Journal of Robotic Surgery最新文献

Total hip arthroplasty (THA) effectively treats various end-stage hip conditions, offering pain relief and improved joint function. However, surgical outcomes are influenced by multifaceted factors. This research aims to create a predictive model, incorporating radiomic and clinical information, to forecast post-surgery joint function in robot-assisted THA (RA-THA) patients. The study set comprised 136 patients who underwent unilateral RA-THA, which were subsequently partitioned into a training set (n = 95) and a test set (n = 41) for analysis. Preoperative CT imaging was employed to derive 851 radiomic characteristics, selecting those with an intra-class correlation coefficient > 0.75 for analysis. Least absolute shrinkage and selection operator regression reduced redundancy to six significant radiomic features. Clinical data including preoperative Visual Analog Scale (VAS), Harris Hip Score (HHS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score were collected. Logistic regression identified significant predictors, and three models were developed. Receiver operating characteristic and decision curves evaluated the models. Preoperative VAS, HHS, WOMAC score, and radiomics feature scores were significant predictors. In the training set, the AUCs were 0.835 (clinical model), 0.757 (radiomic model), and 0.891 (combined model). In the test set, the AUCs were 0.777 (clinical model), 0.824 (radiomic model), and 0.881 (combined model). The constructed nomogram prediction model combines radiological features with relevant clinical data to accurately predict functional outcomes 3 years after RA-THA. This model has significant prediction accuracy and broad clinical application prospects and can provide a valuable reference for formulating personalized treatment plans and optimizing patient management strategies.

Because of the increasing popularity of Hugo RAS as a surgical platform, a comparison examination of intraoperative and oncological outcomes across DaVinci and Hugo RAS robotic surgery platforms is urgently needed. We carried out a comprehensive review and meta-analysis of the literature of current research, comprehensively searching PubMed, Cochrane and Embase for eligible studies comparing the results between the DaVinci and Hugo RAS. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were followed in the conduct of this study, with language restricted to English and a final search date of June 2024. We excluded articles composed solely of conference abstracts and irrelevant content. Composite outcomes were assessed using weighted mean differences (WMD) and odds ratios (ORs). The risk of bias in individual research was assessed using the Newcastle-Ottawa Scale (NOS), and heterogeneity and bias risk were controlled for using a sensitivity analysis. Six studies in all were considered, comprising 1025 patients, including 626 DaVinci patients and 399 Hugo RAS patients. Review Manager V5.4.1 software (Cochrane Collaboration, Oxford, UK) was utilized to conduct the meta-analysis, including 6 trials, which demonstrated that compared to Hugo RAS, DaVinci was associated with statistically significant differences in several outcomes: a reduction in operative time (OT) (WMD - 8.46, 95% CI - 13.56 to 3.36; p = 0.001), an increase in estimated blood loss (EBL) (WMD 41.68, 95% CI 23.59 to 59.77; p < 0.00001), and an increased pelvic lymphadenectomy ratio (OR 1.5, 95% CI 1.05-2.05; p = 0.01). On the contrary, there were no statistically noteworthy differences in the length of hospital stay (LOS) between the two teams (WMD - 0.05, 95% CI - 0.14 to 0.04; p = 0.25), nerve sparing (unilateral or bilateral) (OR 0.96, 95% CI 0.68-1.35; p = 0.8), postoperative complications (OR 1.15, 95% CI 0.50-2.64; p = 0.75), or positive surgical margins (PSM) (OR 1.08, 95% CI 0.76-1.54; p = 0.68). Although DaVinci offers shorter operating times (OT) and increased pelvic lymph node dissection rates, Hugo RAS demonstrates lower estimated blood loss (EBL). Overall, Hugo RAS Robot-Assisted Radical Prostatectomy (RARP) results seem to be similar to those obtained with the DaVinci system. Further research and long-term follow-up are necessary to ascertain durable oncological and functional outcomes, allowing doctors to switch between robotic systems and use their skills. These findings are crucial for patients, surgeons, and healthcare policymakers and warrant future studies with extended follow-up.

