Is the Da Vinci Xi system a real improvement for oncologic transoral robotic surgery? A systematic review of the literature
AbstractIn this paper, we reviewed the current literature about TORS procedures performed with Xi system and we discussed the pros and cons of this robotic system comparing it to the previous Si model. A systematic literature review was conducted using the PubMed, Scopus, Web of Science and Cochrane databases for adequate published studies about TORS procedure performed with da Vinci Si and Xi models. Five papers on the TORS-Xi procedures met our inclusion and exclusion criteria. These papers showed results based on 74 subjects (mean age 60.51  ± 4.55 years old). The most common TORS procedure was...
Source: Journal of Robotic Surgery - August 4, 2020 Category: Surgery Source Type: research

Learning curve in robotic colorectal surgery
AbstractWith the rapid adoption of robotics in colorectal surgery, there has been growing interest in the pace at which surgeons gain competency, as it may aid in self-assessment or credentialing. Therefore, we sought to evaluate the learning curve of an expert laparoscopic colorectal surgeon who performed a variety of colorectal procedures robotically. This is a retrospective review of a prospective database of 111 subsequent colorectal procedures performed by a single colorectal surgeon. The cumulative summation technique (CUSUM) was used to construct a learning curve for robotic proficiency by analyzing total operative ...
Source: Journal of Robotic Surgery - August 4, 2020 Category: Surgery Source Type: research

Propensity score-matched analysis comparing laparoscopic to robotic surgery for colorectal cancer shows comparable clinical and oncological outcomes
The objective of this study was to compare clinical and cancer outcomes in propensity-score matched cohorts (PSM-1:1) undergoing colorectal cancer (CRC) surgery performed using laparoscopic or robotic surgery in a single institution. A PSM cohort comparison was performed in a tertiary referral cancer and National accredited rectal cancer surgery centre. Patients with CRC undergoing laparoscopic or robotic resection with curative intent from 2016 to 2019 (inclusive) were assessed for inclusion. Matched cohorts were selected using a 1:1 ratio. Statistical analysis was performed using SPSS, version 22. 128 patients were analy...
Source: Journal of Robotic Surgery - July 8, 2020 Category: Surgery Source Type: research

Comparison of valve-less and standard insufflation on pneumoperitoneum-related complications in robotic partial nephrectomy: a prospective randomized trial
AbstractTo prospectively compare standard and valve-less insufflation systems on pneumoperitoneum-related complications in robotic-assisted laparoscopic partial nephrectomy. A prospective randomized controlled trial was conducted during a 1.5-year period to compare insufflation-related complications in partial nephrectomy surgery by a single surgeon. Thirty-one patients were recruited for each group: AirSeal insufflation system at 12  mmHg (AIS12), AirSeal at 15 mmHg (AIS15), and conventional insufflation system at 15 mmHg (CIS). Primary outcome assessed was rate of subcutaneous emphysema. Secondary outcomes...
Source: Journal of Robotic Surgery - July 6, 2020 Category: Surgery Source Type: research

Robotic surgery vs. open surgery for thymectomy, a retrospective case-match study
AbstractThe robotic approach in the treatment of thymus diseases has been described in many papers, but few studies have compared the early outcome of patients after robotic and open transsternal procedure. Our study aims to confirm the non-inferiority of the robotic technique in terms of feasibility, safety and postoperative patient recovery compared to the open standard. This is a retrospective cohort study in which we compare 114 patients who underwent thymectomy for a thymus disease at our thoracic surgery unit. Our robotic surgery programme started in February 2012 with the treatment of mediastinal diseases. Since the...
Source: Journal of Robotic Surgery - July 6, 2020 Category: Surgery Source Type: research

A prospective study of real-time identification of line of transection in robotic colorectal cancer surgery by ICG
AbstractColorectal cancer is the second most common cancer in women and the third most common cancer in men in the world. Surgical resection is the gold standard treatment and minimally invasive surgery remains the standard of care. Anastomotic leakage is one of the most feared postoperative complications in colorectal surgery. Although several factors have been identified as possible causes of anastomotic leakage (i.e., surgical techniques, patient risk factors, suture material or devices), the complete pathogenesis is still unclear. The reported leak rate ranges from 1 to 30% and increases as the anastomosis is more dist...
Source: Journal of Robotic Surgery - June 30, 2020 Category: Surgery Source Type: research

