Although robot-assisted surgery has been rapidly gaining popularity in recent years, few reports have examined the impact of individual robotic arm movements on surgical outcomes. This study investigated the relationship between extra arm (EA) usage and experience of surgeons in robot-assisted surgery.
Methods
A total of 176 robot-assisted rectal resections were performed by three surgeons from 2018 to 2022. Each surgeon's first 20 cases categorized in the Early group and the 21st–40th cases in the Late group. Sixty cases in the Early group and 60 cases in the Late group were included to compare patient background, EA motion, and surgical outcomes.
Results
More anastomoses were performed closer to the anus in the Late group (p = 0.001). Console time was significantly shorter in the Late group (196 min vs. 153 min, p = 0.020). EA injuries, improper grasping, and intraoperative problems (intraoperative bleeding, misidentification of layers) were significantly less frequent in the Late group (p = 0.001).
Conclusions
As experience with robot-assisted surgery increases, appropriate and safe use of an EA was achieved, and operative time and intraoperative problems were reduced.
虽然近年来机器人辅助手术已经迅速普及，但很少有报告研究了单个机器人手臂运动对手术结果的影响。本研究调查了机器人辅助手术中额外手臂（EA）的使用与外科医生经验之间的关系。方法2018 - 2022年，3位外科医生共进行了176例机器人辅助直肠切除术。每个外科医生的前20例被分类为早期组，21 - 40例被分类为晚期组。早期组60例，晚期组60例，比较患者背景、EA运动和手术结果。结果Late组近肛门吻合术较多（p = 0.001）。后期组的控制台时间显著缩短（196 min vs 153 min, p = 0.020）。在Late组中，EA损伤、抓握不当和术中问题（术中出血、层错识别）的发生率显著降低（p = 0.001）。结论随着机器人辅助手术经验的增加，可以实现适当和安全的EA使用，减少手术时间和术中问题。
{"title":"Operator Experience With Robot-Assisted Laparoscopic Rectal Resection and the Impact of Using an Extra Arm on Surgical Outcomes","authors":"Tetsuro Tominaga, Takashi Nonaka, Yuma Takamura, Kaido Oishi, Toshio Shiraishi, Shintaro Hashimoto, Keisuke Noda, Rika Ono, Makoto Hisanaga, Terumitsu Sawai, Keitaro Matsumoto","doi":"10.1111/ases.13420","DOIUrl":"https://doi.org/10.1111/ases.13420","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although robot-assisted surgery has been rapidly gaining popularity in recent years, few reports have examined the impact of individual robotic arm movements on surgical outcomes. This study investigated the relationship between extra arm (EA) usage and experience of surgeons in robot-assisted surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 176 robot-assisted rectal resections were performed by three surgeons from 2018 to 2022. Each surgeon's first 20 cases categorized in the Early group and the 21st–40th cases in the Late group. Sixty cases in the Early group and 60 cases in the Late group were included to compare patient background, EA motion, and surgical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>More anastomoses were performed closer to the anus in the Late group (<i>p</i> = 0.001). Console time was significantly shorter in the Late group (196 min vs. 153 min, <i>p</i> = 0.020). EA injuries, improper grasping, and intraoperative problems (intraoperative bleeding, misidentification of layers) were significantly less frequent in the Late group (<i>p</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>As experience with robot-assisted surgery increases, appropriate and safe use of an EA was achieved, and operative time and intraoperative problems were reduced.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142763989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laparoscopic liver resection (LLR) is a difficult procedure that requires the scopist to have a high skill level. Scopists play an important role in ensuring an appropriate surgical field. This is the first study that focuses on the scopist's skills in perioperative outcomes of LLR.
Materials and Methods
Patients who underwent LLR from April 2018 to March 2023 were included in this study. The scopists were separated into expert (≥ 10 LLR procedures as a scopist) and beginner (< 10 LLR procedures as a scopist) groups. The effects of the scopists' skills on the perioperative outcomes of LLR between the two groups were examined retrospectively. In addition to listing baseline characteristics and perioperative outcomes, this study viewed video recordings to list intraoperative surgical manipulation factors as new attempts.
