Robotic-assisted abdominal aortic surgery: evidence and techniques

Feasibility study to evaluate the MMI Symani robotic system for microsurgical techniques in an in-vitro circulation model

The Symani Surgical System is a novel robotic microsurgical platform. This study investigated its feasibility for arterial reconstructive techniques in an in vitro model. Two senior surgeons without preliminary expertise in robotic surgery performed different techniques in a porcine artery circulation model (bypass, patch plastic, and direct closure of arteriotomy). There was an overall improvement in procedure times with a minor leakage rate and upper range values in the qualitative assessment of anastomoses. In this model, the Symani Surgical System seems to be suitable for the robotic-assisted conductance of microsurgical procedures on arterial vessels.

Inhibition of GPR4 Attenuates the Formation of Abdominal Aortic Aneurysm Through Inhibiting the SP-1/VEGF-A Signaling

Abdominal aortic aneurysm (AAA) is a severe cardiovascular disease (CVD) that is partly attributable to endothelial dysfunction, inflammatory response, and angiogenesis. G protein-coupled receptor 4 (GPR4), a proton-sensitive G protein-coupled receptor that is abundantly expressed in vascular endothelial cells, has been associated with numerous physiological functions. Nevertheless, its potential involvement in the development of AAA remains unexplored. In this study, we examined the impact of GPR4 deletion on the development of AAA in ApoE-deficient mice. The mice were categorized into four distinct groups: the ApoE-/- with saline group, the ApoE-/-GPR4-/- with saline group, the ApoE-/- with Ang II group, and the ApoE-/-GPR4-/- with Ang II group. AAA were induced in the ApoE-/- mice through the perfusion of angiotensin II (Ang II). Notably, GPR4 was substantially elevated in the AAA tissues from both human subjects and experimental mice. The deletion of GPR4 substantially decreased the formation of Ang II-induced AAA, damages to elastin, and the expression of aortic inflammatory cytokines interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α), as well as vascular endothelial growth factor A/vascular endothelial growth factor receptor 2 (VEGF-A/VEGF-R2), in ApoE-/- mice. Human aortic endothelial cells (HAECs) were transfected with lenti-viral GPR4 shRNA and subsequently stimulated with Ang II. Our findings indicate that the knockout of GPR4 attenuated Ang II-induced angiogenic tube formation in HAECs by decreasing the expression of VEGF-A and VEGF-R2. Furthermore, GPR4 knockout also hindered the activation of specificity protein-1 (SP-1) by reducing its expression and transcriptional activity. Notably, the overexpression of SP-1 reversed the inhibitory effects of GPR4 knockout on angiogenic tube formation and the expression of VEGF-A/VEGF-R2. This suggests that the protective effects of GPR4 knockout are achieved through the inhibition of SP-1. In summary, the absence of GPR4 impeded AAA formation, indicating that GPR4 could potentially serve as a therapeutic target for AAA.

S, Sharma S. Patient satisfaction and quality of life outcomes following robotic-assisted surgery: A survey-based study

Robotic-assisted surgery has gained interest due to its potential for improved precision, reduced trauma and quicker recovery. This cross-sectional survey assessed patient satisfaction and quality-of-life outcomes in 100 patients who underwent robotic-assisted procedures across various specialties. The findings revealed high satisfaction levels, with 85% of patients expressing positive feedback about surgical outcomes. Quality-of-life improvements were noted in pain reduction, physical recovery and psychological well-being. Minor dissatisfaction arose from discomfort during postoperative stages and extended recovery periods in complex cases. The results highlight the need for enhanced preoperative counseling to align patient expectations, reinforcing robotic-assisted surgery as a method associated with high satisfaction and improved quality of life.

Radiologists' perceptions and readiness for integrating artificial intelligence in diagnostic imaging: A survey-based study

Artificial intelligence (AI) is revolutionizing diagnostic imaging, enhancing precision, speed and efficiency. This study explored radiologists' perceptions of AI through a survey of 100 radiologists across various institutions, focusing on awareness, benefits, concerns and preparedness for AI adoption. Most radiologists recognized AI's potential to improve diagnostic accuracy and workflow efficiency but expressed concerns about its reliability, job displacement and ethical implications. Readiness to adopt AI varied significantly based on age, experience and familiarity with AI tools. These findings underscore the need for targeted education and training programs to address skepticism and support the effective integration of AI into diagnostic imaging practices.

Decreasing Resident Vascular Case Volumes Have Not Changed National Numbers of Vascular Fellowship Applications in US General Surgery Residents Over the Past Twenty Years

OBJECTIVES

With an aging workforce and high prevalence of vascular disease, the US is expected to face a pronounced shortage of vascular surgeons over the next 2 decades. This has driven initiatives to expand vascular surgery training positions leading to the rise of integrated residency programs (0 + 5) and the expansion of traditional fellowships (VSFs, 5 + 2). Given the increase in dedicated vascular surgery training positions, there has been a growing concern that general surgery residents (GSRs) are experiencing decreased vascular case volumes. We aim to evaluate trends in vascular surgery specialty choice relative to vascular case volumes for US GSRs over the last 20 years.

