scholarly journals Performance with robotic surgery versus 3D- and 2D­laparoscopy during pancreatic and biliary anastomoses in a biotissue model: pooled analysis of two randomized trials

2021 ◽  
Author(s):  
Maurice J. W. Zwart ◽  
Leia R. Jones ◽  
Ignacio Fuente ◽  
Alberto Balduzzi ◽  
Kosei Takagi ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Robotic Surgery ◽  
Operative Time ◽  
Laparoscopic Group ◽  
Pooled Analysis ◽  
Surgical Performance ◽  
Pooled Data ◽  
3D Laparoscopy ◽  
Time Required ◽  
The Impact

Abstract Background Robotic surgery may improve surgical performance during minimally invasive pancreatoduodenectomy as compared to 3D- and 2D-laparoscopy but comparative studies are lacking. This study assessed the impact of robotic surgery versus 3D- and 2D-laparoscopy on surgical performance and operative time using a standardized biotissue model for pancreatico- and hepatico-jejunostomy using pooled data from two randomized controlled crossover trials (RCTs). Methods Pooled analysis of data from two RCTs with 60 participants (36 surgeons, 24 residents) from 11 countries (December 2017–July 2019) was conducted. Each included participant completed two pancreatico- and two hepatico-jejunostomies in biotissue using 3D-robotic surgery, 3D-laparoscopy, or 2D-laparoscopy. Primary outcomes were the objective structured assessment of technical skills (OSATS: 12–60) rating, scored by observers blinded for 3D/2D and the operative time required to complete both anastomoses. Sensitivity analysis excluded participants with excess experience compared to others. Results A total of 220 anastomoses were completed (robotic 80, 3D-laparoscopy 70, 2D­laparoscopy 70). Participants in the robotic group had less surgical experience [median 1 (0–2) versus 6 years (4–12), p < 0.001], as compared to the laparoscopic group. Robotic surgery resulted in higher OSATS ratings (50, 43, 39 points, p = .021 and p < .001) and shorter operative time (56.5, 65.0, 81.5 min, p = .055 and p < .001), as compared to 3D- and 2D­laparoscopy, respectively, which remained in the sensitivity analysis. Conclusion In a pooled analysis of two RCTs in a biotissue model, robotic surgery resulted in better surgical performance scores and shorter operative time for biotissue pancreatic and biliary anastomoses, as compared to 3D- and 2D-laparoscopy.

3D Vision Provides Shorter Operative Time and More Accurate Intraoperative Surgical Performance in Laparoscopic Hiatal Hernia Repair Compared With 2D Vision

2017 ◽  
Vol 24 (2) ◽  
pp. 155-161 ◽  
Author(s):  
Piera Leon ◽  
Roberta Rivellini ◽  
Fabiola Giudici ◽  
Antonio Sciuto ◽  
Felice Pirozzi ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Operative Time ◽  
Cost Savings ◽  
Laparoscopic Group ◽  
Hiatal Hernia Repair ◽  
High Definition ◽  
Surgical Performance ◽  
3D Vision ◽  
Conversion To Open Surgery ◽  
Laparoscopic Hiatal Hernia Repair

Background. The aim of this study is to evaluate if 3-dimensional high-definition (3D) vision in laparoscopy can prompt advantages over conventional 2D high-definition vision in hiatal hernia (HH) repair. Study design. Between September 2012 and September 2015, we randomized 36 patients affected by symptomatic HH to undergo surgery; 17 patients underwent 2D laparoscopic HH repair, whereas 19 patients underwent the same operation in 3D vision. Results. No conversion to open surgery occurred. Overall operative time was significantly reduced in the 3D laparoscopic group compared with the 2D one (69.9 vs 90.1 minutes, P = .006). Operative time to perform laparoscopic crura closure did not differ significantly between the 2 groups. We observed a tendency to a faster crura closure in the 3D group in the subgroup of patients with mesh positioning (7.5 vs 8.9 minutes, P = .09). Nissen fundoplication was faster in the 3D group without mesh positioning ( P = .07). Conclusions. 3D vision in laparoscopic HH repair helps surgeon’s visualization and seems to lead to operative time reduction. Advantages can result from the enhanced spatial perception of narrow spaces. Less operative time and more accurate surgery translate to benefit for patients and cost savings, compensating the high costs of the 3D technology. However, more data from larger series are needed to firmly assess the advantages of 3D over 2D vision in laparoscopic HH repair.

