Objective:Radical prostatectomy(RP)is considered the gold standard treatment for patients with localized prostate cancer(PCa).All patients undergoing RP,either open,laparoscopic,or robotic,are at risk of developing ur...Objective:Radical prostatectomy(RP)is considered the gold standard treatment for patients with localized prostate cancer(PCa).All patients undergoing RP,either open,laparoscopic,or robotic,are at risk of developing urinary incontinence after RP.Our study aimed to analyze possible predictors of early postoperative(within 3 months)urinary continence(UC)outcomes following extraperitoneal single-site robot-assisted RP(ss-RARP)for localized PCa.Methods:We retrospectively reviewed data from 113 patients with localized PCa who were operated on by a highly experienced surgeon between September 2022 and December 2023.Patient characteristics(age,body mass index,prostate volume,prostate dimensions,preoperative and postoperative membranous urethral length,and percentage of membranous urethra removed)were analyzed using logistic regression to determine the independent factors contributing to short-term UC recovery after extraperitoneal ss-RARP.From the time of urinary catheter removal after surgery,the recovery of UC was followed up every month,and UC was defined as using≤1 safety pad daily,known as social continence.Results:The proportions of continent patients immediately after urinary catheter removal,1 month,and 3 months after extraperitoneal ss-RARP were 22%,49%,and 82%,respectively.The multivariate logistic regression analysis showed that the percentage of membranous urethra removed(p=0.016)and prostate volume(p=0.049)were associated with social UC recovery immediately after urinary catheter removal,and craniocaudal dimension of the prostate(p=0.042)and age(p=0.014)were associated with social UC recovery 1 month and 3 months after extraperitoneal ss-RARP,respectively.Conclusion:The percentage of membranous urethra removed,prostate volume,craniocaudal dimension of the prostate,and age are independent risk factors for social UC early after extraperitoneal ss-RARP.展开更多
Background:Dorsal approach is the potentially effective strategy for minimally invasive liver resection.This study aimed to compare the outcomes between robot-assisted and laparoscopic hemihepatectomy through dorsal a...Background:Dorsal approach is the potentially effective strategy for minimally invasive liver resection.This study aimed to compare the outcomes between robot-assisted and laparoscopic hemihepatectomy through dorsal approach.Methods:We compared the patients who underwent robot-assisted hemihepatectomy(Rob-HH)and who had laparoscopic hemihepatectomy(Lap-HH)through dorsal approach between January 2020 and December 2022.A 1:1 propensity score-matching(PSM)analysis was performed to minimize bias and confounding factors.Results:Ninety-six patients were included,41 with Rob-HH and 55 with Lap-HH.Among them,58 underwent left hemihepatectomy(LHH)and 38 underwent right hemihepatectomy(RHH).Compared with LapHH group,patients with Rob-HH had less estimated blood loss(median:100.0 vs.300.0 m L,P=0.016),lower blood transfusion rates(4.9%vs.29.1%,P=0.003)and postoperative complication rates(26.8%vs.54.5%,P=0.016).These significant differences consistently existed after PSM and in the LHH subgroups.Furthermore,robot-assisted LHH was associated with decreased Pringle duration(45 vs.60 min,P=0.047).RHH subgroup analysis showed that compared with Lap-RHH,Rob-RHH was associated with less estimated blood loss(200.0 vs.400.0 m L,P=0.013).No significant differences were found in other perioperative outcomes among pre-and post-PSM cohorts,such as Pringle duration,operative time,and hospital stay.Conclusions:The dorsal approach was a safe and feasible strategy for hemi-hepatectomy with favorable outcomes under robot-assisted system in reducing intraoperative blood loss,transfusion,and postoperative complications.展开更多
Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a m...Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a matter of debate.We evaluated the efficacy and safety of ThuFLEP compared to RASP.Methods:Between January 2020 and December 2023,all patients who underwent either RASP or ThuFLEP for a prostate volume>80 mL were retrospectively included.The surgical procedure choice was left to the surgeon’s and patient’s discretion.Preoperative patient evaluation included the assessment of functional parameters.The groups were compared.Results:A total of 234 patients were included:106(45%)underwent RASP and 128(55%)underwent ThuFLEP.The mean operative time was shorter in the ThuFLEP group compared to the RASP group(106.4 with standard deviation[SD]46.1 min vs.123.2[SD 32.8]min,p=0.012).The mean lengths of catheterization and stay were significantly longer in the RASP group(5.0[SD 3.9]days vs.1.7[SD 2.0]days,p=0.009[catheterization]and 4.9[SD 3.0]days vs.1.9[SD 1.8]days,p=0.009[stay]).The overall complication rate was significantly higher in the ThuFLEP group(12%vs.2.8%in the RASP group,p=0.022).However,we did not observe significant differences in major complications(Clavien-Dindo≥3)between the two groups(four[3.1%]in the ThuFLEP group vs.one[0.94%]in the RASP group,p=0.073).At 3 months,the rate of stress urinary incontinence was 4.7%after ThuFLEP and 1.9%after RASP(p=0.2).Finally,the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups,but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group(p=0.012).Conclusion:Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia.ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.展开更多
Urinary incontinence is a common complication following robot-assisted radical prostatectomy(RARP).Urethral length has been identified as a factor affecting postoperative continence recovery.In this meta-analysis,we e...Urinary incontinence is a common complication following robot-assisted radical prostatectomy(RARP).Urethral length has been identified as a factor affecting postoperative continence recovery.In this meta-analysis,we examined the association between use of the maximal urethral length preservation(MULP)technique and postoperative urinary continence in patients undergoing RARP.We conducted a comprehensive search of PubMed,Web of Science,Embase,and the Cochrane Library up to December 31,2023.The quality of the literature was assessed using the Newcastle-Ottawa Scale.A random-effects meta-analysis was performed to synthesize data and calculate the odds ratio(OR)from eligible studies on continence and MULP.Six studies involving 1869 patients met the eligibility criteria.MULP was positively associated with both early continence(1 month after RARP;Z=3.62,P=0.003,OR=3.10,95% confidence interval[CI]:1.68-5.73)and late continence(12 months after RARP;Z=2.34,P=0.019,OR=2.10,95%CI:1.13–3.90).Oncological outcomes indicated that MULP did not increase the overall positive surgical margin rate or the positive surgical margin status at the prostate apex(both P>0.05).In conclusion,the use of the MULP technique in RARP significantly improved both early and late postoperative continence outcomes without compromising oncological outcomes.展开更多
Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelin...Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelines to guide clinical practice.We aimed to obtain expert opinions for RASP for large BPH.Methods:A systematic review of the literature was performed in April 2024 using the PubMed,Embase,and Web of Science databases.Search terms were combined to construct the following search strings:(robotic)AND(simple OR benign)AND(prostatectomy).Search results were filtered by language(English only),species(human),and publication type(original article).This study used a two-phase modified Delphi approach.Results:In this expert consensus,some frequently used RASP techniques,including robot-assisted retropubic prostatectomy,robot-assisted transvesical prostatectomy,and robot-assisted urethra-sparing prostatectomy,are described.RASP offers a short learning curve for surgeons with experience in robotic surgery.Severe complications are rare in patients who undergo RASP.Conclusion:RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.展开更多
Objective:We investigated patients who underwent robot-assisted radical prostatectomy(RARP)with pelvic lymph node dissection(PLND),analyzing the prevalence and risk factors associated with symptomatic lymphoceles(SLCs...Objective:We investigated patients who underwent robot-assisted radical prostatectomy(RARP)with pelvic lymph node dissection(PLND),analyzing the prevalence and risk factors associated with symptomatic lymphoceles(SLCs).Methods:We evaluated 354 consecutive patients who underwent RARP with PLND by our team between June 2016 and December 2022.After analyzing the prevalence of SLCs,patients were divided into two groups,with and without SLCs.The variables were age,body mass index(BMI),prostate-specific antigen,surgery time,blood loss,length of stay,International Society of Urological Pathology score in the pathology,and the number of lymph nodes removed.These variables were compared between these groups using the Chi-square test and Student's t-test,according to the type of the variable.In all analyses,a significance level of<0.05 was considered.Results:The prevalence of SLCs in this sample of patients undergoing RARP with PLND was 2.0%(7/354),which is slightly lower than the minimum rate reported in the literature.In our analysis,BMI(p=0.041),the number of lymph nodes removed(p=0.007),and length of hospital stay(p=0.007)were factors associated with the presence of SLCs.Conclusion:The prevalence of SLCs in patients undergoing RARP with PLND is approximately 2.0%.Higher BMI,greater number of lymph nodes removed,and longer length of hospital stay are factors associated with the presence of SLCs.展开更多
Subretinal injection is a complicated task for retinal surgeons to operate manually.In this paper we demonstrate a robust framework for needle detection and localisation in robotassisted subretinal injection using mic...Subretinal injection is a complicated task for retinal surgeons to operate manually.In this paper we demonstrate a robust framework for needle detection and localisation in robotassisted subretinal injection using microscope-integrated Optical Coherence Tomography with deep learning.Five convolutional neural networks with different architectures were evaluated.The main differences between the architectures are the amount of information they receive at the input layer.When evaluated on ex-vivo pig eyes,the top performing network successfully detected all needles in the dataset and localised them with an Intersection over Union value of 0.55.The algorithm was evaluated by comparing the depth of the top and bottom edge of the predicted bounding box to the ground truth.This analysis showed that the top edge can be used to predict the depth of the needle with a maximum error of 8.5μm.展开更多
Robot-assisted surgery has evolved into a crucial treatment for prostate cancer(PCa).However,from its appearance to today,brain-computer interface,virtual reality,and metaverse have revolutionized the field of robot-a...Robot-assisted surgery has evolved into a crucial treatment for prostate cancer(PCa).However,from its appearance to today,brain-computer interface,virtual reality,and metaverse have revolutionized the field of robot-assisted surgery for PCa,presenting both opportunities and challenges.Especially in the context of contemporary big data and precision medicine,facing the heterogeneity of PCa and the complexity of clinical problems,it still needs to be continuously upgraded and improved.Keeping this in mind,this article summarized the 5 stages of the historical development of robot-assisted surgery for PCa,encompassing the stages of emergence,promotion,development,maturity,and intelligence.Initially,safety concerns were paramount,but subsequent research and engineering advancements have focused on enhancing device efficacy,surgical technology,and achieving precise multi modal treatment.The dominance of da Vinci robot-assisted surgical system has seen this evolution intimately tied to its successive versions.In the future,robot-assisted surgery for PCa will move towards intelligence,promising improved patient outcomes and personalized therapy,alongside formidable challenges.To guide future development,we propose 10 significant prospects spanning clinical,research,engineering,materials,social,and economic domains,envisioning a future era of artificial intelligence in the surgical treatment of PCa.展开更多
Objective: Radical cystectomy(RC)is a standard treatment for localized muscle invasive bladder cancer and high-risk or very high-risk non-muscle invasive bladder cancer not responding to adequate endovesical therapy.I...Objective: Radical cystectomy(RC)is a standard treatment for localized muscle invasive bladder cancer and high-risk or very high-risk non-muscle invasive bladder cancer not responding to adequate endovesical therapy.In women,traditionally RC is performed with hystero-adnexectomy and resection of the anterior vaginal wall,often resulting in sexual disorders.Vaginal-sparing techniques have been developed to improve functional outcomes.The present study explores the safety and the functional outcome of vaginal-sparing techniques.Methods: We retrospectively analyzed all consecutive female patients undergoing robot-assisted RC(RARC)with neobladder diversion between October 2017 and February 2022.The indications for vaginal-sparing RC were absence of tumor on bladder neck or urethra and no sign of infiltration of posterior bladder wall at the preoperative MRI.Functional results were evaluated with the aid of five questions out of the Bladder Cancer Index questionnaire.Complications were reported according to the Clavien–Dindo classification and cancer control was evaluated by recurrence-free and cancer-specific survival.Results: A total of 22 female patients underwent RARC with neobladder diversion.Neoadjuvant chemotherapy was given in 17(77%)cases.Clavien–Dindo grades III–IV complications occurred in four(18%)cases.After a mean follow-up of 29(interquartile range 16–44)months,six(27.3%)patients developed distant metastases,and one(4.5%)woman loco-regional relapse.Sexual-sparing surgery was performed in 19(86%)patients,and in the others the anterior vaginal wall was resected,but neobladder was still performed.During daytime,no patients reported total incontinence and 73%(11/15)reported total continence or only occasional leaks.Sexual results showed that seven of 15(47%)women regained sexual activity after surgery,with a quality reported as“good”or“very good”in 40%of all 19 cases.Conclusion: RARC in female with anterior vaginal wall preservation is feasible.The approach showed a good safety profile,with satisfying results on continence and sexual activity.Sexual-sparing approaches should be carried out after correct patient selection.展开更多