Robotic surgery in treatment of retroperitoneal tumors. Comparative single center study
AbstractRetroperitoneal tumors (RT) —group of benign and malignant mesenchymal tumors without any specific organ affiliation. Surgery is the only effective treatment. Robotic surgery is becoming popular and an effective approach in abdominal surgery. There is insufficient data about robotic treatment of retroperitoneal tumors. The c omparative retrospective study of the results of surgical treatment of RTs between 2009 and 2019 was performed. 88 patients were surgically treated. The average age of patients was 58 (21;85). Clinical manifestations of RT were presented in 59 (67.1%) cases. RTs were asymptomatic in 29 pa...
Source: Journal of Robotic Surgery - June 29, 2020 Category: Surgery Source Type: research

Posterior reconstruction during robotic-assisted radical cystectomy with intracorporeal orthotopic ileal neobladder: description and outcomes of a simple step
AbstractA posterior reconstruction (PR) might improve the fluidity and delicacy of the maneuvers related to the neovesico-urethral anastomosis during robotic-assisted radical cystectomy (RARC). Our objective is to describe in detail the surgical steps of PR and to assess its feasibility and functional outcomes. The data regarding patients undergoing a totally intracorporeal RARC with neobladder and PR for high-grade and/or muscle-invasive urothelial cancer of the bladder at Karolinska University Hospital between October 2015 and November 2016 by a single surgeon (PW) were reviewed. Prior to the anastomosis, a modified post...
Source: Journal of Robotic Surgery - June 29, 2020 Category: Surgery Source Type: research

Rethinking the need for overnight admission after robotic-assisted laparoscopic prostatectomy
AbstractRobotic-assisted laparoscopic prostatectomy (RALP) is the gold standard for the surgical management of localized prostate cancer (PCa). Multi-institutional series have demonstrated complications and readmissions in less than 5% of patients and most are now discharged within 24  h of surgery. Recently, several high-volume surgeons demonstrated the safety of same-day discharge (SDD) after RALP. The main benefits include lower costs and reduced exposure to nosocomial infections and hospital errors. The leading arguments for criticism include potential suboptimal postoperati ve care and the risk of missing a catas...
Source: Journal of Robotic Surgery - June 29, 2020 Category: Surgery Source Type: research

Robot-assisted real-time sentinel lymph node mapping in oral cavity cancer: preliminary experience
This study aims to assess the feasibility of using indocyanine green and robotic near infra-red fluorescent imaging (Firefly®) for sentinel lymph node biopsy in cN0 oral cavity cancer. Ten patients with early squamous cell carcinoma of the tongue (n = 8) and buccal mucosa (n = 2) were included. Peritumoral injection of 10 mg indocyanine green and real-time mapping of sentinel lymph nodes in the neck was performed using Firefly® via a retro-auricular trans-hairline incision. Sentinel lymph node was detected in all patients at 1.2 sentinel lymph node per person. Majority were situated...
Source: Journal of Robotic Surgery - June 27, 2020 Category: Surgery Source Type: research

Incidence of venous thromboembolism after robotic-assisted hysterectomy in obese patients with endometrial cancer: do we need extended prophylaxis?
AbstractRobotic surgery for gynecologic malignancy is associated with a lower rate of venous thromboembolism (VTE) than laparotomy. Obese patients represent a particularly high-risk group for VTE, but prior studies tend to focus on patients with a much lower BMI and without extended VTE prophylaxis. Our objective was to examine the role of extended thromboprophylaxis in obese patients who underwent robotic-assisted surgery for endometrial cancer. We conducted a retrospective cohort study of obese patients (BMI  ≥ 35 kg/m2) who underwent robotic surgery for newly diagnosed endometrial cancer. The prima...
Source: Journal of Robotic Surgery - June 26, 2020 Category: Surgery Source Type: research

Surgeon-administered transversus abdominis plane block for robot-assisted surgery
(Source: Journal of Robotic Surgery)
Source: Journal of Robotic Surgery - June 25, 2020 Category: Surgery Source Type: research

