American journal of robotic surgery最新文献

The laparoscopic approach to the pyeloplasty procedure has proven to be safe and effective in the pediatric population. Multiple studies have revealed outcomes comparable to the open approach. However, a major drawback to laparoscopy is the technical challenge of precise suturing in the small working space in children. The advantages of robotic surgery when compared to conventional laparoscopy have been well established and include motion scaling, enhanced magnification, 3-dimensional stereoscopic vision, and improved instrument dexterity. As a result, surgeons with limited laparoscopic experience are able to more readily acquire robotic surgical skills. Limitations of the robotic platform include its high costs for acquisition and maintenance, as well as the need for additional robotic surgical training. In this article, we review the current status of the robot-assisted laparoscopic pyeloplasty, including a brief history, comparative outcomes, cost considerations, and training.

As a novel technology that utilizes the endogenous immune defense system in bacteria, CRISPR/Cas9 has transcended DNA engineering into a more pragmatic and clinically efficacious field. Using programmable sgRNA sequences and nucleases, the system effectively introduces double strand breaks in target genes within an entire organism. The applications of CRISPR range from biomedicine to drug development and epigenetic modification. Studies have demonstrated CRISPR mediated targeting of various tumorigenic genes and effector proteins known to be involved in colon carcinomas. This technology significantly expands the scope of gene manipulation and allows for an enhanced modeling of colon cancers, as well as various other malignancies.

The peer review processes as outlined in the Health Care Quality Improvement Act (HCQIA) is meant ensure quality standard of care through a self-policing mechanism by the medical community. This process grants immunity for people filing a peer review, which is meant to protect whistleblowers. However, it also creates a loophole that can be used maliciously to hinder competition. This is accentuated when surgeons are integrating new technologies, such as robotic surgery, into their practice. With more than 2000 da Vinci robots in use and more than 300 new units being shipped each year, robotic surgery has become a mainstay in the surgical field. The applications for robots continue to expand as surgeons discover their expanding capability. We need a better peer review process. That ensures the peer review is void of competitive bias. Peer reviewers need to be familiar with the procedure and the technology. The current process could stymie innovation in the name of competition.

Recently, the discussion on the implications of irreproducibility in the sciences has been brought into the spotlight. This topic has been discussed for years in the literature. A multitude of reasons have been attributed to this issue; one commonly labeled culprit is the overuse of the p value as a determinant of significance by the scientific community. Both scientists and statisticians have questioned the use of null hypothesis testing as the basis of scientific analysis. This survey of the current issues at hand in irreproducibility in research emphasizes potential causes of the issue, impacts that this can have for drug development and efforts been taken to increase transparency of findings in research.

The introduction of robotic technology and minimally invasive surgical techniques has revolutionized the field of urological surgery over the last 25 years. Robotic technology has been proven to be both safe and efficacious in the management of several urological malignancies and benign urological conditions. While some robotic applications have been well established, others are still at varying stages of evolution. In comparison to conventional open approaches, the robot has been shown to enhance intraoperative visualization and precision, mitigate surgeon tremor, hasten post-operative recovery, and shorten length of hospital stay for certain indications. This technology has not yet been universally adopted, however, due to its relatively high cost, longer associated operative times, and limited outcomes data. We herein review the current applications, outcomes, and drawbacks of robotic technology within the field of urological surgery and speculate on the future directions and implications within the field.