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Zhang Y, Wu W, Chen J, Si X, Li J, Wang T. Preliminary experience in using the lateral single-incision laparoscopic totally extraperitoneal approach for inguinal hernia repair. Updates Surg 2025; 77:237-244. [PMID: 39692979 PMCID: PMC11876255 DOI: 10.1007/s13304-024-02058-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 11/29/2024] [Indexed: 12/19/2024]
Abstract
To evaluate the feasibility, safety, and efficacy of the lateral single-incision laparoscopic totally extraperitoneal (L-SILTEP) approach in patients with inguinal hernia who had contraindications to the midline approach. This study included 58 patients who underwent L-SILTEP. Data on their baseline characteristics and perioperative details were collected. Quality of life and cosmetic satisfaction assessments were performed. Of the evaluated patients, 25.9% had a history of middle and lower abdominal surgery and 10.3% had skin diseases around the umbilicus. The mean surgical duration, blood loss volume, and incision length were 53.5 (± 22.3) min, 7.2 (± 9.7) mL, and 2.0 (± 0.13) cm, respectively. Additionally, 29.3% of patients experienced intraoperative peritoneal rupture, and one patient had epigastric vessel bleeding. The 6-, 24-, and 48-h postoperative pain scores were 3.0 (± 0.6), 1.6 (± 0.6), and 1.1 (± 0.4), respectively. Postoperative complications included seroma (n = 3), hematoma (n = 1), and scrotal edema (n = 1). The surgical incision in the L-SILTEP approach was more aesthetically pleasing than that in previous surgeries. Approximately 17.2%, 8.6%, and 10.3% of patients reported pain, mesh sensation, and movement limitation, respectively. Severe or disabling symptoms were not reported, and there were no cases of 30-day readmissions. Hernia recurrence or incisional hernia was not observed over a mean follow-up duration of 14.6 (± 6.1) months. L-SILTEP can be used for patients with contraindications to the midline approach. Furthermore, it is a safe and effective procedure.
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Affiliation(s)
- Yizhong Zhang
- Department of Hernia and Hepatobiliary Surgery, the First Affiliated Hospital of Ningbo University, 247 Renmin Road, Ningbo, 31500, China
| | - Weidong Wu
- Gastrointestinal Surgery Department of General Surgery Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 85 Wujin Road, Shanghai, 200080, China.
| | - Junjie Chen
- Department of General Surgery, Ningbo Beilun District Traditional Chinese Medicine Hospital, 221 Yanan Xi Road, Shanghai, 200041, China
| | - Xianke Si
- Department of Hernia and Abdominal Wall Surgery, Putuo Hospital Affiliated to Shanghai University of TCM, Shanghai, 200062, China
| | - Jian Li
- Department of General Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Yangpu, Shanghai, 200090, China
| | - Tingfeng Wang
- Department of General Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China.
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Shen A, Barmparas G, Melo N, Chung R, Burch M, Bhatti U, Margulies DR, Wang A. Incorporating Robotic Cholecystectomy in an Acute Care Surgery Practice Model is Feasible. Am Surg 2024; 90:2457-2462. [PMID: 38654460 DOI: 10.1177/00031348241248816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION The role of robotic surgery in the nonelective setting remains poorly defined. Accessibility, patient acuity, and high turn-over may limit its applicability and utilization. The goal is to characterize the role of robotic cholecystectomy (CCY) in a busy acute care surgery (ACS) practice at a quaternary medical center, and compare surgical outcomes and resource utilization between robotic and laparoscopic CCY. METHODS Adult patients who underwent robotic (Da Vinci Xi) or laparoscopic CCY between 01/2021-12/2022 by an ACS attending within 1 week of admission were included. Primary outcomes included time from admission to surgery, off hour (weekend and 6p-6a) cases, operation time, and hospital costs, to reflect "feasibility" of robotic compared to laparoscopic CCY. Secondary outcomes encompassed surgery-related outcomes and complications. RESULTS The proportion of robotic CCY increased from 5% to 32% within 2 years. In total 361 laparoscopic and 89 robotic CCY were performed. Demographics and gallbladder disease severity were similar. Feasibility measures-operation time, case start time, time from admission to surgery, proportion of off-hour cases, and cost-were comparable between robotic and laparoscopic CCY. There were no differences in surgical complications, common bile duct injury, readmission, or mortality. Conversion to open surgery occurred more often in laparoscopic cases (5% vs 0%, P = .02, OR = 1.05). DISCUSSION Robotic CCY is associated with fewer open conversions and otherwise similar outcomes compared to laparoscopic CCY in the non-elective setting. Incorporation of robotic CCY in a busy ACS practice model is feasible with available resources.