Objective:We described the technique and outcomes of robot-assisted repair of uretero-enteric strictures(UES)following robot-assisted radical cystectomy(RARC)and urinary diversion.Methods:Retrospective review of our R...Objective:We described the technique and outcomes of robot-assisted repair of uretero-enteric strictures(UES)following robot-assisted radical cystectomy(RARC)and urinary diversion.Methods:Retrospective review of our RARC database from November 2005 to August 2023 at Roswell Park Comprehensive Cancer center was performed.Patients who developed UES and ultimately underwent robot-assisted uretero-enteric reimplantation(RUER)were identified.KaplaneMeier method was used to compute the cumulative incidence recurrence rate of UES after RUER.A multivariable regression model was used to identify variables associated with UES recurrence.Results:A total of 123(15%)out of 808 RARC patients developed UES,of whom 52 underwent reimplantation(45 patients underwent RUER[n=55 cases]and seven patients underwent open ureteroenteric reimplantation).The median time from RARC to UES was 4.4(interquartile range 3.0e7.0)months,and the median time between UES and RUER was 5.2(interquartile range 3.2e8.9)months.The 3-year recurrence rate after RUER is about 29%.On multivariable analysis,longer hospital stay(hazard ratio 1.37,95%confidence interval 1.16e1.61,p<0.01)was associated with recurrent UES after RUER.Conclusion:RUER for UES after RARC is feasible with durable outcomes although a notable subset of patients experienced postoperative complications and UES recurrence.展开更多
Objective:To highlight the role of hyper accuracy three-dimensional(3D)reconstruction in facilitating surgical planning and guiding selective clamping during robot-assisted partial nephrectomy(RAPN).Methods:A transper...Objective:To highlight the role of hyper accuracy three-dimensional(3D)reconstruction in facilitating surgical planning and guiding selective clamping during robot-assisted partial nephrectomy(RAPN).Methods:A transperitoneal RAPN was performed in a 62-year-old male patient presenting with a 4 cm right anterior interpolar renal mass(R.E.N.A.L nephrometry score 7A).An abnormal vasculature was observed,with a single renal vein and two right renal arteries originating superiorly to the vein and anterior,when dividing in their segmental branches.According to the hyper accuracy 3D(HA3D^(®))rainbow model(MEDICS Srl,Turin,Italy),one branch belonging to one of the segmental arteries was feeding the tumor.This allowed for an accurate prediction of the area vascularized by each arterial branch.The 3D model was included in the intraoperative console view during the whole procedure,using the TilePro feature.A step-by-step explanation of the procedure is provided in the video attached to the present article.Results:The operative time was 90 min with a warm ischemia time on selective clamping of 13 min.Estimated blood loss was 180 mL.No intraoperative complication was encountered and no drain was placed at the end of the procedure.The patient was discharged on postoperative Day 2,without any early postoperative complications.The final pathology report showed a pathological tumor stage 1 clear cell renal cell carcinoma with negative surgical margins.Conclusion:The present study and the attached video illustrate the value of 3D rainbow model during the planning and execution of a RAPN with selective clamping.It shows how the surgeon can rely on this model to be more efficient by avoiding unnecessary surgical steps,and to safely adopt a“selective”clamping strategy that can translate in minimal functional impact.展开更多
Robotic surgery systems,as emerging minimally invasive approaches,have been increasingly applied for the treatment of esophageal cancer because they provide a high-definition three-dimensional surgical view and mechan...Robotic surgery systems,as emerging minimally invasive approaches,have been increasingly applied for the treatment of esophageal cancer because they provide a high-definition three-dimensional surgical view and mechanical rotating arms that surpass the limitations of human hands,greatly enhancing the accuracy and flexibility of surgical methods.Robot-assisted McKeown esophagectomy(RAME),a common type of robotic esophagectomy,has been gradually implemented with the aim of reducing postoperative complications,improving postoperative recovery and achieving better long-term survival.Multiple centers worldwide have reported and summarized their experiences with the RAME,and some have also discussed and analyzed its perioperative effects and survival prognosis compared with those of video-assisted minimally invasive esophagectomy.Compared to traditional surgery,the RAME has significant advantages in terms of lymph node dissection although there seems to be no difference in overall survival or disease-free survival.With the continuous advancement of technology and the development of robotic technology,further development and innovation are expected in the RAME field.This review elaborates on the prospects of the application and advancement of the RAME to provide a useful reference for clinical practice.展开更多
BACKGROUND Robot-assisted gastrointestinal and liver surgery has been an important development direction in the field of surgery in recent years and it is also one of the fastest developing and most concerning fields ...BACKGROUND Robot-assisted gastrointestinal and liver surgery has been an important development direction in the field of surgery in recent years and it is also one of the fastest developing and most concerning fields in surgical operations.AIM To illustrate the major areas of research and forward-looking directions over the past twenty-six years.METHODS Using the Web of Science Core Collection database,a comprehensive review of scholarly articles pertaining to robot-assisted gastrointestinal and liver surgery was researched out between 2000 and 2023.We used Citespace(Version 6.2.4)and Bibliometrix package(Version 4.3.0)to visualize the analysis of all publications including country,institutional affiliations,authors,and keywords.RESULTS In total,346 articles were retrieved.Surgical Endoscopy had with the largest number of publications and was cited in this field.The United States was a core research country in this field.Yonsei University was the most productive institution.The current focus of this field is on rectal surgery,long-term prognosis,perioperative management,previous surgical experience,and the learning curve.CONCLUSION The scientific interest in robot-assisted gastrointestinal and liver surgery has experienced a significant rise since 1997.This study provides new perspectives and ideas for future research in this field.展开更多
