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Graell EL, Morsi M, Tabbara MM, Alvarez A, Chandar J, Vianna R, Ciancio G. Robotically procured living donor kidneys transplanted into pediatric recipients. J Pediatr Urol 2025:S1477-5131(25)00147-0. [PMID: 40175199 DOI: 10.1016/j.jpurol.2025.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 02/01/2025] [Accepted: 03/10/2025] [Indexed: 04/04/2025]
Abstract
BACKGROUND Use of living donors for kidney transplantation in pediatric recipients provides optimal long-term graft and patient survival; however, it accounts for only 28.5 % of transplants performed in the United States in 2021. Robotic-assisted living donor nephrectomy is shown to be a safe and feasible option, offering enhanced visualization and improved surgical dexterity, allowing for a potential increase in the living donor pool for pediatric kidney transplant recipients, even in cases of grafts with anatomical variants. METHODS We reviewed all pediatric patients (≤18 years of age) that received an open kidney transplant with a robotically procured living donor graft at our institution between October 2022 and July 2023. Recipient and living donor demographics, peri- and post-operative data, and graft characteristics were obtained and analyzed. RESULTS Eight pediatric recipients were evaluated. Mean recipient age was 11 years, and seven recipients were male. Four kidney grafts required back-table reconstruction: three underwent vascular reconstruction (two requiring deceased donor vascular grafts as extensions of renal veins; one requiring conjoining of two renal arteries), and one underwent cyst removal. Mean cold and warm ischemia time were 73 and 29 min, respectively. There were no cases of delayed graft function or post-operative vascular or urological complications. Mean serum creatinine value at 1, 3, 6, and 12 months post-transplant was 0.785 mg/dL (N = 8), 0.808 mg/dL (N = 8), 0.818 mg/dL (N = 8) and 0.9 mg/dL (N = 3), respectively. CONCLUSION Our study shows that robotically procured living donor kidney grafts, even with anatomical variants, are a safe and feasible source for pediatric kidney transplantation. Utilization of grafts with vascular abnormalities for transplantation after vascular reconstruction does not appear to increase the risk of developing complications and therefore, can increase the donor pool for pediatric transplant candidates.
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Affiliation(s)
- Enric Lledo Graell
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Mahmoud Morsi
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Marina M Tabbara
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Angel Alvarez
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Jayanthi Chandar
- Divison of Pediatric Nephrology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Rodrigo Vianna
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA; Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
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Arcieri M, Paparcura F, Giorgiutti C, Taliento C, Bogani G, Driul L, Greco P, Ercoli A, Chiantera V, Fanfani F, Fagotti A, Scambia G, Mariani A, Restaino S, Vizzielli G. Robotic Surgery in Severely Obese Frail Patients for the Treatment of Atypical Endometrial Hyperplasia and Endometrial Cancer: A Propensity-Match Analysis at an ESGO-Accredited Center. Cancers (Basel) 2025; 17:482. [PMID: 39941849 PMCID: PMC11815858 DOI: 10.3390/cancers17030482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Revised: 01/25/2025] [Accepted: 01/26/2025] [Indexed: 02/16/2025] Open
Abstract
BACKGROUND AND OBJECTIVES Robotic-assisted laparoscopy (RS) has been widely adopted for the management of endometrial cancer (EC) due to favorable perioperative outcomes, especially in the context of obesity, which is an established risk factor for EC. This study retrospectively evaluated the perioperative outcomes of RS versus conventional laparoscopy (LS) in treating EC and atypical endometrial hyperplasia (AH). METHODS Between November 2021 and October 2023, 138 patients with AH or EC underwent surgery at the Clinic of Obstetric and Gynecological-Azienda Sanitaria Universitaria Friuli Centrale, Udine. All patients had total hysterectomy with bilateral salpingo-oophorectomy, with or without lymphadenectomy or sentinel lymph node biopsy. The study included 62 patients treated with LS and 62 with RS. RESULTS The median BMI was higher in the RS group (35.5 vs. 24 kg/m2, p = 0.001). There was no significant difference in operative time between the laparoscopic group and the robotic console time (median 130 vs. 130 min, p = 0.131). No significant differences were found in terms of blood loss, conversion to laparotomy, intraoperative complications, hospital stay, or early postoperative complications between the two groups. CONCLUSIONS Our data confirm the feasibility of robotic surgery in obese patients, allowing surgical results comparable to those of laparoscopy in normal-weight patients.
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Affiliation(s)
- Martina Arcieri
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (M.A.); (G.V.)
| | | | | | - Cristina Taliento
- Obstetrics and Gynecology Unit, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
- Department of Development and Regeneration, Woman and Child, KU Leuven, 3000 Leuven, Belgium
| | - Giorgio Bogani
- Gynaecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (M.A.); (G.V.)
