Vinci Robotic Surgical System Research Articles

The pancreatic surgery in the era of digital medical science

ABSTRACT The development of science and technology not only promotes the development of the society but also has a great influence on the progress of medicine. The three-dimensional (3D) printing technology together with other digital production modes will promote the realization of the third industrial revolution. New 3D equipment and concepts brought a huge leap forward in surgery, and pancreatic surgery also benefits from this. The author has committed himself to the scientific research of 3D pancreatic surgery for decades, and applying 3D visualization technology to the diagnosis and treatment of pancreatic cancer, 3D visualization of peripancreatic vessels, resectability evaluation of the pancreatic cancer and prevention of pancreatic fistula. This article presents a new idea on the development of pancreatic surgery and introduces not only the progress in the diagnosis and treatment of pancreatic diseases in the era of digital medicine, but also the relative advantages brought about by the new equipment (such as da Vinci robotic surgical system, 3D Laparoscope).

Cost effectiveness of transoral robotic surgery for the treatment of oropharyngeal squamous cell carcinoma: a systematic review

Cost effectiveness of transoral robotic surgery for the treatment of oropharyngeal squamous cell carcinoma: a systematic review Nicole L Aaronson, Paul D Neubauer, Benjamin L Judson Yale Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA Abstract: Since the first transoral use of the da Vinci robotic surgical system in 2005 and the subsequent FDA approval for the system's use in 2009, there has been a large uptick in the number of transoral robotic surgery (TORS) procedures performed in the United States. The most common use of TORS has been in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). The rise in TORS cases for OPSCC is driven in part by the epidemic of human papilloma virus (HPV)-associated OPSCC. The advantage of TORS is that it allows transoral resection of tumors previously requiring open approaches associated with longer hospitalization and recovery, and higher functional morbidity. In addition to oncologic and functional outcomes, the cost of treatments using the robot is also a consideration in determining what role TORS should have in the treatment of OPSCC. A systematic review of the literature was performed by searching for articles addressing the cost-effectiveness of TORS. We have analyzed the articles obtained and report that analysis here. The results include case series and other analyses. They suggest that TORS for OPSCC is cost-effective compared to other available modalities due to decreased hospital stay, increased chance of finding an unknown primary and thereby avoiding some adjuvant treatment, and decreased rates of gastrostomy tube and tracheotomy. The methods used for calculating costs varied widely, and studies universally lack long-term follow-up. Further studies are needed, which define and measure costs and compare TORS with open surgery and non-surgical treatments. Keywords: oropharyngeal cancer, transoral robotic surgery, da Vinci robot, cost

Robot-Assisted Laparoscopic Ureteral Reimplantation: Our Technique and Outcomes

Introduction: Robotic assistance has facilitated the performance of many complex reconstructive procedures previously relegated to an open approach with numerous reported advantages. Distal ureteral reconstruction and reimplantation is one such procedure often performed laparoscopically with robotic assistance using the da Vinci robotic surgical system. We evaluated perioperative and long-term outcomes among patients who underwent treatment with robot-assisted laparoscopic ureteral reimplantation (RALUR) at a single center. Materials and Methods: Patients who underwent RALUR between July 2006 and October 2012 were identified. In all procedures, the distal ureter was spatulated for 1.5 cm. An ~1 cm cystotomy was created. The ureterovesical anastomosis was completed in a triangular manner, including two arms of 4-0 polydioxanone suture up the sides of the spatulation and a third arm anteriorly following stent placement to form a widely patent refluxing anastomosis. All procedures were performed at a single institution. A retrospective review of perioperative and clinical data was performed assessing the operative time, estimated blood loss, length of admission, and success of procedure as indicated by the absence of obstruction on follow-up imaging. Results: A total of 21 patients underwent RALUR in the study period. The mean age of patients was 43.2 years. Twenty of the 21 RALUR were completed robotically with conversion to open in one patient. Etiology of stricture included 11 due to gynecologic procedural injury and three secondary to iatrogenic ureteral injuries. The remainder comprised congenital, nongynecologic surgery, radiation, and idiopathic. Thirteen required the psoas hitch procedure as well. The mean operative time was 237 minutes. The mean estimated blood loss was 85 mL. The average length of hospital admission was 3.1 days. Currently, all patients remain nonobstructed by a Lasix renogram at mean follow-up of 12.4 months. Conclusions: RALUR with psoas hitch (when indicated) is a safe and effective option for distal ureteral reconstruction. Further investigation will help to more clearly refine patient selection and delineate patient benefits in comparison to an open procedure. No authors with conflicts of interest to disclose. Runtime of video: 5 mins 45 secs