Anaesthetic management for robotic-assisted laparoscopic prostatectomy: the first UK national survey of current practice
AbstractRobotic-assisted laparoscopic prostatectomy (RALP) is the most common robotic surgical procedure, but there are little published data to inform anaesthetic practice. We aimed to characterise the range of anaesthetic practice for RALP in the United Kingdom through a national survey. We conducted an online national survey to determine current anaesthetic practice for RALP. The survey was distributed to all NHS hospitals within the UK that perform RALP. Thirty-four (79%) of 43 hospitals responded to the survey. Fourteen (41%) centres routinely provide spinal anaesthesia and 79% of these use diamorphine as their intrat...
Source: Journal of Robotic Surgery - June 24, 2020 Category: Surgery Source Type: research

Primary robotic retroperitoneal lymph node dissection following orchiectomy for testicular germ cell tumors: a single-surgeon experience
Conclusion: primary R-RPLND is a safe and efficacious procedure for carefully selected men with stage I and II non-seminomatous germ cell tumors of the testis. Long-term data are needed to evaluate the comparative oncol ogic efficacy with open surgery and the notably high rate of chylous ascites. (Source: Journal of Robotic Surgery)
Source: Journal of Robotic Surgery - June 22, 2020 Category: Surgery Source Type: research

Less is more: clinical impact of decreasing pneumoperitoneum pressures during robotic surgery
The objective of this study was to investigate the effects of decreasing insufflation pressure during robotic gynecologic surgery. The primary outcomes were patient-reported postoperative pain scores and length of stay. Secondary outcomes include surgical time, blood loss, and intraoperative respiratory parameters. This is a retrospective cohort study of patients undergoing robotic surgery for benign gynecologic conditions by a single minimally invasive surgeon at an academic hospital between 2014 and 2017. Patients were categorized by the maximum insufflation pressure reached during the surgery as either 15, 12, 10, or 8 ...
Source: Journal of Robotic Surgery - June 22, 2020 Category: Surgery Source Type: research

Single-port robotic-assisted partial nephrectomy: initial clinical experience and lessons learned for successful outcomes
This study is a retrospective review of sequential SP-RAPN cases between 7/2019 and 3/2020. We extracted patient characteristics and early surgical outcomes. Surgical tips and tricks were recorded during the se cases and compiled. SP-RAPN was successfully completed in 12 patients. Patients mean age was 57.8 ± 11.0 years and median ASA score was 2. Mean tumor size was 3.1 ± 2.2 cm. The average OR Time was 172 ± 41 min and EBL was 68 ± 75 mL. All cases had warm ischemia time 
Source: Journal of Robotic Surgery - June 20, 2020 Category: Surgery Source Type: research

Trends in the diffusion of robotic surgery in prostate, uterus, and colorectal procedures: a retrospective population-based study
This study aimed to propose quantifiable metrics on the adoption lifecycle of robotic-assisted surgery (RAS) within and across prostate, hysterectomy, and colorectal procedures. This was a retrospective population-based cohort study of commonly performed RAS procedures in the US conducted from July 2001 to July 2015. The patients were identified from the Premier Hospital Database using International Classification of Diseases, 9th revision, Clinical Modification codes denoting prostate, uterus, and colorectal procedures. The Diffusion of Innovations theory was applied to percent RAS utilization to determine discrete eras o...
Source: Journal of Robotic Surgery - June 20, 2020 Category: Surgery Source Type: research

Safety and feasibility of the three-port robot-assisted hysterectomy across uterine weights
AbstractOne strategy thought to reduce direct costs associated with robotic surgery is minimizing the number of robotic arms used for a surgery. We aim to demonstrate the safety and feasibility of the three-port robot-assisted hysterectomy across uterine weights. Retrospective cohort study in a tertiary care university hospital of consecutive patients undergoing a three-port robot-assisted hysterectomy for benign indications. All surgeries were performed between 2012 and 2018 by fellowship-trained minimally invasive gynecologic surgeons. Data from 232 patients were collected. Eighty-eight (37.9%) patients had a uterine weight  
Source: Journal of Robotic Surgery - June 17, 2020 Category: Surgery Source Type: research