Impact of radiotherapy on risk of adverse events in patients receiving immunotherapy: A U.S. Food and Drug Administration pooled analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 3018-3018
Author(s):  
Mitchell Steven Anscher ◽  
Shaily Arora ◽  
Chana Weinstock ◽  
Rachael Lubitz ◽  
Anup Amatya ◽  
...  
Keyword(s):  
Adverse Events ◽  
Inflammatory Responses ◽  
Checkpoint Inhibitors ◽  
Pooled Analysis ◽  
Hematologic Toxicity ◽  
Pooled Data ◽  
Advanced Malignancies ◽  
Prospective Trials ◽  
Grade 3 ◽  
The Impact

3018 Background: Immune checkpoint inhibitors (ICIs) are widely used in the treatment of multiple advanced malignancies. Radiotherapy (RT) has been used in combination with ICIs to activate tumor-specific T cell responses, and RT also promotes non-specific acute and chronic inflammatory responses both locally and systemically. More than 50% of patients receive RT at some point during their course of cancer therapy, and relatively little information is available pertaining to the impact of RT, if any, on the risk of adverse events (AEs) in patients receiving ICIs. Methods: Pooled data from prospective trials of ICIs submitted to the FDA in initial or supplemental BLAs or NDAs through 12/2019 were included (N=66). Trials from applications that were withdrawn or not approved were not included. Patients were subdivided by whether or not radiotherapy was administered at any time during the course of their cancer treatment. AEs common to both ICI treatment and RT were identified to focus on the following reactions: neutropenia, thrombocytopenia, colitis, hepatitis, pneumonitis, and myocarditis. Descriptive statistics were used to examine AEs associated with the use of radiation and ICIs. Results: A total of 25,836 patients were identified, of which 9087 (35%) received RT and 16,749 (65%) did not. Radiation was associated with similar rates of AEs overall with numerically higher hematologic toxicities and pneumonitis and numerically lower colitis, hepatitis and myocarditis (Table). Patients receiving RT were more likely to experience Grade 3-5 hematologic toxicities compared to those not receiving RT. Conclusions: To our knowledge, this is the largest report of AE risk associated with the use of radiation and ICIs. Our results show that the incidence of hematologic toxicity and pneumonitis in patients receiving RT may be slightly higher. Analysis to determine comparability of baseline demographic characteristics, comprehensive AE profile, and timing of RT is underway. [Table: see text]

scholarly journals A comparison between laparoscopic and robotic-assisted laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction

2020 ◽  
Author(s):  
Niwat Lukkanawong ◽  
Masashi Honda ◽  
Shogo Teraoka ◽  
Yusuke Kimura ◽  
Tetsuya Yumioka ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Operative Time ◽  
Ureteropelvic Junction Obstruction ◽  
Laparoscopic Group ◽  
Ureteropelvic Junction ◽  
Laparoscopic Pyeloplasty ◽  
Robotic Group ◽  
Robotic Assisted ◽  
Drain Removal ◽  
Significant Difference

Abstract Background The aim of this study is to compare the results of laparoscopic pyeloplasty and robotic-assisted laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction. Methods Between March 2008 and May 2019, the patients who underwent retroperitoneal laparoscopic or robotic-assisted laparoscopic pyeloplasty in our institution were retrospectively reviewed. Results Thirteen patients underwent laparoscopically, and 12 patients underwent robotic surgery. The significant difference was found in median operative time between laparoscopic group (296 minutes) and robotic group (199 minutes) (P = 0.001). The median time for drain removal in laparoscopic group was longer than robotic group (3 vs 2 days, respectively, P = 0.029). Conclusions Laparoscopic and robotic-assisted laparoscopic pyeloplasty is safe and excellent success rates in patients with ureteropelvic junction obstruction. However, our experience study suggested that robotic surgery improves a total operative time, decreases drain removal time and less intraoperative blood loss than laparoscopic approach.

