Can Robotic-Assisted Surgery Overcome the Risk of Mortality in Cardiac Reoperation?

2018 ◽  
Vol 13 (6) ◽  
pp. 438-444 ◽  
Author(s):  
Hiroto Kitahara ◽  
Brody Wehman ◽  
Husam H. Balkhy
Keyword(s):  
Robotic Surgery ◽  
Three Dimensional ◽  
Robotic Assistance ◽  
Robotic Arms ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Risk Of Mortality ◽  
Prolonged Ventilation ◽  
Cardiac Reoperation ◽  
The Mean

Objective A robotic-assisted approach potentially has many advantages for cardiac reoperation, which include sternum-sparing and three-dimensional visualization leading to precise adhesiolysis and excellent exposure in a limited field. Methods We retrospectively reviewed our patients undergoing robotic cardiac reoperation (redo group) from July 2013 to April 2017 at our institution and compared with our patients undergoing standard robotic surgery (nonredo group). In the reoperative cases, a thoracoscope was inserted through a 5-mm port placed away from the previous scar. Another 5-mm port was inserted under direct vision to make space for one or two robotic arms, and further precise dissection was performed robotically. Results A total of 486 patients underwent robotic-assisted cardiac surgery. There were 36 patients who had one or more previous cardiac surgeries (42 surgeries). Although the mean operative and cardiopulmonary bypass time were longer in the redo group (median = 351 minutes vs. 289 minutes and 219 minutes vs. 178 minutes, P < 0.05, respectively), cardiac arrest time was similar between two groups. The redo group had a higher incidence of postoperative prolonged ventilation (16.7% vs. 6.9%, P = 0.046) and pneumonia (11.1% vs. 0.2%, P < 0.001). The 30-day mortality was 2.8% (1/36) in the redo group and similar to that in the nonredo group (1.3%, P = 0.419). Conclusions Robotic cardiac reoperation is feasible with acceptable clinical outcomes including a low mortality rate similar to standard robotic surgery in our hands. Robotic assistance may have the potential to minimize morbidity and mortality.

scholarly journals The follow-up of the robotic-assisted Soave procedure for Hirschsprung’s disease in children

2021 ◽  
Author(s):  
Tran Anh Quynh ◽  
Pham Duy Hien ◽  
Le Quang Du ◽  
Le Hoang Long ◽  
Nguyen Thi Ngoc Tran ◽  
...  
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Pediatric Patients ◽  
Three Dimensional ◽  
Dentate Line ◽  
Robotic Arms ◽  
Robotic Assisted ◽  
The Mean ◽  
Pull Through

AbstractRobotic surgery offers three-dimensional visualization and precision of movement that could be of great value to gastrointestinal surgeons. There were many previous reports on robotic technology in performing Soave colonic resection and pull-through for Hirschsprung’s disease in children. This study described the follow-up of the Robotic-assisted Soave procedure for Hirschsprung’s disease in children. Robotic-assisted endorectal pull-through was performed using three robotic arms and an additional 5-mm trocar. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies. The rest of the procedure was carried out according to the Soave procedure. We left a short rectal seromuscular sleeve of 1.5–2 cm above the dentate line. From December 2014 to December 2017, 55 pediatric patients were operated on. Age ranged from 6 months to 10 years old (median = 24.5 months). The aganglionic segment was located in the rectum (n = 38), the sigmoid colon (n = 13), and the left colon (n = 4). The mean total operative time was 93.2 ± 35 min (ranging from 80 to 180 min). Minimal blood was lost during the surgery. During the follow-up period, 41 patients (74.6%) had 1–2 defecations per day, 12 patients (21.8%) had 3–4 defecations per day, and 2 patients (3.6%) had more than 4 defecations per day. Fecal incontinence, enterocolitis, and mild soiling occurred in three (5.4%), four (7.3%), and two pediatric patients, respectively. Robotic-assisted Soave procedure for Hirschsprung’s disease in children is a safe and effective technique. However, a skilled robotic surgical team and procedural modifications are needed.