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Affiliation(s)
- Aricia Shen
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Galinos Barmparas
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nicolas Melo
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rex Chung
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Miguel Burch
- Department of Surgery, Division of Minimally Invasive and Gastrointestinal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Umar Bhatti
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel R Margulies
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew Wang
- Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Cheng X, Huang C, Jia W, Guo Z, Shi Y, Song Z, Feng H, Huang H, Xu S, Li H, Wang S, Zhang Y, Zhang T, Liu K, Ji X, Zhao R. Clinical status and future prospects of single-incision robotic-assisted surgery: a review. Int J Surg 2023; 109:4221-4237. [PMID: 37988410 PMCID: PMC10720873 DOI: 10.1097/js9.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
Since the advent of conventional multiport laparoscopic surgery, the prosperity of minimally invasive surgery has been thriving on the advancement of endoscopic techniques. Cosmetic superiority, recovery benefits, and noninferior surgical outcomes weigh single-incision laparoscopic surgery as a promising modality. Although there are surgical challenges posed by steep learning curve and technological difficulties, such as instruments collision, triangulation loss and limited retraction, the establishment of robotic surgical platform as a solution to all is inspiring. Furthermore, with enhanced instrument maneuverability and stability, robotic ergonomic innovations adopt the advantages of single-incision laparoscopic surgery and surmount its recognized barriers by introducing a novel combination, single-incision robotic-assisted surgery. As was gradually diffused in general surgery and other specialties, single-incision robotic-assisted surgery manifests privileges in noninferior clinical outcomes an satisfactory cosmetic effect among strictly selected patients, and has the potential of a preferable surgical option for minimally invasive surgery.
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Affiliation(s)
- Xi Cheng
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenhao Huang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenqing Jia
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zichao Guo
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqing Shi
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zijia Song
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haoran Feng
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Huang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuiyu Xu
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haosheng Li
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaodong Wang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaqi Zhang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Zhang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Liu
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaopin Ji
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ren Zhao
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Choi YJ, Sang NT, Jo HS, Kim DS, Yu YD. A single-center experience of over 300 cases of single-incision robotic cholecystectomy comparing the da Vinci SP with the Si/Xi systems. Sci Rep 2023; 13:9482. [PMID: 37301853 PMCID: PMC10257706 DOI: 10.1038/s41598-023-36055-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 05/28/2023] [Indexed: 06/12/2023] Open
Abstract
Minimally invasive surgery is usually more beneficial than open surgeries in various fields of surgery. With the newly developed Single-Port (SP) robotic surgical system, even single-site surgery has become easier to access. We compared single-incision robotic cholecystectomy between the Si/Xi and SP systems. This retrospective single-center study enrolled patients who underwent single-incision robotic cholecystectomy between July 2014 and July 2021. The clinical outcomes of the da Vinci Si/Xi and SP systems were compared. In total, 334 patients underwent single-incision robotic cholecystectomy (118 Si/Xi vs. 216 SP). The SP group had more chronic or acute cholecystitis than the Si/Xi group did. There was more bile spillage in the Si/Xi group during the surgery. The total operative and docking times were significantly shorter in the SP group. There was no difference in the postoperative outcomes. The SP system is safe and feasible regarding comparable postoperative complication rates and is more convenient regarding docking and techniques.
