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Redondo-Sáenz D, Cortés-Salas C, Parrales-Mora M. Perioperative Nursing Role in Robotic Surgery: An Integrative Review. J Perianesth Nurs 2023:S1089-9472(22)00594-9. [PMID: 36754770 DOI: 10.1016/j.jopan.2022.11.001] [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: 06/05/2022] [Revised: 09/25/2022] [Accepted: 11/06/2022] [Indexed: 02/10/2023]
Abstract
PURPOSE Robotic surgery is an increasingly popular approach across surgical specialties in several countries. Nurses embedded in this highly-technological environment, however, could excessively center their attention to the robot, deviating their focus from the patient. The Perioperative Patient Focused Model is proposed as a theoretical framework to guide nursing perioperative care towards a patient-centered approach based upon 4 dimensions: Health System, Safety, Behavioral Responses and Physiological Responses. This review aimed to understand the role of perioperative nursing in robotic surgery according to the Perioperative Patient Focused Model. DESIGN An integrative review. METHODS The Whittemore and Knafl methodology guided this review. The following databases were searched: PubMed, Cochrane Library, ProQuest, Scielo, and LILACS. The keywords used were "Robotic Surgical Procedures" and "Nursing" and their equivalents in Spanish, Portuguese, and French, using the Boolean operator "AND," within the time frame of 2010-2021. FINDINGS A total of 1,695 articles were retrieved, of which 26 were retained for the final analysis. The majority (n = 17) were written in English, with a level of evidence between 4 and 5. The main actions performed by nursing professionals were retrieved in the Health Systems, Safety, and Behavioral Responses dimensions, focusing on the intraoperative and postoperative period. However, most of the patient's responses were presented in the postoperative stage, even after discharge. Encompassing these findings, a theoretical framework is proposed. CONCLUSIONS Nursing professional duties are diverse within the course of robotic surgery. It is necessary to expand the Perioperative Nursing specialty towards an extended care, encompassing even the community settings.
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Affiliation(s)
| | | | - Mauricio Parrales-Mora
- Hepato-Pancreato-Biliary (HPB) Surgery Unit, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Barcelona, Spain
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Singh K, Agrawal A. Robotic surgery: is it here to flourish? Med J Armed Forces India 2023; 79:1-5. [PMID: 36605343 PMCID: PMC9807742 DOI: 10.1016/j.mjafi.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- K.J. Singh
- Consultant (Surgery & GI Surgery), Command Hospital (Western Command), Chandimandir, Panchkula, Haryana, India
| | - Amit Agrawal
- Senior Advisor (Surgery) & Urologist, Army Hospital (R&R), Delhi Cantt, India
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Robotic-assisted vertical sleeve gastrectomy in adolescents: Do BMI limits apply? J Pediatr Surg 2022; 57:1158-1161. [PMID: 35148900 DOI: 10.1016/j.jpedsurg.2022.01.033] [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: 12/29/2021] [Accepted: 01/22/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Robotic-assisted vertical sleeve gastrectomy (VSG) in adolescent patients has been shown to have comparable outcomes to laparoscopic VSG. Recent data suggests that metabolic and bariatric surgery (performed using robotic and laparoscopic techniques) in patients with BMI ≥ 50 kg/m2 have a higher risk of adverse events compared to those with BMI < 50 kg/m2. The aim of this study was to compare the outcomes of robotic-assisted VSG in adolescents with a BMI above and below 50 kg/m2. METHODS A retrospective analysis of all adolescents undergoing robotic-assisted VSG between January 2014 and December 2020. Subjects were categorized based on preoperative BMI; Group 1 (BMI < 50 kg/m2) or Group 2 (BMI ≥ 50 kg/m2). Data collection included patient demographics, preoperative BMI, total operative time, access time (i.e., total time for port-placement), 30 day complications, and 30 day hospital readmissions. Analysis was performed using chi-square, Fisher's Exact, and student t-test. RESULTS Total of 115 subjects (Group 1 N = 64 and Group 2 N = 51) were included. No differences in age or ethnicity were detected; however, Group 2 had a higher percentage of male patients (27.5% vs. 4.7%, respectively, p = 0.001). Mean operative times (Group 1 = 122.2 min vs. Group 2 = 121.6 min) and access times (Group 1 = 19.1 min vs. Group 2 = 19.7 min) were similar between groups. Thirty day complication rates were similar between groups (p = 0.133); however, there was a higher rate of hospital readmission in Group 1. CONCLUSION While recent data demonstrate an increased likelihood of adverse events occurring among patients with BMI ≥ 50 kg/m2 undergoing robotic surgery, we observed no differences in intraoperative or early postoperative outcomes based on BMI in this robotic-assisted pediatric cohort.