Results
No significant differences were observed in the baseline characteristics or perioperative outcomes between the two groups. The duration of the time during which the surgical procedure was interrupted due to scope operation errors during the Pringle maneuver was significantly longer in the beginner group (71 vs. 198 s, p < 0.001).
Conclusion
The scope manipulation by the less experienced LLR scopists sometimes hindered the progress of the surgery. The scopist's skills may lead to an increased psychological burden on the surgeon and prolonged operative times.
腹腔镜肝切除术（LLR）是一项困难的手术，需要术者有很高的技术水平。内镜医师在确保合适的手术范围方面发挥着重要作用。这是第一个关注腹腔镜医师在LLR围手术期预后中的技能的研究。材料与方法2018年4月至2023年3月期间接受LLR的患者纳入本研究。检查人员被分为专家组（≥10个LLR程序作为检查人员）和初学者组（<； 10个LLR程序作为检查人员）。回顾性分析两组间内镜师技能对LLR围手术期疗效的影响。除了列出基线特征和围手术期结果外，本研究还通过视频记录列出术中手术操作因素作为新的尝试。结果两组患者的基线特征和围手术期结局无显著差异。在新手组中，由于Pringle操作过程中的范围操作错误而导致手术中断的时间明显更长（71 vs. 198 s, p < 0.001）。结论经验不足的小内眦镜术者对内眦镜的操作有时会阻碍手术的进展。内镜师的技能可能会增加外科医生的心理负担，延长手术时间。
{"title":"Effects of the Scopist's Skills on the Perioperative Outcomes of Laparoscopic Liver Resection","authors":"Taku Kimura, Hiroyuki Nitta, Hirokatsu Katagiri, Shoji Kanno, Akira Umemura, Daiki Takeda, Taro Ando, Satoshi Amano, Toma Kawashima, Koji Kikuchi, Shuta Kuchida, Akira Sasaki","doi":"10.1111/ases.13413","DOIUrl":"https://doi.org/10.1111/ases.13413","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Laparoscopic liver resection (LLR) is a difficult procedure that requires the scopist to have a high skill level. Scopists play an important role in ensuring an appropriate surgical field. This is the first study that focuses on the scopist's skills in perioperative outcomes of LLR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Patients who underwent LLR from April 2018 to March 2023 were included in this study. The scopists were separated into expert (≥ 10 LLR procedures as a scopist) and beginner (< 10 LLR procedures as a scopist) groups. The effects of the scopists' skills on the perioperative outcomes of LLR between the two groups were examined retrospectively. In addition to listing baseline characteristics and perioperative outcomes, this study viewed video recordings to list intraoperative surgical manipulation factors as new attempts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant differences were observed in the baseline characteristics or perioperative outcomes between the two groups. The duration of the time during which the surgical procedure was interrupted due to scope operation errors during the Pringle maneuver was significantly longer in the beginner group (71 vs. 198 s, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The scope manipulation by the less experienced LLR scopists sometimes hindered the progress of the surgery. The scopist's skills may lead to an increased psychological burden on the surgeon and prolonged operative times.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Tamaki, K. Yamashita, and A. Tangoku. “Practice Guidelines on Endoscopic Surgery for Qualified Surgeons by the Endoscopic Surgical Skill Qualification System: Breast.” Asian Journal of Endoscopic Surgery 17, no. 4 (2024): E13376.
In the part of affiliations of authors
Incorrect
4Department of Thoracic Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School of Medicine, Tokushima, Japan
5Department of Breast Surgery, Nippon Medical School, Bunkyo-ku, Japan
Correct
4Department of Breast Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
5Department of Thoracic Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School of Medicine, Tokushima, Japan
We apologize for this error.