V4-10 ROBOTIC-ASSISTED LAPAROSCOPIC URETERAL REIMPLANTATION: OUR TECNIQUE AND OUTCOMES

You have accessJournal of UrologyRobotics – Prostate/Novel Imaging1 Apr 2015V4-10 ROBOTIC-ASSISTED LAPAROSCOPIC URETERAL REIMPLANTATION: OUR TECNIQUE AND OUTCOMES Daniel Zainfeld, Andrew Windsperger, Moben Mirza, and David Duchene Daniel ZainfeldDaniel Zainfeld More articles by this author , Andrew WindspergerAndrew Windsperger More articles by this author , Moben MirzaMoben Mirza More articles by this author , and David DucheneDavid Duchene More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.722AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic assistance has facilitated performance of many complex reconstructive procedures previously relegated to an open approach with numerous reported advantages. Distal ureteral reconstruction and reimplantation is one such procedure which is now often performed laparoscopically with robotic assistance using the da Vinci robotic surgical system. We evaluated perioperative and long-term outcomes among patients who underwent treatment with robotic-assisted laparoscopic ureteral reimplantation (RALUR) at a single center. METHODS Patients who underwent RALUR between 7/2006 and 10/2012 were identified. In all procedures, the distal ureter was spatulated for 1.5 centimeters. An approximately 1 centimeter cystotomy was created. The ureterovesical anastomosis was completed in a triangular fashion including two arms of 4-0 PDS suture up the sides of the spatulation and a third arm anteriorly following stent placement to form a widely patent, refluxing anastomosis. All procedures were performed at a single institution. A retrospective review of perioperative and clinical data was performed assessing operative time, estimated blood loss, length of admission, and success of procedure as indicated by the absence of obstruction on follow-up imaging. RESULTS A total of 21 patients underwent RALUR in the study period. Mean age of patients was 43.2 years. 20 of the 21 RALUR were completed robotically with conversion to open in one patient. Etiology of injury included 11 due to gynecologic procedural injury and three secondary to iatrogenic ureteral injuries. The remainder were comprised of congenital, non-gynecologic surgery, radiation, and idiopathic. 13 required psoas hitch procedure as well. Mean operative time was 237 minutes. Mean estimated blood loss was 85cc. Mean length of hospital admission was 3.1 days. Currently, all patients remain non-obstructed by Lasix renogram at mean follow-up of 12.4 months. CONCLUSIONS RALUR with psoas hitch (when indicated) is a safe and effective option for distal ureteral reconstruction. Further investigation will help to more clearly refine patient selection and delineate patient benefits in comparison to an open procedure. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e407 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Zainfeld More articles by this author Andrew Windsperger More articles by this author Moben Mirza More articles by this author David Duchene More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Short-term efficacy of da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer: a Meta analysis

Objective To compare the short-term efficacy between da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer. Methods Database including PubMed, EMBASE, the Cochrane Library, Medline, the China National Knowledge Infrastructure (CNKI) , Wanfang Database, VIP and China Biomedicine were searched with the key words of gastric cancer, gastrectomy, da Vinci surgical system, laparoscopic, laparoscopy，胃癌，胃切除术，达芬奇机器人手术系统and腹腔镜. Literatures published between May 2002 and March 2014 were retrieved. Related controlled trials containing the clinical efficacy of da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer were enrolled in the study, and then the literatures were screened and the data were extracted by 2 independent reviewers. The quality of the literatures was assessed, and the data were analyzed using the RevMan 5.2 software. Patients receiving da Vinci robotic surgery and laparoscopic surgery were allocated into the robotic group and laparoscopy group, respectively. The count data were analyzed using the relative risk (RR) and 95% confidence interval (95% CI) , and the measurement data were analyzed using weighted mean difference (WMD) and 95% CI. The heterogeneity of the data was analyzed using the I2 test. Results Eleven literatures including 3 698 cases were enrolled in the study. There were 953 patients in the robotic group and 2 745 patients in the laparoscopic group. There were significant differences in the operation time, volume of intraoperative blood loss, time of postoperative flatus, time of first oral intake and duration of postoperative hospital stay between the 2 groups (WMD =51.23, -36.96, -0.24, -0.26, -1.11, 95% CI: 28.01-74.46, -61.28--12.65, -0.42- -0.06, -0.39- -0.14, -1.92- -0.29, P 0.05). Conclusion Da Vinci robotic radical gastrectomy for gastric cancer is safe and feasible, with the advantages of minimal invasion and rapid postoperative recovery. Key words: Gastric neoplasms; Da Vinci robotic surgical system; Laparoscopy; Radical gastrectomy; Meta analysis