Analysis of performance factors in 240 consecutive cases of robot-assisted flexible ureteroscopic stone treatment
AbstractFlexible ureteroscopy is the keystone of modern kidney stone treatment. Although a simple surgical technique achieves good clinical results and a low complication rate, there are high demands on the surgeon ’s dexterity and ergonomic restrictions. Robotic-assisted flexible ureteroscopy (rfURS) could overcome these limitations. After 4 years of use of rfURS at a tertiary stone center, performance factors were analyzed to define the role of rfURS in kidney stone management. A rfURS system was installe d in August 2014 at the SLK Kliniken (Heilbronn, Germany). Treatment data ofN = 240 consecut...
Source: Journal of Robotic Surgery - June 16, 2020 Category: Surgery Source Type: research

Minimally invasive urologic surgery is safe during COVID-19: experience from two high-volume centers in Italy
In conclusion, minimally invasive urologic surgery can be safely performed during the pandemic period with adequate planning. We believe that reno uncing the benefits of it would be counterproductive, especially in a scenario of long-lasting cohabitation with the virus. (Source: Journal of Robotic Surgery)
Source: Journal of Robotic Surgery - June 15, 2020 Category: Surgery Source Type: research

COVID-19 model-based practice changes in managing a large prostate cancer practice: following the trends during a month-long ordeal
We describe changes in our practice based on real-time assessment of various national and international trends of COVID-19 and its effectiveness in the management of our resources. Initial risk assessment and peak resource requirement using the COVID-19 Hospital Impact Model for Epidemics (CHIME) and McKinsey models. Strengths, weaknesses, opportunities, and threats (SWOT) analysis of our practice ’s approach during the pandemic. Based on CHIME the community followed 60% social distancing, the number of expected new patients hospitalized at maximum surge would be 401, with 100 patients requiring ventilator support. I...
Source: Journal of Robotic Surgery - June 14, 2020 Category: Surgery Source Type: research

Robotic glove port technique for the endowristed rigid instruments in robotic single-site transabdominal and transvaginal surgery
AbstractAlthough robotic single-site (RSS) surgery employing cross setup of semirigid instruments allows effective triangulation of instruments, it has some limitations in performing RSS transabdominal and transvaginal surgeries. We introduced the robotic glove port technique (RGPT) using parallel setup of endowristed rigid instruments in performing RSS transabdominal surgery and transvaginal surgery in July of 2017. Thirty-five patients underwent RSS surgery with RGPT. Twenty-one patients had RSS transabdominal reconstructive or fertility-preserving surgeries such as myomectomy (12 patients), adenomyomectomy (3 patients),...
Source: Journal of Robotic Surgery - June 6, 2020 Category: Surgery Source Type: research

Demonstrating the effectiveness of the fundamentals of robotic surgery (FRS) curriculum on the RobotiX Mentor Virtual Reality Simulation Platform
AbstractFundamentals of robotic surgery (FRS) is a proficiency-based progression curriculum developed by robotic surgery experts from multiple specialty areas to address gaps in existing robotic surgery training curricula. The RobotiX Mentor is a virtual reality training platform for robotic surgery. Our aims were to determine if robotic surgery novices would demonstrate improved technical skills after completing FRS training on the RobotiX Mentor, and to compare the effectiveness of FRS across training platforms. An observational, pre-post design, multi-institutional rater-blinded trial was conducted at two American Colle...
Source: Journal of Robotic Surgery - May 14, 2020 Category: Surgery Source Type: research

Cardiothoracic robotic assisted surgery in times of COVID-19
AbstractThe coronavirus disease 2019 (COVID-19) pandemic poses an immense threat to healthcare systems worldwide. At a time when elective surgeries are being suspended and questions are being raised about how the remaining procedures on COVID-19 positive patients can be performed safely, it is important to consider the potential role of robotic assisted surgery within the current pandemic. Recently, several robotic assisted surgery societies have issued their recommendations. To date, however, no specific recommendations are available for cardiothoracic robotic assisted surgery in COVID-19 positive patients. Here, we discu...
Source: Journal of Robotic Surgery - May 8, 2020 Category: Surgery Source Type: research

Patient injuries and malfunctions associated with robotic prostatectomy: review of the manufacturer and user facility device experience database
AbstractRobotic prostatectomy is the most commonly performed robotic procedure in the United States. Increasing utilization of this procedure necessitates characterization of robot malfunctions and associated patient injuries. We performed a review of adverse events reported to a publicly available database. We searched the Manufacturer and User Facility Device Experience (MAUDE) database for reported adverse events (RAE) involving the intuitive surgical system. Reports involving prostatectomy from 2014 to 2019 were extracted and analyzed for data regarding death, patient injury, and device malfunction. Of 9109 reported ad...
Source: Journal of Robotic Surgery - May 8, 2020 Category: Surgery Source Type: research