Tamaki， K. Yamashita和A. Tangoku。内窥镜手术技能鉴定系统合格外科医生的内窥镜手术实践指南：乳腺。亚洲内窥镜外科杂志17，第1期。4 (2024): e13376。在作者所属单位中：4日本德岛大学医学研究生院健康生物科学研究所胸部内分泌外科与肿瘤科；5日本文京区日本医学院乳房外科；4日本东京文京区日本医学院乳房外科；5日本健康生物科学研究所胸部内分泌外科与肿瘤科；德岛大学医学研究生院，德岛，日本我们为这个错误道歉。
{"title":"Correction to “Practice Guidelines on Endoscopic Surgery for Qualified Surgeons by the Endoscopic Surgical Skill Qualification System: Breast”","authors":"","doi":"10.1111/ases.13417","DOIUrl":"https://doi.org/10.1111/ases.13417","url":null,"abstract":"<p>Y. Tamaki, K. Yamashita, and A. Tangoku. “Practice Guidelines on Endoscopic Surgery for Qualified Surgeons by the Endoscopic Surgical Skill Qualification System: Breast.” <i>Asian Journal of Endoscopic Surgery</i> 17, no. 4 (2024): E13376.</p><p>In the part of affiliations of authors</p><p>Incorrect</p><p><sup>4</sup>Department of Thoracic Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School of Medicine, Tokushima, Japan</p><p><sup>5</sup>Department of Breast Surgery, Nippon Medical School, Bunkyo-ku, Japan</p><p>Correct</p><p><sup>4</sup>Department of Breast Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan</p><p><sup>5</sup>Department of Thoracic Endocrine Surgery and Oncology, Institute of Health Bioscience, The University of Tokushima Graduate School of Medicine, Tokushima, Japan</p><p>We apologize for this error.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.13417","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Masaki Shiota, Tokiyoshi Tanegashima, Shigehiro Tsukahara, Jun Mutaguchi, Shunsuke Goto, Satoshi Kobayashi, Takashi Matsumoto, Masatoshi Eto
Objective
This study investigated the perioperative and oncological outcomes of laparoscopic retroperitoneal lymph node dissection (RPLND) procedures for post-chemotherapy patients with nonseminomatous testicular germ-cell tumor at a single center.
Methods
This study included patients with nonseminomatous testicular cancer who underwent RPLND after chemotherapy at the Kyushu University Hospital between 2016 and 2024. The preoperative clinicopathological characteristics, perioperative outcomes, and oncological outcomes were investigated.
Results
A total of 13 patients underwent laparoscopic RPLND. Median maximum retroperitoneal tumor size at post-chemotherapy before RPLND was 11 mm (range, 2–30 mm). RPLND template was one side and both sides in nine and four patients. Median operative time was 272 min (range, 129–490 min), and median estimated blood loss was 27 mL (range, 0–100 mL). Median time from operation to discharge was 8 days (range, 5–15 days). There was no severe perioperative and postoperative complication. Residual cancer and teratoma were detected in one and seven patients. During median follow-up of 18.6 months (range, 1.0–95.7 months), no case presented recurrence.
Conclusion
Laparoscopic RPLND presented safety in perioperative outcomes and favorable oncological outcomes. Thus, it was confirmed that laparoscopic RPLND is a feasible minimally invasive procedure for selected cases.