A Simplified Approach to Intracorporeal Robot-Assisted Laparoscopic Ileal Conduit Formation

Introduction: During robot-assisted radical cystectomy, urinary diversions are often performed extracorporeally. However, an optimized minimally invasive technique is possible with total intracorporeal urinary diversion. In this video, we provide a step-by-step demonstration of a simplified approach to the intracorporeal robot-assisted laparoscopic ileal conduit with the Wallace and Bricker anastomosis. Methods: A total intracorporeal ileal conduit formation was performed using the da Vinci robotic surgical system. During ureteral dissection and tunneling, the sigmoid colon was retracted using a dual-blade retractor. A 15-cm segment of ileum ~20 cm from the ileocecal valve was used for the conduit. A 60-mm endoscopic stapler was used to staple, transect, and restore the continuity of bowel segments. Both the Bricker and Wallace ureteroileal anastomoses were performed using a 4-0 monofilament absorbable suture on an RB-1 needle in a continuous manner. Results: This technique of robot-assisted total intracorporeal ileal conduit urinary diversion was performed in 11 patients. No patients developed uretero-enteric or entero-enteric anastomotic leak. One patient required re-operation for bowel obstruction. When performed along with robotic assisted cystectomy and lymphadenectomy, mean total operative time was 445 minutes and mean hospital stay was 7 days. Conclusion: Robotic total intracorporeal ileal conduit urinary diversion offers a truly minimally invasive technique that can be performed for a variety of indications, regardless of the need for specimen extraction. While following similar steps to the traditional Bricker or Wallace anastomosis, the robotic intracorporeal approach utilizes precise control of surgical instruments and allows for a meticulous dissection with minimal blood loss. For patients undergoing radical cystectomy, females bore no abdominal incisions other than port sites since the specimen is removed through the vagina. In males, the incision can be limited to ~5 cm and placed either periumbilical or Pfannenstiel. The authors declare that no competing financial interests exist. Runtime of video: 5 mins

English

Objective: To demonstrate the feasibility of using da Vinci robotic surgical system to perform spinal surgery. Methods: Magnetic resonance imaging (MRI) of a 29-year-old female patient complaining right pelvic pain for 1 month revealed a 17x8x10 cm non-homogeneous dumbbell shape encapsulated mass with cystic change located in the pelvic cavity and caused an anterior displacement of urinary bladder and colon. Results: There was no systemic complication and pain decrease 24 hours after surgery and during 2 years of follow up. The patient started a diet 6 hours after the surgery and was discharged 72 hours after the surgery. The pathological diagnosis of the tumor was schwannoma. Conclusions: Giant dumbbell shape presacral schwannomas are rare tumours and their surgical treatment is challenging because of the complex anatomy of the presacral. Clinical application of da Vinci robotic surgical system in the spinal surgical field is currently confined to the treatment of some specific diseases or procedures. However, robotic surgery is expected to play a practical future role as it is minimally invasive. The advent of robotic technology will prove to be a boon to the neurosurgeon. Keywords: da Vinci robotic surgical system, presacral, schwannoma DOI: 10.15850/ijihs.v3n1.407

Robotics and medicine: A scientific rainbow in hospital.