- Department of Medicine (DMED), University of Udine, 33100 Udine, Italy
| | - Pantaleo Greco
- Obstetrics and Gynecology Unit, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Alfredo Ercoli
- Department of Human Pathology in Adult and Childhood “G. Barresi”, University of Messina, 98122 Messina, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, National Cancer Institute, IRCCS, Fondazione “G. Pascale”, 80131 Naples, Italy
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00136 Rome, Italy (G.S.)
| | - Anna Fagotti
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00136 Rome, Italy (G.S.)
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00136 Rome, Italy (G.S.)
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA
| | - Stefano Restaino
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (M.A.); (G.V.)
- PhD School in Biomedical Sciences, Gender Medicine, Child and Women Health, University of Sassari, 07100 Sassari, Italy
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (M.A.); (G.V.)
- Department of Medicine (DMED), University of Udine, 33100 Udine, Italy
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3
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Lefetz O, Baste JM, Hamel JF, Mordojovich G, Lefevre-Scelles A, Coq JM. Robotic surgery and work-related stress: A systematic review. APPLIED ERGONOMICS 2024; 117:104188. [PMID: 38301320 DOI: 10.1016/j.apergo.2023.104188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 02/03/2024]
Abstract
Despite robot-assisted surgery (RAS) becoming increasingly common, little is known about the impact of the underlying work organization on the stress levels of members of the operating room (OR) team. To this end, assessing whether RAS may impact work-related stress, identifying associated stress factors and surveying relevant measurement methods seems critical. Using three databases (Scopus, Medline, Google Scholar), a systematic review was conducted leading to the analysis of 20 articles. Results regarding OR team stress levels and measurement methods were heterogeneous, which could be explained by differing research conditions (i.e., lab. vs. real-life). Relevant stressors such as (in)experience with RAS and quality of team communication were identified. Development of a common, more reliable methodology of stress assessment is required. Research should focus on real-life conditions in order to develop valid and actionable knowledge. Surgical teams would greatly benefit from discussing RAS-related stressors and developing team-specific strategies to handle them.
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Affiliation(s)
- Ophélie Lefetz
- Univ Rouen Normandie, CRFDP, UR 7475, F-76000, Rouen, France.
| | - Jean-Marc Baste
- Faculté de Médecine et de Pharmacie, Université de Rouen, 22 Boulevard Gambetta, CS, 76183, Rouen Cedex 1, France; Rouen University Hospital, Department of general and thoracic surgery, F-76000, Rouen, France; Normandie Univ, UNIROUEN, INSERM, U1096, Rouen University Hospital, Rouen, France
| | | | - Gerardo Mordojovich
- Clínica Alemana de Santiago, Av. Vitacura 5951, Vitacura, Región Metropolitana, Santiago, Chile; Hospital de la Fuerza Aérea de Chile, Santiago, Chile; Universidad Mayor de Santiago, Santiago, Chile
| | - Antoine Lefevre-Scelles
- Rouen University Hospital, Department of intensive care, anesthesia and perioperative medicine, F-76000, Rouen, France; Rouen University Hospital, Emergency Care Training Center (CESU-76A) of Emergency medical service (SAMU-76A), F-76000, Rouen, France
| | - Jean-Michel Coq
- Univ Rouen Normandie, CRFDP, UR 7475, F-76000, Rouen, France
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Leijte E, De Blaauw I, Rosman C, Botden SMBI. Transferability of the robot assisted and laparoscopic suturing learning curves. J Robot Surg 2024; 18:56. [PMID: 38280121 PMCID: PMC10821960 DOI: 10.1007/s11701-023-01753-1] [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: 08/07/2023] [Accepted: 10/11/2023] [Indexed: 01/29/2024]
Abstract
Robot assisted surgery (RAS) is increasingly used, and besides conventional minimally invasive surgery (cMIS) surgeons are challenged to learn an increased array of skills. This study aimed to assess the influence of both learning curves on each other. A prospective randomized crossover study was performed. Participants without cMIS or RAS experience (Groups 1 and 2), and cMIS experienced, (Group 3) were recruited. Three suturing tasks (intracorporal suturing, tilted plane and anastomosis needle transfer) were performed on the EoSim cMIS simulator or RobotiX RAS simulator up to twenty repetitions. Subsequently, Groups 1 and 2 performed the tasks on the other modality. Outcomes were simulator parameters, validated composite and pass/fail scores. In total forty-three participants were recruited. Overall RAS suturing was better in Group 1 (cMIS followed by RAS tasks) and 3 (RAS tasks) versus Group 2 (RAS followed by cMIS tasks) for time (163 s and 157 s versus 193 s p = 0.004, p = 0.001) and composite scores (92/100 and 91/100 versus 89/100 p = 0.008, p = 0.020). The cMIS suturing was better for Group 2 versus 1 (time 287 s versus 349 s p = 0.005, composite score 96/100 versus 94/100 p = 0.002). Significant differences from the RAS suturing pass/fail were reached earlier by Group 3, followed by Groups 1 and 2 (repetition six, nine and twelve). In cMIS suturing Group 2 reached significant differences from the pass/fail earlier than Group 1 (repetition four versus six). Transferability of skills was shown for cMIS and RAS, indicating that suturing experience on cMIS or RAS is beneficial in learning either approach.
