Laparoscopic Endoscopic and Robotic Surgery最新文献

Objective

Robotic general surgery remains controversial, with some employing the technology for common laparoscopic procedures such as appendectomies. Very few studies have compared robotic appendectomy (RA) to existing techniques, partly due to the relative scarcity of data. The purpose of this study was to compare outcomes for RA versus laparoscopic appendectomy (LA).

Methods

This retrospective cohort study evaluated procedural specific databases of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) for appendectomy between January 2016 and December 2019 and included all available cases at the time of analysis (June 2021). Demographic and surgical outcomes including composite 30-day complications, specific complications, and length of operation were analyzed using a univariate analysis.

Results

In total, there were 52,559 appendectomies in the NSQIP database between 2016 and 2019. Analysis was restricted to those who underwent minimally invasive approaches. In total, 49,850 patients were included in the analysis. Of those, 49,800 patients underwent LA, and 50 patients underwent RA. Participants who underwent RA were older (35.8 ± 4.5 y vs. 23.0 ± 0.2 y, p < 0.01). There was no difference in the total number of comorbidities (92.0% vs. 73.4%, p = 0.32) or the severity of appendicitis (p > 0.90) between RA and LA cases. RA had a longer median operation time (71.0 min vs. 46.0 min, p < 0.01) but a shorter postoperative stay (0.7 d vs. 1.3 d, p < 0.01). There was no difference in the frequency of readmission likely related to procedure (4.0% vs. 3.0%, p = 0.88) or complications (18.0% vs. 23.8%, p = 0.88); however, RA was associated with increased 30-day mortality (2.0% vs. <0.1%, p < 0.01) compared to LA.

Conclusion

Our results demonstrated that LA and RA had a similar frequency and profile of complications. Robotic procedures took longer but resulted in shorter postoperative stays. Our study revealed that RA constituted a mere 0.1% of all cases, with only 50% showing pathology consistent with appendicitis, despite 92.2% of LA cases presenting with the condition. Despite our findings of RA offering some benefit, more research is necessary, particularly regarding outcomes and value delivery.

Objective

In robot-assisted minimally invasive surgery, proper port positioning ensures that surgical tools have adequate access to the surgical site and avoids mid-surgery collisions of robotic arms. To date, several guidelines have been proposed for more accurate port placement. However, challenges remain due to variations in patient morphology, anatomy, and, in particular, organ displacement due to insufflation in certain laparoscopic procedures. The objective of this study was to design and develop a decision aid for optimal port placement in robot-assisted hysterectomy that accounts for patient variability and organ displacement due to insufflation.

Methods

Three components were constructed: a robot model, a patient-specific model, and an optimization algorithm. The three components were integrated, and the system was verified using four different patients who underwent robotic hysterectomy. Once verified, two expert surgeons were asked to evaluate the decision aid for face and construct validity. A usability test was conducted using a torso phantom with target organs located in three different locations. Two expert surgeons performed a simulated hysterectomy task with and without the decision aid to evaluate performance and satisfaction.

Results

The optimization algorithm was sensitive to individual differences in anatomy in the four patients. Expert surgeons successfully established face and construct validity. Usability test results showed a 28%–40% reduction in time to task completion with the optimized ports compared to expert-determined port locations without using the decision aid.

Conclusions

The decision aid, based on an individualized patient-specific model, robot model, and optimization algorithm, was shown to be effective at addressing the challenges of displaced organs due to insufflation in robot-assisted hysterectomy. The face and construct validity of the decision aid was established by expert surgeons, while efficiency gains in task performance were demonstrated experimentally.

Objective

The popularization of gastroenteroscopy and the introduction of comfortable medical care have further promoted the growth of people's demand, especially the demand for painless endoscopy. This cross-sectional study aims to investigate the current situation and change in county people's demand for endoscopy to promote the development of endoscopy centers in county hospitals in southeast China.

Methods

From October to December 2021, patients and their family members who came to the Gastroenterology Department in Suichang County People's Hospital of Zhejiang Province were randomly selected to complete the questionnaire. A total of 838 valid questionnaires were collected. Additionally, the original software data of the Endoscopy Center were sampled and retrieved (from October to December every year from 2018 to 2021) for statistical analysis of real-world data. Those who would choose painless endoscopy the next time in the valid questionnaires were included in the painless endoscopy group, while those who would choose ordinary endoscopy the next time were included in the ordinary endoscopy group.