The journey of robotics is a real wonder and astonishingly can be considered as a scientific rainbow showering surprising priceless power in the era of future technologies. The astonishing seven technologies discussed in this paper are da Vinci Robotic surgical system and sperm sorters for infertility, Veebot for blood investigation, Hanako the robotic dental patient for simulating the dental patient and helping a trainee dentist, RP-7 robot who is around-the-clock physician connecting the physician and patient, Robot for Interactive Body Assistance (RIBA) who is a RIBA serving as a nurse, Bushbot serving as a brilliant surgeon, and Virtibot helping in virtual autopsy. Thus, robotics in medicine is a budding field contributing a great lot to human life from before birth to afterlife in seven forms thus gracefully portraying a scientific rainbow in hospital environment.

Robotic Trans-Abdominal Transplant Nephrectomy for a Failed Renal Allograft

Minimally invasive surgery for removal of a failed renal allograft has not previously been reported. Herein, we report the first robotic trans-abdominal transplant nephrectomy (TN). A 34-year-old male with Alport’s syndrome lost function of his deceased donor allograft after 12 years and presented with fever, pain over his allograft and hematuria. The operation was performed intra-abdominally using the Da Vinci Robotic Surgical System with four trocars. The total operative time was 235 min and the estimated blood loss was less than 25 cm3. There were no peri-operative complications observed and the patient was discharged to home less than 24 h postoperatively. The utilization of robotic technology facilitated the successful performance of a minimally invasive, trans-abdominal TN.

Transoral robotic lingual tonsillectomy in adults: preliminary results

Conclusion: Hypertrophy of lingual tonsils can be safely and effectively managed by transoral robotic surgery via a minimally invasive approach. The operating costs can be relatively high although the advantages to patients seem to justify the procedure. Transoral robotic surgery can represent the definitive treatment in hypertrophy of the lingual tonsils. Objective: The purpose of this work was to assess the feasibility, safety, and outcomes of transoral robotic surgery for lingual tonsillar hypertrophy in adults with obstructive sleep apnea. Methods: Retrospective medical records of six patients who underwent tongue base resection using the da Vinci Surgical Robotic System from September, 2012 through December, 2013 in a tertiary care hospital were evaluated. Demographic data, preoperative and postoperative polysomnography and Epworth Sleepiness Scale (ESS) scores, robot docking time, operative and postoperative aspects including surgical time, amount of bleeding, and early and late complications were collected and analyzed. Results: All patients successfully underwent lingual tonsillectomy using the da Vinci Surgical system. Transnasal endotracheal entubation was performed in all patients and they were all extubated before leaving the operation room. No tracheotomies were performed perioperatively for airway management. The patients were discharged on the fifth postoperative day. Operative time, estimated blood loss, and postoperative complication profiles were within the expected and acceptable limits for lingual tonsillectomy. There was a statistically significant decrease in apnea hypopnea index (AHI) (mean AHI from 27.5 to 6.3) and ESS scores (from 14.1 to 7.1).

Value of the combination of multi-slice spiral computed tomography perfusion scan and intraoperative ultrasonography for localizing insulinoma in the da Vinci robotic surgical system