Robotic rectal cancer surgery with single side-docking technique: experience of a tertiary care university hospital
AbstractRobotics in colorectal surgery has been in the market for 17  years now, and continuously gaining popularity; three-dimensional steady views, great range of motion, tremor filtration, augmented dexterity, and articulated instruments, help surgeons to overcome some of the difficulties of laparoscopy and enables them to reach very low into the pelvis. The obje ctive of our study is to present our experience with robotic, total and partial mesorectal excision and evaluate the efficiency of robotic surgery in the group of patients with rectal tumours. This is a prospective, observational study. The procedures were...
Source: Journal of Robotic Surgery - May 8, 2020 Category: Surgery Source Type: research

Pathological features of prostate cancer in men treated with robot-assisted radical prostatectomy in the Middle East
AbstractLittle is known about the pathological features of radical prostatectomy among men living in the Middle East. Although prostate cancer became the most common malignancy among males in some countries in the Middle East, the incidence is much lower compared to western populations. The aim of this study is to analyze pathological features and biochemical recurrence in men who underwent  robotic-assisted radical prostatectomy (RARP) in Kuwait. The data on all RARP cases performed by a uro-oncologist (SA) were recorded. A comprehensive database was collected, including demographic, clinical, and pathologi...
Source: Journal of Robotic Surgery - May 6, 2020 Category: Surgery Source Type: research

Oncologic outcomes of patients with incidental prostate cancer who underwent RARC: a comparison between nerve sparing and non-nerve sparing approach
AbstractBackgroundIncidental Prostate cancer (iPCa) is a relatively common finding during histopathological evaluation of radical cystectomy (RC) specimens. To reduce the high impact of RC on erectile function, several sexual-preserving techniques have been proposed. The aim of this study was to evaluate and compare the oncologic outcomes of patients with iPCa who underwent nerve spring and no-nerve sparing robot-assisted radical cystectomy (RARC).MethodsThe clinicopathologic data of male patients who underwent RARC at our institution between 2006 and 2016 were retrospectively analysed. Patients with iPCa at definitive pat...
Source: Journal of Robotic Surgery - May 4, 2020 Category: Surgery Source Type: research

Robotic-assisted right colectomy versus laparoscopic approach: case-matched study and cost-effectiveness analysis
AbstractAimThe aim of this study is to compare clinical and oncological outcomes of robot-assisted right colectomy with those of conventional laparoscopy-assisted right colectomy, reporting for the first time in literature, a cost-effectiveness analysis.MethodsThis is a case-matched prospective non-randomized study conducted from October 2013 to October 2017 at Sanchinarro University Hospital, Madrid. Patients with right-sided colonic adenocarcinoma or adenoma, not suitable endoscopic resection were treated with robot-assisted right colectomy and a propensity score-matched (1:1) was used to balance preoperative characteris...
Source: Journal of Robotic Surgery - May 4, 2020 Category: Surgery Source Type: research

Comparisons of surgical outcomes between transperitoneal and retroperitoneal approaches in robot-assisted laparoscopic partial nephrectomy for lateral renal tumors: a propensity score-matched comparative analysis
This study included patients who underwent RAPN for lateral renal tumors between 2013 and 2019. Lateral tumors were defined as X of A factors in the RENAL nephrometry score. In total, 290 and 48 patients with TP and RP, respectively, were included in the analysis. To minimize the effects of selection bias, the following variables were adjusted using 1:1 propensity score matching: age, sex, body mass index, American Society of Anesthesiologists score, preoperative estimated glomerular filtration rate, tumor size, and RENAL nephrometry score.ResultsAfter matching, 48 patients were allocated to each group. The mean age was 55...
Source: Journal of Robotic Surgery - May 1, 2020 Category: Surgery Source Type: research

Trends in the practice of renal surgery for cancer in France after the introduction of robotic-assisted surgery: data from the National Health Care System Registry
(Source: Journal of Robotic Surgery)
Source: Journal of Robotic Surgery - April 30, 2020 Category: Surgery Source Type: research