BACKGROUND Anterior cutaneous nerve entrapment syndrome(ACNES)is a condition mani-festing with pain caused by strangulation of the anterior cutaneous branch of the lower intercostal nerves.This case report aims to pro...BACKGROUND Anterior cutaneous nerve entrapment syndrome(ACNES)is a condition mani-festing with pain caused by strangulation of the anterior cutaneous branch of the lower intercostal nerves.This case report aims to provide new insight into the selection of peripheral nerve blocks for the ACNES treatment.CASE SUMMARY A 66-year-old woman manifested ACNES after a robot-assisted distal gastrec-tomy.An ultrasound-guided rectal sheath block was effective for pain triggered by the port scar.However,the sudden severe pain,which radiated laterally from the previous site,remained.A transversus abdominis plane block was performed for the remaining pain and effectively relieved it.CONCLUSION In this case,the trocar port was inserted between the rectus and transverse abdominis muscles.The intercostal nerves might have been entrapped on both sides of the rectus and transversus abdominis muscles.Hence,rectus sheath and transverse abdominis plane blocks were required to achieve complete pain relief.To the best of our knowledge,this is the first report on use of a combination of rectus sheath and transverse abdominis plane blocks for pain relief in ACNES.展开更多
Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE)....Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE). Methods: A total of 150 patients who underwent RAMIE from January 2020 to January 2022 at our hospital were randomly assigned to either the observation group or the control group, with 75 patients in each. The control group received standard perioperative management and nursing care, while the observation group was treated with ERAS nursing strategies. Interventions continued until discharge, and outcomes such as postoperative complications, quality of life, and nutritional status were compared between the groups. Results: The observation group exhibited a significantly lower incidence of postoperative adverse reactions compared to the control group (P ionally, all dimension scores of the Short-Form 36 Health Survey (SF-36), including the total score, were higher in the observation group (P < 0.05). Furthermore, the Nutritional Risk Screening (NRS) scores for impaired nutritional status and disease severity, along with the total NRS score, were significantly lower in the observation group compared to the control group (P Conclusion: Implementing ERAS nursing in the perioperative care of patients undergoing RAMIE is associated with reduced postoperative complications and enhanced postoperative quality of life and nutritional status. .展开更多
Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provi...Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.展开更多
AIM To evaluate the potential effectiveness of robot-assisted gastrectomy(RAG) in comparison to open gastrectomy(OG) for gastric cancer patients.METHODS A comprehensive systematic literature search using PubM ed,EMBAS...AIM To evaluate the potential effectiveness of robot-assisted gastrectomy(RAG) in comparison to open gastrectomy(OG) for gastric cancer patients.METHODS A comprehensive systematic literature search using PubM ed,EMBASE,and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric cancer.Participants of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy.A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to OG.The primary outcome measures were set for estimated blood loss,operative time,conversion rate,morbidity,and hospital stay.Secondary among postoperative complications,wound infection,bleeding and anastomotic leakage were also analysed.RESULTS A total of 6 articles,5 retrospective and 1 randomized controlled study,involving 6123 patients overall,with 689(11.3%) cases submitted to RAG and 5434(88.7%) to OG,satisfied the eligibility criteria and were included in the meta-analysis.RAG was associated with longer operation time than OG(weighted mean difference 72.20 min;P < 0.001),but with reduction in blood loss and shorter hospital stay(weighted mean difference-166.83 mL and-1.97 d respectively;P < 0.001).No differences were found with respect to overall postoperative complications(P = 0.65),wound infection(P = 0.35),bleeding(P = 0.65),and anastomotic leakage(P = 0.06).The postoperative mortality rates were similar between the two groups.With respect to oncological outcomes,no statistical differences among the number of harvested lymph nodes were found(weighted mean difference-1.12;P = 0.10).CONCLUSION RAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.展开更多
Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the ...Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the acceptance of this technology in Europe and the rest of the world has been somewhat slower. This article reviews the current literature on RARP with regard to oncological, continence and potency outcomes-the so-called ＇trifecta＇. Preliminary data appear to show an advantage of RARP over open prostatectomy, with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most studies show good postoperative continence and potency with RARP; however, this needs to be viewed in the context of the paucity of randomized data available in the literature. There is no definitive evidence to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging. Finally, evolving techniques of single-port robotic prostatectomy, laser- guided robotics, catheter-free prostatectomy and image-guided robotics are discussed.展开更多
Needle insertion is a common surgical procedure used in diagnosis and treatment.The needle steering technologies make continuous developments in theoretical and practical aspects along with the in-depth research on ne...Needle insertion is a common surgical procedure used in diagnosis and treatment.The needle steering technologies make continuous developments in theoretical and practical aspects along with the in-depth research on needle insertion.It is necessary to summarize and analyze the existing results to promote the future development of theories and applications of needle insertion.Thus,a survey of the state of the art of research is presented on algorithms of needle steering techniques,the surgical robots and devices.Based on the analysis of the needle insertion procedure,the concept of needle steering is defined as a kinematics problem,which is to place the needle at the target and avoid the obstacles.The needle steering techniques,including the artificial potential field method and the nonholonomic model,are introduced to control the needles for improving the accuracy.Based on the quasi-static thinking,the virtual spring model and the cantilever-beam model are developed to calculate the amount of needle deflection and generate the needle path.The phantoms instead of the real tissue are used to verify the models mentioned in most of the experimentations.For the desired needle trajectories,the image-guided robotic devices and some novel needles are presented to achieve the needle steering.Finally,the challenges are provided involving the controllability of the long flexible needle and the properties of soft tissue.The results and investigations can be used for further study on the precision and accuracy of needle insertion.展开更多