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Fei C, Karatassas A, Cheah S, Hensman C. Addressing ergonomic, skill acquisition and mentoring constraints that may be contributory to gender disparity in surgery: a 'value add' for robotics? ANZ J Surg 2022; 92:649-650. [PMID: 35434955 DOI: 10.1111/ans.17386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Carrie Fei
- Medical undergraduate, Monash University, Melbourne, Victoria, Australia
| | - Alex Karatassas
- University of Adelaide, Masters of minimally invasive surgery course, Department of Surgery Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Sheryn Cheah
- Surgeon Department, Surgeon, Box Hill Hospital & LapSurgery Australia, Melbourne, Victoria, Australia
| | - Chrys Hensman
- Department of Surgery Monash, University of Melbourne, Melbourne, Victoria, Australia.,Department of Robotics, Swinburne University of Technology Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, Masters of Minimally Invasive Surgery Course University of Adelaide, Adelaide, South Australia, Australia
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Roriz-Silva R, Vilallonga R, Fort JM, Khoraki J, de Gordejuela AGR, Gonzalez O, Caubet E, Rodríguez-Luna MR, Armengol M. Robotic and laparoscopic Roux-en-Y gastric bypass after learning curve: 30-day and 12-month outcomes. J Robot Surg 2022; 16:1257-1263. [PMID: 35218480 DOI: 10.1007/s11701-022-01384-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/06/2022] [Indexed: 01/01/2023]
Abstract
This study compares laparoscopic RYGB (L-RYGB) and robotic RYGB (R-RYGB) performed by the same team after the learning curve in both approaches. A retrospective cohort study was done, and the surgical outcome was analyzed in 30 days and 12 months for patients with similar characteristics and an equal number of cases in each group (233 cases). Four hundred and sixty-six patients were included in this study. Mean age was 46.8 ± 8.3 years and 2/3 were women. R-RYGB presented a longer operative time (150.7 versus 135.4 min; p < 0.001) with no differences in the length of hospital stay. The main 30-day complications were G-J stricture, leakage, and intraluminal bleeding. The reoperation rate was 1.6% by leakage (G-J anastomosis) and was higher in R-RYGB (2.1 versus 0.4; p = 0.108). The multivariate analysis identified that L-RYGB was the factor independently associated with a LOS longer than 2 days (odds ratio: 4.7, 95% CI: 2.6-8.2, p value < 0.001). At the FU time (12 months), no differences between the groups were found. The outcomes between the groups after the learning curve did not present differences in terms of 30 days and 12 months of FU when same preoperative characteristics and an equal number of cases in each group are considered. L-RYGB was the unique independent factor associated with long LOS.
