Does robotic technology successfully restore the joint line after total knee arthroplasty? A retrospective analysis

Background Our study aims to determine the effectiveness of robotic technology for total knee arthroplasty in the successful restoration of the joint line of the knee with respect to that of a normal human anatomical knee. The restoration of the joint line is an important technical goal on which the postoperative outcomes and the success of the surgery depend. Methods Sixty-four postoperative plain anteroposterior radiographs of 60 patients, who received total knee arthroplasty by using the robotic technology were analyzed and compared with 66 similar radiographs of 60 patients who received the conventional method. The distances of the lateral epicondyle to the joint line (LEJL) and proximal tibiofibular joint to the joint line (PTFJJL) were calculated and analyzed. Results We found that the mean value of LEJL minus PTFJJL in the robotic group was 0.334 ± 0.115 (mean ± SD), while in the conventional group, it was 2.304 ± 0.308. The difference between the two groups was statistically significant. The mean ratio (LEJL:PTFJJL) in the robotic group was also equal to 1.017 ± 0.042. Conclusion From these findings it could be concluded that the robotic technology significantly increases the accuracy of the total knee arthroplasty and, compared to the conventional method, achieves an almost anatomical position of the joint line.

Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis

The aim of this study was to review the latest evidence on the robotic approach (RHR) for inguinal hernia repair comparing the pooled outcome of this technique with those of the standard laparoscopic procedure (LHR). A systematic literature search was performed in PubMed, Web of Science and Scopus for studies published between 2010 and 2021 concerning the comparison between RHR versus LHR. After screening 582 articles, 9 articles with a total of 64,426 patients (7589 RHRs) were eligible for inclusion. Among preoperative variables, a pooled higher ratio of ASA > 2 patients was found in the robotic group (12.4 vs 8.6%, p < 0.001). Unilateral hernia repair was more common in the laparoscopic group (79.9 vs 68.1, p < 0.001). Overall, operative time was longer in the robotic group (160 vs 90 min, p < 0.001); this was confirmed also in the sub-analysis on unilateral procedures (88 vs 68 min, p = 0.040). The operative time for robotic bilateral repair was similar to the laparoscopic one (111 vs 100, p = 0.797). Conversion to open surgery was 0% in the robotic group. The pooled rate of chronic pain and postoperative complications was similar between the groups. The standardized mean difference MD of the costs between LHR versus RHR was − 3270$ (95% CI – 4757 to − 1782, p < 0.001). In conclusion, laparoscopic and robotic inguinal hernia repair have similar safety parameters and postoperative outcomes. Robotic approach may require longer operative time if the unilateral repair is performed. Costs are higher in the robotic group.

727 Robotic Assisted Versus Fluoroscopic Guided Approach in Pedicle Screw Insertion: A Systematic Review and Meta-Analysis

Aim The robotic assisted surgery has become prevalent in most of the surgical subspecialty. The adaption of such technique in spine surgery has resulted in minimising several issues encountered with fluoroscopic guided approach. The aim of this study is to compare the outcomes of robotic assisted approach and fluoroscopic guided approach in pedicle screw insertion. Method PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched from its inception until November 2020. All the studies comparing robotic assisted surgery and fluoroscopic guided approach in pedicle screw insertion were included for quantitative and qualitative analysis. Results Twenty-eight studies enrolling 2105 patients (robotic group: 1027, fluoroscopic: 1078) and total screws of 8668 screws (robotic group: 4217, fluoroscopic group: 4451) were eligible for inclusion, these studies consisted of 19 observational studies, 7 randomised controlled trials (RCTs) and 2 cadaveric study. Robotic assisted approach was associated with significantly higher accuracy (Grade A+B) (OR = 2.34; P &lt; 0.0001) and distance between pedicle and screw (MD: 1.69; P = 0.001), lower incident of facet joint violation (OR = 0.22; P &lt; 0.00001), screw revision (OR = 0.38; P = 0.009), intraoperative blood loss (MD: -116.95; P = 0.0006), shorter pedicle screw placement time (MD: -4.66; P &lt; 0.00001), radiation exposure time (MD:-5.27; P = 0.0001), radiation dose (MD:-22.30; P = 0.0002) and postoperative hospital stay (MD: -0.79; P = 0.02) compared to fluoroscopic guided approach. There was no significant difference in operative time and wound infection. Conclusions In this meta-analysis, robotic assisted approach is more effective in achieving better clinical outcomes compared to fluoroscopic guided technique in pedicle screw insertion. However, future adequately powered RCTs are warranted to generate standardised outcomes.