The impact of the AirSeal ® valve-less trocar system in robotic colorectal surgery: a single-surgeon retrospective review
ConclusionIn patients undergoing low anterior resections, the AirSeal® trocar system demonstrated a statistically significant reduction in mean operative time and EBL compared to the traditional trocar system. There was also a trend towards decreased length of stay and post-operative complications with AirSeal® use in low anterior resections and right hemicolectomies. In patients undergoing distal colorectal procedures, the AirSeal® trocar system should be considered. (Source: Journal of Robotic Surgery)
Source: Journal of Robotic Surgery - April 24, 2020 Category: Surgery Source Type: research

Learning curve of robotic-assisted laparoscopic pyeloplasty (RALP) in children: how to reach a level of excellence?
AbstractIt has been suggested that up to 40 cases of RALP are required to reach the operative results equal to open surgery. We have hypothesized that previous experience in open and laparoscopic surgeries might shorten the learning curve of robotic surgery. We have retrospectively evaluated the data of all children who underwent pyeloplasty in our institute by a single surgeon since 2003. The children were divided into three groups: open pyeloplasty (OP) of 72 children, laparoscopic pyeloplasty (LAP) of 22, and RALP of 33 patients subsequently. The data included: demographics, duration of surgery, length of stay, success ...
Source: Journal of Robotic Surgery - April 24, 2020 Category: Surgery Source Type: research

Use of transversus abdominis plane block to decrease pain scores and narcotic use following robot-assisted laparoscopic prostatectomy
AbstractThe aim of this study was to assess whether transversus abdominis plane (TAP) blocks can be utilized to decrease patient pain scores and narcotic use during the first 24  h following robot-assisted laparoscopic prostatectomy (RALP). 100 patients received a TAP block with a mixture of 1.3% liposomal bupivacaine, 0.5% Marcaine and 0.9% NaCl prior to RALP. This was in addition to an already established pain management regiment, which included preoperative PO acetamino phen (650 mg), celecoxib (200 mg), and tolterodine ER (4 mg). These patients were prospectively followed and then retrospectively co...
Source: Journal of Robotic Surgery - April 22, 2020 Category: Surgery Source Type: research

Training benchmarks based on validated composite scores for the RobotiX robot-assisted surgery simulator on basic tasks
This study aimed to determine the validity evidence on multiple levels of the RobotiX simulator for basic skills. Participants were divided in either the novice, laparoscopic or robotic experienced group based on their minimally invasive surgical experience. Two basic tasks were performed: wristed manipulation (Task 1) and vessel energy dissection (Task 2). The performance scores and a questionnaire regarding the realism, didactic value, and usability were gathered (content). Composite scores (0 –100), pass/fail values, and alternative benchmark scores were calculated. Twenty-seven novices, 21 laparoscopic, and 13 ro...
Source: Journal of Robotic Surgery - April 20, 2020 Category: Surgery Source Type: research

Comment on: Dirie NI, Ahmed MA, Wang S. Is secondary robotic pyeloplasty safe and effective as primary robotic pyeloplasty? A systematic review and meta-analysis. J Robotic Surg 2020;14:241 –8
(Source: Journal of Robotic Surgery)
Source: Journal of Robotic Surgery - April 20, 2020 Category: Surgery Source Type: research

Effect of BMI on clinical outcomes following minimally invasive sacrocolpopexy
AbstractOur objective was to compare success and complication rates following minimally invasive sacrocolpopexy (SCP) based on body mass index (BMI). This is a retrospective cohort study of women who underwent laparoscopic or robotic SCP at one academic center from 2006 to 2016. Women were included if they had a postoperative pelvic organ prolapse quantification (POPQ) exam and subjective success documented. For our primary outcome, we compared composite success (POPQ stage  ≤ I and report of no bulge symptoms) amongst three groups: normal weight (BMI ≤ 25), overweight (BMI 25–30) an...
Source: Journal of Robotic Surgery - April 16, 2020 Category: Surgery Source Type: research

Readmission and complications after robotic surgery: experience of 10,000 operations at a comprehensive cancer center
AbstractEvaluation of safety is of paramount importance with adoption of novel surgical technology. Although robotic surgery has become widely used in oncologic surgery, analysis of safety is lacking in comparison to traditional techniques. Standardized assessment of robotic surgical outcomes and adverse events following oncologic surgery is necessary for quality improvement with innovative technology. Between 2003 and 2016, 10,013 unique robotic operations were performed in 9,858 patients. Our prospectively maintained database was retrospectively reviewed for hospital readmissions and Clavien –Dindo grade &ge...
Source: Journal of Robotic Surgery - April 10, 2020 Category: Surgery Source Type: research