Results

The stepwise forward binary logistic regression model analysis showed that, patients with “secondhand smoke exposure” were more willing to choose painless endoscopy (OR = 1.459, 95% CI: 1.050–2.028, p = 0.025). However, patients with an education level of “primary and below” and “junior high school”, and patients who are suffering from “currently experiencing abdominal distension”, were more willing to choose ordinary endoscopy (OR = 0.270, 95% CI: 0.149–0.488, p < 0.001; OR = 0.528, 95% CI: 0.330–0.845, p = 0.008; OR = 0.536, 95% CI: 0.334–0.861, p = 0.010). Patients with previous experience in painless endoscopy tended to choose painless endoscopy the next time, while patients with previous experience in ordinary endoscopy tended to choose ordinary endoscopy the next time (χ² = 140.97, p < 0.001). From 2018 to 2021, the proportion of painless endoscopy has increased yearly (p < 0.001). Most patients indicated that they would “regularly review gastroenteroscopy” (477/838, 56.9%).

Conclusions

With Suichang County of Zhejiang Province as the representative, the demand for painless endoscopy for people's gastrointestinal cancer detection in southeast China has been increasing yearly. The development of endoscopy centers in county-level hospitals can basically meet the demand growth. Meanwhile, advanced concepts such as comfortable medical care and regular follow-up are gradually popularized at the grassroots level in southeast China.

Approximately 25% of goiters extend to the substernal area, and most of them can be removed through a cervical incision. Goiters that extend into the posterior mediastinum are very rare, and resection usually requires thoracotomy. In recent years, there have been several reports of resection of substernal goiters by minimally invasive surgery. Here, we present a 75-year-old female with a giant substernal goiter who successfully underwent resection of the goiter extending to the posterior mediastinum using low cervical incision combined with video-assisted thoracoscopy.

Objective

With the widespread application of robotic liver surgery, the body of literature related to robotic liver resection is growing. However, there is a lack of understanding of the publication activities surrounding robotic liver resection research. This bibliometric study aimed to detect the global publication distributions of robotic liver resection research over the past 20 years.

Methods

Articles on robotic liver resection published from January 1, 2003 to August 31, 2022 were extracted from the Web of Science Core Collection database. The publication language was restricted to English. Literature distribution analyses were performed at the country/region, institution, author, and journal levels. In addition, each author's productivity was assessed with Lotka's law. Academic influence was assessed by local citation score and global citation score. The keywords evolution was also analyzed. R software and HistCite were applied for the analyses.

Results

A total of 685 articles were identified, with 4107 local citations and 9458 global citations. These articles were published in 156 journals and written by 2449 authors from 785 institutions in 49 countries/regions. The cumulative publication number of the last 5 years accounted for 66.3% (454/685) of the total publication number. The USA played a leading role in the publication output (212, 30.9%), followed by Italy (120, 17.5%) and China (104, 15.2%). The three countries also had the most citations. Yonsei University from South Korea had the highest publication number (30, 4.4%). The Asian Journal of Surgery published the most articles (51, 7.4%), and Surgical Endoscopy and Other Interventional Techniques had the most local citations (575) and global citations (1115). Sucandy published 44 articles, ranking first in productivity. Choi had many more citations than other scholars, with 465 local citations and 1253 global citations. Lotka's law reflected that the majority of the authors (1783, 72.8%) wrote one document. The top 5 most prominent keywords were “surgery”, “hepatocellular-carcinoma”, “outcomes”, “hepatectomy”, and “experience”.

Conclusion

The number of publications on robotic liver resection research has been rapidly increasing over the last 20 years. The most prolific countries/regions and institutions also had strong academic influence. The articles, institutions and authors with high citations mainly came from USA, China, South Korea, Italy, and Singapore. The research hotspots shifted from survival to complications, mortality, and augmented reality.

Objective

Although robotic surgery adoption and its indications are growing worldwide, for multiple factors, including costs, there is a lack of training and experience. Our aim was to study the impact of a robotic introduction training program on gesture performance, such as suturing, in robot-naive individuals.

Methods

Using the DaVinci robot, a 2-hour program was based on virtual reality and anatomical model exercises. All participants performed 3 repetitions of virtual reality exercises on the virtual simulator, and then performed and were assessed on 2 tests, ie robot and laparoscopic training box. After the course, the participants were surveyed for this training program.

