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Technical, Oncological, and Functional Safety of Bilateral Axillo-Breast Approach (BABA) Robotic Total Thyroidectomy. Surg Laparosc Endosc Percutan Tech 2017; 26:253-8. [PMID: 27077223 DOI: 10.1097/sle.0000000000000262] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to identify whether bilateral axillo-breast approach (BABA) robotic total thyroidectomy (RoTT) is technically, oncologically, and functionally safe. MATERIALS AND METHODS One hundred eighteen patients underwent BABA robotic thyroidectomy between July 2010 and February 2013. Ninety-one (77.1%) patients underwent RoTT, and 27 (22.9%) underwent robotic unilateral lobectomy. RESULTS RoTT (n=91) resulted in lower rate of surgical complication and in higher rate of transient hypocalcemia comparing with robotic unilateral lobectomy (n=27) (35.16% vs. 3.7%; P<0.013), but not in a permanent hypocalcemia, transient, or permanent recurrent laryngeal nerve palsy (2.2% vs. 0%; P=1.000, 3.3% vs. 0%; P=1.000, and 0% vs. 0%; P=NS), respectively. Successful remnant ablation rate for the patients with RoTT was 100% on a subsequent 6 months follow-up. No significant differences between 2 groups existed in mean Voice Handicap Index-10 scores during postoperative 6 months (P=0.308). CONCLUSIONS BABA RoTT might be oncologically safe as well as technically and functionally safe procedure.
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Intraoperative neuromonitoring of the recurrent laryngeal nerve in robotic thyroid surgery. Surg Laparosc Endosc Percutan Tech 2015; 25:23-26. [PMID: 25238177 DOI: 10.1097/sle.0000000000000074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study evaluated the technical feasibility and efficacy of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) to aid its identification and preservation during robotic thyroidectomy (RoT). IONM of the RLN was evaluated in 30 consecutive patients undergoing RoT. All patients underwent an indirect laryngoscope examination to objectively assess vocal cord function. Their Voice Handicap Index-10 (VHI-10) was measured to subjectively assess vocal cord function preoperatively and at postoperative months 1 and 3. Of the 56 RLNs at risk in 30 patients undergoing RoT, all were visualized and identified by IONM. The IONM sensitivity for postoperative permanent RLN palsy was 100%, with a positive predictive value of 100%. The mean VHI-10 scores preoperatively and at postoperative months 1 and 3 were 0.20±0.66, 3.47±5.04, and 1.53±2.47, respectively (P<0.001). IONM of the RLN during RoT is technically feasible and effective for identifying this nerve.
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Bae DS, Kim SJ, Koo DH, Paek SH, Kwon H, Chai YJ, Choi JY, Lee KE, Youn YK. Prospective, randomized controlled trial on use of ropivacaine after robotic thyroid surgery: Effects on postoperative pain. Head Neck 2015; 38 Suppl 1:E588-93. [PMID: 25782919 DOI: 10.1002/hed.24045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We evaluated the effects of ropivacaine for pain relief after robotic thyroid surgery. METHODS One hundred eight patients scheduled for robotic thyroid surgery were randomized into ropivacaine (n = 54) or control (n = 54) groups. After surgery, 40 mL of 0.25% ropivacaine or 0.9% saline (control) was instilled into the skin flap. Postoperative pain intensity (visual analog scale [VAS]), analgesic requirements (fentanyl), and adverse events were assessed at 1, 2, 4, 8, 16, and 24 hours postoperatively. RESULTS One hundred three patients completed the study protocol. VAS scores were lower in the ropivacaine group than the control group (p = .010); however, VAS scores were not significantly different after 8 hours postoperatively. Total analgesic consumption was higher in controls than ropivacaine-treated patients (p = .01). Adverse events did not differ between the 2 groups. CONCLUSION Ropivacaine instillation after robotic thyroid surgery reduces acute postoperative pain and analgesic requirements without adverse events. © 2015 Wiley Periodicals, Inc. Head Neck 38: E-E, 2016.