Vasectomy reversal （VR） has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwen...Vasectomy reversal （VR） has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwent either robot-assisted VR （RAVR） or microsurgical VR （MVR） by a single fellowship trained microsurgeon between 2011 and 2013 and had a 6 weeks postoperative semen analysis. Fifty-two men who were interested in VR were counseled and given the option of RAVR versus MVR. Twenty-seven men elected to have MVR while 25 men elected RAVR. These included vasovasostomies and vasoepididymostomies in both groups, as well as redo VRs in men who had failed previous VR attempts by other surgeons. There was no statistically significant difference between the microsurgical group and the robot-assisted group, respectively, in overall patency rates （89% vs 92%）, 6 weeks post-VR mean sperm concentrations （28 million m1-1 vs 26 million m1-1） or total motile counts （29 million vs 30 million）, or mean operative times （141 min vs 150 min）. There was a statistically significant difference in anastomosis time （64 min vs 74 min）, however, clinically this only represented a 10 min longer anastomosis time in the early robotic experience, which was found to be decreasing as the case series continued. Transitioning from MVR to RAVR is feasible with comparable outcomes.展开更多
文摘Objective:Radical prostatectomy(RP)is considered the gold standard treatment for patients with localized prostate cancer(PCa).All patients undergoing RP,either open,laparoscopic,or robotic,are at risk of developing urinary incontinence after RP.Our study aimed to analyze possible predictors of early postoperative(within 3 months)urinary continence(UC)outcomes following extraperitoneal single-site robot-assisted RP(ss-RARP)for localized PCa.Methods:We retrospectively reviewed data from 113 patients with localized PCa who were operated on by a highly experienced surgeon between September 2022 and December 2023.Patient characteristics(age,body mass index,prostate volume,prostate dimensions,preoperative and postoperative membranous urethral length,and percentage of membranous urethra removed)were analyzed using logistic regression to determine the independent factors contributing to short-term UC recovery after extraperitoneal ss-RARP.From the time of urinary catheter removal after surgery,the recovery of UC was followed up every month,and UC was defined as using≤1 safety pad daily,known as social continence.Results:The proportions of continent patients immediately after urinary catheter removal,1 month,and 3 months after extraperitoneal ss-RARP were 22%,49%,and 82%,respectively.The multivariate logistic regression analysis showed that the percentage of membranous urethra removed(p=0.016)and prostate volume(p=0.049)were associated with social UC recovery immediately after urinary catheter removal,and craniocaudal dimension of the prostate(p=0.042)and age(p=0.014)were associated with social UC recovery 1 month and 3 months after extraperitoneal ss-RARP,respectively.Conclusion:The percentage of membranous urethra removed,prostate volume,craniocaudal dimension of the prostate,and age are independent risk factors for social UC early after extraperitoneal ss-RARP.
基金supported by grants from the National Nat-ural Science Foundation of China(82173129)the Innova-tive and Entrepreneurial Talent Doctor of Jiangsu Province,China(JSSCBS20221872)。
文摘Background:Dorsal approach is the potentially effective strategy for minimally invasive liver resection.This study aimed to compare the outcomes between robot-assisted and laparoscopic hemihepatectomy through dorsal approach.Methods:We compared the patients who underwent robot-assisted hemihepatectomy(Rob-HH)and who had laparoscopic hemihepatectomy(Lap-HH)through dorsal approach between January 2020 and December 2022.A 1:1 propensity score-matching(PSM)analysis was performed to minimize bias and confounding factors.Results:Ninety-six patients were included,41 with Rob-HH and 55 with Lap-HH.Among them,58 underwent left hemihepatectomy(LHH)and 38 underwent right hemihepatectomy(RHH).Compared with LapHH group,patients with Rob-HH had less estimated blood loss(median:100.0 vs.300.0 m L,P=0.016),lower blood transfusion rates(4.9%vs.29.1%,P=0.003)and postoperative complication rates(26.8%vs.54.5%,P=0.016).These significant differences consistently existed after PSM and in the LHH subgroups.Furthermore,robot-assisted LHH was associated with decreased Pringle duration(45 vs.60 min,P=0.047).RHH subgroup analysis showed that compared with Lap-RHH,Rob-RHH was associated with less estimated blood loss(200.0 vs.400.0 m L,P=0.013).No significant differences were found in other perioperative outcomes among pre-and post-PSM cohorts,such as Pringle duration,operative time,and hospital stay.Conclusions:The dorsal approach was a safe and feasible strategy for hemi-hepatectomy with favorable outcomes under robot-assisted system in reducing intraoperative blood loss,transfusion,and postoperative complications.
文摘Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a matter of debate.We evaluated the efficacy and safety of ThuFLEP compared to RASP.Methods:Between January 2020 and December 2023,all patients who underwent either RASP or ThuFLEP for a prostate volume>80 mL were retrospectively included.The surgical procedure choice was left to the surgeon’s and patient’s discretion.Preoperative patient evaluation included the assessment of functional parameters.The groups were compared.Results:A total of 234 patients were included:106(45%)underwent RASP and 128(55%)underwent ThuFLEP.The mean operative time was shorter in the ThuFLEP group compared to the RASP group(106.4 with standard deviation[SD]46.1 min vs.123.2[SD 32.8]min,p=0.012).The mean lengths of catheterization and stay were significantly longer in the RASP group(5.0[SD 3.9]days vs.1.7[SD 2.0]days,p=0.009[catheterization]and 4.9[SD 3.0]days vs.1.9[SD 1.8]days,p=0.009[stay]).The overall complication rate was significantly higher in the ThuFLEP group(12%vs.2.8%in the RASP group,p=0.022).However,we did not observe significant differences in major complications(Clavien-Dindo≥3)between the two groups(four[3.1%]in the ThuFLEP group vs.one[0.94%]in the RASP group,p=0.073).At 3 months,the rate of stress urinary incontinence was 4.7%after ThuFLEP and 1.9%after RASP(p=0.2).Finally,the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups,but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group(p=0.012).Conclusion:Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia.ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.
基金supported by the National Natural Science Foundation of China(No.82170783).