Comparison of Surgical Outcomes between Robotic Transaxillary and Conventional Open Thyroidectomy in Pediatric Thyroid Cancer

Thyroid cancer in children is very uncommon. For pediatric thyroid cancer, robotic surgery has served as a minimally invasive surgical alternative to conventional open surgery. Our study aimed to evaluate the results of robotic versus open surgical treatment for patients with thyroid cancer younger than 20 years of age at the time of diagnosis. This retrospective review included 161 pediatric patients who underwent robotic transaxillary or conventional open thyroidectomy at our institution from 2008 to 2019. Of these patients, 99 comprised the robotic group and 62 the open group. Patient demographics, surgical outcomes, and disease-free survival rates were compared between the two groups. Patients in the open group were more likely to have advanced stage diseases with a larger tumor size and higher tumor-node-metastasis stage than those in the robotic group. Operation time and follow-up period were similar in both groups. Patients in the robotic group had a lower rate of postoperative complications and a shorter length of hospital stay, but they also had a lower average number of retrieved central lymph nodes. However, there were no significant between group differences in recurrence rates and disease-free survival. In the hands of an experienced surgeon, robotic thyroidectomy is a feasible and safe option for pediatric patients.

Robotic versus laparoscopic surgery for colorectal cancer: a case-control study

Background Robotic resections represent a novel approach to treatment of colorectal cancer. The aim of our study was to critically assess the implementation of robotic colorectal surgical program at our institution and to compare it to the established laparoscopically assisted surgery. Patients and methods A retrospective case-control study was designed to compare outcomes of consecutively operated patients who underwent elective laparoscopic or robotic colorectal resections at a tertiary academic centre from 2019 to 2020. The associations between patient characteristics, type of operation, operation duration, conversions, duration of hospitalization, complications and number of harvested lymph nodes were assessed by using univariate logistic regression analysis. Results A total of 83 operations met inclusion criteria, 46 robotic and 37 laparoscopic resections, respectively. The groups were comparable regarding the patient and operative characteristics. The operative time was longer in the robotic group (p < 0.001), with fewer conversions to open surgery (p = 0.004), with less patients in need of transfusions (p = 0.004) and lower reoperation rate (p = 0.026). There was no significant difference between the length of stay (p = 0.17), the number of harvested lymph nodes (p = 0.24) and the overall complications (p = 0.58). Conclusions The short-term results of robotic colorectal resections were comparable to the laparoscopically assisted operations with fewer conversions to open surgery, fewer blood transfusions and lower reoperation rate in the robotic group.

Basic Reliable Intraperitoneal Extravesical Flexible (BRIEF) Technique in Robotic-Assisted Radical Nephroureterectomy With Excision of Bladder Cuff for Upper Tract Urothelial Carcinoma: Step by Step

ObjectiveTo describe a technique of robotic-assisted radical nephroureterectomy with excision of bladder cuff.MethodIn our institution, a total of 64 patients were enrolled in which 29 patients underwent robotic technique and 35 patients underwent laparoscopic technique. We compared perioperative data and tumor recurrence rates in two groups to confirm the advantages of robotic technique.ResultAll 64 patients finished their operation without converting operation. As the general conditions were no differences, the robotic group had less intraoperative blood loss (36.38±15.86ml verse 50.57±27.94ml, P<0.05), earlier ambulation (7.24±1.37h verse 9.14±2.03h, P<0.05), and shorter hospitalization time (3.55±0.69days verse 6.32±1.68days, P<0.05). And the visual analogue scale scores of the robotic group in 1h, 12h and 24h was lower than traditional laparoscopic group (P<0.05). And tumor recurrence and positive surgical margin were not difference between two groups (P>0.05).ConclusionCompared with laparoscopic method, the robotic technique has the advantages in postoperative recovery.