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Affiliation(s)
- E Leijte
- Department of Surgery, Radboud University Medical Centre, Geert Grooteplein 10 Route 618, 6500HB, Nijmegen, The Netherlands.
- Department of Paediatric Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - I De Blaauw
- Department of Paediatric Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C Rosman
- Department of Surgery, Radboud University Medical Centre, Geert Grooteplein 10 Route 618, 6500HB, Nijmegen, The Netherlands
| | - S M B I Botden
- Department of Paediatric Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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Chahal B, Aydın A, Amin MSA, Ong K, Khan A, Khan MS, Ahmed K, Dasgupta P. Transfer of open and laparoscopic skills to robotic surgery: a systematic review. J Robot Surg 2023; 17:1207-1225. [PMID: 36418717 PMCID: PMC10374669 DOI: 10.1007/s11701-022-01492-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
Abstract
Due to its advantages over open surgery and conventional laparoscopy, uptake of robot-assisted surgery has rapidly increased. It is important to know whether the existing open or laparoscopic skills of robotic novices shorten the robotic surgery learning curve, potentially reducing the amount of training required. This systematic review aims to assess psychomotor skill transfer to the robot in clinical and simulated settings. PubMed, EMBASE, Cochrane Library and Scopus databases were systematically searched in accordance with PRISMA guidelines from inception to August 2021 alongside website searching and citation chaining. Article screening, data extraction and quality assessment were undertaken by two independent reviewers. Outcomes included simulator performance metrics or in the case of clinical studies, peri- and post-operative metrics. Twenty-nine studies met the eligibility criteria. All studies were judged to be at high or moderate overall risk of bias. Results were narratively synthesised due to heterogeneity in study designs and outcome measures. Two of the three studies assessing open surgical skill transfer found evidence of successful skill transfer while nine of twenty-seven studies evaluating laparoscopic skill transfer found no evidence. Skill transfer from both modalities is most apparent when advanced robotic tasks are performed in the initial phase of the learning curve but quality and methodological limitations of the existing literature prevent definitive conclusions. The impact of incorporating laparoscopic simulation into robotic training curricula and on the cost effectiveness of training should be investigated.
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Affiliation(s)
- Baldev Chahal
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5Th Floor Southwark Wing, London, SE1 9RT, UK
| | - Abdullatif Aydın
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5Th Floor Southwark Wing, London, SE1 9RT, UK.
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK.
| | | | - Kelly Ong
- Department of Urology, Princess Royal University Hospital, Orpington, UK
| | - Azhar Khan
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
- Urology Centre, Guy's and St, Thomas' NHS Foundation Trust, London, UK
| | | | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5Th Floor Southwark Wing, London, SE1 9RT, UK
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, 5Th Floor Southwark Wing, London, SE1 9RT, UK
- Urology Centre, Guy's and St, Thomas' NHS Foundation Trust, London, UK
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Flynn J, Larach JT, Kong JCH, Waters PS, Warrier SK, Heriot A. The learning curve in robotic colorectal surgery compared with laparoscopic colorectal surgery: a systematic review. Colorectal Dis 2021; 23:2806-2820. [PMID: 34318575 DOI: 10.1111/codi.15843] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/08/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023]
Abstract
AIM The learning curve has implications for efficient surgical training. Robotic surgery is perceived to have a shorter learning curve than laparoscopy; however, detailed analysis is lacking. The aim of this work was to analyse studies comparing robotic and laparoscopic colorectal learning curves. Simulation studies comparing novices' learning curves were analysed in order to surmise applicability to colorectal surgery. METHOD A systematic search of Medline, PubMed, Embase and the Cochrane Library identified colorectal papers (from 1 January 2000 to 3 March 2021) comparing robotic and laparoscopic learning curves where surgeons lacked laparoscopic colorectal experience. Simulation studies comparing learning curves were also included. The learning curve was defined as the period of ongoing improvement in speed and/or accuracy. RESULTS From 576 abstracts reviewed, three operative and 16 simulation studies were included. The robotic learning curve for right colectomy was significantly faster in one study (16 vs. 25 cases) and equal for anterior resection in two studies (44 vs. 41 cases and 55 vs. 55). One study showed fewer complications for robotic patients (14.6% vs. 0%, p = 0.013). Ten simulation studies reported faster times and eight recorded error rates favouring robotic surgery. Seven studies measured the learning curve. Four favoured laparoscopic surgery, but operating times were faster using the robotic platform. CONCLUSION Operating times for robotic surgery may be faster than laparoscopy when surgeons are inexperienced with both platforms. This may be related to a superior baseline performance rather than a shorter learning curve. Whether a shorter learning curve on the laparoscopic platform will persist for long enough to enable skills to overtake robotic ability needs further investigation.