文摘Urinary incontinence is a common complication following robot-assisted radical prostatectomy(RARP).Urethral length has been identified as a factor affecting postoperative continence recovery.In this meta-analysis,we examined the association between use of the maximal urethral length preservation(MULP)technique and postoperative urinary continence in patients undergoing RARP.We conducted a comprehensive search of PubMed,Web of Science,Embase,and the Cochrane Library up to December 31,2023.The quality of the literature was assessed using the Newcastle-Ottawa Scale.A random-effects meta-analysis was performed to synthesize data and calculate the odds ratio(OR)from eligible studies on continence and MULP.Six studies involving 1869 patients met the eligibility criteria.MULP was positively associated with both early continence(1 month after RARP;Z=3.62,P=0.003,OR=3.10,95% confidence interval[CI]:1.68-5.73)and late continence(12 months after RARP;Z=2.34,P=0.019,OR=2.10,95%CI:1.13–3.90).Oncological outcomes indicated that MULP did not increase the overall positive surgical margin rate or the positive surgical margin status at the prostate apex(both P>0.05).In conclusion,the use of the MULP technique in RARP significantly improved both early and late postoperative continence outcomes without compromising oncological outcomes.
基金funded by National Natural Science Foundation of China(82072846 to Xu B).
文摘Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelines to guide clinical practice.We aimed to obtain expert opinions for RASP for large BPH.Methods:A systematic review of the literature was performed in April 2024 using the PubMed,Embase,and Web of Science databases.Search terms were combined to construct the following search strings:(robotic)AND(simple OR benign)AND(prostatectomy).Search results were filtered by language(English only),species(human),and publication type(original article).This study used a two-phase modified Delphi approach.Results:In this expert consensus,some frequently used RASP techniques,including robot-assisted retropubic prostatectomy,robot-assisted transvesical prostatectomy,and robot-assisted urethra-sparing prostatectomy,are described.RASP offers a short learning curve for surgeons with experience in robotic surgery.Severe complications are rare in patients who undergo RASP.Conclusion:RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.
文摘Objective:We investigated patients who underwent robot-assisted radical prostatectomy(RARP)with pelvic lymph node dissection(PLND),analyzing the prevalence and risk factors associated with symptomatic lymphoceles(SLCs).Methods:We evaluated 354 consecutive patients who underwent RARP with PLND by our team between June 2016 and December 2022.After analyzing the prevalence of SLCs,patients were divided into two groups,with and without SLCs.The variables were age,body mass index(BMI),prostate-specific antigen,surgery time,blood loss,length of stay,International Society of Urological Pathology score in the pathology,and the number of lymph nodes removed.These variables were compared between these groups using the Chi-square test and Student's t-test,according to the type of the variable.In all analyses,a significance level of<0.05 was considered.Results:The prevalence of SLCs in this sample of patients undergoing RARP with PLND was 2.0%(7/354),which is slightly lower than the minimum rate reported in the literature.In our analysis,BMI(p=0.041),the number of lymph nodes removed(p=0.007),and length of hospital stay(p=0.007)were factors associated with the presence of SLCs.Conclusion:The prevalence of SLCs in patients undergoing RARP with PLND is approximately 2.0%.Higher BMI,greater number of lymph nodes removed,and longer length of hospital stay are factors associated with the presence of SLCs.
基金ZJU 100 Young Talent ProgramKey Program for Robot-assisted Subretinal Injection Research Center in Zhejiang Province,Grant/Award Number:2023ZY1061。
文摘Subretinal injection is a complicated task for retinal surgeons to operate manually.In this paper we demonstrate a robust framework for needle detection and localisation in robotassisted subretinal injection using microscope-integrated Optical Coherence Tomography with deep learning.Five convolutional neural networks with different architectures were evaluated.The main differences between the architectures are the amount of information they receive at the input layer.When evaluated on ex-vivo pig eyes,the top performing network successfully detected all needles in the dataset and localised them with an Intersection over Union value of 0.55.The algorithm was evaluated by comparing the depth of the top and bottom edge of the predicted bounding box to the ground truth.This analysis showed that the top edge can be used to predict the depth of the needle with a maximum error of 8.5μm.
基金supported by the Fundamental Research Funds for the Central Universities(2023SCU12057)the National Natural Science Foundation of China(82373106,82372831,and 32270690).
文摘Robot-assisted surgery has evolved into a crucial treatment for prostate cancer(PCa).However,from its appearance to today,brain-computer interface,virtual reality,and metaverse have revolutionized the field of robot-assisted surgery for PCa,presenting both opportunities and challenges.Especially in the context of contemporary big data and precision medicine,facing the heterogeneity of PCa and the complexity of clinical problems,it still needs to be continuously upgraded and improved.Keeping this in mind,this article summarized the 5 stages of the historical development of robot-assisted surgery for PCa,encompassing the stages of emergence,promotion,development,maturity,and intelligence.Initially,safety concerns were paramount,but subsequent research and engineering advancements have focused on enhancing device efficacy,surgical technology,and achieving precise multi modal treatment.The dominance of da Vinci robot-assisted surgical system has seen this evolution intimately tied to its successive versions.In the future,robot-assisted surgery for PCa will move towards intelligence,promising improved patient outcomes and personalized therapy,alongside formidable challenges.To guide future development,we propose 10 significant prospects spanning clinical,research,engineering,materials,social,and economic domains,envisioning a future era of artificial intelligence in the surgical treatment of PCa.