Objective To investigate the value of the multi-slice spiral computed tomograpby (MSCT) perfusion scan and intraoperative ultrasonography (IOUS) for localizing insulinoma in the da Vinci robotic surgical system.Methods The clinical data of 20 patients with insulinoma who were admitted to the Peking Union Hospital from July 2013 to July 2014 were retrospectively analyzed.The condition of the patients was evaluated by MSCT perfusion scan before operation,and the tumor was located by uhrasonograhy during the operation.The operation methods were selected according to the location of the tumors.The diagnostic accuracy of the MSCT perfusion scan and IOUS for locating insulinoma was analyzed,and the operation time,volume of intraoperative blood loss,perioperative complications,pre-and postoperative levels of blood glucose were recorded.Patients were followed up via out-patient cxamination and phone call till July 31,2014.The count data were presented by x ± s and were analyzed using the t test.Results Twenty-one insulinomas were detected in the 20 patients.The accurate rate of the MSCT perfusion scan was 90.0％ (18/20) in locating the tumor,and the accurate rate of the MSCT perfusion scan and intraoperative ultrasonography was 100.0％ (20/20).The blood flow,blood volume,permeability were (97 ±37)mL/(100 mL · min),(20 ± 14)mL/100 mL and (38 ±22)mL/(100 mL · min) in the normal pancreatic tissues,and (170 ±50)mL/(100 mL · min),(26 ± 14) mL/100 mL and (51 ±42)mL/(100 mL · min)in the tumor tissues.The blood flow of the tumor tissues was significantly higher than that of the normal pancreatic tissues (t =5.58,P ＜0.05),while no significant difference was detected in the blood volume and permeability between the tumor tissues and the normal pancreatic tissues (t =1.31,1.18,P ＞ 0.05).Eleven insulinomas were located at the head of the pancreas,6 at the body of the pancreas and 4 at the tail of the pancreas.Of the 20 patients,19 received enucleation of the insulinoma in the da Vinci robotic surgical system (1 of the them was converted to open surgery),and 1 patient received spleen-preserving distal pancreatectomy in the da Vinci robotic surgical system.The operation time and median volume of blood loss were (146 ±54) minutes and 50 mL (range,20-1 000 mL),respectively.No complications such as bleeding,infection or death occurred after the operation.Eleven patients were complicated with grade A pancreatic fistula and 9 with grade B pancreatic fistula.The levels of blood glucose before operation and at 60 minutes after the operation were (3.8 ± 1.0) mmol/L and (6.4 ± 1.8) mmol/L,with significant difference (t =6.69,P ＜ 0.05).The symptoms were dismissed at the deadline of the follow-up,with the remission rate of 100.0％ (20/20).Conclusion Combination of MSCT perfusion scan and IOUS could improve the diagnostic rate of insulinoma,and significantly increase the efficacy of da Vinci robotic surgical system for treating insulinoma. Key words: Insulinoma; Multislice spiral computed tomography perfusion scan; Intraoperative ultrasonography; Da Vinci robotic system

Robotic Surgery Twice Performed in the Treatment of Hilar Cholangiocarcinoma With Deep Jaundice

To explore and find a new method to treat hilar cholangiocarcinoma with deep jaundice assisted by Da Vinci robot. A hilar cholangiocarcinoma patient of type Bismuch-Corlette IIIa was found with deep jaundice (total bilirubin: 635 µmol/L). On the first admission, we performed Da Vinci robotic surgery including drainage of left hepatic duct, dissection of right hepatic vessels (right portal vein and right hepatic artery), and placement of right-hepatic vascular control device. Three weeks later on the second admission when the jaundice disappeared we occluded right-hepatic vascular discontinuously for 6 days and then sustained later. On the third admission after 3 weeks of right-hepatic vascular control, the right hemihepatectomy was performed by Da Vinci robot for the second time. The future liver remnant after the right-hepatic vascular control increased from 35% to 47%. The volume of left lobe increased by 368 mL. When the total bilirubin and liver function were all normal, right hemihepatectomy was performed by Da Vinci robot 10 weeks after the first operation. The removal of atrophic right hepatic lobe with tumor in bile duct was found with no pathologic cancer remaining in the margin. The patient was followed up at our outpatient clinic every 3 months and no tumor recurrence occurs by now (1 y). Under the Da Vinci robotic surgical system, a programmed treatment can be achieved: first, the hepatic vessels were controlled gradually together with biliary drainage, which results in liver's partial atrophy and compensatory hypertrophy in the other part. Then a radical hepatectomy could be achieved. Such programmed hepatectomy provides a new treatment for patients of hilar cholangiocarcinoma with deep jaundice who have the possibility of radical heptolobectomy.

Robotic total thyroidectomy with modified radical neck dissection via unilateral retroauricular approach.