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Affiliation(s)
- Julie Flynn
- Department of Surgery, Epworth Healthcare, Richmond, Vic, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia.,University of Melbourne, Melbourne, Vic., Australia
| | - José Tomás Larach
- Department of Surgery, Epworth Healthcare, Richmond, Vic, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia.,Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joseph C H Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia.,University of Melbourne, Melbourne, Vic., Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
| | - Peadar S Waters
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
| | - Satish K Warrier
- Department of Surgery, Epworth Healthcare, Richmond, Vic, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia.,University of Melbourne, Melbourne, Vic., Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
| | - Alexander Heriot
- Department of Surgery, Epworth Healthcare, Richmond, Vic, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia.,University of Melbourne, Melbourne, Vic., Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
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Laparoscopic and Robotic Surgery for Endometrial and Cervical Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e372-e382. [PMID: 34053834 DOI: 10.1016/j.clon.2021.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 12/18/2022]
Abstract
Minimally invasive surgery (MIS) has many benefits, in the form of reduced postoperative morbidity, improved recovery and reduced inpatient stay. It is imperative, however, when new techniques are adopted, in the context of treating oncology patients, that the oncological efficacy and safety are established rigorously rather than assumed based on first principles. Here we have attempted to provide a comprehensive review of all the contentious and topical themes surrounding the use of MIS in the treatment of endometrial and cervix cancer following a thorough review of the literature. On the topic of endometrial cancer, we cover the role of laparoscopy in both early and advanced disease, together with the role and unique benefits of robotic surgery. The surgical challenge of patients with a raised body mass index and the frail and elderly are discussed and finally the role of sentinel lymph node assessment. For cervical cancer, the role of MIS for staging and primary treatment is covered, together with the interesting and highly specialist topics of fertility-sparing treatment, ovarian transposition and the live birth rate associated with this. We end with a discussion on the evidence surrounding the role of adjuvant hysterectomy following radical chemoradiation and pelvic exenteration for recurrent cervical cancer. MIS is the standard of care for endometrial cancer. The future of MIS for cervix cancer, however, remains uncertain. Current recommendations, based on the available evidence, are that the open approach should be considered the gold standard for the surgical management of early cervical cancer and that MIS should only be adopted in the context of research. Careful counselling of patients on the current evidence, discussing in detail the risks and benefits to enable them to make an informed choice, remains paramount.
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Are Surgeons Working Smarter or Harder? A Systematic Review Comparing the Physical and Mental Demands of Robotic and Laparoscopic or Open Surgery. World J Surg 2021; 45:2066-2080. [PMID: 33772324 DOI: 10.1007/s00268-021-06055-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Minimally invasive surgical techniques such as robotic surgical platforms have provided favourable outcomes for patients, but the impact on surgeons is not well described. This systematic review aims to synthesize and evaluate the physical and mental impact of robotic surgery on surgeons compared to standard laparoscopic or open surgery. METHODS A search strategy was developed to identify peer-reviewed English articles published from inception to end of December 2019 on the following databases: MEDLINE, PubMed, PsycINFO and Embase. The articles were assessed using a modified Newcastle-Ottawa tool. RESULTS Of the 6563 papers identified, 30 studies were included in the qualitative synthesis of this review. Most of the included studies presented a high risk of bias. A total of 13 and 21 different physical and mental tools, respectively, were used to examine the impact on surgeons. The most common tool used to measure physical and mental demand were surface electromyography (N = 9) and the NASA Task Load Index (NASA-TLX; N = 8), respectively. Majority of studies showed mixed results for physical (N = 10) and mental impact (N = 7). This was followed by eight and six studies favouring RS over other surgical modalities for physical and mental impact, respectively. CONCLUSION Most studies showed mixed physical and mental outcomes between the three surgical modalities. There was a high risk of bias and methodological heterogeneity. Future studies need to correlate mental and physical stress with long-term impact on the surgeons.
