Bilateral internal thoracic artery harvesting under robotic video-assistance

Head and neck reconstruction in the vessel depleted neck using robot-assisted harvesting of the internal mammary vessels

We report a novel technique of robot-assisted harvesting of the internal mammary vessels to provide effective recipient vessels in a patient with bilateral vessel depleted neck (VDN). A 44-year-old with a Notani grade III osteoradionecrosis (ORN) of the anterior mandible underwent robot-assisted (Da Vinci® Surgical System, Intuitive Surgical) harvesting of the left internal mammary vessels (LIMA, LIMV). Reconstruction of the mandibular defect was done with a virtually planned composite fibular free flap and microvascular anastomosis of the peroneal vessels to the LIMA and LIMV. Successful reconstruction of the anterior mandible was achieved with excellent recipient arterial diameter and length, devoid of any significant thoracic morbidities resulting from robot-assisted harvesting of the internal mammary vessels. Robot-assisted harvesting of internal mammary vessels is a viable alternative to an open approach. The advantages in tissue handling, vessel length, and favourable profile of complications may extend the indications for this otherwise 'niche' solution in the VDN.

All we need to know about internal thoracic artery harvesting and preparation for myocardial revascularization: a systematic review

Internal thoracic arteries (ITAs) are the gold standard conduits for coronary revascularization because of their long-term patency and anti-atherosclerotic properties. Harvesting and preparation of ITAs for revascularization is a technically demanding procedure with multiple challenges. Over the last few decades, various methods and techniques for ITAs harvesting have been introduced by different surgeons and applied in clinical practice with different results. Harvesting of ITAs in pedicled or skeletonized fashion, with electrocautery or harmonic scalpel, with open or intact pleura, with clipping the end or keeping it perfused; papaverine delivery with intraluminal injection, perivascular injection, injecting into endothoracic fascia, and papaverine topical spray are the different techniques introduced by the number of researchers. At the same time, access to the ITAs for harvesting has also been studied. Access and harvesting through median sternotomy, mini anterolateral thoracotomy, thoracoscopic, and robotic-assisted harvesting of ITAs are the different techniques used in clinical practice. However, the single standard method for harvesting and preparation of ITAs has yet to be determined. In this review article, we aimed to discuss and analyze all these techniques of harvesting and preparing ITAs with the help of literature to find the best way for ITAs harvesting and preparation for myocardial revascularization.

Overview and fundamentals of urologic robot-integrated systems

Advances in technology have revolutionized urology. Minimally invasive tools now form the core of the urologist's armamentarium. Laparoscopic surgery has become the favored approach for treating many complicated urologic ailments. Surgical robots represent the next evolutionary step in the fruitful man-machine partnership. The introduction of robotic technology in urology changes how urologists learn, teach, plan, and operate. As technology evolves, robots not only will improve performance in minimally invasive procedures, but also enhance other procedures or enable new kinds of operations.

A robotic wide-angle view endoscope using wedge prisms

BACKGROUND

The aim was to develop a new type of robotic wide-angle view endoscope that does not require rotation or bending of the endoscope to move the field of view. This endoscope allows the surgeon to make extensive observations in a small space. It is safe because it avoids the possibility of hitting organs accidentally.

METHODS

The system consists of an endoscope with a zoom facility and two wedge prisms at the tip. Each prism is set on its own sleeve at the end of the endoscope, and both prisms rotate independently about the axis of the endoscope.

RESULTS

In the in vivo experiment, the high quality of the image was confirmed, and almost whole liver could be observed without the observer moving the endoscope itself.

CONCLUSIONS

This system provides safe robotic endoscopic surgery because of the high quality of the image. It has great significance for future clinical use.

Development of Wide-Angle-View Laparoscope Using Wedge Prisms

We describe a novel robotic laparoscope system. It can be used to observe a wide area without moving or bending the laparoscope. The system consists of an endoscope with zoom facility and two wedge prisms at the tip. This new concept produces excellent characteristics as follows. Firstly, it can change the field of view even in a small space. Secondly, it is safe because it avoids the possibility of hitting internal organs. Finally, because it does not require a large mechanism for manipulation of the endoscope, it does not obstruct the surgeon’s operation. We performed basic characteristics evaluation experiment and in-vivo experiment. During evaluation, we confirmed that the positioning accuracy and image quality were acceptable for clinical use.