{"title":"Laparoscopic Retroperitoneal Lymph Node Dissection After Chemotherapy for Nonseminomatous Testicular Germ-Cell Tumor at a Single Center","authors":"Masaki Shiota, Tokiyoshi Tanegashima, Shigehiro Tsukahara, Jun Mutaguchi, Shunsuke Goto, Satoshi Kobayashi, Takashi Matsumoto, Masatoshi Eto","doi":"10.1111/ases.13416","DOIUrl":"10.1111/ases.13416","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study investigated the perioperative and oncological outcomes of laparoscopic retroperitoneal lymph node dissection (RPLND) procedures for post-chemotherapy patients with nonseminomatous testicular germ-cell tumor at a single center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included patients with nonseminomatous testicular cancer who underwent RPLND after chemotherapy at the Kyushu University Hospital between 2016 and 2024. The preoperative clinicopathological characteristics, perioperative outcomes, and oncological outcomes were investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 13 patients underwent laparoscopic RPLND. Median maximum retroperitoneal tumor size at post-chemotherapy before RPLND was 11 mm (range, 2–30 mm). RPLND template was one side and both sides in nine and four patients. Median operative time was 272 min (range, 129–490 min), and median estimated blood loss was 27 mL (range, 0–100 mL). Median time from operation to discharge was 8 days (range, 5–15 days). There was no severe perioperative and postoperative complication. Residual cancer and teratoma were detected in one and seven patients. During median follow-up of 18.6 months (range, 1.0–95.7 months), no case presented recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Laparoscopic RPLND presented safety in perioperative outcomes and favorable oncological outcomes. Thus, it was confirmed that laparoscopic RPLND is a feasible minimally invasive procedure for selected cases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Managing choledocholithiasis alongside cholelithiasis has seen significant evolution, presenting options such as single-stage cholecystectomy with common bile duct (CBD) exploration, or a two-stage procedure involving endoscopic retrograde cholangiopancreatography (ERCP) performed before or after cholecystectomy. Evidence from Western settings may not fully capture the unique disease burden and demographic characteristics prevalent in developing countries. Laparoscopic common bile duct exploration (LCBDE) is more commonly performed in the Indian subcontinent compared to Western centers due to limited access to advanced procedures and specialized instrumentation for complex ERCP cases. The high cost and the need for extensive armamentarium in managing failed ERCPs make LCBDE a more feasible option in many Indian centers.
Methods
This prospective study, conducted from August 2019 to July 2020 at King George's Medical University, UP, India, included n = 24 patients diagnosed with choledocholithiasis. The operative procedures performed included laparoscopic CBD exploration and cholecystectomy, along with internal endo-biliary drainage. Perioperative outcomes were assessed, and follow-up data were included to monitor any recurrence until 36 months post-surgery.
Results
The study population had a mean age of 42.2 years, with 83% (n = of the patients being female). Abdominal pain was the predominant symptom, reported by 91.66% of the patients, followed by nausea/vomiting in 79.20% of cases. The mean CBD diameter observed was consistent with existing literature. The mean operating time was 2.02 h, with primary duct closure taking an average of 13.66 min. Mean blood loss during surgery was 136.25 mL. The average hospital stay was 5.54 days, with the majority of drain removals occurring by the third postoperative day. Complications included fever in 25.0% of the patients and bile leakage in n = 3 out of 24 cases (~12.50%). During the follow-up period, one patient (4.17%) experienced a retained stone.
Conclusion
Laparoscopic CBD exploration with primary duct closure and internal biliary drainage appears to be a feasible approach, yielding satisfactory perioperative outcomes. However, further studies are required to firmly establish its superiority over alternative approaches within the Indian context.
{"title":"Perioperative Outcomes and Feasibility of Single-Stage Laparoscopic Common Bile Duct Exploration (LCBDE) and Cholecystectomy With Internal Endo-Biliary Drainage for Management of Concomitant Cholelithiasis With Choledocholithiasis: A Report From a Tertiary Care Hospital","authors":"Ankita Bajpai, Akshay Anand, Awanish Kumar, Manish Agrawal, Ajay Kumar Pal, Pankaj Kumar, Amit Karnik, Sumit Rungta, Harvinder Singh Pahwa, Abhinav Arun Sonkar","doi":"10.1111/ases.13418","DOIUrl":"10.1111/ases.13418","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Managing choledocholithiasis alongside cholelithiasis has seen significant evolution, presenting options such as single-stage cholecystectomy with common bile duct (CBD) exploration, or a two-stage procedure involving endoscopic retrograde cholangiopancreatography (ERCP) performed before or after cholecystectomy. Evidence from Western settings may not fully capture the unique disease burden and demographic characteristics prevalent in developing countries. Laparoscopic common bile duct exploration (LCBDE) is more commonly performed in the