Journal of Robotic Surgery最新文献

The aim of this study is To compare robotic-assisted and conventional total knee arthroplasty (TKA) on both short- and long-term outcomes A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane, Scopus, and Web of Science databases were searched for relevant studies. The studies included were randomised controlled trials directly comparing robotic-assisted versus conventional TKA. The outcomes were pooled as mean difference (MD) or risk ratio (RR), with 95% confidence interval. RevMan software version 5.4 was used for performing the statistical analysis. Nine studies deemed eligible for inclusion. The data showed a significant favouring of robotic-assisted than the conventional TKA in mechanical alignment, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and femoral coronal plane outliers (MD =  - 1.10, 95% CI [- 1.51, - 0.69], p < 0.00001), (MD =  - 1.19, 95% CI [- 2.35, - 0.03], p = 0.04), and (RR = 0.49, 95% CI [0.30, 0.80], p = 0.004), respectively. On the other hand, conventional TKA was better in range of motion-flexion (long-term) than the robotic-assisted one (MD =  - 3.02, 95% CI [- 3.68, - 2.37], p < 0.00001). There were no significant differences between them in knee society score-knee score, knee society score-function score, change in hospital for special surgery (HSS) knee rating scale, and change in range of motion-extension (MD =  - 0.36, 95% CI [- 2.43, 1.70], p = 0.73), (MD =  - 0.34, 95% CI [- 2.36, 1.68], p = 0.74), (MD = 0.78, 95% CI [- 0.84, 2.40], p = 0.34), and (MD = 0.16, 95% [- 1.32, 1.64], p = 0.83), respectively. Robotic-assisted TKA demonstrated better outcomes than conventional TKA in terms of mechanical alignment and WOMAC scores. However, the conventional TKA showed a better range of motion-flexion in the long term. More data are needed to assess long-term outcomes comprehensively.

A nephroureterectomy conventionally consists of two independent section, which will considerably prolong the operation time. We developed a novel surgical technique for robotic-assisted laparoscopic nephroureterectomy without re-docking in a single position and aimed to access the safety, feasibility, and efficiency of our novel surgical technique. From August 2021 to October 2023, 53 patients who received robotic-assisted laparoscopic nephroureterectomy were retrospectively enrolled in this study. 25 patients underwent traditional nephroureterectomy and 28 patients underwent single-position nephroureterectomy. The basic characteristics of the enroll patients, perioperative parameters, and oncological outcomes were gathered and compared between novel technique robotic surgery group and traditional surgery group. The basic characteristics between two groups had no significantly difference except for the proportion of anticoagulation therapy. The operation time in novel technique robotic surgery group was shorter than that in traditional robotic surgery group, although there was no significant difference (p = 0.403). Lymph-node dissection in novel technique robotic surgery group was obvious more common than that in traditional robotic surgery group (p = 0.037), while the incision length in novel technique robotic surgery group was obviously shorter than that in traditional robotic surgery group (p < 0.001). The oncological outcomes showed no difference between two groups. Compared with traditional robotic-assisted laparoscopic nephroureterectomy, the innovative surgical technique of robotic-assisted laparoscopic nephroureterectomy in a single position showed the advantages of less surgical time, streamlined lymph-node dissection, less trauma, and expedited postoperative recovery, which is worth promoting in clinical practice.

The objective is to demonstrate that omitting ureteral stent placement in robotic intracorporeal urinary diversion does not lead to increased risk of perioperative complications, namely ureteral strictures or anastomotic leaks. We retrospectively reviewed the records of 68 consecutive patients who underwent robotic radical cystectomy with ileal conduit creation or orthotopic neobladder by a single surgeon between January 2020 and September 2023. Chronologically, the first cohort of patients had ureteral stents placed to bridge the ureteroenteric anastomosis, and in the second cohort, stenting was omitted. Cohort 1 consisted of 28 patients with surgeries performed between January 2020 and April 2021, while cohort 2 had 40 patients who underwent surgery from April 2021 to September 2023. The cohorts were well matched with regard to patient age, gender, ASA score and rate of neoadjuvant chemotherapy. The choice of urinary diversion was left to surgeon and patient preference, and there was no significant difference in the proportion of ileal conduits versus orthotopic neobladders within each cohort. Estimated blood loss, total operative time, inpatient length of stay and pathologic T and N staging did not statistically differ between the cohorts. Overall, there was no difference in the rates of postoperative ileus, ureteral stricture, anastomotic leak, infectious complications, and 30-day readmission rates between the groups. Tubeless ureteroenteric anastomosis in patients undergoing robotic radical cystectomy with intracorporeal diversion does not appear to increase the risk of anastomotic strictures or postoperative complications. Further prospective evaluation is warranted.