Gynecologic surgery with minimally invasive method using robotic or laparoscopic techniques has gained popularity for reducing perioperative discomfort and length of hospital stay. However, the debate over postoperative pain superiority between traditional laparoscopy and robotic surgery persist. This study compared the postoperative pain of patients within 24 h of robotic (RM) and laparoscopic myomectomy (LM). This retrospective cohort study included 24 and 53 patients who underwent RM and LM, respectively, between January 2019 and July 2023. The primary outcomes were the postoperative pain levels of patients within 24 h and the use and dosage of postoperative analgesia. Additional perioperative analgesia, including long-acting non-steroidal anti-inflammatory drugs (Dynastat) and abdominal nerve block, was also recorded. The secondary outcomes were blood loss and hospitalization duration. The patient characteristics were similar between the groups. Factors that could potentially increase pain, such as the number of ports (p < 0.0001), additional procedures (p = 0.0195), operative time (p < 0.0001), number of myomas (p = 0.0057), and the largest myoma size (p = 0.0086), were significantly higher in the RM group than in the LM group. However, there were no significantly different in the postoperative visual analog scale pain scores, use and dosage of ketorolac and opioid, and use of Dynastat and nerve block between the groups. Hospitalization duration and intraoperative blood loss were similar between the groups. RM and LM offer comparable postoperative pain outcomes, emphasizing the importance of patient-specific factors in decision-making regarding myomectomy techniques.

To compare perioperative outcomes of robot-assisted radical cystectomy (RARC) using a single-port (SP) or multi-port (MP) robotic platform. We conducted a comprehensive search of the PubMed, Web of Science, Scopus, and Google Scholar databases until June 2024. For a combined analysis of the data using random effects, Review Manager 5.4 was employed. To compare continuous and categorical variables, the weighted mean difference (WMD) and odds ratio (OR) were employed, respectively. Three original studies were included, comprising a total of 170 patients (SP-RARC: 73 versus MP-RARC: 93).Recovery of bowel function was faster in SP-RARC (WMD -1.02 days, 95% CI - 1.33 to - 0.17; p < 0.001), and lymph-node yield was lower than in MP-RARC patients (WMD - 6.32, 95% CI - 8.90 to - 3.75; p < 0.00001).There were no significant differences between the SP-RARC and MP-RARC groups in terms of other perioperative outcomes such as surgery duration, length of hospital stay, estimated blood loss, major complication rate, positive surgical margin rate, readmission rate, and recurrence rate. The SP robot offers a safe alternative surgical approach to RARC, providing similar postoperative outcomes compared to the MP robot. The SP system remains an attractive option that will require longer follow-up and cohort validation in the future.

Robotic surgery has expanded internationally at pace. There are multiple local robotic training pathways but there is inconsistency in standardisation of core common components for curricula internationally. A framework is required to define key objectives that can be implemented across robotic training ecosystems. This Delphi consensus aimed to provide recommendations for core considerations in robotic training design across diverse training environments internationally. A literature search was performed and an international steering committee (AG, KL, JW, HM, TC) proposed key components for contemporary robotic training design and a modified Delphi approach was used to gather stakeholder opinion. The outcomes were then discussed at a face-to-face international expert consensus at the IMRA educational session at the Society of Robotic Surgery (SRS) meeting and final voting was conducted on outstanding items. Stakeholders included robotic surgeons, proctors, trainees and robotic surgical training providers. There was consensus achieved in 139 statements organised into 15 themes. There was 100% agreement that standardised themes in robotic curricula may improve patient safety. Key take-home messages include-training curricula should be multiplatform, non-technical skills are an important component of a robotic curriculum as well as console and bedside skills, clinically relevant performance metrics should be used for assessment where available, the reliance on cadaveric and live animal models should be reduced as high-fidelity synthetic models emerge, and stepwise component training is useful for advanced procedural training. These consensus recommendations are intended to guide design of fit for purpose contemporary robotic surgical curricula. Integration of these components into robotic training pathways internationally is recommended.