Does robotic assisted technology improve the accuracy of acetabular component positioning in patients with DDH?

Background: Accurate positioning of the acetabular component is key in performing total hip arthroplasty (THA). However, reconstruction of the acetabulum in the setting of developmental dysplasia of the hip (DDH) is a challenge. Robotic assisted THA has the potential to improve the accuracy of implantation of the acetabular cup in cases with DDH. The purpose of this study was to assess whether robotic technology improves the accuracy of acetabular component positioning in patients with DDH. Material and methods: We included 59 THAs using robotic assisted technology from June 2019 to January 2020 as the study group. These were compared to conventional THAs without robotic technology after control for age, gender, body mass index (BMI), Crowe type and operation date. Radiographic measurements were taken by 2 blinded orthopaedic residents. The percentage of hips within the Lewinnek and Collanan safe zones were calculated, along with acetabular rotation centers for the “target zone.” Surgical time and perioperative bleeding were also compared between both groups. Results: One patient suffered dislocation in conventional group while no dislocation occurred in robotic group. The acetabular components of the robotic assisted group had more cases located within the Lewinnek ( p = 0.013) and Collanan ( p = 0.008) safe zones than conventional group (94.9% vs 79.7% and 74.6% vs 50.8%). There were 7 cases in conventional group and 4 cases in robotic group that had more lateral or more superior rotational centers of THA, but did not reach statistical significance ( p = 0.342). No statistical difference was detected between groups with regards to blood loss ( p = 0.098) and surgical time ( p = 0.602). Conclusion: Robot assisted technology can assist surgeons with implanting acetabular cups more in Lewinnek and Callanan safe zone than conventional techniques without additional blood loss and surgical time. Level of Evidence: Therapeutic Level Ⅲ.

A Randomized Clinical Control Study on The Efficacy of Three-Dimensional Upper Limb Robotic Exoskeleton Training in Chronic Stroke

Background - Although robotics assisted rehabilitation has proven to be effective in stroke rehabilitation, a limited functional improvements in Activities of Daily Life has been also observed after the administration of the robotic intervention. To this aim in this manuscript we compare the efficacy in terms of both clinical and functional outcomes of a robotic training performed with a multi-joint functional exoskeleton in goal-oriented exercises compared to a conventional physical therapy program, equally matched in terms of intensity and time. As a secondary goal of the study, it was assessed the capability of kinesiologic measurements - extracted by the exoskeleton robotic system - of predicting the rehabilitation outcomes using a set of robotic biomarkers collected at the baseline. Methods – A parallel-group randomized clinical trial was conducted within a group of 26 chronic post-stroke patients. Patients were randomly assigned to two groups receiving robotic or manual therapy. The primary outcome was the change in score on the upper extremity section of the Fugl-Meyer Assessment (FMA) scale. As secondary outcome a specifically designed bimanual functional scale, Bimanual Activity Test (BAT), was used for upper limb functional evaluation. Two robotic performance indices were extracted with the purpose of monitoring the recovery process and investigating the interrelationship between pre-treatment robotic biomarkers and post-treatment clinical improvement in the robotic group. Results – A significant clinical and functional improvements in both groups (p<0.01) was reported. More in detail a significantly higher improvement of the robotic group was observed in the proximal portion of the FMA (p<0.05) and in the timing for accomplishing the tasks of the BAT (p<0.01). The multilinear-regression analysis pointed out a significant correlation between robotic biomarkers at the baseline and change in FMA score (R2 = 0.91, p<0.05), suggesting their potential ability of predicting clinical outcomes. Conclusion – Exoskeleton-based robotic upper limb treatment might lead to better functional outcomes, if compared to manual physical therapy. The extracted robotic performance could represent predictive indices of the recovery of the upper limb. These results are promising for their potential exploitation in implementing personalized robotic therapy. Clinical Trial Registration – clinicaltrials.gov, NCT03319992 Unique Protocol ID: RH-UL-LEXOS-10. Registered 20.10.2017, https://clinicaltrials.gov/ct2/show/NCT03319992