The Impact of Body Mass Index on Perioperative Outcomes of Robotic Adrenalectomy: An Update

2019 ◽  
Vol 26 (6) ◽  
pp. 687-691 ◽  
Author(s):  
Orhan Agcaoglu ◽  
Melis Akbas ◽  
Murat Ozdemir ◽  
Ozer Makay
Keyword(s):  
Body Mass Index ◽  
Robotic Surgery ◽  
Blood Loss ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Perioperative Outcomes ◽  
Total Operative Time ◽  
Estimated Blood Loss ◽  
Robotic Adrenalectomy ◽  
The Impact

Background. Robotic surgery has gained increasing popularity over the past 2 decades. However, factors including patient comorbidities and tumor characteristics are still crucial factors for outcomes of surgery. In this study, we evaluated the impact of body mass index (BMI) on perioperative outcomes in patients who underwent robotic adrenal surgery. Methods. Between May 2012 and November 2017, 66 consecutive patients who underwent robotic adrenalectomy were included in this study. Patients were divided into 2 groups based on their BMI: nonobese (<30 kg/m2) and obese (≥30 kg/m2). Additionally, patient demographics, tumor size, total operative time, docking time, console time, estimated blood loss, conversion to open, complications, additional analgesia requirement, length of hospital stay, and rough costs were evaluated. Results. Of the 66 patients, a total of 26 patients were obese (30%). Between study groups, the median BMI was calculated as 26 (18-29) and 33 (30-57). The groups were similar in terms of age, gender, American Society of Anesthesiologists scores, and previous history of abdominal surgery. Likewise, there were no significant differences between groups regarding total operative time ( P = .085), docking time ( P = .196), console time ( P = .211), estimated blood loss ( P = .180), complications ( P = .991), length of hospital stay ( P = .598), and rough costs ( P = .468). Five cases were converted to open surgery. Nonobese cases required additional analgesia ( P = .007). We had no unexpected hospitalizations in either group. Conclusion. Guidelines express the advantages of robotic surgery in obese patients. No statistically significant differences were detected between the 2 groups except for the additional analgesia required in nonobese patients.

Short-Term Outcomes with Robotic Right Colectomy

2018 ◽  
Vol 84 (11) ◽  
pp. 1768-1773 ◽  
Author(s):  
Scott R. Kelley ◽  
Emilie Duchalais ◽  
David W. Larson
Keyword(s):  
Robotic Surgery ◽  
Operative Time ◽  
Univariate Analysis ◽  
Oral Morphine ◽  
Intracorporeal Anastomosis ◽  
Right Colectomy ◽  
Laparoscopic Technique ◽  
Short Term ◽  
Robotic Right Colectomy ◽  
The Impact

Few series have reported on the impact of robotic right colectomy compared with conventional laparoscopy. Even fewer have reported on the outcomes of intracorporeal anastomoses. The aim of our study was to determine the impact of robotic surgery on short-term operative outcomes in patients undergoing right colectomy with intracorporeal anastomosis. One hundred and fourteen consecutive patients who underwent a right colectomy by two colorectal surgeons between 2012 and 2017 were included. Patients were separated into two groups: laparoscopic technique with extracorporeal anastomosis (n = 87) and robotic technique with intracorporeal anastomosis (n = 27). Univariate analysis was performed to determine differences in outcomes. Differences between cohorts were only identified with regard to gender (62 vs 37%, P = 0.022) and year of surgery. In comparison with laparoscopy, robotic colectomy resulted in a shorter time of GI recovery (1.3 ± 0.6 vs 3 ± 1.1, P < 0.0001), lower rates of postoperative ileus (4 vs 28%, P = 0.007), lower overall morbidity (26 vs 52%, P = 0.019), less blood loss ( P = 0.001), 50 per cent lower narcotic use, and longer operative time (255 ± 66 vs 139 ± 49, P < 0.001). Despite longer operative time, robotic surgery improved GI recovery, significantly lowered oral morphine equivalent usage, and decreased short-term complications.