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Affiliation(s)
- Renato Roriz-Silva
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. .,Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Medical College of Virginia, Virginia Commonwealth University School of Medicine, Richmond, USA. .,Department of Medicine, Federal University of Rondônia, Porto Velho, Brazil.
| | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jose Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jad Khoraki
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Medical College of Virginia, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Amador Garcia Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Manel Armengol
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Five Year Trends in the Utilization of Robotic Bariatric Surgery Procedures, United States 2015-2019. Obes Surg 2022; 32:1539-1545. [PMID: 35169953 DOI: 10.1007/s11695-022-05964-7] [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: 10/07/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Robotic approaches have been steadily replacing laparoscopic approaches in metabolic and bariatric surgeries (MBS); however, their superiority has not been rigorously evaluated. The main goal of the study was to evaluate the 5-year utilization trends of robotic MBS and to compare to laparoscopic outcomes. METHODS Retrospective analysis of 2015-2019 MBSAQIP data. Kruskal-Wallis test/Wilcoxon and Fisher's exact/chi-square were used to compare continuous and categorical variables, respectively. Generalized linear models were used to compare surgery outcomes. RESULTS The use of robotic MBS increased from 6.2% in 2015 to 13.5% in 2019 (N= 775,258). Robotic MBS patients had significantly higher age, BMI, and likelihood of 12 diseases compared to laparoscopic patients. After adjustment, robotic MBS patients showed higher 30-day interventions and 30-day readmissions alongside longer surgery time (26-38 min). CONCLUSION Robotic MBS shows higher intervention and readmission even after controlling for cofounding variables.
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Petrick AT, Rosenthal RJ, Wood GC. Understanding the causes of conflicting outcomes reported using the same cohorts from the MBASQIP PUF data registry. Surg Obes Relat Dis 2021; 17:e42-e45. [PMID: 34092516 DOI: 10.1016/j.soard.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/07/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Anthony T Petrick
- Division of Bariatric and Foregut Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Raul J Rosenthal
- Bariatric and Metabolic Institute, Cleveland Clinic, Weston, Florida
| | - G Craig Wood
- Obesity Research Institute, Geisinger Medical Center, Danville, Pennsylvania
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Laparoscopic sleeve gastrectomy in patients with complex abdominal wall hernias. Surg Endosc 2020; 35:3881-3889. [PMID: 32725476 DOI: 10.1007/s00464-020-07831-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/15/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Patients with severe obesity and complex abdominal wall hernias (CAWH) present a challenging clinical dilemma. Their body mass index (BMI) is often prohibitive of successful ventral hernia repair (VHR) and the CAWH presents technical challenges when pursuing bariatric surgery. Our hernia center policy is to refer patients with severe obesity for evaluation with the surgical weight loss program. This study describes outcomes of laparoscopic sleeve gastrectomy (LSG) in patients with both severe obesity and CAWH. METHODS A retrospective analysis was performed on data prospectively collected between 2014 and 2020. CAWH patients referred for and undergoing LSG were included. Revisional bariatric surgery patients were excluded. The dataset was augmented with operative time, BMI changes, length of stay (LOS), hernia characteristics, postoperative complications, time from referral to weight loss surgery, and time from LSG to VHR. RESULTS Twenty patients (10 males, mean age 54.3 years) met inclusion criteria. Mean BMI at LSG was 45.6 ± 6.1 kg/m2. Mean hernia area was 494.9 ± 221.2 cm2 and 90% had hernia extension into the subxiphoid and/or epigastric regions. Mean time from bariatric referral to LSG was 10.5 ± 5.4 months. Mean LSG operative time was 121.2 ± 50.3 min, and mean LOS was 1.6 ± 0.8 days. One patient had postoperative bleeding necessitating laparoscopic re-exploration. There were no readmissions. Sixteen patients subsequently underwent VHR on average13.5 ± 11.7 months later and on average 22.6 ± 12.5 months after initial hernia consultation. Two patients had a hernia-related complication between the period of initial hernia consultation and ultimate repair. Mean BMI was 37.5 ± 7.5 kg/m2 (mean 20.7 ± 12.3% decrease, p < 0.0001) at mean follow-up of 27.2 ± 17.2 months. CONCLUSIONS LSG can be performed successfully even in patients with CAWH. Outcomes do not appear to differ significantly from typical patients undergoing LSG. Further study with larger cohorts is warranted to better delineate complication rates in this population as well as to determine long-term outcomes.
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