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Affiliation(s)
- Yoo Jin Choi
- Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, Korea
| | - Nguyen Thanh Sang
- Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, Korea
- Department of Surgery, Trung Vuong Hospital, Ho Chi Minh City, Vietnam
| | - Hye-Sung Jo
- Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, Korea
| | - Dong-Sik Kim
- Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, Korea
| | - Young-Dong Yu
- Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, Korea.
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Kim WJ, Choi SB, Kim WB. Feasibility and Efficacy of Single-Port Robotic Cholecystectomy Using the da Vinci SP® Platform. JSLS 2022; 26:JSLS.2021.00091. [PMID: 35815324 PMCID: PMC9205460 DOI: 10.4293/jsls.2021.00091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Background Single-incision laparoscopic cholecystectomy, first introduced in 1995, features acceptable cosmetic outcomes and postoperative pain control. The outcomes of single-port cholecystectomy by laparoscopy and robots were recently examined in many studies owing to surgeon and patient preference for minimally invasive surgery. A next-level da Vinci robotic platform was recently released. This study aimed to evaluate the feasibility and efficacy of robotic cholecystectomy (RC) using the da Vinci SP® system. Methods In this retrospective observational single-center study, we analyzed the medical records of 304 patients who underwent RC between March 1, 2017 and May 31, 2021. Results Of the 304 patients, the da Vinci Xi® (Xi) was used in 159 and the da Vinci SP® (SP) was used in 145. The mean operation time was 45.7 mins in the SP group versus 49.8 mins in the Xi group. The mean docking time of the SP group was shorter than that of the Xi group (5.7 min vs 8.8 min; p = 0.024). The mean immediate postoperative numerical rating scale (NRS) score was 4.0 in the SP group and 4.3 in the Xi group, showing a significant difference (p = 0.003). A separate analysis of only patients with acute cholecystitis treated with the da Vinci SP® showed that the immediate postoperative NRS score in the acute group was higher than that in the nonacute group. Conclusions This study demonstrated acceptable results of single-site cholecystectomy using da Vinci SP®. Thus, pure single-port RC using the da Vinci SP® for various benign gallbladder diseases may be an excellent treatment option.
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Affiliation(s)
- Wan-Joon Kim
- Division of Hepatobiliary Pancreas Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Sae-Byeol Choi
- Division of Hepatobiliary Pancreas Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Wan-Bae Kim
- Division of Hepatobiliary Pancreas Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
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Kang YH, Kang JS, Cho YS, Kim HS, Lee M, Han Y, Sohn HJ, Kim H, Kwon W, Jang JY, Lee HK. A retrospective multicentre study on the evaluation of perioperative outcomes of single-port robotic cholecystectomy comparing the Xi and SP versions of the da Vinci robotic surgical system. Int J Med Robot 2021; 18:e2345. [PMID: 34676970 DOI: 10.1002/rcs.2345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 09/26/2021] [Accepted: 10/15/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Single-incision robotic cholecystectomy (SIRC) is widely performed with both the da Vinci Xi system (Xi) and the da Vinci SP system (SP). But there are limited numbers of studies comparing these platforms. METHODS Patients who underwent SIRC between 2019 and 2020 were enrolled. Patient demographics, intraoperative factors, postoperative complications, postoperative pain were compared using a one-to-one propensity score matching (PSM). RESULTS Overall, 258 patients underwent SIRC with Xi and 72 with SP. After PSM, there were significant differences between the Xi and SP in operation time at console and numeric rating scale for postoperative pain, but no difference in total operation time and postoperative complications. The SP group showed more estimated blood loss. CONCLUSIONS Despite the statistical difference, clinical benefit was not significant. Both platforms can be safe and feasible to perform SIRC, but further investigation including the surgeon's workload and ergonomics is needed as a prospective study.
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Affiliation(s)
- Yoon Hyung Kang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Seung Kang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yo Seok Cho
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Seok Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mirang Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngmin Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Ju Sohn
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hongbeom Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyeon Kook Lee
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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