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Willuth E, Hardon SF, Lang F, Haney CM, Felinska EA, Kowalewski KF, Müller-Stich BP, Horeman T, Nickel F. Robotic-assisted cholecystectomy is superior to laparoscopic cholecystectomy in the initial training for surgical novices in an ex vivo porcine model: a randomized crossover study. Surg Endosc 2021; 36:1064-1079. [PMID: 33638104 PMCID: PMC8758618 DOI: 10.1007/s00464-021-08373-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/09/2021] [Indexed: 12/11/2022]
Abstract
Background Robotic-assisted surgery (RAS) potentially reduces workload and shortens the surgical learning curve compared to conventional laparoscopy (CL). The present study aimed to compare robotic-assisted cholecystectomy (RAC) to laparoscopic cholecystectomy (LC) in the initial learning phase for novices. Methods In a randomized crossover study, medical students (n = 40) in their clinical years performed both LC and RAC on a cadaveric porcine model. After standardized instructions and basic skill training, group 1 started with RAC and then performed LC, while group 2 started with LC and then performed RAC. The primary endpoint was surgical performance measured with Objective Structured Assessment of Technical Skills (OSATS) score, secondary endpoints included operating time, complications (liver damage, gallbladder perforations, vessel damage), force applied to tissue, and subjective workload assessment. Results Surgical performance was better for RAC than for LC for total OSATS (RAC = 77.4 ± 7.9 vs. LC = 73.8 ± 9.4; p = 0.025, global OSATS (RAC = 27.2 ± 1.0 vs. LC = 26.5 ± 1.6; p = 0.012, and task specific OSATS score (RAC = 50.5 ± 7.5 vs. LC = 47.1 ± 8.5; p = 0.037). There were less complications with RAC than with LC (10 (25.6%) vs. 26 (65.0%), p = 0.006) but no difference in operating times (RAC = 77.0 ± 15.3 vs. LC = 75.5 ± 15.3 min; p = 0.517). Force applied to tissue was similar. Students found RAC less physical demanding and less frustrating than LC. Conclusions Novices performed their first cholecystectomies with better performance and less complications with RAS than with CL, while operating time showed no differences. Students perceived less subjective workload for RAS than for CL. Unlike our expectations, the lack of haptic feedback on the robotic system did not lead to higher force application during RAC than LC and did not increase tissue damage. These results show potential advantages for RAS over CL for surgical novices while performing their first RAC and LC using an ex vivo cadaveric porcine model. Registration number researchregistry6029 Graphic abstract ![]()
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Affiliation(s)
- E Willuth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - S F Hardon
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, The Netherlands
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - F Lang
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - C M Haney
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - E A Felinska
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - K F Kowalewski
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - B P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Horeman
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
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Lacitignola L, Trisciuzzi R, Imperante A, Fracassi L, Crovace AM, Staffieri F. Comparison of Laparoscopic Steerable Instruments Performed by Expert Surgeons and Novices. Vet Sci 2020; 7:vetsci7030135. [PMID: 32942765 PMCID: PMC7558073 DOI: 10.3390/vetsci7030135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 01/19/2023] Open
Abstract
As an alternative to the surgical robot, some medical companies have engineered new steerable devices that mimic the robot’s capacities. This study aimed to assess how steerable instruments ameliorate the efficacy of suturing in comparison with the traditional instrument, and a combination instruments, performed by experienced and novice surgeons. The study was performed by three experienced surgeons and three novice surgeons. The instruments employed were divided into three surgical sets: two steerable dissectors; one steerable dissector and one straight needle; two straight needle holders. The study supervisor recorded the total time for the procedure, the number of bites completed, the time for each bite, and the quality of the procedure. In our study, we found consistent data demonstrating that experienced laparoscopists completed the prescribed suture pattern with more bites in less time than novices. The use of two steerable instruments was more time consuming than standard straight instruments, but a combination of instruments was significantly less time consuming, as was the use of two straight needle holders. This result was even observed in novice surgeons. Combining a steerable instrument with a traditional straight needle holder provided more advantages in this study.
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Affiliation(s)
- Luca Lacitignola
- Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Sezione di Cliniche Veterinarie e P.A, Università degli Studi di Bari “Aldo Moro”, 70010 Bari, Italy; (L.F.); (F.S.)
