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Kim K, Park D, Oh MY, Chai YJ, Kim HY. Safety and surgical outcomes of robotic adrenalectomy from a 15-year experience at a single institution. Sci Rep 2024; 14:12174. [PMID: 38806567 PMCID: PMC11133357 DOI: 10.1038/s41598-024-63105-9] [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: 02/16/2024] [Accepted: 05/24/2024] [Indexed: 05/30/2024] Open
Abstract
Robotic adrenalectomy (RA) has gained significant popularity in the management of adrenal gland diseases. We report our experience at a single tertiary institution and evaluate the safety and surgical outcomes of RA. The data of 122 consecutive patients who underwent RA from October 2009 to December 2022 at Korea University Anam Hospital (Seoul, Korea) were reviewed. There were no perioperative complications. Clinicopathological features and surgical outcomes were retrospectively analyzed through complete chart reviews. Noteworthy findings include the influence of sex, tumor size, and body mass index on operation time, with the female and small tumor groups exhibiting shorter operation times (P = 0.018 and P = 0.009, respectively). Pheochromocytoma was identified as a significant independent risk factor for a longer operation time in the multivariate analysis [odds ratio (OR), 3.709; 95% confidence interval (CI), 1.127-12.205; P = 0.031]. A temporal analysis revealed a decreasing trend in mean operation times across consecutive groups, reflecting a learning curve associated with RA adoption. RA is a safe and effective operative technique alternative to laparoscopic adrenalectomy that has favorable surgical outcomes and enhances the convenience of the operation.
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Affiliation(s)
- Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dawon Park
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Moon Young Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hoon Yub Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
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2
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Wang SH, Hsieh TH, Chao WP, Lo TY, Huang TS, Chen YH. Application and advantages of a joystick-controlled robotic scope holder in transoral endoscopic thyroidectomy vestibular approach: a comparative study. Updates Surg 2024:10.1007/s13304-024-01783-w. [PMID: 38468019 DOI: 10.1007/s13304-024-01783-w] [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: 05/16/2023] [Accepted: 02/03/2024] [Indexed: 03/13/2024]
Abstract
Transoral endoscopic thyroidectomy has gained popularity due to its scarless nature, but the use of a handheld endoscope can lead to an unstable visual field. Soloassist II, a robotic scope holder, enables precise control using a joystick, ensuring stable vision. This study aims to evaluate the application and the advantages of Soloassist II in transoral thyroidectomy. Patients who underwent transoral thyroidectomy with Soloassist II or human assistance between June 2019 and May 2021 were reviewed. Patient demographics and surgical outcomes were compared. The ergonomic stress of the assistant in both groups was also measured. A total of 100 consecutive patients were included: 32 were assisted by Soloassist II and 68 by humans. The Soloassist II group demonstrated significantly shorter operation times (median [IQR]) (165 [149,179] vs. 181 [165,204] min, P = 0.004) in unilateral lobectomy and less blood loss (median [IQR]) (2 [2,2] vs. 2 [2,3] ml, P = 0.002) than the human-assisted group. Postoperative course and complication rates were similar. The musculoskeletal pain of the assistant was significantly higher and involved more areas in the human-assisted group. The utilization of Soloassist II in transoral endoscopic thyroidectomy is easy to set up and leads to shorter operation times, reduced blood loss, and decreased musculoskeletal pain compared to human handheld endoscope. These findings support the potential of Soloassist II in improving surgical outcomes and minimizing physical strain during transoral thyroidectomy.
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Affiliation(s)
- Suo-Hsien Wang
- Department of General Surgery, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., Keelung, 204, Taiwan
| | - Tsai-Heng Hsieh
- Department of General Surgery, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., Keelung, 204, Taiwan
| | - Wu-Po Chao
- Department of General Surgery, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., Keelung, 204, Taiwan
| | - Ta-You Lo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan
| | - Ting-Shuo Huang
- Department of General Surgery, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., Keelung, 204, Taiwan
| | - Yu-Hsien Chen
- Department of General Surgery, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist., Keelung, 204, Taiwan.