Robotic colectomy has been associated with comparable or improved short-term morbidity and mortality when compared to laparoscopic colectomy, including shorter length of stay. In this study, we sought to understand oncologic advantages for robotic as compared to laparoscopic colectomy in colon cancer. We analyzed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) participant user files for all elective colon cancer cases from 1/2016 through 12/2021 performed with minimally invasive surgical techniques (robotic and laparoscopic). We calculated relative risks (RR) through Poisson Regression models and treatment effect coefficients by propensity-score match, after adjusting for age, BMI, ASA scores, mechanical and antibiotic bowel preparation, emergency surgery, race, gender, smoking status, hypertension and diabetes mellitus. Analyzed outcomes included rate of chemotherapy initiation within 90 days of surgery, number of harvested lymph nodes, any occurrence of intraoperative or postoperative blood transfusion, and the need for ostomy. During the study period, 44,745 patients underwent minimally invasive colectomy for colon cancer; 39,614 in the laparoscopic cohort and 7,831 in the robotic cohort. After adjusting for confounders, robotic colectomy was associated with a significant increase in the likelihood for initating chemotherapy within 90 days (RR 1.98, 95% CI {1.86-2.10}, p < 0.001). The robotic-treated patients had a significantly more lymph nodes harvested, a significant decrease in the need for intraperative or postoperative blood transfusion (RR 0.64, 95% CI {0.57-0.71}, p < 0.001) and a significant reduction in the need for ostomy formation (RR 0.26, 95% CI {0.22-0.30}, p < 0.001). As a retrospective and non-randomized study, residual bias and confouding variables are likely to exist. The study is also subject to coding incompleteness and inaccuracies. We also do not have additional context on potential factors that might influence time to chemotherapy. In addition, there is no information on surgeon or hospital volume, which can be associated with outcomes. Robotic colectomy for colon cancer was associated with significant improvement in the rate of chemotherapy initiation within 90 days, a significant reduction in need for blood transfusions, and a lower likelihood of receiving an ostomy when compared to laparoscopic colectomy procedures. The data reveal substantial short-term gains in oncologic outcomes for colon cancer performed with robotic techniques.

Worldwide, healthcare systems are struggling to tackle a nursing shortage. As per the data released by the American Hospital Association, the healthcare workforce could face a loss of around 5 lakh nurses by the end of the year. Consequently, it could result in those deficiencies, which will be 1.1 million instead of 0.6 million. The current nursing scenario in India as per the Indian Nursing Council (INC), which is a board under the ministry and is responsible for legally confirming and maintaining universal standardized training for nursing, is that the 1.96 nurses out of every 1000 Indians that are there are much behind the World Health Organization's (WHO) recommended figure of 3 nurses per 1000. To mitigate the nurse shortage, a collaborative robotic system was designed that can assist with surgical procedures with a collaborative robot acting as a scrub nurse for cataract surgery (CRASCS) represented in Fig. 1. Accordingly, the model has been built to empower a customized 3d printed 5-Degree of freedom robotic arm by tracking the phase of surgery in real-time and automatically supplying the clinician with the ideal equipment that is needed for the particular phase of surgery. The system is supported with one more model which can identify where the surgical equipment is located within the arm range. The system is also supported with voice commands which help in picking up the right surgical equipment in the middle of any phase of the surgery. In this way, the system could be able to potentially handle the shortage of surgical nurses around the world and benefit humanity.

The anatomical dimensions and the shape of the pelvis influence surgical difficulty for rectal cancer. Compared to conventional laparoscopic surgery, robot-assisted surgery is expected to improve surgical outcomes due to the multi-joint movement of its surgical instruments. The aim of this study was to investigate the impact of pelvic anatomical indicators on short-term outcomes of patients with rectal cancer. A retrospective analysis was conducted using data from 129 patients with rectal cancer who underwent conventional laparoscopic low anterior resection (L-LAR) or robot-assisted low anterior resection (R-LAR) with total mesorectal excision or tumor-specific mesorectal excision between January 2014 and December 2022. The transverse diameter of the lesser pelvis and the sacral promontory angle were used as indicators of pelvic anatomy. The sacral promontory angle was not associated with age and sex while the pelvic width was smaller in male than in female. The pelvic width did not affect postoperative complications in both L-LAR and R-LAR. In contrast, postoperative urinary dysfunction occurred more frequently in patients with a small sacral promontory angle (p = 0.005) in L-LAR although there was no impact on short-term outcomes in R-LAR. Multivariate analysis demonstrated that a small sacral promontory angle was an independent predictive factor for urinary dysfunction (p = 0.032). Sharp angulation of the sacral promontory was a risk factor for UD after L-LAR. Robot-assisted surgery could overcome anatomical difficulties and reduce the incidence of UD.