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Affiliation(s)
- Dong Sik Bae
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University College of Medicine and Hospital, Cancer Research Institute, Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - Do Hoon Koo
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Se-Hyun Paek
- Department of Surgery, Seoul National University College of Medicine and Hospital, Cancer Research Institute, Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - Hyungju Kwon
- Department of Surgery, Seoul National University College of Medicine and Hospital, Cancer Research Institute, Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University Boramae Medical Center and College of Medicine, Seoul, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University College of Medicine and Hospital, Cancer Research Institute, Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - Yeo-Kyu Youn
- Department of Surgery, Seoul National University College of Medicine and Hospital, Cancer Research Institute, Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
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Sood HS, Arya M, Maple H, Grange P, Haq A. Robotic telemanipulating surgical systems for laparoscopy: the story so far in the UK. Expert Rev Med Devices 2014; 7:745-52. [DOI: 10.1586/erd.10.65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Coker AM, Barajas-Gamboa JS, Cheverie J, Jacobsen GR, Sandler BJ, Talamini MA, Bouvet M, Horgan S. Outcomes of robotic-assisted transhiatal esophagectomy for esophageal cancer after neoadjuvant chemoradiation. J Laparoendosc Adv Surg Tech A 2014; 24:89-94. [PMID: 24401141 DOI: 10.1089/lap.2013.0444] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND We previously reported our experience performing robotic-assisted transhiatal esophagectomy (RATE) in patients with early-stage esophageal cancer who had had no preoperative treatment. The purpose of this report was to determine if RATE could be performed safely with good outcomes for esophageal cancer in a more recent series of patients, the majority of whom were treated with neoadjuvant chemoradiation. SUBJECTS AND METHODS This was a retrospective review of patients with adenocarcinoma of the distal esophagus or gastroesophageal junction who underwent RATE between November 2006 and November 2012 at a single tertiary-care hospital. Main outcome measures included operative and oncologic parameters, morbidity, and mortality. RESULTS In total, 23 patients underwent RATE, consisting of 20 men and 3 women with a median age of 64 years (range, 40-81 years). The majority of patients (19/23 [83%]) underwent neoadjuvant chemoradiation, although 1 patient had preoperative chemotherapy only, and 3 patients went straight to surgery. Median operative time was 231 minutes (range, 179-319 minutes), and median estimated blood loss was 100 mL (range, 25-400 mL). There were no conversions to open surgery. Complications included seven strictures, two anastomotic leaks, and two pericardial/pleural effusions requiring drainage. One patient required pyloroplasty 3 months after esophagectomy. One patient died from pulmonary failure 21 days after surgery (30-day mortality rate of 4%). The median length of stay was 9 days (range, 7-37 days). Seven of the 19 patients who underwent preoperative chemoradiation had a complete response on final pathology. The mean lymph node yield was 15 (range, 5-29), and surgical margins were negative for cancer in 21 cases. CONCLUSIONS RATE can be performed safely with good oncologic outcomes following neoadjuvant chemoradiation in patients with esophageal cancer. This technique has become our choice of operation for most patients with esophageal cancer.
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Affiliation(s)
- Alisa M Coker
- Department of Surgery, University of California San Diego , La Jolla, California
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Najarian S, Fallahnezhad M, Afshari E. Advances in medical robotic systems with specific applications in surgery--a review. J Med Eng Technol 2011; 35:19-33. [PMID: 21142589 DOI: 10.3109/03091902.2010.535593] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Although robotics was started as a form of entertainment, it gradually became used in different branches of science. Medicine, particularly in the operating room, has been influenced significantly by this field. Robotic technologies have offered valuable enhancements to medical or surgical processes through improved precision, stability and dexterity. In this paper we review different robotics and computer-assisted systems developed with medical and surgical applications. We cover early and recently developed systems in different branches of surgery. In addition to the united operational systems, we provide a review of miniature robotic, diagnostic and sensory systems developed to assist or collaborate with a main operator system. At the end of the paper, a discussion is given with the aim of summarizing the proposed points and predicting the future of robotics in medicine.
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Affiliation(s)
- S Najarian
- Biomechanics Department, Laboratory of Artificial Tactile Sensing and Robotic Surgery, Faculty of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Hafez Avenue, Tehran, Iran.