Background Traditionally, total thyroidectomy was performed through an open transcervical incision; in cases where there was evident nodal metastasis, the conventional surgical approach was to extend the incision into a large single transverse incision to complete the required neck dissection. However, recent innovation in the surgical technique of thyroidectomy has offered the opportunity to reduce the patient’s burden from these prominent surgical scars in the neck. Minimally invasive surgical techniques have been developed and applied by many institutions worldwide, and more recently, various techniques of remote access surgery have been suggested and actively applied.1, 2, 3, 4, 5, 6 Since the advent of robotic surgical systems, some have adopted the concept of remote access surgery into developing various robotic thyroidectomy techniques. The more former and widely acknowledged robotic thyroidectomy technique uses a transaxillary (TA) approach, which has been developed by Chung et al. in Korea.7,8 This particular technique has some limitations in the sense that accessing the lymph nodes of the central compartment is troublesome. Terris et al. realized some shortcomings of robotic TA thyroidectomy, especially in their patients in the United States, and developed and reported the feasibility of robotic facelift thyroidectomy.9, 10, 11, 12, 13 In cases of thyroid carcinomas with lateral neck node metastases, most abandoned the concept of minimally invasive or remote access surgery and safely adopted conventional open surgical methods to remove the tumor burden. However, Chung et al. have attempted to perform concomitant modified radical neck dissection (MRND) after robotic thyroidectomy through the same TA port.14 This type of robot-assisted neck dissection (RAND) had some inherent limitations, due to fact that lymph nodes of the upper neck were difficult to remove. Over the past few years, we have developed a RAND via modified facelift (MFL) or retroauricular (RA) approach and reported the feasibility and safety of this technique.15, 16 Since then, we have actively applied such RAND techniques in various head and neck cancers. In our country, almost all cases of robotic total thyroidectomy utilize the TA approach. According to the reports made by Terris et al., robotic facelift thyroidectomy technique has been solely applied for ipsilateral hemithyroidectomy. For total thyroidectomy, Terris et al. performed the robotic surgery with bilateral RA incisions. Here, we intend to introduce our novel surgical method after successfully attempting simultaneous robotic total thyroidectomy and RAND via a single RA approach without an axillary incision. To our knowledge, this is the first to report in the medical literature.

Technology advances in hospital practices: robotics in treatment of patients.

Laparoscopic cholecystectomy is widely considered as the treatment of choice for acute cholecystitis. The safety of the procedure and its minimal invasiveness made it a valid treatment option for a patient not responding to antibiotic therapy. Our research shows that patients positively assess this treatment method, but the world's tendency is to turn to a more sophisticated method utilizing robot-assisted surgery as a gold standard. Providing patient with minimally invasive surgical procedures that utilize the state-of-the-art equipment like the da Vinci Robotic Surgical System underscores the commitment to high-quality patient care while enhancing patient safety. The advantages include minimal invasive scarring, less pain and bleeding, faster recovery time, and shorter hospital stay. The move toward less invasive and less morbid procedures and a need to re-create the true open surgical experience have paved the way for the development and application of robotic and computer-assisted systems in surgery in Poland as well as the rest of the world.

Da Vinci robot-assisted system for thymectomy: experience of 55 patients in China

Da Vinci robot-assisted thymectomy has been used in the past several years in China, however, practical experience in performing this approach in China remains limited. Thus, the study aimed to evaluate the experience of da Vinci robot-assisted thymectomy in China. From June 2010 to December 2012, 55 patients with diseases of the thymus underwent thymectomy using the da Vinci surgical HD robotic system. The clinical data of the da Vinci robot-assisted thymectomies were compared with the data of video-assisted thoracoscopic thymectomies in the same period. All da Vinci robot operations were successful. This is a retrospective analysis which demonstrated that compared with video-assisted thoracoscopic thymectomy in the same period, the clinical outcomes of da Vinci robot-assisted thymectomy were not significantly different. The da Vinci robot-assisted thymectomy is a safe, minimally invasive, and convenient operation, and shows promise for general thoracic surgery in China.

Robotic Extramucosal Excision of Bladder Wall Leiomyoma

Multiple case reports and reviews have been described in the literature for bladder wall leiomyoma resection via different approaches. The minimally invasive partial cystectomy remains the most widely accepted technique; however, case reports for enucleation of bladder wall leiomyoma have also been described. The purpose of this video is to demonstrate the robotic extramucosal excision of a bladder wall leiomyoma, without cystotomy, but with complete removal of the muscular layer. A 35-year old male present with lower urinary tract symptoms and imaging showed bladder wall mass with histopathology showed leiomyoma. The patient consented for mass excision with the possibility of a partial cystectomy. The patient was placed in the supine, 30-degree Trendelenburg position during the procedure. A total of 4 ports were inserted. A 3-arm da Vinci robotic surgical system was docked, and the arms were connected. Extramucosal excision was accomplished without cystotomy and muscle approximation was achieved by 2 0 Vicryle. The operative time was 90 minutes, blood loss of approximately 50mL and the patient was discharged after 72 hours with no immediate complications and a 6 months follow-up showed no recurrence. Such a technique results in complete excision of the tumor, without cystotomy, and also maintains an intact mucosa. These steps, in addition to decreasing the risk of local recurrence, also shorten the period of postoperative catheterization and hospitalization.