- Correspondence: ; Tel.: +39-08-0467-9872
| | - Rodrigo Trisciuzzi
- Dottorato di Ricerca in “Trapianti di Tessuti ed Organi e Terapie Cellulari”, Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Università degli Studi di Bari “Aldo Moro”, 70100 Bari, Italy; (R.T.); (A.I.)
| | - Annarita Imperante
- Dottorato di Ricerca in “Trapianti di Tessuti ed Organi e Terapie Cellulari”, Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Università degli Studi di Bari “Aldo Moro”, 70100 Bari, Italy; (R.T.); (A.I.)
| | - Laura Fracassi
- Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Sezione di Cliniche Veterinarie e P.A, Università degli Studi di Bari “Aldo Moro”, 70010 Bari, Italy; (L.F.); (F.S.)
| | - Alberto Maria Crovace
- Scuola di Bioscienze e Medicina Veterinaria, Università di Camerino, 62024 Matelica, Italy;
| | - Francesco Staffieri
- Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Sezione di Cliniche Veterinarie e P.A, Università degli Studi di Bari “Aldo Moro”, 70010 Bari, Italy; (L.F.); (F.S.)
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11
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Patel H, Madhuri K, Rockell T, Montaser R, Ellis P, Chatterjee J, Butler‐Manuel S, Tailor A. Robotic radical hysterectomy for stage
1B1
cervical cancer: A case series of survival outcomes from a leading
UK
cancer centre. Int J Med Robot 2020; 16:e2116. [DOI: 10.1002/rcs.2116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Hersha Patel
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
| | - Kavitha Madhuri
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
| | - Thomas Rockell
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
| | - Rugaia Montaser
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
| | - Patricia Ellis
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
| | - Jayanta Chatterjee
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
| | - Simon Butler‐Manuel
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
| | - Anil Tailor
- Department of Gynaecological OncologyRoyal Surrey County Hospital Guildford UK
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12
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Leijte E, de Blaauw I, Van Workum F, Rosman C, Botden S. Robot assisted versus laparoscopic suturing learning curve in a simulated setting. Surg Endosc 2019; 34:3679-3689. [PMID: 31754849 PMCID: PMC7326898 DOI: 10.1007/s00464-019-07263-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022]
Abstract
Background Compared to conventional laparoscopy, robot assisted surgery is expected to have most potential in difficult areas and demanding technical skills like minimally invasive suturing. This study was performed to identify the differences in the learning curves of laparoscopic versus robot assisted suturing. Method Novice participants performed three suturing tasks on the EoSim laparoscopic augmented reality simulator or the RobotiX robot assisted virtual reality simulator. Each participant performed an intracorporeal suturing task, a tilted plane needle transfer task and an anastomosis needle transfer task. To complete the learning curve, all tasks were repeated up to twenty repetitions or until a time plateau was reached. Clinically relevant and comparable parameters regarding time, movements and safety were recorded. Intracorporeal suturing time and cumulative sum analysis was used to compare the learning curves and phases. Results Seventeen participants completed the learning curve laparoscopically and 30 robot assisted. Median first knot suturing time was 611 s (s) for laparoscopic versus 251 s for robot assisted (p < 0.001), and this was 324 s versus 165 (sixth knot, p < 0.001) and 257 s and 149 s (eleventh knot, p < 0.001) respectively on base of the found learning phases. The percentage of ‘adequate surgical knots’ was higher in the laparoscopic than in the robot assisted group. First knot: 71% versus 60%, sixth knot: 100% versus 83%, and eleventh knot: 100% versus 73%. When assessing the ‘instrument out of view’ parameter, the robot assisted group scored a median of 0% after repetition four. In the laparoscopic group, the instrument out of view increased from 3.1 to 3.9% (left) and from 3.0 to 4.1% (right) between the first and eleventh knot (p > 0.05). Conclusion The learning curve of minimally invasive suturing shows a shorter task time curve using robotic assistance compared to the laparoscopic curve. However, laparoscopic outcomes show good end results with rapid outcome improvement. Electronic supplementary material The online version of this article (10.1007/s00464-019-07263-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erik Leijte
- Department of Pediatric Surgery, Radboud University Medical Centre - Amalia Children's Hospital, Geert Grooteplein 10 Route 618, 6500HB, Nijmegen, The Netherlands.