文摘Objective: Radical cystectomy(RC)is a standard treatment for localized muscle invasive bladder cancer and high-risk or very high-risk non-muscle invasive bladder cancer not responding to adequate endovesical therapy.In women,traditionally RC is performed with hystero-adnexectomy and resection of the anterior vaginal wall,often resulting in sexual disorders.Vaginal-sparing techniques have been developed to improve functional outcomes.The present study explores the safety and the functional outcome of vaginal-sparing techniques.Methods: We retrospectively analyzed all consecutive female patients undergoing robot-assisted RC(RARC)with neobladder diversion between October 2017 and February 2022.The indications for vaginal-sparing RC were absence of tumor on bladder neck or urethra and no sign of infiltration of posterior bladder wall at the preoperative MRI.Functional results were evaluated with the aid of five questions out of the Bladder Cancer Index questionnaire.Complications were reported according to the Clavien–Dindo classification and cancer control was evaluated by recurrence-free and cancer-specific survival.Results: A total of 22 female patients underwent RARC with neobladder diversion.Neoadjuvant chemotherapy was given in 17(77%)cases.Clavien–Dindo grades III–IV complications occurred in four(18%)cases.After a mean follow-up of 29(interquartile range 16–44)months,six(27.3%)patients developed distant metastases,and one(4.5%)woman loco-regional relapse.Sexual-sparing surgery was performed in 19(86%)patients,and in the others the anterior vaginal wall was resected,but neobladder was still performed.During daytime,no patients reported total incontinence and 73%(11/15)reported total continence or only occasional leaks.Sexual results showed that seven of 15(47%)women regained sexual activity after surgery,with a quality reported as“good”or“very good”in 40%of all 19 cases.Conclusion: RARC in female with anterior vaginal wall preservation is feasible.The approach showed a good safety profile,with satisfying results on continence and sexual activity.Sexual-sparing approaches should be carried out after correct patient selection.
文摘Objective:We described the technique and outcomes of robot-assisted repair of uretero-enteric strictures(UES)following robot-assisted radical cystectomy(RARC)and urinary diversion.Methods:Retrospective review of our RARC database from November 2005 to August 2023 at Roswell Park Comprehensive Cancer center was performed.Patients who developed UES and ultimately underwent robot-assisted uretero-enteric reimplantation(RUER)were identified.KaplaneMeier method was used to compute the cumulative incidence recurrence rate of UES after RUER.A multivariable regression model was used to identify variables associated with UES recurrence.Results:A total of 123(15%)out of 808 RARC patients developed UES,of whom 52 underwent reimplantation(45 patients underwent RUER[n=55 cases]and seven patients underwent open ureteroenteric reimplantation).The median time from RARC to UES was 4.4(interquartile range 3.0e7.0)months,and the median time between UES and RUER was 5.2(interquartile range 3.2e8.9)months.The 3-year recurrence rate after RUER is about 29%.On multivariable analysis,longer hospital stay(hazard ratio 1.37,95%confidence interval 1.16e1.61,p<0.01)was associated with recurrent UES after RUER.Conclusion:RUER for UES after RARC is feasible with durable outcomes although a notable subset of patients experienced postoperative complications and UES recurrence.
文摘Objective:To highlight the role of hyper accuracy three-dimensional(3D)reconstruction in facilitating surgical planning and guiding selective clamping during robot-assisted partial nephrectomy(RAPN).Methods:A transperitoneal RAPN was performed in a 62-year-old male patient presenting with a 4 cm right anterior interpolar renal mass(R.E.N.A.L nephrometry score 7A).An abnormal vasculature was observed,with a single renal vein and two right renal arteries originating superiorly to the vein and anterior,when dividing in their segmental branches.According to the hyper accuracy 3D(HA3D^(®))rainbow model(MEDICS Srl,Turin,Italy),one branch belonging to one of the segmental arteries was feeding the tumor.This allowed for an accurate prediction of the area vascularized by each arterial branch.The 3D model was included in the intraoperative console view during the whole procedure,using the TilePro feature.A step-by-step explanation of the procedure is provided in the video attached to the present article.Results:The operative time was 90 min with a warm ischemia time on selective clamping of 13 min.Estimated blood loss was 180 mL.No intraoperative complication was encountered and no drain was placed at the end of the procedure.The patient was discharged on postoperative Day 2,without any early postoperative complications.The final pathology report showed a pathological tumor stage 1 clear cell renal cell carcinoma with negative surgical margins.Conclusion:The present study and the attached video illustrate the value of 3D rainbow model during the planning and execution of a RAPN with selective clamping.It shows how the surgeon can rely on this model to be more efficient by avoiding unnecessary surgical steps,and to safely adopt a“selective”clamping strategy that can translate in minimal functional impact.
文摘Robotic surgery systems,as emerging minimally invasive approaches,have been increasingly applied for the treatment of esophageal cancer because they provide a high-definition three-dimensional surgical view and mechanical rotating arms that surpass the limitations of human hands,greatly enhancing the accuracy and flexibility of surgical methods.Robot-assisted McKeown esophagectomy(RAME),a common type of robotic esophagectomy,has been gradually implemented with the aim of reducing postoperative complications,improving postoperative recovery and achieving better long-term survival.Multiple centers worldwide have reported and summarized their experiences with the RAME,and some have also discussed and analyzed its perioperative effects and survival prognosis compared with those of video-assisted minimally invasive esophagectomy.Compared to traditional surgery,the RAME has significant advantages in terms of lymph node dissection although there seems to be no difference in overall survival or disease-free survival.With the continuous advancement of technology and the development of robotic technology,further development and innovation are expected in the RAME field.This review elaborates on the prospects of the application and advancement of the RAME to provide a useful reference for clinical practice.
基金Natural Science Foundation of Sichuan Province,No.2021YFS1834。
文摘BACKGROUND Robot-assisted gastrointestinal and liver surgery has been an important development direction in the field of surgery in recent years and it is also one of the fastest developing and most concerning fields in surgical operations.AIM To illustrate the major areas of research and forward-looking directions over the past twenty-six years.METHODS Using the Web of Science Core Collection database,a comprehensive review of scholarly articles pertaining to robot-assisted gastrointestinal and liver surgery was researched out between 2000 and 2023.We used Citespace(Version 6.2.4)and Bibliometrix package(Version 4.3.0)to visualize the analysis of all publications including country,institutional affiliations,authors,and keywords.RESULTS In total,346 articles were retrieved.Surgical Endoscopy had with the largest number of publications and was cited in this field.The United States was a core research country in this field.Yonsei University was the most productive institution.The current focus of this field is on rectal surgery,long-term prognosis,perioperative management,previous surgical experience,and the learning curve.CONCLUSION The scientific interest in robot-assisted gastrointestinal and liver surgery has experienced a significant rise since 1997.This study provides new perspectives and ideas for future research in this field.