Indian subcontinent compared to Western centers due to limited access to advanced procedures and specialized instrumentation for complex ERCP cases. The high cost and the need for extensive armamentarium in managing failed ERCPs make LCBDE a more feasible option in many Indian centers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective study, conducted from August 2019 to July 2020 at King George's Medical University, UP, India, included <i>n</i> = 24 patients diagnosed with choledocholithiasis. The operative procedures performed included laparoscopic CBD exploration and cholecystectomy, along with internal endo-biliary drainage. Perioperative outcomes were assessed, and follow-up data were included to monitor any recurrence until 36 months post-surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study population had a mean age of 42.2 years, with 83% (<i>n</i> = of the patients being female). Abdominal pain was the predominant symptom, reported by 91.66% of the patients, followed by nausea/vomiting in 79.20% of cases. The mean CBD diameter observed was consistent with existing literature. The mean operating time was 2.02 h, with primary duct closure taking an average of 13.66 min. Mean blood loss during surgery was 136.25 mL. The average hospital stay was 5.54 days, with the majority of drain removals occurring by the third postoperative day. Complications included fever in 25.0% of the patients and bile leakage in <i>n</i> = 3 out of 24 cases (~12.50%). During the follow-up period, one patient (4.17%) experienced a retained stone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Laparoscopic CBD exploration with primary duct closure and internal biliary drainage appears to be a feasible approach, yielding satisfactory perioperative outcomes. However, further studies are required to firmly establish its superiority over alternative approaches within the Indian context.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robotic surgery is gaining traction in Japan due to its technological advancements, but its financial viability for hospitals remains uncertain. This study investigates the impact of robotic surgery on hospital gross profits, comparing it to laparoscopic surgery using data from surgeries performed at Red Cross Hospital Osaka. The study spans multiple surgical fields, including gastrointestinal, urology, gynecology, and thoracic surgery. While the number of robotic surgeries has increased, they consistently generate lower gross profits for hospitals compared with laparoscopic surgeries, primarily due to the high costs of robotic instruments and maintenance. Certain procedures, such as hernia repair, proximal gastrectomy, and distal pancreatectomy, result in negative profits when performed robotically. This article highlights the financial challenges hospitals face under Japan's current healthcare reimbursement system, where the fees for robotic and laparoscopic surgeries are largely the same. Policy adjustments may be necessary to ensure the financial sustainability of robotic surgery.
{"title":"The financial impact of robotic surgery on hospital gross profits in Japan compared to laparoscopic surgery","authors":"Yoshiharu Sakai, Tsutomu Morishita","doi":"10.1111/ases.13410","DOIUrl":"https://doi.org/10.1111/ases.13410","url":null,"abstract":"<p>Robotic surgery is gaining traction in Japan due to its technological advancements, but its financial viability for hospitals remains uncertain. This study investigates the impact of robotic surgery on hospital gross profits, comparing it to laparoscopic surgery using data from surgeries performed at Red Cross Hospital Osaka. The study spans multiple surgical fields, including gastrointestinal, urology, gynecology, and thoracic surgery. While the number of robotic surgeries has increased, they consistently generate lower gross profits for hospitals compared with laparoscopic surgeries, primarily due to the high costs of robotic instruments and maintenance. Certain procedures, such as hernia repair, proximal gastrectomy, and distal pancreatectomy, result in negative profits when performed robotically. This article highlights the financial challenges hospitals face under Japan's current healthcare reimbursement system, where the fees for robotic and laparoscopic surgeries are largely the same. Policy adjustments may be necessary to ensure the financial sustainability of robotic surgery.</p>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In robot-assisted sacrocolpopexy (RSC) for patients with cystocele, accurate identification of the vaginal point Aa from the serosal side is crucial for surgical mesh placement in the appropriate position. We developed a novel Pharus method for exactly locating the point Aa for RSC.
Methods
In the Pharus method, the tip of a rigid endoscope was placed directly on the vaginal point Aa. In a preliminary experiment, we observed LED lights with different wavelengths of 450–870 nm using the Firefly imaging system to evaluate which wavelengths of light were captured by the Firefly mode. In a clinical study, the Pharus method was employed in four patients with Stage II or more advanced cystocele undergoing RSC. For comparison, a near-infrared fluorescence method by indocyanine green (ICG) tattooing at the point Aa was also performed. The visibility of each method was evaluated under Firefly-mode imaging.