The goal of this systematic review and meta-analysis is to evaluate the perioperative and oncologic results of natural orifice specimen extraction (NOSE) compared to conventional transabdominal specimen extraction (TASE) in robotic-assisted surgery for colorectal cancer. A comprehensive electronic search will be performed on PubMed, Embase, and the Cochrane Library to find research articles published from the beginning of the databases to July 2024 that focus on patients who have undergone robotic-assisted surgery for colorectal cancer. Specifically, this review will compare NOSE with conventional TASE. Only studies published in English will be considered. Literature screening will adhere closely to predetermined criteria for inclusion and exclusion, specifically targeting randomized controlled trials and cohort studies. The evaluation of quality will involve the use of the Newcastle-Ottawa Scale (NOS). Meta-analysis of the included studies' data will be performed using Review Manager 5.4.1. In the final analysis, 9 retrospective cohort studies comprising 1571 patients were included. Out of these, 732 patients opted for NOSE, while 839 patients chose conventional TASE in robotic colorectal surgery. Patients who received TASE experienced enhancements in hospital stay duration, time until first gas passage, wound infection rates, and time until the first intake of a liquid diet. Nevertheless, there were no notable distinctions noted between the two methods regarding surgery duration, projected blood loss, intestinal blockage, or frequency of anastomotic leakage. In patients undergoing robotic-assisted colorectal surgery, the safety and feasibility of NOSE are demonstrated. Compared to traditional TASE, it provides clear benefits including shorter hospital stays, earlier first flatus, quicker initiation of a liquid diet, and lower risk of wound infection.

We sought to examine whether scheduled intravenous (IV) ketorolac decreased post-operative narcotic utilization and changed peri-operative outcomes (including complications) in patients undergoing robotic-assisted simple prostatectomy (RASP). An IRB-approved, retrospective chart review was performed of all patients undergoing RASP at a single institution from November 2017 to July 2019. Patient demographic, peri-operative, and post-operative data, including morphine equivalent use (MEU), were collected. Scheduled ketorolac use was implemented at the surgeon's discretion for up to 5 days post-operatively. The primary outcome was MEU in the post-operative stay. Two hundred seven men underwent RASP during the study period, of which 143 (69%) received scheduled ketorolac. No differences in patient demographics, prostate size, prior opioid utilization, or operative characteristics were identified between groups. Median MEU was significant less (5 vs 15, p < 0.001) in patients receiving scheduled ketorolac. Significantly more patients receiving scheduled ketorolac did not require the use of any narcotic during hospitalization (30% vs 11%, p = 0.005). On multivariable linear regression adjusted for age, BMI, prior opioid use, and length of stay, ketorolac use independently associated with decreased narcotic use (p = 0.003). No significant difference in transfusion rates were identified (3.5% vs. 1.6%, p = 0.44). Scheduled ketorolac is effective in reducing post-operative, in-hospital opioid utilization without increasing morbidity after RASP. Almost a third of patients on scheduled ketorolac did not require any opioids post-operatively.

The effect of radical resection of male rectal cancer on sexual function has been the focus of attention. Despite this, there remains a dearth of robust evidence regarding the influence of robotic radical resection of rectal cancer on postoperative sexual function, particularly in men diagnosed at an early age. This study aims to explore the implications of robotic radical resection of rectal cancer on sexual function in early-onset overweight male patients diagnosed with this disease. A retrospective analysis was performed on male patients under 50 years old and over 20 years old who were diagnosed with rectal cancer (cT1-3N0M0) and underwent surgical treatment in the First Affiliated Hospital of Nanchang University from May 2015 to August 2020. Sexual function was evaluated by the International Index of Erectile Function (IIEF) test and scored at 1, 3, 6, and 12 months postoperatively. The sexual function of traditional laparoscopic radical resection of rectal cancer (L-RE) and robotic radical resection of rectal cancer (R-RE) were compared. According to body mass index, L-RE and R-RE groups were further divided into normal body weight groups (LN-RE and RN-RE) and overweight groups (LO-RE and RO-RE), and the sexual function of each group was compared successively. Neither L-RE nor R-RE patients had significant differences in number of lymph nodes removed, tumour size, pathological TNM stage, or first exhaust time or time to eat liquids. The OS and DFS of the L-RE and R-RE groups, as well as the LO-RE and RO-RE groups, did not differ statistically after the logarithmic rank test (P > 0.05). IIEF scores in both the L-RE and R-RE groups declined sharply 1 month after surgery and then steadily increased. The R-RE group's IIEF scores significantly recovered in 6 months, compared to 12 months in the L-RE group. In comparison of subgroups, the results of sexual function in the LN-RE and RN-RE groups were similar to those in the L-RE and R-RE groups. Conversely, the RO-RE group showed slightly improved sexual function recovery than the LO-RE group 3 and 6 months post-surgery. 12 months after surgery, no significant difference was observed between the two groups. With similar long-term oncology outcomes, the robot-assisted surgical approach provided better protection of sexual function for men with early-onset rectal cancer, especially for those with a higher body mass index (BMI).