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Kang SW, Lee SH, Ryu HR, Lee KY, Jeong JJ, Nam KH, Chung WY, Park CS. Initial experience with robot-assisted modified radical neck dissection for the management of thyroid carcinoma with lateral neck node metastasis. Surgery 2011; 148:1214-21. [PMID: 21134554 DOI: 10.1016/j.surg.2010.09.016] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 09/16/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Since the introduction of endoscopic techniques in thyroid surgery, several trials of endoscopic lateral neck dissection have been conducted with the aim of avoiding a long cervical scar, but these endoscopic procedures require more effort than open surgery, mainly because of the relatively nonsophisticated instruments used. However, the recent introduction of surgical robotic systems has simplified the operations and increased the precision of endoscopic techniques. We have described our initial experience with robot-assisted modified radical neck dissection (MRND) in thyroid cancer using the da Vinci S system. METHODS From October 2007 to October 2009, 33 patients with thyroid cancer with lateral neck lymph node (LN) metastases underwent robot-assisted thyroidectomy and additional robotic MRND using a gasless, transaxillary approach. Clinicopathologic data were analyzed retrospectively. RESULTS Mean patient age was 37 ± 9 years and the gender ratio (male to female) was 7:26. The mean operating time was 281 ± 41 minutes and mean postoperative hospital stay was 5.4 ± 1.6 days. The mean tumor size was 1.1 ± 0.5 cm and 20 cases (61%) had papillary thyroid microcarcinoma. The mean number of retrieved LNs was 6.1 ± 4.4 in the central neck compartment and 27.7 ± 11.0 in the lateral compartment. No serious postoperative complications, such as Horner's syndrome or major nerve injury, occurred. CONCLUSION Robot-assisted MRND is technically feasible, safe, and produces excellent cosmetic results. Based on our initial experience, robot-assisted MRND should be viewed as an acceptable alternative method in patients with low-risk, well-differentiated thyroid cancer with lateral neck node metastasis.
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Affiliation(s)
- Sang-Wook Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
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Berber E, Akyildiz HY, Aucejo F, Gunasekaran G, Chalikonda S, Fung J. Robotic versus laparoscopic resection of liver tumours. HPB (Oxford) 2010; 12:583-6. [PMID: 20887327 PMCID: PMC2997665 DOI: 10.1111/j.1477-2574.2010.00234.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are scant data in the literature regarding the role of robotic liver surgery. The aim of the present study was to develop techniques for robotic liver tumour resection and to draw a comparison with laparoscopic resection. METHODS Over a 1-year period, nine patients underwent robotic resection of peripherally located malignant lesions measuring <5 cm. These patients were compared prospectively with 23 patients who underwent laparoscopic resection of similar tumours at the same institution. Statistical analyses were performed using Student's t-test, χ(2) -test and Kaplan-Meier survival. All data are expressed as mean ± SEM. RESULTS The groups were similar with regards to age, gender and tumour type (P= NS). Tumour size was similar in both groups (robotic -3.2 ± 1.3 cm vs. laparoscopic -2.9 ± 1.3 cm, P= 0.6). Skin-to-skin operative time was 259 ± 28 min in the robotic vs. 234 ± 17 min in the laparoscopic group (P= 0.4). There was no difference between the two groups regarding estimated blood loss (EBL) and resection margin status. Conversion to an open operation was only necessary in one patient in the robotic group. Complications were observed in one patient in the robotic and four patients in the laparoscopic groups. The patients were followed up for a mean of 14 months and disease-free survival (DFS) was equivalent in both groups (P= 0.6). CONCLUSION The results of this initial study suggest that, for selected liver lesions, a robotic approach provides similar peri-operative outcomes compared with laparoscopic liver resection (LLR).
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Affiliation(s)
- Eren Berber
- Endocrinology and Metabolism InstituteCleveland, OH, USA
| | | | - Federico Aucejo
- Digestive Disease Institute, Cleveland ClinicCleveland, OH, USA
| | | | | | - John Fung
- Digestive Disease Institute, Cleveland ClinicCleveland, OH, USA
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Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 2009; 23:2399-406. [PMID: 19263137 DOI: 10.1007/s00464-009-0366-x] [Citation(s) in RCA: 269] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 12/17/2008] [Accepted: 01/12/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Various robotic surgical procedures have been performed in recent years, and most reports have proved that the application of robotic technology for surgery is technically feasible and safe. This study aimed to introduce the authors' technique of robot-assisted endoscopic thyroid surgery and to demonstrate its applicability in the surgical management of thyroid cancer. METHODS From 4 October 2007 through 14 March 2008, 100 patients with papillary thyroid cancer underwent robot-assisted endoscopic thyroid surgery using a gasless transaxillary approach. This novel robotic surgical approach allowed adequate endoscopic access for thyroid surgeries. All the procedures were completed successfully using the da Vinci S surgical robot system. Four robotic arms were used with this system: a 12-mm telescope and three 8-mm instruments. The three-dimensional magnified visualization obtained by the dual-channel endoscope and the tremor-free instruments controlled by the robotic systems allowed surgeons to perform sharp and precise endoscopic dissections. RESULTS Ipsilateral central compartment node dissection was used for 84 less-than-total and 16 total thyroidectomies. The mean operation time was 136.5 min (range, 79-267 min). The actual time for thyroidectomy with lymphadenectomy (console time) was 60 min (range, 25-157 min). The average number of lymph nodes resected was 5.3 (range, 1-28). No serious complications occurred. Most of the patients could return home within 3 days after surgery. CONCLUSIONS The technique of robot-assisted endoscopic thyroid surgery using a gasless transaxillary approach is a feasible, safe, and effective method for selected patients with thyroid cancer. The authors suggest that application of robotic technology for endoscopic thyroid surgeries could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid cancer.