Robotic-assisted repair of complex ventral hernia: can it pay off?
AbstractPressure on health care providers is growing due to capping of remuneration for medical services in most Western European countries. We wanted to investigate, if robotic-assisted ventral hernia repair is reasonable from an economic point of view in our setting. Patients undergoing open or robotic-assisted repair for complex abdominal wall hernia using a Transversus Abdominis Release (TAR) between September 2017 and January 2019 were included. Procedure-related costs were calculated exact to the minute and cost unit accounting for the postoperative in-patient stay was done. Abdominal wall reconstruction using the TA...
Source: Journal of Robotic Surgery - April 10, 2020 Category: Surgery Source Type: research

Reducing the cost of robotic hysterectomy: assessing the safety and efficacy of using prograsp forceps in lieu of needle holder for vaginal cuff closure
This study shows that using prograsp in lieu of needle holder for suturing is safe, there is no increase in operative time or complications, and there is a cost advantage. (Source: Journal of Robotic Surgery)
Source: Journal of Robotic Surgery - April 7, 2020 Category: Surgery Source Type: research

Effective intracorporeal space in robot-assisted multiquadrant surgery in a pediatric inanimate model
AbstractPediatric robot-assisted surgery is technically challenging, but it is becoming the most desirable approach for most of the pediatric urological abdominal surgical procedures. Distance between ports has been adopted based on adult surgery experience. Currently, there is scarce information and literature about effective trocar position and distance between ports for highly complex pediatric multiquadrant surgery. The aim of this study is to evaluate the most effective way of port placement for pediatric multiquadrant robot-assisted surgery using an inanimate model. Two inanimate models simulating the abdominal area ...
Source: Journal of Robotic Surgery - April 7, 2020 Category: Surgery Source Type: research

Cost variance across obesity class for women undergoing laparoscopic hysterectomy by high-volume gynecologic surgeons
AbstractHealth-care costs are affected by obesity with both the direct and indirect costs of health care increasing as body mass index (BMI) increases. However, one important aspect of obesity that lacks rigorous study is what impact BMI has on direct surgical cost. We performed a retrospective cohort study of women undergoing a laparoscopic hysterectomy at our single academic university center between January 2012 and December 2017. Women were excluded if their surgery was performed by anyone other than those surgeons with subspecialty training in minimally invasive gynecologic surgery (MIGS), if their hysterectomy was pe...
Source: Journal of Robotic Surgery - April 6, 2020 Category: Surgery Source Type: research

Robotic dismembered pyeloplasty surgical simulation using a 3D-printed silicone-based model: development, face validation and crowdsourced learning outcomes assessment
We describe the development and face validation of a robotic pyeloplasty simulation using a 3D-printed silicone-based model of UPJO for surgical training, in combination with crowdsourced scoring to objectively assess performance and learning outcomes. The organs were created using 3D modeling software and printed using a silicone-based material by Lazarus 3D, LLC. They were secured in a laparoscopic box trainer and the robotic system was docked. Eight residents and three faculty each performed two robotic-assisted right dismembered pyeloplasties on separate occaisions. Face validity was evaluated on a 5-point Likert scale...
Source: Journal of Robotic Surgery - April 2, 2020 Category: Surgery Source Type: research

Robot-assisted radical cystectomy with totally intracorporeal urinary diversion: surgical and early functional outcomes through the learning curve in a single high-volume center
AbstractThe aim of the study is to report surgical and early functional outcomes of first 100 patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD) in a single center. The main surgeon (A.P.) attended a modular training program at a referring center mentored by a worldwide-recognized robotic surgeon (P.W.). The program consisted of: (a) 10  h of theoretical lessons; (b) video session (c) step-by-step in vivo modular training. Each procedure was performed as taught, without any technique variation. Demographics, intra-operative data and post-operative complica...
Source: Journal of Robotic Surgery - April 1, 2020 Category: Surgery Source Type: research

