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Napolitano L, Pandolfo SD, Aveta A, Cirigliano L, Martino R, Mattiello G, Celentano G, Barone B, Rosati C, La Rocca R, Spena G, Spirito L. The Management of Clinical Varicocele: Robotic Surgery Approach. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:791330. [PMID: 36303643 PMCID: PMC9580646 DOI: 10.3389/frph.2022.791330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/07/2022] [Indexed: 12/04/2022] Open
Abstract
Varicocele is a pathologic dilation of the testicular veins within the spermatic cord. Varicocele is considered the most common problem in reproductive medicine practice. It is identified in 15% of healthy men and up to 35% of men with primary infertility. The exact pathophysiology of varicoceles is not very well understood, and several theories have been proposed to explain it. Varicocele can impair sperm quality and fertility via various mechanisms: reflux of adrenal metabolites, increased testicular hypoxia, oxidative stress, and increased testicular temperature have been proposed. Several studies have reported the significant benefits on semen parameters with the surgical treatment of varicocele: reducing oxidatively induced sperm DNA damage and potentially improving fertility. Varicocele repair should be offered as a part of treatment option for male partners of infertile couples presenting with palpable varicoceles. Nowadays, there are several surgical approaches available for the treatment of varicocele, such as the retroperitoneal approach, inguinal approach, and the subinguinal approach. The subinguinal microscopic approach offers the best outcomes, such as shorter hospital stays, preservation of the testicular arteries and lymphatics, least number of postoperative complications, recurrence, and a higher number of pregnancies. Currently robotic-assisted laparoscopic surgery is widely adopted in urology and surgeons began to explore the potential applications of the robotic platform to male infertility microsurgical operations. Robotic approach offers many advantages: elimination of tremor, retraction with third arm, high quality, 3-dimensional visualization and surgeon ergonomics, all contributing to the precision of surgery.
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Affiliation(s)
- Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Achille Aveta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Lorenzo Cirigliano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Raffaele Martino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Gennaro Mattiello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Biagio Barone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Claudia Rosati
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Gianluca Spena
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Lorenzo Spirito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
- *Correspondence: Lorenzo Spirito
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Gözen AS, Tokas T, Tawfick A, Mousa W, Kotb M, Tzanaki E, Rassweiler J. Robot-assisted vasovasostomy and vasoepididymostomy: Current status and review of the literature. Turk J Urol 2020; 46:329-334. [PMID: 32915714 DOI: 10.5152/tud.2020.20257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Microscope-assisted vasovasostomy (MAVV) is a standard procedure used to reverse vasectomies. Robotic surgery has been established primarily for technically demanding urological procedures and has also been recently implemented in male reproductive surgery. We aimed to review the current evidence of robot-assisted vasovasostomy (RAVV) and robot-assisted vasoepididymostomy (RAVE). MATERIAL AND METHODS We performed a systematic literature review using PubMed to identify relevant original articles. We identified 2017 records through database search, and after removing duplicates, 782 records remained for further analysis. RESULTS In total, 12 human and three animal studies were selected. Reported vasal patency rate ranges were 88%-100% for RAVVs and 55%-61% for RAVEs. The sperm count and postoperative pregnancy rates of RAVV ranged between 8.4 × 106-120 × 106 sperm/mL and 65%, respectively. Finally, procedure times in the human studies, recorded for extracorporeal RAVVs and RAVEs ranged from 97 to 238 minutes. CONCLUSION Robot-assisted vasal reversal is feasible with similar patency rates as for the microsurgical approach and showing comparable outcomes. Additional benefits of this technique include improved vision and movement precision.