The da vinci robot system eliminates multispecialty surgical trainees' hand dominance in open and robotic surgical settings.

Background and Objectives:Handedness, or the inherent dominance of one hand's dexterity over the other's, is a factor in open surgery but has an unknown importance in robot-assisted surgery. We sought to examine whether the robotic surgery platform could eliminate the effect of inherent hand preference.Methods:Residents from the Urology and Obstetrics/Gynecology departments were enrolled. Ambidextrous and left-handed subjects were excluded. After completing a questionnaire, subjects performed three tasks modified from the Fundamentals of Laparoscopic Surgery curriculum. Tasks were performed by hand and then with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, California). Participants were randomized to begin with using either the left or the right hand, and then switch. Left:right ratios were calculated from scores based on time to task completion. Linear regression analysis was used to determine the significance of the impact of surgical technique on hand dominance.Results:Ten subjects were enrolled. The mean difference in raw score performance between the right and left hands was 12.5 seconds for open tasks and 8 seconds for robotic tasks (P < .05). Overall left-right ratios were found to be 1.45 versus 1.12 for the open and robot tasks, respectively (P < .05). Handedness significantly differed between robotic and open approaches for raw time scores (P < .0001) and left-right ratio (P = .03) when controlling for the prior tasks completed, starting hand, prior robotic experience, and comfort level. These findings remain to be validated in larger cohorts.Conclusion:The robotic technique reduces hand dominance in surgical trainees across all task domains. This finding contributes to the known advantages of robotic surgery.

Role of Haptic Interfaces in Robot-Assisted Minimally Invasive Surgery

Robot-Assisted Minimally Invasive Surgery (RAMIS) was introduced in the mid-eighties, when a PUMA robotic arm was used in a neurosurgical biopsy, successfully. RAMIS has evolved since then and has brought a revolution in surgical procedures. In 1990 the AESOP system was introduced by Computer Motion, became the first robotic endoscopic surgical system. Ten years later in year 2000 a fullfledged master/slave Da Vinci robotic surgical system was introduced by Intuitive Surgical,consists of a master console and a slave robotic system.

State of the Art of Robotic Surgery in Organ Transplantation

Within the last two decades the application of minimally invasive surgical technologies has shown significant benefits when it comes to complex surgical procedures. Lower rates of complications and higher patient satisfaction are commonly reported. Until recently these benefits were inaccessible for patients with solid organ transplantation, because conventional laparoscopy was seen as nonapplicable in such technically demanding procedures. The introduction of the da Vinci Robotic Surgical System, with its inherent advantages, has expanded the ability to complete solid organ transplantation in a minimally invasive fashion. Robotic applications in kidney, pancreas, and liver transplantation have been reported. The initial results showed the viability of this technique in the field. The most extensive experience has been described in kidney transplantation. Over 700 donor nephrectomies and more than 70 renal transplants have been performed successfully with the robotic system. The proven advantage of the robotic technique, especially in obese kidney recipients, is a significantly lower rate of surgical site infection, which in these highly immunosuppressed patients is reflected in superior outcomes. The first results in pancreas transplantation and living donor hepatectomy are very promising; however, larger series are needed in order to address the value of the robotic surgery in these areas of solid organ transplantation.

Anesthesia management of artificial intelligence-assisted surgery

Background With the development of minimally invasive surgery in our country,to da Vinci robotic surgical system has been developed to carry out complex and difficult surgery.As the representative of artificial intelligence-assisted surgery systems in clinical surgery more widely,prolonged anesthesia artificial intelligence assisted surgery increases the complexity of the anesthesia presents new challenges.Objective This paper analyzed and summarized the anesthetic management strategies of artificial intellgence-assisted surgery systems.Content This paper reviewed preoperative evaluation,type of anesthesia and anesthetic management of the central nervous system and other aspects in patients in artificial intelligence surgical system.Trend Artificial intelligenc-assisted surgery is an important advance in minimally invasive surgery.The effects about respiratory,circulatory and nervous system need to be further summarized. Key words: Anesthesia; da Vinci Surgical System; Artificial intelligence assisted surgery system