Journal of Robotic Surgery最新文献

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.

Urology's pioneering role in surgical innovations, from cystoscopy to laparoscopic surgery, culminated in the twenty-first-century advent of robotic surgery. The dominant da Vinci^® system faced new competition following its 2019 patent expiration. Medtronic's Hugo^™ system emerged. Its growing global adoption, especially in robot-assisted radical prostatectomy (RARP), necessitates a systematic review, evaluating safety, feasibility, and comparison with established systems. A comprehensive search identified eligible studies of the Hugo^™ robotic platform for RARP, presenting their current experiences. Following systematic screening, quality of eligible studies was assessed using ROBINS-I. Results then underwent a narrative synthesis. This systematic review analysed 19 eligible studies, consisting of 9 comparative and 10 single arm studies. Due to the non-randomised nature of the studies, a moderate risk of bias was concluded in most. On account of the high heterogeneity between studies, a narrative synthesis of data was enacted; categorised into themes relating to operative timings, transfer of skills, patient demographics, plus safety and feasibility. Eligible studies demonstrated the promise of the Hugo^™ platform within these themes, in comparison to currently available platforms. Despite a paucity of high-quality randomised controlled trials, available evidence indicates Hugo^™ as a promising, safe alternative for RARP. Positive experiences across diverse centres and surgeons revealed minimal differences in surgical outcomes compared to the established da Vinci^® system, fostering global Hugo^™ adoption. Despite evidence demonstrating Hugo^™ safety and comparability, the review underscores the scarcity of high-quality evidence, attributing it to early stage implementation challenges.

Achieving precision in microsurgery requires skill, adequate instruments and magnification, as well as extensive training. Dedicated surgical robotic systems have enhanced and expanded the application of (super-)microsurgical techniques by introducing motion scaling and providing improved surgeon ergonomics. In this prospective preclinical trial, we analyzed the learning curve in robotic assisted microsurgery in 13 participants including medical students, residents, and attending physicians. Data on demographics as well as prior experience in surgery, microsurgery, and gaming were collected. In three study sessions, the participants performed nine microsurgical anastomoses each on 2 mm vessel models using the Symani^® Surgical System in combination the VITOM 3D exoscope. A senior expert microsurgeon reviewed the de-identified and blinded videos and scored all anastomoses using a modified "Structured Assessment of Microsurgical Skills" (SARMS) score. All participants significantly reduced their time needed per anastomosis and their overall SARMS score, as well as individual scores for motion and speed throughout the trial. We saw a significant correlation of prior years of practice in surgery with the overall mean time and mean SARMS score. In a separate analysis of the three sessions, this influence could no longer be seen in the last session. Furthermore, we found no significant effect of gender, age, hand dominance, or gaming experience on speed and quality of the anastomoses. In this study of 117 robotic assisted anastomoses, a rapid improvement of performance of all participants with different surgical skills levels could be shown, serving as encouraging evidence for further research in the implementation of microsurgical robotic systems.

Robotic bariatric surgery may overcome challenges associated with laparoscopy, potentially achieving technically superior results. This review aims to summarise current literature reporting on learning curves for surgeons newly adopting robotic bariatrics and implications for safety, efficiency and outcomes. A systematic review was performed in line with the PRISMA guidelines. Electronic databases PubMed and MEDLINE were searched and articles reporting on learning curves in robotic bariatric surgery were identified. Studies that reported changes in outcome over time, or learning curves for surgeons newly adopting robotic bariatric surgery were included in this review. Eleven studies reporting on 1237 patients were included in this review. Most surgeons reported prior bariatric surgical experience. Differences were noted regarding the approach and adoption of robotics. Ten studies found significant reduction in operative time, with the shortest learning curve of 11 cases. Reporting of clinical outcomes was limited. Three studies reported statistically significant improvement in outcomes after the learning curve. Long-term outcomes were in line with current literature, though none assessed differences between learning curve groups. Reported learning curves in robotic bariatric surgery is variable, with limited reporting of clinical outcomes. With appropriate mentorship, surgeons can improve efficiency, safety and clinical outcomes, maximising the benefits of minimally invasive surgery.

Management of acute and chronic pain after thoracic surgery for pulmonary resection or thymectomy remains a challenge for both thoracic surgeons and anesthesiologists. Advances in minimally invasive robotic procedures have made subcostal outside-the-cage (OTC) resections possible, but the procedure's pain benefits have not been previously measured. A single-center cohort was consented to undergo robotic-assisted thoracoscopic surgery (RATS) with an OTC or transthoracic (TT) approach. On every post-operative day (POD), patients were asked to complete the visual analog scale (VAS) of pain, assigning a score of 0-10 with higher scores equaling higher pain intensity. Additionally, patients' opioid consumption was recorded and classified using morphine equivalent dose (MED). Descriptive statistics of demographics, Mann-Whitney, and Chi-squared tests were performed in a matched analysis. Altogether, 50 OTC patients and 50 TT patients were included. For each group, 1 pneumonectomy, 19 lobectomies, 10 segmentectomies, and 20 thymectomies were performed. Between groups, most were male (n = 54; p = 0.42) and there were no differences in American Society of Anesthesiologists scores (p = 0.51), or tobacco consumption (p = 0.45). Patients who received an OTC approach experienced significantly lower pain scores on POD-0 (p = 0.001), POD-1 (p < 0.001), and POD-2 (p < 0.001). POD-3 OTC VAS scores were not different from those of the TT group (p = 0.09). Similarly, MED was lower for the OTC group on POD-0 (p < 0.001), POD-1 (p = 0.03), and POD-3 (p = 0.03). The RATS-OTC approach results in a more rapid decrease in self-reported pain by the patient as well as significantly lower levels of MED.

We share our experience with the Hugo™ Robotic-Assisted Surgery system in benign gynecological surgeries. We retrospectively analyzed patients who underwent elective robotic surgeries for benign gynecological conditions at our surgical center from February 2023 to February 2024. Data collected included patient demographics, surgery indications, and outcomes. Perioperative data on port-placement time, arm configurations, docking, and console time were documented. Procedural outcome data including troubleshooting and overall satisfaction were also recorded. The primary outcome was perioperative data on port placement, docking time, arm configuration, and console time. The secondary outcome was defined as team satisfaction, system troubleshooting, arm repositioning, and complications graded 3-4 on the Clavien-Dindo Scale. A total of 60 patients underwent procedures for benign gynecological conditions using the Hugo™ RAS over the 12-month study period, primarily for pelvic endometriosis (53%), hysterectomies (27%), and adnexal surgery (10%). The mean port-placement time was 13 min and 41 s. In 31% of cases, low-port placement was used, with arm positioning being asymmetrical in 63% and symmetrical in 37%, demonstrating the system's flexibility in customizing port configurations while optimizing cosmetic outcomes. Docking time averaged 5 min and 51 s, and console time was 1 h and 5 min. Operational challenges included arm tremors and limited workspace for the assistant. This study details our knowledge using the Hugo™ RAS. Learning curves of port placement, arm positioning, docking, and procedure time can be rapidly adapted in a well-trained team. Our experience suggests the technology is still in its learning curve period.