Fast prostate retrieval in robot-assisted laparoscopic prostatectomy for next-generation biobanking
AbstractRobotic-assisted laparoscopic radical prostatectomy (RALP) has become the most widespread treatment for organ-confined prostate cancer. Here, we describe a fast specimen retrieval technique for RALP to obtain high-quality tissue specimen with minimal warm ischemia time for next-generation biobanking. Here, we show that using fast retrieval technique, short warm ischemia times can be achieved while not increasing the surgical time. Patients undergoing RALP with written informed consent participated in Helsinki Urological Bank study. Previously operated RALP patients and those, who were not willing to participate in ...
Source: Journal of Robotic Surgery - April 1, 2020 Category: Surgery Source Type: research

Robotic ventral hernia repair in octogenarians: perioperative and long-term outcomes
AbstractVery few studies have documented perioperative outcomes of ventral hernia repair in octogenarians. The aim of this study is to report the perioperative and the long-term outcomes of robotic ventral hernia repair (RVHR) in aged 80 –89 years patients. From a prospectively maintained database, aged 80–89 years patients who underwent robotic procedures between 2013 and 2018 were analyzed retrospectively including perioperative outcomes and long-term follow-up. Complications were assessed with validated grading systems and index. 21 octogenarians with average age 83.48 were included. Intraperitonea...
Source: Journal of Robotic Surgery - April 1, 2020 Category: Surgery Source Type: research

Comparison of longitudinal health-related quality-of-life outcomes between anterior and posterior surgical approaches to robot-assisted radical prostatectomy
AbstractIncreasingly, studies have explored health-related quality-of-life (HRQOL) outcomes after robot-assisted radical prostatectomy (RARP). Nevertheless, no study has compared differences between anterior and posterior surgical approaches. The aim of this study is to assess differences of HRQOL following these two surgical approaches. From January 2012 to September 2017, 653 patients underwent RARP at our institution. We included patients who underwent operations by three experienced surgeons with interchangeability of role as console operator, and who could evaluate preoperatively the Expanded Prostate Cancer Index Com...
Source: Journal of Robotic Surgery - April 1, 2020 Category: Surgery Source Type: research

A single-center, retrospective review of robot-assisted laparoscopic prostatectomy with and without cryopreserved umbilical cord allograft in improving continence recovery
The objective of this study was to evaluate the safety and effectiveness of cryopreserved umbilical cord (UC) allograft as a nerve wrap around the neurovascular bundle (NVB) in accelerating return to continence after radical prostatectomy. A single-center, retrospective study was performed on 200 patients who underwent bilateral, nerve-sparing robot-assisted radical prostatectomy (RARP) with and without placement of UC around the NVBs (n = 100/group). Patients were excluded if they had previous simple or transurethral prostatectomy or history of pelvic radiation. Post-operative continence, defined as 0 or 1 s...
Source: Journal of Robotic Surgery - April 1, 2020 Category: Surgery Source Type: research

A review of clinical and oncological outcomes following the introduction of the first robotic colorectal surgery programme to a university teaching hospital in Ireland using a dual console training platform
AbstractRobotic-assisted surgery is evolving, with improving clinical and cancer outcomes. The aim of this study was to present the clinical and cancer outcomes of patients undergoing robotic-assisted colorectal surgery (RAS-CR) at University Hospital Limerick (UHL) since its introduction to the 100th case, using the daVinci Xi dual-console surgical system. The RAS-CR programme at UHL commenced in June 2016 and the 100th case was performed in July 2019. All patient-related data were recorded prospectively during the perioperative period by the RAS-CR team. Statistical analysis was performed using SPSS, version 22. One hund...
Source: Journal of Robotic Surgery - March 30, 2020 Category: Surgery Source Type: research

Surgical robotic arm control for tissue ablation
AbstractIn the technology driven era, robot assisted surgery is gradually emerging as a revolutionized surgical procedure over traditional laparoscopic method. Despite the concerns about robotic surgery for minimally invasive surgical procedures, robotized surgical arms have been used in many hospitals. Certain surgical procedures require removal of a segment of an organ or body part like excision biopsy, linear thin layer of soft tissue, triangular mass, and tangential excision in burn management, where shaving-off at an angle of the tissue layer to be removed. For such minimally invasive procedures, we have designed a su...
Source: Journal of Robotic Surgery - March 26, 2020 Category: Surgery Source Type: research