Vinci Xi Surgical System Research Articles

V7-05 ROBOTIC ASSISTED LAPAROSCOPIC ADRENALECTOMY IN THE SETTING OF AN INCIDENTAL ADRENAL MASS

You have accessJournal of UrologyPediatrics1 Apr 2017V7-05 ROBOTIC ASSISTED LAPAROSCOPIC ADRENALECTOMY IN THE SETTING OF AN INCIDENTAL ADRENAL MASS Eli Thompson, Evalynn Vasquez, Paul Kokorowski, and Andy Chang Eli ThompsonEli Thompson More articles by this author , Evalynn VasquezEvalynn Vasquez More articles by this author , Paul KokorowskiPaul Kokorowski More articles by this author , and Andy ChangAndy Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1923AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since Rudolf Virchow first described abdominal “glioma” tumors in children, neuroblastoma has come to be recognized as the most common malignancy in infants and the most common solid malignancy in children. Resection in neuroblastomas that are classified as low risk is often curative. Traditionally the standard operative management has been open surgical resection. More recently however, a shift towards minimally invasive approaches has been described. Here we report a case of neuroblastoma managed with robotic assisted laparoscopic adrenalectomy. This is the first robotic adrenalectomy performed at our institution and, to the best of our knowledge, the first performed on a Da Vinci Xi robot. METHODS A single case was reviewed and reported. RESULTS A 2-year-old female with a history of a febrile urinary tract infection found to have a poorly functioning left upper pole moiety with ectopic ureter initially underwent a successful robotic assisted left upper pole partial nephrectomy. On her postoperative renal ultrasound, she was found to have a new right sided adrenal mass. This was confirmed with MRI and MIBG scan. Metanephrinies, homovanillic acid, and vanillylmandelic acid levels were obtained to evaluate for pheochromocytoma and were within normal limits. Robotic assisted laparoscopic right adrenalectomy was then performed. Intraoperatively, a small iatrogenic cavotomy was made and repaired. There were no further complications and the patient tolerated the procedure well. She had an uneventful recovery and was discharged home on post-operative day two. CONCLUSIONS Robotic assisted laparoscopic adrenalectomy represents a viable option for surgical excision of adrenal tumors and can be accomplished with rapid recovery time, decreased surgical morbidity, and comparable oncologic outcomes. Injury to surrounding vessels presents a known complication to adrenalectomy. Our case demonstrates the advantage of a Da Vinci Xi surgical system for laparoscopic vascular repair and tumor excision. In our experience, while adhering to sound oncologic surgical principles, a robotic assisted laparoscopic approach can be considered as an alternative to traditional open adrenalectomy for select children with neuroblastoma. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e824 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Eli Thompson More articles by this author Evalynn Vasquez More articles by this author Paul Kokorowski More articles by this author Andy Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Transoral robotic thyroidectomy: a preclinical feasibility study using the da Vinci Xi platform

Transoral thyroid surgery allows the surgeon to conceal incisions within the oral cavity without significantly increasing the amount of required dissection. TORT provides an ideal scarless, midline access to the thyroid gland and bilateral central neck compartments. This approach, however, presents multiple technical challenges. Herein, we present our experience using the latest generation robotic surgical system to accomplish transoral robotic thyroidectomy (TORT). In two human cadavers, the da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was used to complete TORT. Total thyroidectomy and bilateral central neck dissection was successfully completed in both cadavers. The da Vinci Xi platform offered several technologic advantages over previous robotic generations including overhead docking, narrower arms, and improved range of motion allowing for improved execution of previously described TORT techniques.

Early clinical experience with the da Vinci Xi Surgical System in general surgery.

The da Vinci Xi Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) has been released in 2014 to facilitate minimally invasive surgery. Novel features are targeted towards facilitating complex multi-quadrant procedures, but data is scarce so far. Perioperative data of patients who underwent robotic general surgery with the da Vinci Xi system within the first 6month after installation were collected and analyzed. The gastric bypass procedures performed with the da Vinci Xi Surgical System were compared to an equal amount of the last procedures with the da Vinci Si Surgical System. Thirty-one foregut (28 Roux-en-Y gastric bypasses), 6 colorectal procedures and 1 revisional biliary procedure were performed. The mean operating room (OR) time was 221.8 (±69.0) minutes for gastric bypasses and 306.5 (±48.8) for colorectal procedures with mean docking time of 9.4 (±3.8) minutes. The gastric bypass procedure was transitioned from a hybrid to a fully robotic approach. In comparison to the last 28 gastric bypass procedures performed with the da Vinci Si Surgical System, the OR time was comparable (226.9 versus 230.6min, p=0.8094), but the docking time significantly longer with the da Vinci Xi Surgical System (8.5 versus 6.1min, p=0.0415). All colorectal procedures were performed with a single robotic docking. No intraoperative and two postoperative complications occurred. The da Vinci Xi might facilitate single-setups of totally robotic gastric bypass and colorectal surgeries. However, further comparable research is needed to clearly determine the significance of this latest version of the da Vinci Surgical System.

First series of total robotic hysterectomy (TRH) using new integrated table motion for the da Vinci Xi: feasibility, safety and efficacy.