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboud University Medical Centre - Amalia Children's Hospital, Geert Grooteplein 10 Route 618, 6500HB, Nijmegen, The Netherlands
| | - Frans Van Workum
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sanne Botden
- Department of Pediatric Surgery, Radboud University Medical Centre - Amalia Children's Hospital, Geert Grooteplein 10 Route 618, 6500HB, Nijmegen, The Netherlands
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13
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Luko L, Parush A, Matanes E, Lauterbach R, Taitler A, Lowenstein L. An Efficient Single-session Spatial Skill Trainer for Robot-assisted Surgery: A Randomized Trial. J Minim Invasive Gynecol 2019; 27:728-737.e2. [PMID: 31146028 DOI: 10.1016/j.jmig.2019.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/16/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE To introduce and examine a single session of spatial skill training as an efficient means of improving surgical suturing performance in robot-assisted surgery. DESIGN A randomized, controlled trial. SETTING A tertiary university medical center in Israel. PARTICIPANTS A purposive sample composed of 41 residents with no robotic suturing skills. INTERVENTIONS A computer-based simulator training of spatial skills. MEASUREMENTS AND MAIN RESULTS Participants were randomly assigned to training (n = 21: mean age of 34 years [standard deviation (SD) = 1.92]) and control (n = 20: mean age of 32 years [SD = 3.17]) conditions. The training group underwent a session of spatial skills training, whereas the control group engaged in a neutral activity. After 1 participant was lost to the follow-up of the posttraining performance test, data of 40 participants were analyzed. Robotic suturing task performance with the da Vinci Skills Simulator (Intuitive Surgical, Sunnyvale, CA) was evaluated using the da Vinci Skills Simulator built-in measure of "excess tissue piercing" and an expert rating of "tissue tearing." The mean number of excess tissue piercing after training (but not after the neutral activity) was significantly lower than before training (3.25 [SD = 1.996] vs 6.75 [SD = 3.68], respectively; p <.001), reflecting an improvement of 52% (decreasing the mean number of excess tissue piercing in a single suture by 3.5 excess piercing trials). After the interventions, the extent of tissue tearing was rated lower in the training group (p = .01), and there was no change in the control group (p = .14). CONCLUSION We showed the efficiency of a training approach that focuses on spatial skills critical in robot-assisted surgery. We showed that surgeons who received a 1 session spatial skill training with a cognitive spatial skill trainer immediately improved the performance of a robotic suturing task compared with surgeons who did not receive such training.
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Affiliation(s)
- Liel Luko
- Faculty of Industrial Engineering and Management, Israel Institute of Technology, Technion City, Haifa, Israel (Drs. Luko and Parush).
| | - Avi Parush
- Faculty of Industrial Engineering and Management, Israel Institute of Technology, Technion City, Haifa, Israel (Drs. Luko and Parush)
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel (Drs. Matanes, Lauterbach, and Lowenstein)
| | - Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel (Drs. Matanes, Lauterbach, and Lowenstein)
| | - Ayal Taitler
- Technion Autonomous Systems Program, Israel Institute of Technology, Technion City, Haifa, Israel (Dr. Taitler)
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel (Drs. Matanes, Lauterbach, and Lowenstein)
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14
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Kawan F, Theil G, Fornara P. Robotic Donor Nephrectomy: Against. Eur Urol Focus 2018; 4:142-143. [PMID: 30082229 DOI: 10.1016/j.euf.2018.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 11/24/2022]
Abstract
The use of robotic techniques in laparoscopic donor nephrectomy currently tends to involve a longer ischemia time without clear advantages, and the cost of robotic surgery is significantly higher. If only one robot is available, then unnecessary prolongation of cold ischemia time also occurs, as the donor must first be undocked to dock the recipient. The combination of laparoscopic donor nephrectomy with parallel initiation of robot-assisted situs preparation and exposure of the renal vessels appears to be the best current approach to safe and cost-effective donor nephrectomy and subsequent robot-assisted kidney transplantation without wasting any time.
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Affiliation(s)
- Felix Kawan
- Clinic of Urology and Transplantation, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Gerit Theil
- Clinic of Urology and Transplantation, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Paolo Fornara
- Clinic of Urology and Transplantation, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
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15
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Pimentel M, Cabral RD, Costa MM, Neto BS, Cavazzola LT. Does Previous Laparoscopic Experience Influence Basic Robotic Surgical Skills? JOURNAL OF SURGICAL EDUCATION 2018; 75:1075-1081. [PMID: 29191757 DOI: 10.1016/j.jsurg.2017.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/19/2017] [Accepted: 11/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Studies addressing the effect of laparoscopic experience on robotic skills have produced conflicting results. This study aimed to compare simulated robotic surgical tasks using the virtual reality simulator dV-Trainer between laparoscopically experienced surgeons and first-year surgical residents. DESIGN A cross-sectional study. Participants completed 4 trials of the following tasks on the dV-Trainer: Peg Board 2, Ring and Rail 1, and Suture Sponge 1. Performance was recorded using a computerized built-in scoring algorithm. Scores and metrics were compared between groups 1 and 2 and between the first and subsequent trials. SETTING Hospital de Clínicas, Porto Alegre, Brazil, a tertiary care teaching hospital. PARTICIPANTS Twenty laparoscopically experienced surgeons (group 1) and 20 first-year surgical residents (group 2). All participants completed the study. RESULTS The overall scores for Peg Board 2 (738.04 ± 267.83 vs 730.39 ± 225.31; p = 0.57), Ring and Rail 1 (919.03 ± 242.69 vs 965.84 ± 222.96; p = 0.13), and Suture Sponge 1 (563.62 ± 185.50 vs 560.99 ± 152.71; p = 0.67) did not differ significantly between groups 1 and 2. Group 1 had better results for master workspace range in Peg Board 2 and Ring and Rail 1. Group 2 had higher scores for economy of motion in Peg Board 2 and Ring and Rail 1 and for excessive instrument force in Ring and Rail 1. In both groups, the overall scores in the third and fourth trials were significantly higher than those in the first trial. CONCLUSIONS There are no significant differences in the performance of simulated robotic surgical tasks between laparoscopically experienced surgeons and laparoscopically naïve surgical residents. Some slight differences were observed in specific metrics, but these differences were not sufficient to change the final results. We may assume that laparoscopic experience should not be an essential step in the initial learning curve of robotic surgery.