DESIGN

Using the Accreditation Council for Graduate Medical Education (ACGME) Case Log Graduate Statistics National Report, a retrospective analysis of ACGME-accredited GSR vascular case volumes was performed from academic year 1999-2000 to 2021-2022. Fellowship data was retrospectively reviewed using the available National Resident Matching Program (NRMP) Fellowship Match Data & Reports for 2004-2023.

RESULTS

Graduating GSRs logged increasing numbers of major cases between AY 1999-2000 and AY 2021-2022 (p < 0.001) with 2022 graduates logging on average 98 more cases per resident compared to 2000 graduates. Mean total vascular cases decreased (p = 0.005) with 2022 graduates logging approximately 78 fewer vascular cases on average compared to the 2000 graduates, a 40% decrease in vascular case volume. Despite the decrease, US GSRs have applied to VSF at a relatively consistent rate: 8.5% in 2001-2002, 8% in 2011-2012, and 6% in 2021-2022. 2023 demonstrated an increase to 8.3%.

CONCLUSION

Over the past 2 decades, GSRs have experienced a substantial decrease in exposure to vascular surgery cases during their training; however, residents continue to apply for VSF at a relatively constant rate suggesting that interest in the specialty may be related to factors other than exposure to vascular cases.

Robotically assisted outflow graft anastomosis in minimally invasive left-ventricular assist device implantation: feasibility, surgeon comfort, and operative times in an anatomical study

Upper hemi-sternotomy is a common approach for outflow graft anastomosis to the ascending aorta in minimally invasive left-ventricular assist device implantation. Right mini-thoracotomy may also be used, but use of robotic assistance has been reported only anecdotally. The aim of our study was to confirm the feasibility of robotically assisted suturing of the outflow graft anastomosis and to assess performance metrics for the robotic suturing part of the procedure. The procedure was carried out in eight cadaver studies by two surgeons. The assist device pump head was inserted through a left-sided mini-thoracotomy and the outflow graft was passed toward a right-sided second interspace mini-thoracotomy through the pericardium. After placement of a partial occlusion clamp on the ascending aorta, a longitudinal aortotomy was performed and the outflow graft to ascending aorta anastomosis was carried out robotically. The procedure was feasible in all eight attempts. The mean outflow graft anastomotic time was 20.1 (SD 6.8) min and the mean surgeon confidence and comfort levels to complete the anastomoses were 8.3 (SD 2.4) and 6.9 (SD2.2), respectively, on a ten-grade Likert scale. On open inspection of the anastomoses, there was good suture alignment in all cases. We conclude that suturing of a left-ventricular assist device outflow graft to the human ascending aorta is very feasible with good surgeon comfort. Anastomotic times are acceptable and suture placement can be performed with appropriate alignment.

Bridging the gap: robotic applications in cerebral aneurysms neurointerventions - a systematic review

Cerebral aneurysm is a life-threatening condition, which requires high precision during the neurosurgical procedures. Increasing progress of evaluating modern devices in medicine have led to common usage of robotic systems in many fields, including cranial aneurysm operations. However, currently no systematic review describes up-to date knowledge of this topic. Following PRISMA guidelines, we have independently screened and extracted works from seven databases. Only studies fulfilling inclusion criteria were presented in this study. Device used, operation time, complications, aneurysm type and patient demographics were extracted from each work. We identified a total of 995 articles from databases. We have found six original works and one supplementary article eligible for this synthesis. Majority of works (4/6) have implemented CorPath GRX in cerebral aneurysm procedures. The procedures involved diverse aneurysm locations, utilizing flow diverters, stents, or coiling. One study described implementation of robot-assist on 117 patients and compared results to randomized clinical trials. One work with a small patient cohort described use of the magnetically-controlled microguidewire in the coiling procedures, without any complications. Additionally, one case-series study described use of a robotic arm for managing intraoperative aneurysm rupture. Currently, robotical devices for cerebral aneurysm treatment mainly lack jailing and haptic feedback feature. Further development of these devices will certainly be beneficial for operators and patients, allowing for more precise and remote surgeries.

Evaluation of the MMI Symani® robotic microsurgical system for coronary-bypass anastomoses in a cadaveric porcine model

The MMI Symani® is a recently approved robotic microsurgical system for surgical procedures in adults. The system enables the surgeon to create microanastomoses. Clinical applications so far include lymphatic vessels surgery and the creation of special flap plastics. The use of the system in coronary arteries has not yet been assessed. The aim of this preclinical study was to evaluate the applicability of the Symani® surgical system in the creation of coronary anastomoses a cadaveric porcine model. A total of 12 anastomoses were performed by three senior cardiovascular surgeons on the left main coronary artery of three porcine hearts. Artificial bypasses (diameter 1 mm) were performed to the left main trunk. The anastomoses were performed with the Symani® surgical system. Evaluation included procedure times and anastomosis leakage. All anastomoses could be successfully performed. The procedure time decreased due to the learning curve between the first anastomosis 47:28 ± 5:30 min and the last anastomosis 22:37 ± 3:25 min. The final evaluation of the anastomoses showed excellent results with low leakage. The quality of the anastomosis also improved in relation to the increasing learning curve. The Symani® surgical system could be used to create coronary anastomoses in an acceptable time frame and without technical failures. Hence, the system appears feasible for conventional coronary surgery. Further studies in animal models are mandatory prior to clinical application.