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Judkins TN, Oleynikov D, Stergiou N. Objective evaluation of expert and novice performance during robotic surgical training tasks. Surg Endosc 2008; 23:590-7. [DOI: 10.1007/s00464-008-9933-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 01/31/2008] [Accepted: 04/05/2008] [Indexed: 11/24/2022]
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Judkins TN, Oleynikov D, Stergiou N. Enhanced Robotic Surgical Training Using Augmented Visual Feedback. Surg Innov 2008; 15:59-68. [DOI: 10.1177/1553350608315953] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The goal of this study was to enhance robotic surgical training via real-time augmented visual feedback. Thirty novices (medical students) were divided into 5 feedback groups (speed, relative phase, grip force, video, and control) and trained during 1 session in 3 inanimate surgical tasks with the da Vinci Surgical System. Task completion time, distance traveled, speed, curvature, relative phase, and grip force were measured immediately before and after training and during a retention test 2 weeks after training. All performance measures except relative phase improved after training and were retained after 2 weeks. Feedback-specific effects showed that the speed group was faster than other groups after training, and the grip force group applied less grip force. This study showed that the real-time augmented feedback during training can enhance the surgical performance and can potentially be beneficial for both training and surgery.
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Affiliation(s)
- Timothy N. Judkins
- Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland, , HPER Biomechanics Laboratory, University of Nebraska
| | | | - Nick Stergiou
- Department of Environmental, Agricultural and Occupational Health Sciences, College of Public Health University of Nebraska Medical Center, Omaha, Nebraska, HPER Biomechanics Laboratory, University of Nebraska
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Galvani CA, Gorodner MV, Moser F, Jacobsen G, Chretien C, Espat NJ, Donahue P, Horgan S. Robotically assisted laparoscopic transhiatal esophagectomy. Surg Endosc 2008; 22:188-95. [PMID: 17939004 DOI: 10.1007/s00464-007-9441-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Esophagectomy is a technically demanding operation with high procedure-related morbidity and mortality rates. Minimally invasive techniques were introduced in the late 1980s in an effort to decrease the invasiveness of the procedure. Data concerning the use of robotic systems for esophageal cancer are scarce in the literature. The goal of this report is to describe the authors' early experience using robotically assisted technology to perform transhiatal esophagectomy (RATE). METHODS Between September 2001 and May 2004, 18 patients underwent RATE at the authors' institution. A retrospective review of prospectively collected data was performed. Gender, age, postoperative diagnosis, operative time, conversion rate, blood loss, hospital stay, length of the follow-up period, and complications were assessed. RESULTS At the authors' institution, 18 patients underwent RATE, including 16 men (89%), with a mean age of 54 years (range, 41-73 years). The RATE procedure was completed for all 18 patients (100%). The mean operative time was 267 +/- 71 min, and estimated blood loss was 54 ml (range, 10-150 ml). The mean intensive care unit stay was 1.8 days (range, 1-5 days), and the mean hospital stay was 10 days (range, 4-38 days). A total of 12 perioperative complications occurred for 9 patients, including 6 anastomotic leaks, 1 thoracic duct injury, 1 vocal cord paralysis, 1 pleural effusion, and 2 atrial fibrillations. Anastomotic stricture was observed in six patients. There were no perioperative deaths. Pathologic examination of the surgical specimen yielded an average of 14 lymph nodes per patient (range, 7-27). During the mean follow-up period of 22 +/- 8 months, 2 patients died, 2 were lost to follow-up evaluation, 3 had recurrence, and 11 were disease free. CONCLUSION The current study shows that RATE, with its decreased blood loss, minimal cardiopulmonary complications, and no hospital mortality, represents a safe and effective alternative for the treatment of esophageal adenocarcinoma.
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Affiliation(s)
- C A Galvani
- Minimally Invasive Surgery Center, University of Illinois, 840 South Wood Street, Room 435, Chicago, IL 60612, USA.