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3
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Steinkraus KC, Wittau M, Kornmann M. Robotic-assisted thoracoscopy in the management of mediastinal ectopic parathyroid adenoma: a case report. J Surg Case Rep 2024; 2024:rjae044. [PMID: 38370589 PMCID: PMC10873174 DOI: 10.1093/jscr/rjae044] [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: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Mediastinal ectopic parathyroid adenomas, a rare cause of primary hyperparathyroidism, has evolved significantly with the advent of robotic-assisted surgery. Traditional surgical approaches, while effective, may be associated with considerable morbidity and extended recovery periods. This study aims to evaluate the effectiveness, precision, and postoperative outcomes of robotic thoracoscopy with parathyroidectomy in the management of mediastinal ectopic parathyroid adenomas. A case of a 70-year-old man with a history of primary hyperparathyroidism underwent a successful left robotic thoracoscopy with parathyroidectomy in an ectopic mediastinal parathyroid adenoma. The robotic approach demonstrated advantages such as enhanced precision and minimal invasiveness. However, the learning curve and cost implications of this technology were identified as considerations. Robotic thoracoscopy with parathyroidectomy underscores the potential of robotic surgery in revolutionizing the management of mediastinal ectopic parathyroid adenomas, offering promising precision, emphasizing the need for ongoing research, and evaluation to optimize this innovative surgical method.
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Affiliation(s)
- Kira C Steinkraus
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Matthias Wittau
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Marko Kornmann
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Choi YS, Choi JH, Jeon MS, Yu MJ, Lee HM, Shin AY, Yi JW. First Experience of Single-Port Robotic Areolar Approach Thyroidectomy. Clin Exp Otorhinolaryngol 2023; 16:275-281. [PMID: 37475141 PMCID: PMC10471905 DOI: 10.21053/ceo.2023.00682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/14/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Numerous minimally invasive thyroidectomy techniques have been developed and are actively utilized in hospitals around the globe. Herein, we describe a recently developed minimally invasive thyroidectomy technique that employs the da Vinci SP, and we present the preliminary clinical outcomes of single-port robotic areolar thyroidectomy (SPRA). METHODS A 3-cm semi-circular incision on the right areola and a small 8-mm incision on the left areola were created. Using hydro-dissection and an advanced bipolar device, a subcutaneous skin flap was created, extending from the areola to the thyroid cartilage. The da Vinci SP was then inserted through the incision in the right areola. Between December 2022 and March 2023, 21 SPRA procedures were conducted. Patients' medical records and surgical videos were subsequently reviewed. RESULTS Lobectomy was performed in 17 patients, isthmectomy in 2 patients, and total thyroidectomy in 2 patients. The mean flap time was 14.9±4.2 minutes and the console time was 62.4±17.1 minutes. The mean tumor size was 0.89± 0.65 cm and the number of retrieved lymph nodes was 3.94±3.98 (range, 0-12). There were no observed instances of vocal cord palsy or hypoparathyroidism. CONCLUSION We successfully developed and performed the novel SPRA for the first time worldwide. Unlike other robotic surgery. METHODS SPRA is less invasive and leaves no visible scars. This technique employs a sophisticated single-port robotic device. However, to assess the efficacy of this method, we need to analyze more cases and conduct comparative studies in the near future.
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Affiliation(s)
- Yun Suk Choi
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Ji Hyun Choi
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Mi Sook Jeon
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Min Jung Yu
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Hye Mi Lee
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Ae Young Shin
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Jin Wook Yi
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
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5
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Wang J, Lin Q, Wu X, Lin Y, Liu E. Total areola approach for endoscopic thyroidectomy: Six years of experience with the same surgeon. J Minim Access Surg 2023; 19:42-50. [PMID: 36722529 PMCID: PMC10034795 DOI: 10.4103/jmas.jmas_359_21] [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: 11/24/2021] [Revised: 06/05/2022] [Accepted: 06/23/2022] [Indexed: 02/03/2023] Open
Abstract
Background Scarless endoscopic thyroidectomy (ET) is increasingly accepted by the growing amount of surgeons. The target of this study is to assess the efficacy and summarise the experiences of total areola approach for ET (TAAET). Subjects and Methods TAAET was performed on 529 patients between January 2016 and October 2021. All operated patients were divided into two groups according to the chronological order. Demographic data, perioperative data and post-operative complications were collected to assess the effectiveness of TAAET. Results Five hundred and twenty-eight patients were successfully treated with TAAET, while 1 case was converted to open surgery due to bleeding. The surgical approach consists of lobectomy or total thyroidectomy with or without central lymph node dissection. The post-operative pathology of 433 (81.9%) patients was diagnosed with T1 ~2N0M0. The average number of unilateral lymph node dissection was 7.72 ± 2.44 while the bilateral lymph node was 10.70 ± 3.72. In terms of complications, 38 cases had transient hoarseness, 28 cases had tetany and numbness, 3 cases had post-operative bleeding, 1 case had infection and 33 cases had subcutaneous fluid. There were statistically significant differences between the two groups with respect to transient hoarseness (P < 0.001), tetany and numbness (P = 0.005), intraoperative blood loss (P = 0.003) and operation time for malignant tumour (P < 0.001) because of the accumulation of surgical experience and the maturation of technology. Conclusions TAAET which conforms to the anatomical pathway of open thyroidectomy is a safe, effective and feasible technique and is highly suitable for novices.