scholarly journals Robotic-Assisted Surgery for Benign Urological Conditions

2006 ◽  
Vol 6 ◽  
pp. 2573-2580 ◽  
Author(s):  
Declan G. Murphy ◽  
Ben J. Challacombe ◽  
Lail-U-Mah Zaheer ◽  
M. Shamim Khan ◽  
Prokar Dasgupta
Keyword(s):  
Radical Prostatectomy ◽  
Da Vinci ◽  
Robotic Assistance ◽  
Robotic Technology ◽  
Robotic Assisted ◽  
The Past ◽  
Robotic Assisted Surgery ◽  
Urological Procedures ◽  
Robotic Assisted Radical Prostatectomy ◽  
Surgical System

Robotic technology for use in surgery has advanced considerably in the past 10 years. This has become particularly apparent in urology where robotic-assisted radical prostatectomy using the da VinciTMsurgical system (Intuitive Surgical, CA) has become very popular. The use of robotic assistance for benign urological procedures is less well documented. This article considers the current robotic technology and reviews the situation with regard to robotic surgery for benign urological conditions.

Robotic Thoracic Surgery Training for Residency Programs

2018 ◽  
Vol 13 (6) ◽  
pp. 417-422 ◽  
Author(s):  
Wissam N. Raad ◽  
Adil Ayub ◽  
Chyun-Yin Huang ◽  
Landon Guntman ◽  
Sadiq S. Rehmani ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Thoracic Surgery ◽  
Residency Program ◽  
Program Directors ◽  
Robotic Assisted ◽  
Surgery Training ◽  
Robotic Assisted Surgery ◽  
Robotic Surgery Training ◽  
Surgery Residency Program ◽  
Residency Program Directors

Objective Robotic-assisted surgery is increasingly being used in thoracic surgery. Currently, the Integrated Thoracic Surgery Residency Program lacks a standardized curriculum or requirement for training residents in robotic-assisted thoracic surgery. In most circumstances, because of the lack of formal residency training in robotic surgery, hospitals are requiring additional training, mentorship, and formal proctoring of cases before granting credentials to perform robotic-assisted surgery. Therefore, there is necessity for residents in Integrated Thoracic Surgery Residency Program to have early exposure and formal training on the robotic platform. We propose a curriculum that can be incorporated into such programs that would satisfy both training needs and hospital credential requirements. Methods We surveyed all 26 Integrated Thoracic Surgery Residency Program Directors in the United States. We also performed a PubMed literature search using the key word “robotic surgery training curriculum.” We reviewed various robotic surgery training curricula and evaluation tools used by urology, obstetrics gynecology, and general surgery training programs. We then designed a proposed curriculum geared toward thoracic Integrated Thoracic Surgery Residency Program adopted from our credentialing experience, literature review, and survey consensus. Results Of the 26 programs surveyed, we received 17 responses. Most Integrated Thoracic Surgery Residency Program directors believe that it is important to introduce robotic surgery training during residency. Our proposed curriculum is integrated during postgraduate years 2 to 6. In the preclinical stage postgraduate years 2 to 3, residents are required to complete introductory online modules, virtual reality simulator training, and in-house workshops. During clinical stage (postgraduate years 4–6), the resident will serve as a supervised bedside assistant and progress to a console surgeon. Each case will have defined steps that the resident must demonstrate competency. Evaluation will be based on standardized guidelines. Conclusions Expansion and utilization of robotic assistance in thoracic surgery have increased. Our proposed curriculum aims to enable Integrated Thoracic Surgery Residency Program residents to achieve competency in robotic-assisted thoracic surgery and to facilitate the acquirement of hospital privileges when they enter practice.

scholarly journals Challenges of single-stage pancreatoduodenectomy: how to address pancreatogastrostomies with robotic-assisted surgery

2021 ◽  
Author(s):  
Lea Timmermann ◽  
Karl Herbert Hillebrandt ◽  
Matthäus Felsenstein ◽  
Moritz Schmelzle ◽  
Johann Pratschke ◽  
...  
Keyword(s):  
Single Stage ◽  
Morbidity And Mortality ◽  
R0 Resection ◽  
Robotic Assistance ◽  
Open Approach ◽  
The Novel ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Operation Rate ◽  
Complications And Mortality