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Affiliation(s)
- Ali Serdar Gözen
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heilbronn, Germany.,Department of Urology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall i.T.,Hall in Tirol, Austria
| | - Ahmed Tawfick
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heilbronn, Germany.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Waleed Mousa
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heilbronn, Germany.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Mohamed Kotb
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heilbronn, Germany.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Eirini Tzanaki
- University of Pavia, Medical School, Harvey Course, Pavia, Italy
| | - Jens Rassweiler
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heilbronn, Germany
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Gifari MW, Naghibi H, Stramigioli S, Abayazid M. A review on recent advances in soft surgical robots for endoscopic applications. Int J Med Robot 2019; 15:e2010. [PMID: 31069938 PMCID: PMC6771908 DOI: 10.1002/rcs.2010] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Soft materials, with their compliant properties, enable conformity and safe interaction with human body. With the advance in actuation and sensing of soft materials, new paradigm in robotics called "soft robotics" emerges. Soft robotics has become a new approach in designing medical devices such as wearable robotic gloves and exoskeleton. However, application of soft robotics in surgical instrument inside human body is still in its infancy. AIMS In this paper, current application and design of soft robots specifically applied for endoscopy are reviewed. MATERIALS & METHODS Different aspects in the implementation of soft robotics in endoscope design were reviewed. The key studies about MIS and NOTES were reviewed to establish the clinical background and extract the limitations of current endoscopic device in the last decade. RESULTS AND DISCUSSION In this review study, the implementation of soft robotics concepts in endoscopic application, with highlights on different features of several soft endoscopes, were evaluated. The progress in different aspects of soft robotics endoscope, current state, and future perspectives were also discussed. CONCLUSION Based on the survey on the structural specification, actuation, sensing, and stiffening the future soft surgical endoscopes are recommended to fulfil the following specifications: safe especially from pressure leakage, fully biocompatible materials, MR-compatible, capable for large bending in at least two antagonistic directions, modularity, adjustable stiffness.
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Affiliation(s)
| | - Hamid Naghibi
- Robotics and MechatronicsUniversiteit TwenteEnschedeNetherlands
| | | | - Momen Abayazid
- Robotics and MechatronicsUniversiteit TwenteEnschedeNetherlands
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Review of emerging surgical robotic technology. Surg Endosc 2018; 32:1636-1655. [PMID: 29442240 DOI: 10.1007/s00464-018-6079-2] [Citation(s) in RCA: 252] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/28/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of laparoscopic and robotic procedures has increased in general surgery. Minimally invasive robotic surgery has made tremendous progress in a relatively short period of time, realizing improvements for both the patient and surgeon. This has led to an increase in the use and development of robotic devices and platforms for general surgery. The purpose of this review is to explore current and emerging surgical robotic technologies in a growing and dynamic environment of research and development. METHODS This review explores medical and surgical robotic endoscopic surgery and peripheral technologies currently available or in development. The devices discussed here are specific to general surgery, including laparoscopy, colonoscopy, esophagogastroduodenoscopy, and thoracoscopy. Benefits and limitations of each technology were identified and applicable future directions were described. RESULTS A number of FDA-approved devices and platforms for robotic surgery were reviewed, including the da Vinci Surgical System, Sensei X Robotic Catheter System, FreeHand 1.2, invendoscopy E200 system, Flex® Robotic System, Senhance, ARES, the Single-Port Instrument Delivery Extended Research (SPIDER), and the NeoGuide Colonoscope. Additionally, platforms were reviewed which have not yet obtained FDA approval including MiroSurge, ViaCath System, SPORT™ Surgical System, SurgiBot, Versius Robotic System, Master and Slave Transluminal Endoscopic Robot, Verb Surgical, Miniature In Vivo Robot, and the Einstein Surgical Robot. CONCLUSIONS The use and demand for robotic medical and surgical platforms is increasing and new technologies are continually being developed. New technologies are increasingly implemented to improve on the capabilities of previously established systems. Future studies are needed to further evaluate the strengths and weaknesses of each robotic surgical device and platform in the operating suite.