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Objective evaluation of expert performance during human robotic surgical procedures. J Robot Surg 2008; 1:307-12. [PMID: 25484983 PMCID: PMC4247470 DOI: 10.1007/s11701-007-0067-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 12/05/2007] [Indexed: 12/20/2022]
Abstract
Robotic laparoscopic surgery has revolutionized minimally invasive surgery and has increased in popularity due to its important benefits. However, evaluation of surgical performance during human robotic laparoscopic procedures in the operating room is very limited. We previously developed quantitative measures to assess robotic surgical proficiency. In the current study, we want to determine if training task performance is equivalent to performance during human surgical procedures performed with robotic surgery. An expert with more than 5 years of robotic laparoscopic surgical experience performed two training tasks (needle passing and suture tying) and one human laparoscopic procedure (Nissan fundoplication) using the da Vinci™ Surgical System (dVSS). Segments of the human procedure that required needle passing and suture tying were extracted. Time to task completion, distance traveled, speed, curvature, and grip force were measured at the surgical instrument tips. Single-subject analysis was used to compare training task performance and human surgical performance. Nearly all objective measures (8 out of 13) were significantly different between training task performance and human surgical performance for both the needle passing and the suture tying tasks. The surgeon moved slower, made more curved movements, and used more grip force during human surgery. Even though it appears that the surgeon performed better in the training tasks, it is likely that during human surgical procedures, the surgeon is more cautious and meticulous in the movements performed in order to prevent tissue damage or other complications. The needle passing and the suture tying training tasks may be suitable to establish a foundation of surgical skill; however, further training may be necessary to improve transfer of learning to the operating room. We recommend that more realistic training tasks be developed to better predict performance during robotic surgical procedures and testing the transferability of basic skill acquisition to surgical performance.
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Ballantyne GH. Telerobotic gastrointestinal surgery: phase 2--safety and efficacy. Surg Endosc 2007; 21:1054-62. [PMID: 17287918 DOI: 10.1007/s00464-006-9130-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Revised: 08/12/2006] [Accepted: 09/25/2006] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Federal Drug Administration (FDA) approved the da Vinci surgical system for all abdominal operations in July 2000. In the past 6 years, virtually all gastrointestinal operations have been accomplished using telerobotic techniques. The purpose of this review is to summarize the short-term outcomes achieved with telerobotic gastrointestinal operations. METHODS All case series of telerobotic gastrointestinal operations identified by PubMed searches are included in this review. RESULTS Case series document the safety and efficacy of telerobotic cholecystectomy, fundoplication, Heller myotomy, gastric bypass, colectomy, gastrectomy, and pancreatectomy. The procedures were accomplished with low rates of conversion to laparoscopic operations, mortality, and morbidity. When comparison groups were available, the analysis shows that telerobotic operations required more time than the laparoscopic operations, although for telerobotic cholecystectomy and telerobotic fundoplication, this difference disappeared in 10 to 20 operations. Specific patient advantages were not identified for telerobotic operations compared with laparoscopic operations, except for a decreased esophageal perforation rate during telerobotic Heller myotomy. Surgeons benefited from the three-dimensional imaging, the handlike motions of the robotic instruments, and an ergonomically comfortable position. CONCLUSION All telerobotic gastrointestinal operations are feasible and can be performed with safety and efficacy. It is difficult to demonstrate patient-specific advantages of telerobotic surgery over laparoscopic operations. Nonetheless, telerobotic surgical systems offer distinct advantages to surgeons and may facilitate an increase in the number of surgeons performing advanced laparoscopic gastrointestinal operations. In addition, telerobotics offer a digital information platform that enables surgical simulation and augmented-reality surgery.
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Affiliation(s)
- G H Ballantyne
- Section of Minimally Invasive and Telerobotic Surgery, Hackensack University Medical Center, Hackensack, New Jersey 07601, USA.