Abstract Introduction Establishing a sufficient pancreatico-enteric anastomosis remains one of the most important challenges in open single stage pancreatoduodenectomy as they are associated with persisting morbidity and mortality. Applicability on a robotic-assisted approach, however, even increases the requirements. With this analysis we introduce a dorsal-incision-only invagination type pancreatogastrostomy (dioPG) to the field of robotic assistance having been previously proven feasible in the field of open pancreatoduodenectomy and compare initial results to the open approach by means of morbidity and mortality. Methods An overall of 142 consecutive patients undergoing reconstruction via the novel dioPG, 38 of them in a robotic-assisted and 104 in an open approach, was identified and further reviewed for perioperative parameters, complications and mortality. Results We observed a comparable R0-resection rate (p = 0.448), overall complication rate (p = 0.52) and 30-day mortality (p = 0.71) in both groups. Rates of common complications, such as postoperative pancreatic fistula (p = 0.332), postoperative pancreatic hemorrhage (p = 0.242), insufficiency of pancreatogastrostomy (p = 0.103), insufficiency of hepaticojejunostomy (p = 0.445) and the re-operation rate (p = 0.103) were comparable. The procedure time for the open approach was significantly shorter compared to the robotic-assisted approach (p = 0.024). Discussion The provided anastomosis appeared applicable to a robotic-assisted setting resulting in comparable complication and mortality rates when compared to an open approach. Nevertheless, also in the field of robotic assistance establishing a predictable pancreatico-enteric anastomosis remains the most challenging aspect of modern single-stage pancreatoduodenectomy and requires expertise and experience.

scholarly journals 1141 Robotic Assisted Surgery in Horseshoe Kidneys: A Safety and Feasibility Multicentre Case Series

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Ng ◽  
A Nathan ◽  
N Campain ◽  
Y Yuminaga ◽  
F Mumtaz ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Anatomical Variation ◽  
High Volume ◽  
Perioperative Outcomes ◽  
Open Approach ◽  
Robot Assisted ◽  
Renal Masses ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Estimated Blood Loss

Abstract Introduction Horseshoe kidneys (HSK) are the most common renal fusion abnormality. However, they are only present in 0.2% of the population. Due to anatomical variation in vasculature, ectopia and malrotation, surgery has traditionally been performed via an open approach. We aimed to assess the safety and feasibility of robot-assisted surgery for HSK. Method Six patients (four female, two male) with HSKs were operated on between 2016 and 2019 across two high-volume centres by high-volume surgeons. All operations were robot-assisted, with three partial nephrectomies and one nephroureterectomy for renal masses and two benign nephrectomies for non-functioning kidneys. 3D reconstruction using CT renal angiograms was used to help identify vasculature and tumour location (where appropriate). Results The median age was 53 years (IQR 47-58.3) and the median BMI was 25 (IQR 25-25.8). Median tumour size in the four patients with renal masses was 35.5 mm (IQR 25.3-44.8). Median console time was 120 minutes (IQR 117-172.5) and the median estimated blood loss was 150 mL (IQR 112.5-262.5). The median pre-operative eGFR was 76 (IQR 70-86.5) and median post-operative eGFR was 65.5 (IQR 59.3-80.8). All operations were uneventful, there were no perioperative transfusions and no complications reported. Length of stay was two days for all patients. Conclusions We report the largest series of mixed robotic-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in high-volume centres with acceptable perioperative outcomes. Further prospective, longer-term, multi-centre studies are required to evaluative if robotic surgery for HSK is superior to open surgery.

Robot-assisted percutaneous scaphoid fracture fixation: a report of ten patients

2019 ◽  
Vol 44 (7) ◽  
pp. 685-691 ◽  
Author(s):  
Bo Liu ◽  
Feiran Wu ◽  
Shanlin Chen ◽  
Xieyuan Jiang ◽  
Wei Tian
Keyword(s):  
Scaphoid Fracture ◽  
Three Dimensional ◽  
Contralateral Side ◽  
Level Of Evidence ◽  
Robotic Assisted ◽  
Scaphoid Fractures ◽  
Flexion Extension ◽  
The Mean ◽  
Set Up

This study reports the technique, efficacy and safety of robotic-assisted, computer-navigated, percutaneous fixation of scaphoid fractures. Ten males with acute undisplaced waist fractures underwent fixation with this method using a commercially available three-dimensional fluoroscopy unit and robotic navigation system. The mean total operative duration was 40 minutes, which comprised of a set-up time of 18 minutes and planning and surgical time of 22 minutes. All patients required only a single guidewire insertion attempt, and there were no screw protuberances or other complications. All fractures united at a mean of 8 weeks. At a mean follow-up of 6.5 months (range 6–8), the mean Mayo wrist score was 96, patient-rated wrist evaluation was 2, flexion-extension arc was 96% and grip strength was 91% of the contralateral side. We conclude from our patients that robotic-assisted percutaneous scaphoid fixation is feasible, safe and accurate, and is a satisfactory method for treating these injuries. Level of evidence: IV

