest, and there were zero conversions to open procedures. Visual analogue scale scores for pain progressively decreased postoperatively and returned to baseline, indicating resolution of postoperative pain. Physical therapy assessment demonstrated recovery of function in all range-of-movement domains by 36 weeks. There was no difference in function of the operated extremity between baseline and 36 weeks' follow-up for Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire (p = 0.87); QuickDASH Work Module (p > 0.05); and QuickDASH Sports Module (p > 0.05). The use of the da Vinci Robotic Surgical System is safe based on zero adverse events attributable to harvest and efficacious based on 100 percent muscle viability after harvest and zero conversions to open technique. There appears to be little to no long-term functional deficit or pain from muscle harvest. Given these results and their own prestudy guidelines, the robotic latissimus dorsi qualifies for 510(k) submission by Intuitive Surgical and approval by the U.S. FDA. Therapeutic, IV.

11 Robotic Left Lower Sleeve Lobectomy with Bronchoplasty for the Removal of a Carcinoid Tumour

Abstract Lung carcinoid tumours constitute approximately 1–2% of all pulmonary tumours. They are derived from enterochromaffin cells, which are also known as ‘Kulchitsky cells' and generally have indolent growth and development patterns. Carcinoid tumours are categorized as typical or atypical, depending on the number of mitoses per high power field and the presence of necrosis. In terms of management, surgical resection has been recognized to be the standard treatment for pulmonary carcinoid tumours. To our knowledge, the da Vinci system and robotic surgery have not been applied in sleeve lobectomies and bronchoplasty for the removal of carcinoid tumours in the United Kingdom. Therefore, we present a case of a sleeve lobectomy with bronchoplasty procedure for the removal of a carcinoid tumour located in the left lower lobe of the patient. The bronchus was repaired using a V-lock suture &amp; Prolene sutures with the surgery performed using the da Vinci robotic surgical system.

Robot-Assisted Repair of Atrial Septal Defect: A Comparison of Beating and Non-Beating Heart Surgery.

BackgroundRobot-assisted repair of atrial septal defect (ASD) can be performed under either beating-heart or non-beating-heart conditions. However, the risk of cerebral air embolism (i.e., stroke) is a concern in the beating-heart approach. This study aimed to compare the outcomes of beating- and non-beating-heart approaches in robot-assisted ASD repair.MethodsFrom 2010 to 2019, a total of 45 patients (mean age, 43.4±14.6 years; range, 19–79 years) underwent ASD repair using the da Vinci robotic surgical system. Twenty-seven of these cases were performed on a beating heart (beating-heart group, n=27) and the other cases were performed on an arrested or fibrillating heart (non-beating-heart group, n=18). Cardiopulmonary bypass (CPB) was achieved via cannulation of the femoral vessels and the right internal jugular vein in all patients.ResultsComplete ASD closure was verified using intraoperative transesophageal echocardiography in all patients. Conversion to open surgery was not performed in any cases, and there were no major complications. All patients recovered from anesthesia without any immediate postoperative neurologic symptoms. In a subgroup analysis of isolated ASD patch repair (beating-heart group n=22 vs. non-beating-heart group n=5), the operation time and CPB time were shorter in the beating-heart group (234±38 vs. 253±29 minutes, p=0.133 and 113±28 vs. 143±29 minutes, p=0.034, respectively).ConclusionRobot-assisted ASD repair can be safely performed with the beating-heart approach. No additional risk in terms of cerebral embolism was found in the beating-heart group.

The application of transumbilical single incision plus one robotic-assisted surgery in choledochal cyst excision and hepaticojejunostomy in children

To explore the effectiveness and summarize the experiences of transumbilical single incision plus one robotic-assisted surgery surgery in the treatment of pediatric choledochal cyst. We retrospectively reviewed the medical records of 10 children who underwent choledochal cyst excision and hepaticojejunostomy from June to December 2020 at Fujian Provincial Hospital. The mean age was (4.6±1.7) years (range from 2 years to 8 years). The mean weight was (17.1±3.8) kg (range from 12.3 kg to 25.0 kg). The Todani classifications were type I (n=6) and type Ⅳ(n=4).The clinical symptoms were asymptomatic (n=4), abdominal pain (n=3), and abdominal pain with jaundice (n=3). Ten cases of transumbilical SILS+1 robotic-assisted choledochal cyst excision and hepaticojejunostomy were completed successfully. The average duration of operation was 204-227 min ((220.0±7.2) min), the mean intraoperative bleeding was (7.67±0.86) ml (range, 6-9 ml) without blood transfusion, average fasting time was (2.30±0.48) days (range, 2-3 days), the average hospitalization time was (4.70±0.67) days (range, 4-6 days) and the medical expense was (5.30±0.42) ten thousand yuan (range, 4-6 ten thousand yuan). Ten patients did not develop early complications such as acute cholangitis, ranging from 3 months to 6 months. Ultrasonography showed no dilation of ductuli hepaticus communis and intrahepatic bile duct occurred at the third month after surgery. With the development of minimally invasive techniques and enhanced recovery, the da Vinci robotic surgical system will be extensively used. Transumbilical SILS+1 robotic-assisted surgery has equal effect with routine robotic-assisted surgery. The incision is more subtle and excellent, but the operation should be taken by sophisticated surgeon.

A retrospective multicentre study on the evaluation of perioperative outcomes of single-port robotic cholecystectomy comparing the Xi and SP versions of the da Vinci robotic surgical system.

Single-incision robotic cholecystectomy (SIRC) is widely performed with both the da Vinci Xi system (Xi) and the da Vinci SP system (SP). But there are limited numbers of studies comparing these platforms. Patients who underwent SIRC between 2019 and 2020 were enrolled. Patient demographics, intraoperative factors, postoperative complications, postoperative pain were compared using a one-to-one propensity score matching (PSM). Overall, 258 patients underwent SIRC with Xi and 72 with SP. After PSM, there were significant differences between the Xi and SP in operation time at console and numeric rating scale for postoperative pain, but no difference in total operation time and postoperative complications. The SP group showed more estimated blood loss. Despite the statistical difference, clinical benefit was not significant. Both platforms can be safe and feasible to perform SIRC, but further investigation including the surgeon's workload and ergonomics is needed as a prospective study.