文摘BACKGROUND Anterior cutaneous nerve entrapment syndrome(ACNES)is a condition mani-festing with pain caused by strangulation of the anterior cutaneous branch of the lower intercostal nerves.This case report aims to provide new insight into the selection of peripheral nerve blocks for the ACNES treatment.CASE SUMMARY A 66-year-old woman manifested ACNES after a robot-assisted distal gastrec-tomy.An ultrasound-guided rectal sheath block was effective for pain triggered by the port scar.However,the sudden severe pain,which radiated laterally from the previous site,remained.A transversus abdominis plane block was performed for the remaining pain and effectively relieved it.CONCLUSION In this case,the trocar port was inserted between the rectus and transverse abdominis muscles.The intercostal nerves might have been entrapped on both sides of the rectus and transversus abdominis muscles.Hence,rectus sheath and transverse abdominis plane blocks were required to achieve complete pain relief.To the best of our knowledge,this is the first report on use of a combination of rectus sheath and transverse abdominis plane blocks for pain relief in ACNES.
文摘Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE). Methods: A total of 150 patients who underwent RAMIE from January 2020 to January 2022 at our hospital were randomly assigned to either the observation group or the control group, with 75 patients in each. The control group received standard perioperative management and nursing care, while the observation group was treated with ERAS nursing strategies. Interventions continued until discharge, and outcomes such as postoperative complications, quality of life, and nutritional status were compared between the groups. Results: The observation group exhibited a significantly lower incidence of postoperative adverse reactions compared to the control group (P ionally, all dimension scores of the Short-Form 36 Health Survey (SF-36), including the total score, were higher in the observation group (P < 0.05). Furthermore, the Nutritional Risk Screening (NRS) scores for impaired nutritional status and disease severity, along with the total NRS score, were significantly lower in the observation group compared to the control group (P Conclusion: Implementing ERAS nursing in the perioperative care of patients undergoing RAMIE is associated with reduced postoperative complications and enhanced postoperative quality of life and nutritional status. .
文摘Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.
文摘AIM To evaluate the potential effectiveness of robot-assisted gastrectomy(RAG) in comparison to open gastrectomy(OG) for gastric cancer patients.METHODS A comprehensive systematic literature search using PubM ed,EMBASE,and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric cancer.Participants of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy.A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to OG.The primary outcome measures were set for estimated blood loss,operative time,conversion rate,morbidity,and hospital stay.Secondary among postoperative complications,wound infection,bleeding and anastomotic leakage were also analysed.RESULTS A total of 6 articles,5 retrospective and 1 randomized controlled study,involving 6123 patients overall,with 689(11.3%) cases submitted to RAG and 5434(88.7%) to OG,satisfied the eligibility criteria and were included in the meta-analysis.RAG was associated with longer operation time than OG(weighted mean difference 72.20 min;P < 0.001),but with reduction in blood loss and shorter hospital stay(weighted mean difference-166.83 mL and-1.97 d respectively;P < 0.001).No differences were found with respect to overall postoperative complications(P = 0.65),wound infection(P = 0.35),bleeding(P = 0.65),and anastomotic leakage(P = 0.06).The postoperative mortality rates were similar between the two groups.With respect to oncological outcomes,no statistical differences among the number of harvested lymph nodes were found(weighted mean difference-1.12;P = 0.10).CONCLUSION RAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.
文摘Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the acceptance of this technology in Europe and the rest of the world has been somewhat slower. This article reviews the current literature on RARP with regard to oncological, continence and potency outcomes-the so-called ＇trifecta＇. Preliminary data appear to show an advantage of RARP over open prostatectomy, with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most studies show good postoperative continence and potency with RARP; however, this needs to be viewed in the context of the paucity of randomized data available in the literature. There is no definitive evidence to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging. Finally, evolving techniques of single-port robotic prostatectomy, laser- guided robotics, catheter-free prostatectomy and image-guided robotics are discussed.
基金supported by National Natural Science Foundation of China (Grant Nos. 51165040,50775119)Visiting Scholar Foundation of Key Lab in University of China (Grant No. GZKF-201020)
文摘Needle insertion is a common surgical procedure used in diagnosis and treatment.The needle steering technologies make continuous developments in theoretical and practical aspects along with the in-depth research on needle insertion.It is necessary to summarize and analyze the existing results to promote the future development of theories and applications of needle insertion.Thus,a survey of the state of the art of research is presented on algorithms of needle steering techniques,the surgical robots and devices.Based on the analysis of the needle insertion procedure,the concept of needle steering is defined as a kinematics problem,which is to place the needle at the target and avoid the obstacles.The needle steering techniques,including the artificial potential field method and the nonholonomic model,are introduced to control the needles for improving the accuracy.Based on the quasi-static thinking,the virtual spring model and the cantilever-beam model are developed to calculate the amount of needle deflection and generate the needle path.The phantoms instead of the real tissue are used to verify the models mentioned in most of the experimentations.For the desired needle trajectories,the image-guided robotic devices and some novel needles are presented to achieve the needle steering.Finally,the challenges are provided involving the controllability of the long flexible needle and the properties of soft tissue.The results and investigations can be used for further study on the precision and accuracy of needle insertion.
文摘Vasectomy reversal （VR） has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwent either robot-assisted VR （RAVR） or microsurgical VR （MVR） by a single fellowship trained microsurgeon between 2011 and 2013 and had a 6 weeks postoperative semen analysis. Fifty-two men who were interested in VR were counseled and given the option of RAVR versus MVR. Twenty-seven men elected to have MVR while 25 men elected RAVR. These included vasovasostomies and vasoepididymostomies in both groups, as well as redo VRs in men who had failed previous VR attempts by other surgeons. There was no statistically significant difference between the microsurgical group and the robot-assisted group, respectively, in overall patency rates （89% vs 92%）, 6 weeks post-VR mean sperm concentrations （28 million m1-1 vs 26 million m1-1） or total motile counts （29 million vs 30 million）, or mean operative times （141 min vs 150 min）. There was a statistically significant difference in anastomosis time （64 min vs 74 min）, however, clinically this only represented a 10 min longer anastomosis time in the early robotic experience, which was found to be decreasing as the case series continued. Transitioning from MVR to RAVR is feasible with comparable outcomes.