Assessing the perioperative, oncological, and functional results of robotic-assisted radical prostatectomy (RARP) versus three-dimensional laparoscopic radical prostatectomy (3D LRP), a comprehensive exploration of the Cochrane Library, PubMed, EMBASE, and Web of Science databases was carried out until July 2024. The combined results were evaluated by utilizing the weighted mean differences (WMDs) and odds ratios (ORs) through the application of Stata version 18, where data were gathered and scrutinized. In addition, sensitivity analyses were performed to ensure the robustness of our findings. In the meta-analysis we conducted, four studies were incorporated in total, which comprised two randomized controlled trials, one study that was retrospective and another that was prospective. The findings revealed that RARP was associated with a significantly reduced estimated blood loss (EBL) (WMD - 31.04, 95%CI - 54.57, - 7.51; p = 0.01) compared to 3D LRP. Nonetheless, there were no notable statistical variances seen between the two groups regarding operative time (OT), nerve-sparing rates, positive surgical margin (PSM) rates, biochemical recurrence (BCR) rates, or the restoration of urinary continence and potency 3 or 6 months after the surgery. In conclusion, our comprehensive meta-analysis has offered a detailed contrast between the results of RARP and 3D LRP in the treatment of prostate cancer. The findings highlight a considerable decrease in projected blood loss linked with RARP, yet no notable variances were detected between the two methods regarding other perioperative, oncological, and functional results.

Objectives: To explore surgical, functional, and symptomatic outcomes in a series of patients who underwent robot-assisted laparoscopic Anderson-Hynes pyeloplasty (RALP) for ureteropelvic junction obstruction using the DaVinci Si surgical robotic system.

Methods: Retrospective study including patients aged 16 years or older who underwent RALP from June 2016 to December2021. The following outcomes were recorded: operative outcome and complications [classified according to the Clavien-Dindo Classification (CD)] within 30 days of the procedure as well as 1 year success rate and restenosis during follow-up.

Results: In total, 194 patients were available for analyses with a median follow-up of 4.5 (IQR 3.0-6.0) years. The primary indications were loss of kidney function (45%), pain (36%), infection (11%), kidney stone (6%), and others (2%). The median operation time was 134 min (IQR 112-159), the median length of stay was 2 days (IQR 2-2), and the median time with double-j stent postoperatively was 24 days (IQR 22-27). Overall, 65 out of 194 patients (33%) experienced a postoperative complication (12% CD I, 13% CD II, 8% CD IIIa or IIIb). The 1 year success rate was 92% for patients treated because of deteriorating renal function, 78% for patients treated because of symptoms, 82% for patients treated because of infections, and 78% for patients treated because of kidney stones. Seven percent of the patients presented a recurrent ureteropelvic junction stricture during follow-up.

Conclusions: In our experience, robot-assisted laparoscopic Anderson-Hynes pyeloplasty performed with the DaVinci Si system is a safe with a few major complications and acceptable success rate.

As robot-assisted laparoscopic techniques continue to advance, becoming increasingly complex and refined, there has been significant progress in the minimally invasive treatment of ureteral strictures. This abstract aims to provide an overview and description of various surgical techniques that utilize robots for repairing ureteral strictures. We have summarized the progression of these surgical methods and highlighted the latest advancements in the procedures. When compared to open surgery, robot-assisted reconstruction techniques demonstrate superior functional outcomes, fewer postoperative complications, and a faster recovery in the treatment of ureteral strictures. This abstract aims to provide an overview and description of various surgical techniques utilizing robots to repair ureteral strictures. Robotic ureteral stricture correction has emerged as a valuable therapeutic option, particularly when endoscopic procedures are not feasible. Compared to traditional open surgery, robotic methods exhibit superior therapeutic effectiveness, fewer postoperative complications, and accelerated recovery. Reconstructive procedures such as reimplantation, psoas hitch, Boari flap, ureter-to-ureter anastomosis, appendix graft, buccal mucosa graft (BMG), ileal transplantation, or kidney autotransplantation can be performed depending on the extent and location of the stricture. Robotic surgical techniques also offer advantages, such as an expanded field of vision and the incorporation of supplementary technologies such as FireflyTM, indocyanine green (ICG), and near-infrared fluorescence (NIRF) imaging. However, further long-term, multicenter investigations are necessary to validate the positive findings reported in existing case series. Compared with open surgery, robot-assisted reconstruction techniques yield superior functional outcomes, fewer postoperative complications, and accelerated recovery for the treatment of ureteral strictures.