Results
In the preliminary experiment, visible LED lights with wavelengths ≤ 720 nm, and near-infrared LED lights with wavelengths ≥ 830 nm were detected by the Firefly mode. In RSC using the Pharus method, the point Aa of each patient was clearly highlighted as a green spot from the serosal side by the endoscopic white light penetrating the vaginal wall with a thickness of 3.3–4.6 mm. Compared with the ICG tattooing method, the Pharus method showed superior visibility in all patients.
Conclusion
The transillumination light effectively guided the surgeon to the vaginal point Aa, which can be likened to the Latin word “pharus,” meaning lighthouse.
简介：在对膀胱阴道畸形患者进行机器人辅助骶尾部结扎术（RSC）时，从浆膜侧准确识别阴道Aa点是将手术网片放置在适当位置的关键。我们开发了一种新颖的 Pharus 方法，用于准确定位 RSC 的 Aa 点：在 Pharus 方法中，刚性内窥镜的顶端直接置于阴道 Aa 点上。在初步实验中，我们使用萤火虫成像系统观察了450-870纳米不同波长的LED光，以评估萤火虫模式能捕捉到哪些波长的光。在一项临床研究中，我们对四名接受 RSC 检查的 II 期或更晚期膀胱囊肿患者采用了 Pharus 方法。为了进行比较，还在 Aa 点采用了吲哚青绿（ICG）纹身的近红外荧光方法。在萤火虫模式成像下对每种方法的可见度进行了评估：在初步实验中，萤火虫模式可检测到波长≤ 720 nm 的可见光 LED 灯和波长≥ 830 nm 的近红外 LED 灯。在使用 Pharus 方法进行 RSC 时，内窥镜白光穿透厚度为 3.3-4.6 毫米的阴道壁，从浆膜侧清晰地显示出每个患者的 Aa 点为绿色斑点。与 ICG 染色法相比，Pharus 染色法在所有患者中都显示出更高的可见度：结论：透射光能有效地引导外科医生找到阴道的 Aa 点，这就好比拉丁语中的 "pharus"，意为灯塔。
{"title":"Close Contact Transillumination Light Guides Surgeon to Vaginal Point Aa: Pharus Method for Robot-Assisted Sacrocolpopexy","authors":"Akiko Yoshida Ueno, Takayuki Sato, Michiya Kobayashi, Shinya Wakatsuki, Takaomi Namba, Kazutoshi Hayashi","doi":"10.1111/ases.13412","DOIUrl":"10.1111/ases.13412","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In robot-assisted sacrocolpopexy (RSC) for patients with cystocele, accurate identification of the vaginal point Aa from the serosal side is crucial for surgical mesh placement in the appropriate position. We developed a novel Pharus method for exactly locating the point Aa for RSC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In the Pharus method, the tip of a rigid endoscope was placed directly on the vaginal point Aa. In a preliminary experiment, we observed LED lights with different wavelengths of 450–870 nm using the Firefly imaging system to evaluate which wavelengths of light were captured by the Firefly mode. In a clinical study, the Pharus method was employed in four patients with Stage II or more advanced cystocele undergoing RSC. For comparison, a near-infrared fluorescence method by indocyanine green (ICG) tattooing at the point Aa was also performed. The visibility of each method was evaluated under Firefly-mode imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the preliminary experiment, visible LED lights with wavelengths ≤ 720 nm, and near-infrared LED lights with wavelengths ≥ 830 nm were detected by the Firefly mode. In RSC using the Pharus method, the point Aa of each patient was clearly highlighted as a green spot from the serosal side by the endoscopic white light penetrating the vaginal wall with a thickness of 3.3–4.6 mm. Compared with the ICG tattooing method, the Pharus method showed superior visibility in all patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The transillumination light effectively guided the surgeon to the vaginal point Aa, which can be likened to the Latin word “pharus,” meaning lighthouse.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ases.13412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter to “Evaluating the Benefit of Contact-Force Feedback in Robotic Surgery Using the Saroa Surgical System: A Preclinical Study”","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1111/ases.13411","DOIUrl":"10.1111/ases.13411","url":null,"abstract":"","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Naruhiko Sawada, Shumpei Mukai, Tomonori Akagi, Ken Okamoto, Fumihiko Fujita, Hirokazu Suwa, Yoshihito Ide, Tomohisa Furuhata, Akiyoshi Kanazawa, Tsukasa Shimamura, Shigehiro Kojima, Shinobu Ohnuma, Tatsuya Kinjo, Nobuki Ichikawa, Shigeki Yamaguchi, Akinobu Taketomi, Takeshi Naitoh, EnSSURE Study Group Collaboratives in the Japan Society of Laparoscopic Colorectal Surgery
Introduction
A technical qualification system was established by the Japanese Society of Endoscopic Surgery in 2004, and its effectiveness in low anterior resection (LAR) has been reported. We herein performed a subgroup analysis of the effectiveness of the participation of technically qualified surgeons in laparoscopy-assisted high anterior resection (HAR), a procedure used for the technical qualification of surgeons.