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Affiliation(s)
- Junxiao Wang
- Department of Thyroid and Breast Surgery, The Second Hospital of Sanming; Department of General Surgery, The Fifth Clinical Medical College of Fujian University of Traditional Chinese Medicine, Sanming City, Fujian Province, China
| | - Qisheng Lin
- Department of Thyroid and Breast Surgery, The Second Hospital of Sanming; Department of General Surgery, The Fifth Clinical Medical College of Fujian University of Traditional Chinese Medicine, Sanming City, Fujian Province, China
| | - Xiaolan Wu
- Department of CT/MR, The Second Hospital of Sanming; Department of Imaging, The Fifth Clinical Medical College of Fujian University of Traditional Chinese Medicine, Sanming City, Fujian Province, China
| | - Yixing Lin
- Department of Thyroid and Breast Surgery, The Second Hospital of Sanming; Department of General Surgery, The Fifth Clinical Medical College of Fujian University of Traditional Chinese Medicine, Sanming City, Fujian Province, China
| | - Ezhang Liu
- Department of Thyroid and Breast Surgery, The Second Hospital of Sanming; Department of General Surgery, The Fifth Clinical Medical College of Fujian University of Traditional Chinese Medicine, Sanming City, Fujian Province, China
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6
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Advancements in Thyroidectomy: A Mini Review. ENDOCRINES 2022. [DOI: 10.3390/endocrines3040065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Demand for minimally invasive surgery has driven the development of new gadgets and surgical techniques. Yet, questions about safety and skeptical views on new technology have prevented proliferation of new modes of surgery. This skepticism is perhaps due to unfamiliarity of new fields. Likewise, there are currently various remote-access techniques available for thyroid surgeons that only few regions in the world have adapted. This review will explore the history of minimally invasive techniques in thyroid surgery and introduce new technology to be implemented.
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7
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Endogenous stimuli-responsive nanoparticles for cancer therapy: From bench to bedside. Pharmacol Res 2022; 186:106522. [DOI: 10.1016/j.phrs.2022.106522] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
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8
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Kim JK, Yang SY, Kim SH, Kim HI. Application of robots in general surgery. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.10.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Application of robotic surgery in the field of general surgery has been increasing. This paper is an overview of the current uses and future perspectives of robotic surgery in four major divisions—endocrine, upper gastrointestinal, hepato-biliary-pancreatic (HBP), and colorectal surgery.Current Concepts: In endocrine surgery, cosmetic advantage is the highest priority when selecting a surgical approach for thyroidectomy. Currently, the transaxillary route is the most common approach. The introduction of the single-port system could maximize the advantages of this technique. In upper gastrointestinal surgery, the use of robots has the advantage of better retrieval of lymph nodes, less bleeding, earlier discharge, and less complications than the laparoscopic approach. However, a more prospective comparative trial is required to confirm those findings. In the HBP field, the indications of robotic surgery have expanded, starting with cholecystectomy to more challenging procedures, such as donor hepatectomy and pancreaticoduodenectomy. Meticulous dissection using robots could provide benefits to patients. In colorectal surgery, robotic surgery is an excellent technical tool for minimally invasive surgeries for rectal cancers, especially in male patients with narrow, deep pelvises. However, further studies are required to confirm the impact of robotic surgery on rectal cancers.Discussion and Conclusion: Robots are used to provide optimal surgical outcomes. Investigating new technologies and innovative surgical procedures is the highly important for a surgeon in the era of minimally invasive surgery.