Neoadjuvant therapy versus upfront surgery for pancreatic adenocarcinoma: A propensity score matched analysis of short-term outcomes.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 361-361
Author(s):  
Gyulnara G. Kasumova ◽  
Susanna W.L. de Geus ◽  
Omidreza Tabatabaie ◽  
Ayotunde B. Fadayomi ◽  
Rebecca A. Miksad ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Propensity Score ◽  
Neoadjuvant Therapy ◽  
Operative Time ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Vascular Resection ◽  
Pancreatic Tumors ◽  
Significant Difference ◽  
The Impact

361 Background: Neoadjuvant therapy is increasingly utilized and has demonstrated a survival advantage in borderline and locally advanced pancreatic cancer. However, many have feared that preoperative chemotherapy and radiation result in a more challenging operative field and consequently increased morbidity. Methods: ACS-NSQIP targeted pancreas database was queried for patients with adenocarcinoma who underwent PD in 2014. Propensity score matching was used to account for potential selection bias in pre-operative and intra-operative characteristics. Sensitivity analysis assessed the impact of neoadjuvant radiation. Results: 1,313 patients were identified, of whom 338 (25.7%) received neoadjuvant therapy. Patients who received neoadjuvant therapy vs upfront surgery were more likely to be: female (53.6% vs 47.2%; p=0.04), < 65 years of age (53.0% vs 39.2%; p < 0.0001), have BMI <25.0 (43.5% vs 36.6%; p = 0.03), and require vascular resection (37.6% vs 19.6%; p < 0.0001). Patients receiving neoadjuvant therapy were less likely to develop pancreatic fistulae (9.2% vs 14.0%; p = 0.02), more likely to require transfusion (27.8% vs 22.4%; p = 0.04), and had longer operative time (median: 405 vs 371 mins; p < 0.0001). After matching, there were no differences in baseline characteristics, approach, biliary stenting, and vascular resection. The only significant difference in outcomes between the two groups was longer operative time (median 405 vs 377, p = 0.006; Table). These results were robust on sensitivity analysis for use of radiation. Conclusions: Neoadjuvant therapy is safe and, despite prolonging operative time, does not affect 30-day outcomes. Concern for increased morbidity should no longer preclude treatment with neoadjuvant chemotherapy and/or radiation in borderline, locally advanced, and resectable pancreatic tumors. [Table: see text]

Is it Worth CANVASing for CREDENCE? A Benefit-risk Analysis

2020 ◽  
Vol 16 (5) ◽  
pp. 509-514
Author(s):  
Binayak Sinha ◽  
Samit Ghosal
Keyword(s):  
Adverse Events ◽  
Fungal Infections ◽  
Absolute Risk ◽  
Pooled Analysis ◽  
Major Adverse Cardiovascular Events ◽  
Number Needed To Treat ◽  
Pooled Data ◽  
The Individual ◽  
Fracture Risks ◽  
Number Needed To Harm

Background and Aims: A number of significant positive and negative signals emerged from the CANVAS Program and CREDENCE trial with the use of canagliflozin. These signals are confusing. A Likelihood of being Helped of Harmed (LHH) analysis was conducted to determine the risk, benefit ratio associated with canagliflozin use and address the signals as a continuum. Materials &Methods: LHH was calculated from the number needed to treat (NNT) and number needed to harm (NNH) available from the absolute risk reductions reported with the outcomes of interest, in these two trials. Results: In the CANVAS Program, LHH for major adverse cardiovascular events (MACE) points at a significant benefit with canagliflozin use in comparison to amputation (1.65), fractures (1.65) and euglycaemic diabetic ketoacidosis (euDKA) (16.67) risks. Only genital fungal infections were significant more in both sexes (0.21-M and 0.1-F) when LHH was matched against the positive outcomes. In contrast, the hHF benefits were outweighed by amputation (0.95) and fracture risks (0.95). : In CREDENCE trial, the LHH for Primary composite, Renal composite and MACE, all supported the benefits in comparison to any adverse events encountered in the trial. : The LHH from pooled data (CANVAS Program and CREDENCE trial) was in favour of all the benefits (hHF and renal composites) except for MACE matched against amputation (0.66). Conclusion: The outcome benefits were in favour of canagliflozin in comparison to all reported adverse events, when hHF and renal composite were under consideration, in both the individual and pooled LHH analysis. However, the MACE benefits were overwhelmed by amputation risk in the pooled analysis.