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Petelin JB, Nelson ME, Goodman J. Deployment and early experience with remote-presence patient care in a community hospital. Surg Endosc 2007; 21:53-6. [PMID: 17031745 DOI: 10.1007/s00464-005-0261-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 07/29/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND The introduction of the RP6 (InTouch Health, Santa Barbara, CA, USA) remote-presence "robot" appears to offer a useful telemedicine device. The authors describe the deployment and early experience with the RP6 in a community hospital and provided a live demonstration of the system on April 16, 2005 during the Emerging Technologies Session of the 2005 SAGES Meeting in Fort Lauderdale, Florida. METHODS The RP6 is a 5-ft 4-in. tall, 215-pound robot that can be remotely controlled from an appropriately configured computer located anywhere on the Internet (i.e., on this planet). The system is composed of a control station (a computer at the central station), a mechanical robot, a wireless network (at the remote facility: the hospital), and a high-speed Internet connection at both the remote (hospital) and central locations. The robot itself houses a rechargeable power supply. Its hardware and software allows communication over the Internet with the central station, interpretation of commands from the central station, and conversion of the commands into mechanical and nonmechanical actions at the remote location, which are communicated back to the central station over the Internet. The RP6 system allows the central party (e.g., physician) to control the movements of the robot itself, see and hear at the remote location (hospital), and be seen and heard at the remote location (hospital) while not physically there. RESULTS Deployment of the RP6 system at the hospital was accomplished in less than a day. The wireless network at the institution was already in place. The control station setup time ranged from 1 to 4 h and was dependent primarily on the quality of the Internet connection (bandwidth) at the remote locations. Patients who visited with the RP6 on their discharge day could be discharged more than 4 h earlier than with conventional visits, thereby freeing up hospital beds on a busy med-surg floor. Patient visits during "off hours" (nights and weekends) were three times more efficient than conventional visits during these times (20 min per visit vs 40-min round trip travel + 20-min visit). Patients and nursing personnel both expressed tremendous satisfaction with the remote-presence interaction. CONCLUSIONS The authors' early experience suggests a significant benefit to patients, hospitals, and physicians with the use of RP6. The implications for future development are enormous.
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Affiliation(s)
- J B Petelin
- Department of Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA.
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Kornprat P, Werkgartner G, Cerwenka H, Bacher H, El-Shabrawi A, Rehak P, Mischinger HJ. Prospective study comparing standard and robotically assisted laparoscopic cholecystectomy. Langenbecks Arch Surg 2006; 391:216-221. [PMID: 16733761 DOI: 10.1007/s00423-006-0046-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 02/21/2006] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Laparoscopic surgery has become the treatment of choice for cholecystectomy. Many studies showed that while this approach benefits the patient, the surgeon faces such distinct disadvantages as a poor ergonomic situation and limited degrees of freedom with limited motion as a consequence. Robots have the potential to overcome these problems. To evaluate the efficiency and feasibility of robotically assisted surgery (RAC), we designed a prospective study to compare it with standard laparoscopic cholecystectomy (SLC). MATERIALS AND METHODS Between 2001 and 2003, 26 patients underwent SLC and 20 patients underwent RAC using the ZEUS system. The feasibility, safety, and possible advantages were evaluated. To assess the efficacy, the total time in the operating room was divided into preoperative, operative, and postoperative time frames. RESULTS For RAC in comparison with SLC, the preoperative phase including equipment setup was significantly longer. In the intraoperative phase, the cut-closure time and camera and trocar insertion times were significantly longer. It is interesting to note that the net dissection time for the cystic artery, duct, and the gall bladder was not different from SLC. CONCLUSIONS The study demonstrates the feasibility of robotically assisted cholecystectomy without system-specific morbidity. There is time loss in several phases of robotic surgery due to equipment setup and deinstallation and therefore, presents no benefit in using the robot in laparoscopic cholecystectomy.
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Affiliation(s)
- Peter Kornprat
- Division of General Surgery, Department of Surgery, University Medical Center, Auenbruggerplatz 29, Graz 8036, Austria
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Winter JM, Talamini MA, Stanfield CL, Chang DC, Hundt JD, Dackiw AP, Campbell KA, Schulick RD. Thirty robotic adrenalectomies. Surg Endosc 2005; 20:119-24. [PMID: 16333534 DOI: 10.1007/s00464-005-0082-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Accepted: 07/05/2005] [Indexed: 01/23/2023]
Abstract
BACKGROUND Robotic adrenalectomy is a minimally invasive alternative to traditional laparoscopic adrenalectomy. To date, only case reports and small series of robotic adrenalectomies have been reported. This study presents a single institution's series of 30 robotic adrenalectomies, and evaluates the procedure's safety, efficacy, and cost. METHODS Thirty patients underwent robotic adrenalectomy at the Johns Hopkins Hospital between April 2001 and January 2004. Patient morbidity, hospital length of stay, operative time, and conversion rate to traditional laparoscopic or open surgery are presented. Improvement in operative time with surgeon experience is evaluated. Hospital charges are compared to charges for traditional laparoscopic and open adrenalectomies performed during the same time period. RESULTS Median operative time was 185 min. Patient morbidity was 7%. There were no conversions to traditional laparoscopic or open surgery. The median hospital stay was 2 days. Operative time improved significantly by 3 min with each operation. Hospital charges for robotic adrenalectomy (12,977 dollars) were not significantly different than charges for traditional laparoscopic (11,599 dollars) or open adrenalectomy (14,600 dollars). CONCLUSIONS Robotic adrenalectomy is a safe and effective alternative to traditional laparoscopic adrenalectomy.