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Etafy M, Gudeloglu A, Brahmbhatt JV, Parekattil SJ. Review of the role of robotic surgery in male infertility. Arab J Urol 2017; 16:148-156. [PMID: 29713546 PMCID: PMC5922003 DOI: 10.1016/j.aju.2017.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/27/2017] [Accepted: 11/04/2017] [Indexed: 02/07/2023] Open
Abstract
Objectives To present the current state of the art in various robot-assisted microsurgical procedures in male infertility and review the latest literature, as the technology in infertility procedures has substantially developed since the incorporation of the Vinci® robotic platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA). Materials and methods The search strategy in this review was conducted in accordance with Cochrane guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search strategy was conducted in MEDLINE, PubMed and the Cochrane electronic databases (from 2000 to present) to identify studies that included both robotic and male infertility. Results In all, 23 studies were found, 12 of which met our inclusion criteria. Articles were excluded if the study did not include both male infertility and robotics. Conclusions Robotic assistance for microsurgical procedures in male infertility appears to be safe and feasible. It has several advantages including elimination of tremor, multi-view magnification, additional instrument arms, and enhanced dexterity with articulating instrument arms. It also has a short learning curve with a small skin incision. However, larger, prospective studies are needed to establish the clinical benefits over standard microsurgery.
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Key Words
- 3D, three-dimensional
- ART, assisted reproductive technology
- FDA, USA Food and Drug Administration
- MeSH, Medical Subject Heading
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- RAVE, robot-assisted microsurgical vasoepididymostomy
- RAVV, robot-assisted vasovasostomy
- RAVx, robot-assisted microsurgical varicocelectomy
- RCT, randomised controlled trial
- Robotic testicular sperm extraction
- Robotic varicocelectomy
- Robotic vasectomy reversal
- Robotic vasoepididymostomy (RAVE)
- Robotic vasovasostomy
- TESE, testicular sperm extraction
- US, ultrasonography
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Affiliation(s)
- Mohamed Etafy
- The Personalized Urology and Robotics (PUR) Clinic, South Lake Hospital, Clermont, FL, USA.,Department of Urology, AlAzhar University Hospital, Assiut, Egypt
| | - Ahmet Gudeloglu
- Department of Urology, Hacettepe University Hospital, Ankara, Turkey
| | - Jamin V Brahmbhatt
- The Personalized Urology and Robotics (PUR) Clinic, South Lake Hospital, Clermont, FL, USA
| | - Sijo J Parekattil
- The Personalized Urology and Robotics (PUR) Clinic, South Lake Hospital, Clermont, FL, USA
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Aro T, Mullerad M, Amiel GE. Expanding the Utilization of Robotic Procedures in Urologic Surgery. Rambam Maimonides Med J 2017; 8:RMMJ.10320. [PMID: 29059044 PMCID: PMC5652935 DOI: 10.5041/rmmj.10320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Although the word "robot" was coined in 1921, only close to 70 years later were robotic devices developed to assist during surgery. Urology has always been at the forefront of endoscopic, minimally invasive, and robotic developments in medicine. Robotic prostatectomy signaled the emerging role of robotic surgery in urology, but since then it has been applied to every urologic laparoscopic procedure.
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Affiliation(s)
- Tareq Aro
- Urology Department, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michael Mullerad
- Urology Department, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gilad E Amiel
- Urology Department, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Abstract
The management of patients suffering with chronic testicular and groin pain is very challenging. With increased awareness of men's health, more patients and clinicians are open to talk about this complex problem that affects over 100,000 men/year. The pathogenesis of chronic orchialgia is still not clear, but there are several postulated theories. Treatment options include conservative medical therapy with NSAIDs, antidepressants, anticonvulsants, and narcotics. Surgical options such as targeted microsurgical denervation and microcryoablation can provide permanent durable pain relief. The goal of this article is to review and discuss the management of patients with chronic orchialgia using currently available literature.