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9
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Sweeney AT, Srivoleti P, Blake MA. Management of the patient with incidental bilateral adrenal nodules. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.jecr.2021.100082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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10
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Perysinakis I, Aggeli C, Kaltsas G, Zografos GN. Adrenal-sparing surgery: current concepts on a theme from the past. Hormones (Athens) 2020; 19:317-327. [PMID: 32388629 DOI: 10.1007/s42000-020-00202-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/07/2020] [Indexed: 12/14/2022]
Abstract
Adrenal insufficiency represents a debilitating condition which mandates lifelong steroid replacement and which is associated with significant long-term morbidity, due to either inadequate or excessive replacement. The concept of preserving healthy cortical tissue by means of partial adrenalectomy has evolved as a means of avoiding the detrimental consequences of adrenal insufficiency. The advent of advanced technology in adrenal surgery has greatly facilitated the performance of partial adrenalectomy, enabling utilization of this method in an increasing number of endocrine diseases. Hereditary pheochromocytoma, Conn's syndrome, Cushing's syndrome, and non-functional adrenal masses represent the current indications for partial adrenalectomy, although the specific circumstances under which adrenal-sparing surgery should be proposed are still debatable. Partial adrenalectomy can be achieved by all types of minimally invasive surgery. In the absence of randomized, prospective, controlled studies designed to compare laparoscopic, retroperitoneoscopic, and robot-assisted partial adrenalectomy, none of these techniques has as yet been proven to be the gold standard for adrenal-sparing surgery. Apart from indications for surgery, results of surgery, and different types of partial adrenalectomy, controversial topics addressed in this review article include technical aspects such as the volume of residual adrenal tissue needed, ligation of adrenal vein, and means of tumor identification. Discussion of these controversial topics represents an attempt to define the role of partial adrenalectomy in modern adrenal surgery.
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Affiliation(s)
- Iraklis Perysinakis
- Third Surgical Department of Surgery, General Hospital "G. Gennimatas", Athens, Greece.
| | - Ch Aggeli
- Third Surgical Department of Surgery, General Hospital "G. Gennimatas", Athens, Greece
| | - Gr Kaltsas
- First Department of Propaedeutic Internal Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - G N Zografos
- Third Surgical Department of Surgery, General Hospital "G. Gennimatas", Athens, Greece
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11
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BAYRAM A, ESKİİZMİR G, CİNGİ C, HANNA E. Robotic Surgery in Otolaryngology-Head and Neck Surgery: Yesterday, Today and Tomorrow. ENT UPDATES 2020. [DOI: 10.32448/entupdates.780604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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12
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Baudouin R, Simon F, Denoyelle F, Couloigner V, Irtan S. Lateral endoscopic parathyroidectomy in children. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:103-106. [PMID: 32798132 DOI: 10.1016/j.anorl.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endoscopic thyroid and parathyroid surgery was first described by Gagner in 1996, and Henry subsequently proposed a lateral endoscopic approach in 1999. Technical progress in the fields of optics, endoscopy, digital imaging and laparoscopy has gradually enhanced the feasibility and clinical utility of this technique for the treatment of benign and malignant lesions. To date, published paediatric cases have only concerned thyroid surgery. In the light of two clinical cases, this article describes our lateral endoscopic approach applied to paediatric parathyroid surgery.
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Affiliation(s)
- R Baudouin
- Service d'ORL et chirurgie cervico-faciale pédiatrique, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France; Faculté de médecine, université de Paris, 15, rue de l'école de médecine, 75005 Paris, France.
| | - F Simon
- Service d'ORL et chirurgie cervico-faciale pédiatrique, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France; Faculté de médecine, université de Paris, 15, rue de l'école de médecine, 75005 Paris, France
| | - F Denoyelle
- Service d'ORL et chirurgie cervico-faciale pédiatrique, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France; Faculté de médecine, université de Paris, 15, rue de l'école de médecine, 75005 Paris, France
| | - V Couloigner
- Service d'ORL et chirurgie cervico-faciale pédiatrique, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France; Faculté de médecine, université de Paris, 15, rue de l'école de médecine, 75005 Paris, France
| | - S Irtan
- Service de chirurgie viscérale néonatale et pédiatrique, hôpital Trousseau, 26, avenue du docteur Arnold-Netter, 75012 Paris, France; Université Sorbonne Paris Cité, 91-105, boulevard de l'Hôpital, 75013 Paris, France
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13
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Perivoliotis K, Baloyiannis I, Sarakatsianou C, Tzovaras G. Comparing the efficacy and safety of laparoscopic and robotic adrenalectomy: a meta-analysis and trial sequential analysis. Langenbecks Arch Surg 2020; 405:125-135. [PMID: 32133562 DOI: 10.1007/s00423-020-01860-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/27/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE A systematic literature review and a meta-analysis were designed and conducted, in order to provide an up-to-date comparison of the robotic (RA) and laparoscopic (LA) adrenalectomy in terms of perioperative efficacy and safety. METHODS The present meta-analysis was completed in accordance with the guidelines provided by the PRISMA study group and the Cochrane Handbook for Systematic Reviews of Interventions. The electronic scholar databases (Medline, Web of Science, Scopus) were screened. For the reduction of type I errors, a trial sequential analysis (TSA) was performed. RESULTS Overall, 21 studies and 2997 patients were included in this study. RA was associated with a significantly lower open conversion rate (OR: 1.79; 95%CI: 1.10, 2.92) and length of hospitalization (LOS WMD: 0.52; 95%CI: 0.2, 0.84). Marginal results regarding blood loss were recorded (WMD: 2.02; 95%CI: 0.0, 4.03). TSA could not validate the superiority of RA in open conversion rate and blood loss. LA and RA were similar in terms of operative duration (P = 0.18) and positive margin (P = 0.81), complications (P = 0.94) and mortality rate (P = 0.45). CONCLUSIONS Even though RA and LA were equivalent regarding perioperative safety, RA was associated with a favorable LOS.