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Affiliation(s)
- J M Winter
- Department of Surgery, Johns Hopkins Medical Institutions, CRB 442, Baltimore, MD 21231, USA
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Iizuka K. Three-dimensional laparoscope based on the manipulation of polarized light by a cellophane half-wave plate. APPLIED OPTICS 2005; 44:7083-90. [PMID: 16318178 DOI: 10.1364/ao.44.007083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A three-dimensional laparoscope that can capture three-dimensional images during surgery is reported. The principle is solely based on the manipulation of polarized light by a cellophane half-wave plate rather than computer processing; hence there is no time delay (it operates in real time) and lesions are viewed in true color, which is important for diagnostics. Three-dimensional images are obtained with a single laparoscope. A unique feature of this three-dimensional laparoscope is that it includes a virtual ruler to measure distances without physically touching the affected areas. The structure is simple, sturdy, lightweight, and its diameter is no bigger than a standard 10 mm diam laparoscope.
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Affiliation(s)
- Keigo Iizuka
- Department of Electrical and Computer Engineering, University of Toronto, 10 King's College Road, Toronto, Ontario, Canada M5S 3G4.
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20
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Sanchez BR, Mohr CJ, Morton JM, Safadi BY, Alami RS, Curet MJ. Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2005; 1:549-54. [PMID: 16925289 DOI: 10.1016/j.soard.2005.08.008] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 08/26/2005] [Accepted: 08/26/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Laparoscopic gastric bypass is a technically demanding operation, especially when hand-sewing is required. Robotics may help facilitate the performance of this difficult operation. This study was undertaken to compare a single surgeon's results using the daVinci Surgical System with those using traditional laparoscopic Roux-en-Y gastric bypass (LRYGB) when the techniques were learned simultaneously. METHODS From July 2004 to April 2005, the new laparoscopic fellow's first 50 patients were randomized to undergo either LRYGB or totally robotic laparoscopic Roux-en-Y gastric bypass (TRRYGB). Data were collected on patient age, gender, body mass index (BMI), co-morbidities, operative time, complication rates, and length of stay. Student's t test with unequal variances was used for statistical analysis. RESULTS No significant differences in age, gender, co-morbidities, complication rates, or length of stay were found between the two groups. The mean operating time was significantly shorter for TRRYGB than for LRYGB (130.8 versus 149.4 minutes; P = 0.02), with a significant difference in minutes per BMI (2.94 versus 3.47 min/BMI; P = 0.02). The largest difference was in patients with a BMI >43 kg/m(2), for whom the difference in procedure time was 29.6 minutes (123.5 minutes for TRRYGB versus 153.2 minutes for LRYGB; P = 0.009) and a significant difference in minutes per BMI (2.49 versus 3.24 min/BMI; P = 0.009). CONCLUSION Our data indicate that the use of the daVinci Surgical System for TRRYGB is safe and feasible. The operating room time is shorter with the use of the robotic system during a surgeon's learning curve, and that decrease is maximized in patients with a larger BMI. TRRYGB may be a better approach to gastric bypass when hand-sewing is required, especially early in a surgeon's experience.