Methods
The EnSSURE study enrolled 3188 patients who underwent laparoscopic rectal resection for rectal cancer between January 2014 and December 2016 at 56 Japanese hospitals. The outcomes of HAR were compared between groups with and without the participation of technically qualified surgeons. The background of the two groups were equalized by propensity score matching.
Results
In the group with the participation of qualified surgeons, the operative time was significantly shorter (p = .0427), more lymph nodes were dissected (p = .0207), and the conversion rate to open surgery was lower (p = .0016); however, no significant difference was observed in blood loss (p = .0616), the R0 resection rate (p = 1.00), intraoperative complication rate (p = .160), postoperative complication rate (p = 1.00), or reoperation rate (p = .6999) between the two groups. Furthermore, no significant difference was noted in long-term outcomes (recurrence-free survival (p = .275) or overall survival (p = .941)).
Conclusions
In HAR, the technical benefits of the participation of qualified surgeons was limited to a shorter operative time and lower conversion rate. Nevertheless, the qualification is unique in that it predicts the usefulness of reducing complications in more technically challenging procedures when its effectiveness in LAR is considered.
{"title":"Usefulness of participation of endoscopic surgical skill qualification system-qualified surgeons in laparoscopic high anterior resection","authors":"Naruhiko Sawada, Shumpei Mukai, Tomonori Akagi, Ken Okamoto, Fumihiko Fujita, Hirokazu Suwa, Yoshihito Ide, Tomohisa Furuhata, Akiyoshi Kanazawa, Tsukasa Shimamura, Shigehiro Kojima, Shinobu Ohnuma, Tatsuya Kinjo, Nobuki Ichikawa, Shigeki Yamaguchi, Akinobu Taketomi, Takeshi Naitoh, EnSSURE Study Group Collaboratives in the Japan Society of Laparoscopic Colorectal Surgery","doi":"10.1111/ases.13409","DOIUrl":"10.1111/ases.13409","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>A technical qualification system was established by the Japanese Society of Endoscopic Surgery in 2004, and its effectiveness in low anterior resection (LAR) has been reported. We herein performed a subgroup analysis of the effectiveness of the participation of technically qualified surgeons in laparoscopy-assisted high anterior resection (HAR), a procedure used for the technical qualification of surgeons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The EnSSURE study enrolled 3188 patients who underwent laparoscopic rectal resection for rectal cancer between January 2014 and December 2016 at 56 Japanese hospitals. The outcomes of HAR were compared between groups with and without the participation of technically qualified surgeons. The background of the two groups were equalized by propensity score matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the group with the participation of qualified surgeons, the operative time was significantly shorter (<i>p</i> = .0427), more lymph nodes were dissected (<i>p</i> = .0207), and the conversion rate to open surgery was lower (<i>p</i> = .0016); however, no significant difference was observed in blood loss (<i>p</i> = .0616), the R0 resection rate (<i>p</i> = 1.00), intraoperative complication rate (<i>p</i> = .160), postoperative complication rate (<i>p</i> = 1.00), or reoperation rate (<i>p</i> = .6999) between the two groups. Furthermore, no significant difference was noted in long-term outcomes (recurrence-free survival (<i>p</i> = .275) or overall survival (<i>p</i> = .941)).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In HAR, the technical benefits of the participation of qualified surgeons was limited to a shorter operative time and lower conversion rate. Nevertheless, the qualification is unique in that it predicts the usefulness of reducing complications in more technically challenging procedures when its effectiveness in LAR is considered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laparoscopic sleeve gastrectomy (LSG) is a commonly performed procedure for bariatric and metabolic surgery. However, few reports exist concerning the learning curves and surgical outcomes of LSG among trainee surgeons. This study aimed to investigate the learning curves and surgical outcomes of LSG for one attending surgeon and trainee surgeons.