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Affiliation(s)
| | - Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece.
| | - Chamaidi Sarakatsianou
- Department of Anesthesiology, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
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14
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Liu P, Zhang Y, Qi X, Liu H, Du J, Liu J, Liu J, Fu W, Zhang Y, Jiang J, Fan L. Unilateral Axilla-Bilateral Areola Approach for Thyroidectomy by da Vinci Robot: 500 Cases Treated by the Same Surgeon. J Cancer 2019; 10:3851-3859. [PMID: 31333802 PMCID: PMC6636286 DOI: 10.7150/jca.31463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/04/2019] [Indexed: 12/14/2022] Open
Abstract
Objective: To investigate the efficacy and safety of da Vinci robot-assisted thyroidectomy via an unilateral axilla-bilateral areola (UABA) approach. Methods: The clinical data of 500 patients undergoing robotic thyroidectomy via an UABA approach from July 2014 to April 2018 were retrospectively analyzed. All 500 patients were operated on by the same surgeon and divided into two groups by the time sequence. The efficacy and complications were compared between the two groups. Results: Robotic thyroidectomy via an UABA approach was performed successfully in 500 cases, including 196 cases of benign thyroid diseases with a lesion diameter of 3.1 ± 1.3 cm (0.4 - 8.2 cm) and 304 cases of thyroid cancer with a tumor diameter of 1.2 ± 0.7 cm (0.4 - 4.4 cm). Surgical procedures included unilateral lobectomy and total thyroidectomy with or without central lymph node dissection. Among the 500 patients, 9 (1.8%) had transient recurrent laryngeal nerve injury, 1 (0.2%) had permanent unilateral recurrent laryngeal nerve injury, 12 (2.4%) had subcutaneous hemorrhage of the trajectory area, and 6 (1.2%) had subcutaneous infection of the trajectory area after surgery. Among 239 thyroid cancer patients undergoing total thyroidectomy, 45 (18.8%) had transient hypoparathyroidism and 5 (2.1%) had permanent hypoparathyroidism. The incidence of permanent hypoparathyroidism was 1.9% (4/212) among the patients undergoing total thyroidectomy plus unilateral central lymph node dissection, and 3.7% (1/27) among the patients undergoing total thyroidectomy plus bilateral central lymph node dissection. During the follow-up of median 17 months, all patients were satisfied with postoperative appearance of the neck and no structural recurrence or metastases occurred. There was no significant difference in efficacy between the two groups (P > 0.05), while the complication rate in phase 2 was significantly lower than that in phase 1 (P < 0.05) as the surgeon became more proficient in the UABA approach. Conclusion: Robotic thyroidectomy via an UABA approach is simple, safe, and minimally invasive, suitable for radical resection of large benign tumors and early thyroid cancer and central lymph node dissection.
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Affiliation(s)
- Pengfei Liu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.,Department of Breast Surgery, First Affiliated Hospital, Hunan Traditional Chinese Medical College, Hunan Provence, China
| | - Ye Zhang
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xiaowei Qi
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Haoxi Liu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Junze Du
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jing Liu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Junlan Liu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Wenying Fu
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yi Zhang
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jun Jiang
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Linjun Fan
- Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
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15
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Andolfi C, Umanskiy K. Current Trends and Perspectives in Robotic Surgery. J Laparoendosc Adv Surg Tech A 2019; 29:127-128. [PMID: 30596544 DOI: 10.1089/lap.2018.29027.ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ciro Andolfi
- Department of Surgery, Center for Simulation, The University of Chicago Pritzker School of Medicine , Chicago Illinois
| | - Konstantin Umanskiy
- Department of Surgery, Center for Simulation, The University of Chicago Pritzker School of Medicine , Chicago Illinois
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