Results

Twenty-seven residents and surgeons were enrolled in the training program. With only 2 hours of training, all of the participants were able to complete the training program, thus learning generic and specific skills in robotic surgery. In virtual reality exercise, the scores of the 3 exercises increased significantly with every repetition (p < 0.001) and the size of the increase was large. The completion time on the robot platform was 2.6 times faster (169.33 ± 28.28 s vs. 447.96 ± 156.55 s, p < 0.001) than that in the laparoscopic box, and the difference between both types of tests was large (_pη² = 0.797). The centralization and passage of the needle were significantly better on the robot platform (5 vs. 3, p < 0.001, r = 0.47; 5 vs. 4, p < 0.001, r = 0.59) than in the laparoscopic box. For the intracorporeal stitch+knot test, every participant was able to perform the exercise on the robot but only 85.2% (23/27) in the laparoscopic box. Twenty-one participants answered the survey, and 13 (61.9%) of them considered robotic performance independent of laparoscopic experience.

Conclusions

Surgeons are interested and seek training in robotic surgery. We implemented the first hands-on robotic surgery training program in Portugal and participants considered it was important and adequate for its purpose. All participants, even without robotic experience, learned quicker, performed better, faster and more precisely on the robot over laparoscopy.

Objective

Shoulder arthroscopic rotator cuff tear repair is currently the main treatment for full-thickness rotator cuff tears, and postoperative rehabilitation training is essential. However, pain and limitation of activity during the rehabilitation process will lead to poor results. Hence, identifying rehabilitation approaches is crucial. This study aimed to compare patient's rehabilitation outcomes and experience between rehabilitation in the supine position and in the standing position.

Methods

This prospective study included patients diagnosed with full-thickness rotator cuff tears who underwent shoulder arthroscopic double-row rivet repair at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from March 2019 to September 2021. The patients were randomly assigned to the standing rehabilitation exercise group (group A) and the supine rehabilitation exercise group (group B). All patients were followed up for 6 months to record and compare the visual analog scale (VAS) scores, shoulder range of motion, and rehabilitation compliance.

Results

Altogether, 86 patients participated in the study, of whom 79 patients completed the 6-month follow-up. Groups A and B had 39 and 40 patients, respectively. Before operation, the VAS score, forward flexion and extension angle, and abduction angle were comparable between groups A and B. After operation, the patients in groups A and B all experienced a significant improvement in the VAS score, forward flexion and extension angle, and abduction angle (p < 0.05). In addition, patients in group B had better VAS score (4.58 ± 0.87 vs. 5.21 ± 1.13, p = 0.0068; 2.15 ± 0.66 vs. 2.51 ± 0.51, p = 0.0078; 0.78 ± 0.86 vs. 1.33 ± 0.81, p = 0.0015), forward flexion and extension angle (109.30 ± 2.87 ° vs. 102.33 ± 3.74°, p = 0.0001; 109.53 ± 3.39° vs. 104.18 ± 2.76°, p = 0.0001; 125.22 ± 6.05° vs. 117.59 ± 2.27°, p = 0.0001), and abduction angle (91.78 ± 2.77° vs. 82.92 ± 2.12°, p = 0.0001; 91.62 ± 2.78° vs. 82.82 ± 1.45°, p = 0.0001; 109.48 ± 3.37° vs. 100.10 ± 2.94°, p = 0.0001) at 2 wk, 6 wk and 6 m postoperatively.

Conclusion

After 6 months of follow-up, the patients who performed rehabilitation exercises in the supine position achieved better rehabilitation outcomes than those who performed rehabilitation exercises while standing.

Rudimentary horn of the uterus is a rare congenital malformation that is characterized by significant anatomic variability. We report two cases involving women who presented with a broadly attached rudimentary horn and large ovarian endometriomas that were innovatively treated by laparoscopic coring-type dissection of the rudimentary horn of the uterus. This novel surgical approach ensured the integrity of the myometrium of the unicornuate uterus and avoided uterine rupture during pregnancy and ipsilateral ovarian function impairment.

As robotic assisted colorectal surgery increases in prevalence new systems are entering the market, each of which requires technique modifications. In this technical note we describe technical insights and tips gained from our extensive experience of 150 colorectal resections using the Versius® system from CMR Surgical. The triad of optimal bedside unit placement, port placement, and arm configuration is described for right hemicolectomy and anterior resection.

The management of Crohn's disease has evolved rapidly in the era of immunomodulators and biologicals. Despite this, a significant proportion of patients with Crohn's disease ultimately require surgical management. One of the indications for operative management includes failure of medical therapy. We report two cases of patients with complicated Crohn's disease who have exhausted medical therapy and failed medical management. In both cases, the patients developed large complex intra-abdominal phlegmons and intractable symptoms of intermittent pain, partial obstruction and/or infectious complications requiring operative intervention. Crohn's disease can present with a wide spectrum of disease. Considering the complexity of management in Crohn's disease, it is important for both physicians and surgeons to be aware of what constitutes failure of medical therapy and when it may be important to consider surgical involvement.