Robotic-Assisted Complex Pulmonary Resection: Sleeve Lobectomy for Cancer

2021 ◽  
pp. 155698452199238
Author(s):  
Ammara A. Watkins ◽  
Syed M. Quadri ◽  
Elliot L. Servais
Keyword(s):  
Robotic Surgery ◽  
Pulmonary Resection ◽  
Robotic Assistance ◽  
Minimally Invasive Techniques ◽  
Robotic Platform ◽  
Sleeve Lobectomy ◽  
Robotic Assisted ◽  
Pulmonary Surgery ◽  
Tissue Manipulation ◽  
Invasive Techniques

The use of robotic assistance for complex pulmonary resections such as segmentectomy and sleeve lobectomy has steadily increased in recent years. These operations are technically challenging as they require fine dissection and suturing, which is often difficult to perform using traditional minimally invasive techniques. Robotic surgery is well-suited for complex pulmonary surgery given its specific advantages related to superior optics and precise tissue manipulation and dissection. Herein we describe our technique for robotic-assisted complex pulmonary surgery with a specific focus on right upper sleeve lobectomy for cancer, including associated video case demonstration. The principles discussed are generalizable to other complex lung and tracheobronchial operations and highlight the benefits of the robotic platform.

Robotic-assisted surgery for colorectal and hepatopancreatobiliary neoplasms

2021 ◽  
Vol 75 (5) ◽  
pp. 410-416
Author(s):  
Daniel Langer ◽  
Michal Vočka ◽  
Jaroslav Kalvach ◽  
Jaroslav Pažin ◽  
Miroslav Ryska ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Robotic Surgery ◽  
Randomized Study ◽  
Radical Resection ◽  
Therapeutic Modality ◽  
Cochrane Library ◽  
Mesorectal Excision ◽  
Gastrointestinal Malignancies ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery

Summary: Introduction: The Czech Republic belongs to countries under significant strain due to malignant tumours. Despite the changes introduced in the therapy of gastrointestinal malignancies, radical removal of the tumour holds a crucial position in the mutimodal therapeutic process and is irreplaceable nowadays. From the beginning of the third millennium, minimally invasive surgery of abdominal tumours is being expanded with robotic-assisted procedures. The aim of this paper is to assess the benefits of robotic-assisted surgery in the treatment of colorectal and hepatopancreatobiliary neoplasms and to present the results of a non-randomized study with prospectively collected data from robotically assisted rectal cancer surgeries. Material and method: The authors summarize studies published in the PubMed, EMBASE, Medline and Cochrane Library databases that compare robotic and laparoscopic approaches in the treatment of colorectal and hepatopancreatobiliary malignancies, and present the results of their own non-randomized study. 204 patients with rectal cancer (<15 cm from the anal verge) who underwent robotic-assisted surgery at our department between 1 January 2016 and 31 December 2020 were included in the study. All demographic, clinical and oncological data were prospectively obtained and analysed. The data were analysed using descriptive statistic methods. Results: 204 patients with rectal cancer of whom 138 were men and 66 were women underwent robotic surgery at our department during the five-year period. In 97 (47.5%) cases the disease was dia­gnosed in an advanced stage (stage III and IV of the TNM classification). 18 patients had synchronous liver metastases and 2 patients had pulmonary metastases at the time of the dia­gnosis. The liver-first approach was indicated in 8 (44.4%) patients, two patients underwent a radical resection of liver lesions together with the primary neoplasm in one surgery. Total mesorectal excision was performed in 136 patients with extraperitoneal disease, partial mesorectal excision was performed in 68 cases. 18 complications were documented. Clinically relevant anastomotic leak requiring intervention occurred in 5 (3.6%) cases. One patient died due to decompensation of chronic toxonutritive liver disease. Local recurrence was documented in 6 patients, half of them underwent radical resection. Conclusion: Surgical therapy holds a crucial position in the treatment of colorectal and hepatopancreatobiliary neoplasms and represents the only potentially curative procedure in multimodal therapy. Robotic-assisted therapy has become a routine therapeutic modality for colorectal and hepatopancreatobiliary malignancies worldwide. Da Vinci assisted surgeries prevail in the surgical treatment of rectal cancer at the authors’ workplace as well as at some foreign centres. Compared to open and laparoscopic resections of rectal carcinoma, robotic-assisted operations achieve the same clinical and oncological results with a lower rate of complications. Key words: robotic surgery – colorectal cancer – liver malignancies – pancreatic carcinoma