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Affiliation(s)
- Barry R Sanchez
- Department of Surgery, Stanford University Medical Center, Stanford, California 94305, USA
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Martin RCG, Kehdy FJ, Allen JW. Formal training in advanced surgical technologies enhances the surgical residency. Am J Surg 2005; 190:244-8. [PMID: 16023439 DOI: 10.1016/j.amjsurg.2005.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 04/15/2005] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Surgeons have been consistently instructed to use better tools by which to improve upon a patient's medical care. Since the first laparoscopic cholecystectomy, the desire for advanced surgical technologies has continued. This surgical breakthrough has been one of many changes in modern surgical and medical therapy that now represents the standard of care. The aim of this article is to examine the changes in surgical technologies that occurred in the past 15 years, evaluate the possible solutions that have been discussed and formally present the results of a formal training rotation in advanced surgical technologies at the University of Louisville, Department of Surgery. METHODS Questionnaires were sent to 36 former residents who had completed the residency and the advanced surgical technologies rotation to evaluate the success of their training. RESULTS From its inception in 1998 to 2004, the residents have performed a total of 1097 procedures, or an average of 35 cases per month. Much of the exposure was gained in advanced laparoscopy, including laparoscopic nissen fundoplication, gastric band, gastric bypass, splenectomy, colon resection, small-bowl resection donor nephrectomy, and hepatic ablation. Similarly, an evaluation of the 2 procedures that in the late 1990s were considered advanced surgical procedures--sentinal node biopsy and endovascular procedures--shows that the number of these procedures performed on this rotation has fallen over the past 2 years. The overall impression of the rotation from these former residents was either integral or essential in 70% and was helpful in 20%. CONCLUSION The number of demands impacting medical education have never been this numerous or complex. The rapid advances in science, systems, and information technology provide numerous advances in surgical training that continue to be the requirement and responsibility of general surgical training. The cultural changes in surgery include the team approach to provide services in surgical technologies, focus on the aging population, and outcomes assessment. The learning curve, for any and all of these procedures, is inevitably steep, and traditional resident training too often focuses on the more conventional procedures done in routine rotations. The need for formal training in advanced surgical technologies continues to be of utmost importance in these rapidly evolving times.
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Affiliation(s)
- Robert C G Martin
- Department of Surgery, Division of Surgical Oncology, University of Louisville, J. Graham Brown Cancer Center, 315 E. Broadway, #313, Louisville, KY 40202, USA.
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Espat NJ, Jacobsen G, Horgan S, Donahue P. Minimally invasive treatment of esophageal cancer: laparoscopic staging to robotic esophagectomy. Cancer J 2005; 11:10-7. [PMID: 15831219 DOI: 10.1097/00130404-200501000-00003] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Minimally invasive surgical (MIS) procedures have become commonplace in modern surgical practice. The term minimally invasive surgery has been and continues to be interchangeably applied to describe laparoscopic, laparoscopic-assisted, thoracoscopic, and telesurgical (robotic) procedures. Minimally invasive surgical procedures for the treatment of benign and malignant disorders of the esophagus are being developed, refined, and clinically applied in parallel with the exponential availability of novel technologies and instrumentation. Herein, we review the progression from laparoscopic/thoracoscopic esophagectomy to telesurgical esophagectomy, presently termed minimally invasive esophagectomy, and describe the telesurgical procedure as well as early the clinical outcome experience.
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Affiliation(s)
- N Joseph Espat
- Minimally Invasive Surgery Center, Department of Surgery, University of Illinois at Chicago, Chicago Illinois 60612, USA.
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Pisch J, Belsley SJ, Ashton R, Wang L, Woode R, Connery C. Placement of 125I implants with the da Vinci robotic system after video-assisted thoracoscopic wedge resection: A feasibility study. Int J Radiat Oncol Biol Phys 2004; 60:928-32. [PMID: 15465211 DOI: 10.1016/j.ijrobp.2004.07.680] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Revised: 06/08/2004] [Accepted: 07/06/2004] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the feasibility of using the da Vinci robotic system for radioactive seed placement in the wedge resection margin of pigs' lungs. METHODS AND MATERIALS Video-assisted thoracoscopic wedge resection was performed in the upper and lower lobes in pigs. Dummy (125)I seeds embedded in absorbable sutures were sewn into the resection margin with the aid of the da Vinci robotic system without complications. In the "loop technique," the seeds were placed in a cylindrical pattern; in the "longitudinal," they were above and lateral to the resection margin. Orthogonal radiographs were taken in the operating room. For dose calculation, Variseed 66.7 (Build 11312) software was used. RESULTS With looping seed placement, in the coronal view, the dose at 1 cm from the source was 97.0 Gy; in the lateral view it was 107.3 Gy. For longitudinal seed placement, the numbers were 89.5 Gy and 70.0 Gy, respectively. CONCLUSION Robotic technology allows direct placement of radioactive seeds into the resection margin by endoscopic surgery. It overcomes the technical difficulties of manipulating in the narrow chest cavity. With the advent of robotic technology, new options in the treatment of lung cancer, as well as other malignant tumors, will become available.
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Affiliation(s)
- Julianna Pisch
- Department of Radiation Oncology and Physics, Beth Israel and St. Luke's-Roosevelt Medical Center, 1st Avenue and 16th Street, New York, NY 10003, USA.
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