Methods
In this study, 90 patients who underwent LSG were retrospectively evaluated. Surgical learning curves for the attending and the trainees were assessed via cumulative sum (CUSUM) analysis. After the attending reached the learning phase, the trainees performed LSG under the guidance of the attending. Surgical and postoperative outcomes were compared retrospectively.
Results
The CUSUM plot of the attending peaked in the 16th case, began to decrease and reached a plateau in the 49th case. Therefore, we defined the attending in Phase I up to 16 LSGs (n = 16; learning phase), in phase II between 27 and 48 LSGs (n = 22; acquisition phase), and in Phase III from 49 or more LSGs (n = 29; plateau phase). The CUSUM of the trainees' operative time declined from the beginning. The median operative time was significantly shorter in the trainees than in the attending in Phase I (184 [146–266] vs. 161 [111–255], p < 0.01). %EWL was significantly better in the patients of the trainees than in those of the attending (92.4 ± 35.7 vs. 71.0 ± 28.7, p < 0.01). These results indicate that trainees could perform LSG in a stable manner.
Conclusion
Under the guidance of experienced surgeons, LSG can be safely performed by trainees without prolonged surgical time.
{"title":"Learning Curves and Surgical Outcomes of Laparoscopic Sleeve Gastrectomy Performed by an Attending Surgeon and Trainee Surgeons","authors":"Takamasa Takahashi, Atsuyuki Maeda, Yuichi Takayama, Hiroki Aoyama, Daigoro Takahashi, Takahiro Hosoi, Atsushi Fujiya","doi":"10.1111/ases.13414","DOIUrl":"10.1111/ases.13414","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Laparoscopic sleeve gastrectomy (LSG) is a commonly performed procedure for bariatric and metabolic surgery. However, few reports exist concerning the learning curves and surgical outcomes of LSG among trainee surgeons. This study aimed to investigate the learning curves and surgical outcomes of LSG for one attending surgeon and trainee surgeons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this study, 90 patients who underwent LSG were retrospectively evaluated. Surgical learning curves for the attending and the trainees were assessed via cumulative sum (CUSUM) analysis. After the attending reached the learning phase, the trainees performed LSG under the guidance of the attending. Surgical and postoperative outcomes were compared retrospectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The CUSUM plot of the attending peaked in the 16th case, began to decrease and reached a plateau in the 49th case. Therefore, we defined the attending in Phase I up to 16 LSGs (<i>n</i> = 16; learning phase), in phase II between 27 and 48 LSGs (<i>n</i> = 22; acquisition phase), and in Phase III from 49 or more LSGs (<i>n</i> = 29; plateau phase). The CUSUM of the trainees' operative time declined from the beginning. The median operative time was significantly shorter in the trainees than in the attending in Phase I (184 [146–266] vs. 161 [111–255], <i>p</i> < 0.01). %EWL was significantly better in the patients of the trainees than in those of the attending (92.4 ± 35.7 vs. 71.0 ± 28.7, <i>p</i> < 0.01). These results indicate that trainees could perform LSG in a stable manner.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Under the guidance of experienced surgeons, LSG can be safely performed by trainees without prolonged surgical time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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