scholarly journals EP.TU.493Attitudes of Irish General Surgery trainees to Robotic-Assisted Surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sinead Ramjit ◽  
Lauren O'Connell ◽  
Noel Donlon ◽  
Paul Neary ◽  
Diarmuid O'Riordain ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
General Surgery ◽  
Unmet Need ◽  
Robotic Prostatectomy ◽  
Previous Exposure ◽  
Robotic Training ◽  
Robotic Assisted ◽  
Republic Of Ireland ◽  
Robotic Assisted Surgery ◽  
The Republic

Abstract Background While the use of robotic-assisted surgery is now mainstream for procedures such as robotic prostatectomy, its role in general surgery is less well established. Access to training in robotics for general surgery trainees in the Republic of Ireland is variable. Further, there is no data on attitudes of Irish trainees towards the role of robotics. We aimed to establish attitudes of Irish general surgery trainees towards the perceived utility of robotic surgery as well as access and satisfaction with training. Methods A survey was disseminated to trainees in the Republic of Ireland enrolled in a General Surgery training scheme via email and social media. Data collected included stage of training, intended subspecialty, interest in developing robotic skills, previous exposure to robotic surgery, satisfaction with current access to robotic training and opinion on formally incorporating training in robotics into the general surgery curriculum. Results The response rate was 44.8%. Of these, 83% reported interest in training in robotics and 69% anticipated using the technology regularly in consultant practice. Previous exposure to robotic-assisted surgery was significantly predictive of interest in developing the skillset (p = 0.014). Over 71% of trainees reported that they were not satisfied with access to robotic training. Of those satisfied with access, 40% felt there was a role for incorporating robotic training into the curriculum, compared to 68% of those dissatisfied. Conclusion Irish general surgery trainees perceive robotic-assisted surgery to be highly relevant to their future practice. There is an unmet need to provide additional training in the skillset.

scholarly journals A comparison of robotically-assisted endoscopic versus sternotomy approach for myxoma excision: A single-center experience

2020 ◽  
Vol 28 (3) ◽  
pp. 450-459
Author(s):  
Ersin Kadiroğulları
Keyword(s):  
Postoperative Pain ◽  
Robotic Surgery ◽  
Endoscopic Surgery ◽  
Cardiac Myxoma ◽  
Median Sternotomy ◽  
Single Center ◽  
Robotic Assisted ◽  
Single Center Experience ◽  
Pain Scores ◽  
The Mean

Background: In this study, we present our single-center experience in robotically-assisted endoscopic surgery versus conventional median sternotomy approach in patients undergoing cardiac myxoma excision. Methods: Between January 2011 and September 2019, a total of 46 patients (24 males, 22 females; mean age 54.1±12.5 years; range, 25 to 79 years) who had a confirmed diagnosis of isolated cardiac myxoma were included in the study. The patients were divided into two groups as those undergoing robotic-assisted surgery (n=16) and those undergoing conventional median sternotomy (n=30). Clinical characteristics, operative, and postoperative outcomes were compared. Robotic approach to right or left-sided tumors and postoperative pain scores were also analyzed. Results: There was no mortality or major complication. No conversion to sternotomy was needed in robotic procedures. The mean cardiopulmonary bypass and aortic cross-clamp times were significantly shorter in the median sternotomy group (p=0.001 for both). The mean ventilation time and the length of hospital stay were significantly shorter in robotic surgery than sternotomy group (p=0.043 and p=0.048, respectively). The mean amount of postoperative blood loss and transfusion rate were significantly lower in robotic surgery patients (p=0.001 and p=0.022, respectively). The mean postoperative pain scores were significantly lower in patients undergoing robotic surgery (p=0.022). Conclusion: Robotic-assisted endoscopic surgery can be performed safely and effectively for cardiac myxoma excision with shorter hospital stay, less pain, and less amount of blood product use, as well as more favorable cosmetic results compared to conventional median sternotomy.

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