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Chammas J, Sauer A, Pizzuto J, Pouthier F, Gaucher D, Marescaux J, Mutter D, Bourcier T. Da Vinci Xi Robot-Assisted Penetrating Keratoplasty. Transl Vis Sci Technol 2017; 6:21. [PMID: 28660096 PMCID: PMC5482186 DOI: 10.1167/tvst.6.3.21] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/30/2017] [Indexed: 12/19/2022] Open
Abstract
PURPOSE This study aims (1) to investigate the feasibility of robot-assisted penetrating keratoplasty (PK) using the new Da Vinci Xi Surgical System and (2) to report what we believe to be the first use of this system in experimental eye surgery. METHODS Robot-assisted PK procedures were performed on human corneal transplants using the Da Vinci Xi Surgical System. After an 8-mm corneal trephination, four interrupted sutures and one 10.0 monofilament running suture were made. For each procedure, duration and successful completion of the surgery as well as any unexpected events were assessed. The depth of the corneal sutures was checked postoperatively using spectral-domain optical coherence tomography (SD-OCT). RESULTS Robot-assisted PK was successfully performed on 12 corneas. The Da Vinci Xi Surgical System provided the necessary dexterity to perform the different steps of surgery. The mean duration of the procedures was 43.4 ± 8.9 minutes (range: 28.5-61.1 minutes). There were no unexpected intraoperative events. SD-OCT confirmed that the sutures were placed at the appropriate depth. CONCLUSIONS We confirm the feasibility of robot-assisted PK with the new Da Vinci Surgical System and report the first use of the Xi model in experimental eye surgery. Operative time of robot-assisted PK surgery is now close to that of conventional manual surgery due to both improvement of the optical system and the presence of microsurgical instruments. TRANSLATIONAL RELEVANCE Experimentations will allow the advantages of robot-assisted microsurgery to be identified while underlining the improvements and innovations necessary for clinical use.
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Affiliation(s)
- Jimmy Chammas
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,EA7290, FMTS, University of Strasbourg, Strasbourg, France
| | - Arnaud Sauer
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Joëlle Pizzuto
- Cornea Bank, EFS Bourgogne Franche-Comté, Besancon, France
| | | | - David Gaucher
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,EA7290, FMTS, University of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- IHU, Institute of Image-Guided Surgery, FMTS, University of Strasbourg, Strasbourg, France.,IRCAD, European Institute of Telesurgery, Strasbourg, France.,Department of Digestive and Robotic Surgery, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Didier Mutter
- IHU, Institute of Image-Guided Surgery, FMTS, University of Strasbourg, Strasbourg, France.,IRCAD, European Institute of Telesurgery, Strasbourg, France.,Department of Digestive and Robotic Surgery, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Tristan Bourcier
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,EA7290, FMTS, University of Strasbourg, Strasbourg, France.,IHU, Institute of Image-Guided Surgery, FMTS, University of Strasbourg, Strasbourg, France
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Abstract
Testicular varicocele, which is defined as the dilation of the veins draining the testicle, has long been associated with a detrimental effect on testicular function. Despite a lack of high-quality, prospective data, recent evidence has shed light on potential links between varicocele and male infertility and serum testosterone levels. Similarly, varicocele repair has increasingly been shown to have a beneficial impact on pregnancy rates, semen parameters, and on improving serum testosterone in adult men. Numerous studies have assessed the optimal technique for varicocele repair and the bulk of the evidence has shown the microsurgical inguinal/subinguinal approach to have the highest success rates, the lowest overall complication rates, and the lowest recurrence rates. The management of varicocele in adolescents remains a clinical conundrum, but contemporary evidence suggests early deleterious effects of varicocele on testicular function in some patients. Well-designed prospective trials are critical to delineate the true impact and role of varicocele repair on male infertility and hypogonadism in adult and adolescent men.
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Affiliation(s)
- Phil V Bach
- Weill Cornell Medical College, New York, NY, 10065, USA
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