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Affiliation(s)
- Marcelo Pimentel
- Postgraduate Program in Surgical Sciences, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Medical School, Universidade de Passo Fundo (UPF), Passo Fundo, Rio Grande do Sul, Brazil.
| | - Renan Desimon Cabral
- Service of Urology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Márcio Machado Costa
- Medical School, Universidade de Passo Fundo (UPF), Passo Fundo, Rio Grande do Sul, Brazil
| | - Brasil Silva Neto
- Postgraduate Program in Surgical Sciences, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Service of Urology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Leandro Totti Cavazzola
- Postgraduate Program in Surgical Sciences, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Service of General Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
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Madureira FAV, Varela JLS, Madureira D, D'Almeida LAV, Madureira FAV, Duarte AM, Vaz OP, Ramos JR. Model of a training program in robotic surgery and its initial results. Rev Col Bras Cir 2017; 44:302-307. [PMID: 28767807 DOI: 10.1590/0100-69912017003013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/27/2017] [Indexed: 01/29/2023] Open
Abstract
Objective: to describe the implementation of a training program in robotic surgery and to point the General Surgery procedures that can be performed with advantages using the robotic platform. Methods: we conducted a retrospective analysis of data collected prospectively from the robotic surgery group in General and Colo-Retal Surgery at the Samaritan Hospital (Rio de Janeiro, Brazil), from October 2012 to December 2015. We describe the training stages and particularities. Results: two hundred and ninety three robotic operations were performed in general surgery: 108 procedures for morbid obesity, 59 colorectal surgeries, 55 procedures in the esophago-gastric transition area, 16 cholecystectomies, 27 abdominal wall hernioplasties, 13 inguinal hernioplasties, two gastrectomies with D2 lymphadenectomy, one vagotomy, two diaphragmatic hernioplasties, four liver surgeries, two adrenalectomies, two splenectomies, one pancreatectomy and one bilio-digestive anastomosis. The complication rate was 2.4%, with no major complications. Conclusion: the robotic surgery program of the Samaritan Hospital was safely implemented and with initial results better than the ones described in the current literature. There seems to be benefits in using the robotic platform in super-obese patients, re-operations of obesity surgery and hiatus hernias, giant and paraesophageal hiatus hernias, ventral hernias with multiple defects and rectal resections.
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Affiliation(s)
- Fernando Athayde Veloso Madureira
- Hospital Samaritano, Grupo de Cirurgia Robótica, Rio de Janeiro, RJ, Brasil.,Hospital Gaffrée Guinle da Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brasil
| | | | - Delta Madureira
- Hospital Samaritano, Grupo de Cirurgia Robótica, Rio de Janeiro, RJ, Brasil
| | | | | | | | - Otávio Pires Vaz
- Hospital Samaritano, Grupo de Cirurgia Robótica, Rio de Janeiro, RJ, Brasil
| | - José Reinan Ramos
- Hospital Samaritano, Grupo de Cirurgia Robótica, Rio de Janeiro, RJ, Brasil
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Persky AM, McLaughlin JE. The Flipped Classroom - From Theory to Practice in Health Professional Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2017; 81:118. [PMID: 28970619 PMCID: PMC5607728 DOI: 10.5688/ajpe816118] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 06/28/2016] [Indexed: 05/13/2023]
Abstract
The flipped classroom is growing in popularity in health professional education. As such, instructors are experiencing various growing pains in functionalizing this model, from justifying the approach to managing time inside and outside of class to assessing impact on learning. This review focuses on some key theories that support the flipped model and translates those key theories into practice across core aspects of the flipped classroom: pre-class preparation, in-class activities, after-class activities and assessment of student learning.
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Affiliation(s)
- Adam M Persky
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jacqueline E McLaughlin
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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