To present the first case series of total robotic hysterectomy (TRH), using integrated table motion (ITM), which is a new feature comprising a unique operating table by Trumpf Medical that communicates wirelessly with the da Vinci Xi surgical system. ITM has been specifically developed to improve multiquadrant robotic surgery such as that conducted in colorectal surgery. Between May and October 2015, a prospective post-market study was conducted on ITM in the EU in 40 cases from different specialties. The gynecological study group comprised 12 patients. Primary endpoints were ITM feasibility, safety and efficacy. Ten patients underwent TRH. Mean number of ITM moves was three during TRH; there were 31 instances of table moves in the ten procedures. Twenty-eight of 31 ITM moves were made to gain internal exposure. The endoscope remained inserted during 29 of the 31 table movements (94%), while the instruments remained inserted during 27 of the 31 moves (87%). No external instrument collisions or other problems related to the operating table were noted. There were no ITM safety-related observations and no adverse events. This preliminary study demonstrated the feasibility, safety and efficacy of ITM for the da Vinci Xi surgical system in TRH. ITM was safe, with no adverse events related to its use. Further studies will be useful to define the real role and potential benefit of ITM in gynecological surgery.

Proctors exploit three-dimensional ghost tools during clinical-like training scenarios: a preliminary study

PurposeIn this study, we examine three-dimensional (3D) proctoring tools (i.e., semitransparent ghost tools overlaid on the surgeon’s field of view) on realistic surgical tasks. Additionally, we develop novel, quantitative measures of whether proctors exploit the additional capabilities offered by ghost tools.MethodsSeven proctor–trainee pairs completed realistic surgical tasks such as tissue dissection and suturing in a live porcine model using 3D ghost tools on the da Vinci Xi Surgical System. The usability and effectiveness of 3D ghost tools were evaluated using objective measures of proctor performance based on proctor hand movements and button presses, as well as post-study questionnaires.ResultsProctors exploited the capabilities of ghost tools, such as 3D hand movement (p < 0.001), wristedness (p < 0.001), finger pinch gestures (p < 0.001), and bimanual hand motions (p < 0.001). The median ghost tool excursion distances across proctors in the x-, y-, and z-directions were 57.6, 31.9, and 50.7, respectively. Proctors and trainees consistently evaluated the ghost tools as effective across multiple categories of mentoring. Trainees found ghost tools more helpful than proctors across all categories (p < 0.05).ConclusionsProctors exploit the augmented capabilities of 3D ghost tools during clinical-like training scenarios. Additionally, both proctors and trainees evaluated ghost tools as effective mentoring tools, thereby confirming previous studies on simple, inanimate tasks. Based on this preliminary work, advanced mentoring technologies, such as 3D ghost tools, stand to improve current telementoring and training technologies in robot-assisted minimally invasive surgery.

Applications of Evolving Robotic Technology for Head and Neck Surgery.

Assess the use and potential benefits of a new robotic system for transoral radical tonsillectomy, transoral supraglottic laryngectomy, and retroauricular thyroidectomy in a cadaver dissection. Three previously described robotic procedures (transoral radical tonsillectomy, transoral supraglottic laryngectomy, and retroauricular thyroidectomy) were performed in a cadaver using the da Vinci Xi Surgical System. Surgical exposure and access, operative time, and number of collisions were examined objectively. The new robotic system was used to perform transoral radical tonsillectomy with dissection and preservation of glossopharyngeal nerve branches, transoral supraglottic laryngectomy, and retroauricular thyroidectomy. There was excellent exposure without any difficulties in access. Robotic operative times (excluding set-up and docking times) for the 3 procedures in the cadaver were 12.7, 14.3, and 21.2 minutes (excluding retroauricular incision and subplatysmal elevation), respectively. No robotic arm collisions were noted during these 3 procedures. The retroauricular thyroidectomy was performed using 4 robotic ports, each with 8 mm instruments. The use of updated and evolving robotic technology improves the ease of previously described robotic head and neck procedures and may allow surgeons to perform increasingly complex surgeries.

Operative technique and early experience for robotic-assisted laparoscopic nephroureterectomy (RALNU) using da Vinci Xi.

PurposeRobotic-assisted laparoscopic nephroureterectomy (RALNU) has been previously utilized for management of upper tract urothelial carcinoma. The da Vinci Xi surgical system was released in April of 2014. We describe our operative technique and early experience for RALNU using the da Vinci Xi system highlighting unique features of this surgical platform.Materials and methodsA total of 10 patients with a diagnosis of upper tract urothelial carcinoma underwent RALNU using the da Vinci Xi system between April and November of 2014. A novel, oblique “in line” robotic trocar configuration was utilized to access the upper abdomen (nephrectomy portion) and pelvis (bladder cuff excision) without undocking. The port hopping feature of da Vinci Xi was utilized to facilitate optimal, multi-quadrant visualization during RALNU.ResultsRobotic-assisted laparoscopic nephroureterectomy was successfully completed without open conversion in all 10 patients. Mean operative time was 184 min (range 140–300 min), mean estimated blood loss was 121 cc (range 60–300 cc), and mean hospital stay was 2.4 days. Final pathology demonstrated high grade urothelial carcinoma in all patients. Surgical margins were negative in all patients. No intra-operative complications were encountered. One patient developed a pulmonary embolus after being discharged. No patients required a blood transfusion. Mean patient follow-up was 130 days (range 15–210 days).ConclusionThe use of da Vinci Xi with a novel, oblique “in line” port configuration and camera port hopping technique allows for an efficient and reproducible method for RALNU without the need for repositioning the patient or the robot during surgery.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-1076-6) contains supplementary material, which is available to authorized users.