scholarly journals Robust Inferences from a Before-and-After Study with Multiple Unaffected Control Groups

2013 ◽  
Vol 1 (2) ◽  
pp. 209-234 ◽  
Author(s):  
Pengyuan Wang ◽  
Mikhail Traskin ◽  
Dylan S. Small
Keyword(s):  
Sensitivity Analysis ◽  
Control Groups ◽  
Two Stage ◽  
Time Effects ◽  
Unaffected Control ◽  
Group Time ◽  
Before And After ◽  
Group Variation ◽  
The Impact ◽  
Before And After Study

AbstractThe before-and-after study with multiple unaffected control groups is widely applied to study treatment effects. The current methods usually assume that the control groups’ differences between the before and after periods, i.e. the group time effects, follow a normal distribution. However, there is usually no strong a priori evidence for the normality assumption, and there are not enough control groups to check the assumption. We propose to use a flexible skew-t distribution family to model group time effects, and consider a range of plausible skew-t distributions. Based on the skew-t distribution assumption, we propose a robust-t method to guarantee nominal significance level under a wide range of skew-t distributions, and hence make the inference robust to misspecification of the distribution of group time effects. We also propose a two-stage approach, which has lower power compared to the robust-t method, but provides an opportunity to conduct sensitivity analysis. Hence, the overall method of analysis is to use the robust-t method to test for the overall hypothesized range of shapes of group variation; if the test fails to reject, use the two-stage method to conduct a sensitivity analysis to see if there is a subset of group variation parameters for which we can be confident that there is a treatment effect. We apply the proposed methods to two datasets. One dataset is from the Current Population Survey (CPS) to study the impact of the Mariel Boatlift on Miami unemployment rates between 1979 and 1982.The other dataset contains the student enrollment and grade repeating data in West Germany in the 1960s with which we study the impact of the short school year in 1966–1967 on grade repeating rates.

scholarly journals A Model for the Thermal Behaviour of an Offshore Cable Installed in a J-Tube

Proceedings ◽  
2020 ◽  
Vol 58 (1) ◽  
pp. 31
Author(s):  
Jeremy Arancio ◽  
Ahmed Ould El Moctar ◽  
Minh Nguyen Tuan ◽  
Faradj Tayat ◽  
Jean-Philippe Roques
Keyword(s):  
Sensitivity Analysis ◽  
Numerical Model ◽  
Thermal Behaviour ◽  
Energy Production ◽  
Power Transmission ◽  
Temperature Fields ◽  
Sobol Indices ◽  
Lumped Element ◽  
Thermal Phenomena ◽  
The Impact

In the race for energy production, supplier companies are concerned by the thermal rating of offshore cables installed in a J-tube, not covered by IEC 60287 standards, and are now looking for solutions to optimize this type of system. This paper presents a numerical model capable of calculating temperature fields of a power transmission cable installed in a J-tube, based on the lumped element method. This model is validated against the existing literature. A sensitivity analysis performed using Sobol indices is then presented in order to understand the impact of the different parameters involved in the heating of the cable. This analysis provides an understanding of the thermal phenomena in the J-tube and paves the way for potential technical and economic solutions to increase the ampacity of offshore cables installed in a J-tube.

Sign in / Sign up

Export Citation Format

Share Document