As robotic surgery provides clinical benefits and increases on a global scale,it also signifies the transition from direct manual control of surgical instruments to digital connectivity and teleoperation.The digital c...As robotic surgery provides clinical benefits and increases on a global scale,it also signifies the transition from direct manual control of surgical instruments to digital connectivity and teleoperation.The digital coupling between human control inputs and surgical motion replaces the previous physical link.Robotic surgery is therefore in effect‘surgery-by-wire’,the term capturing the engineering phenomenon that has also occurred in the‘fly-by-wire’of aviation and‘drive-by-wire’of cars.This paper reviews the fundamental commonality across domains.Intrinsic to‘by-wire’control is digital processing,which generates the control signal to the effector.This processing enables a progressive spectrum of motion modulation,from precision and stability of motion,through assistance and envelope protection,to automation.Precision now manifests in all three domains.In modern aircraft and cars,higher-order assistance is commonplace,such as flight envelope protection,with analogous support in driving,as well as significant automation.In robotic surgery,such assistance and automation have not yet entered wider clinical practice,with concepts such as envelope protection requiring further definition.The digital interface combined with telecommunication has also enabled teleoperation in all domains.Therefore,motion‘by-wire’has enhanced performance across industries.A cross-domain perspective will be increasingly useful to facilitate technology transfer and catalyse progress in robotic surgery.As the pan-industry digital transformation evolves,important principles can be derived for application in robotic surgery.展开更多
BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as...BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as a potential alternative,offe-ring reduced trauma and faster recovery.This meta-analysis compares the effi-cacy and safety of robotic surgery vs conventional sternotomy for cardiac myxo-ma excision.We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery,such as shorter hospital stays and reduced transfusion rates,despite potentially longer operative times.METHODS A systematic review was performed using EMBASE,OVID,Scopus,PubMed,Cochrane,and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision.Continuous outcomes were analyzed using mean differences(MDs),and categorical outcomes with odds ratios(ORs)and 95%confidence intervals(95%CIs).A random-effects model was used to pool data,accounting for study heterogeneity.RESULTS Six studies involving 425 patients(180 robotic,245 conventional)were included.Robotic surgery significantly increased cross-clamp time(MD=12.03 minutes,95%CI:2.14-21.92,P=0.02)and cardiopulmonary bypass time(MD=28.37 minutes,95%CI:11.85-44.89,P=0.001).It reduced hospital stay(MD=-1.86 days,95%CI:-2.45 to-1.27,P<0.00001)and blood transfusion requirements(OR=0.30,95%CI:0.13-0.69,P=0.007).No significant differences were observed in atrial arrhythmia(OR=0.55,95%CI:0.27-1.12)or ventilation time(MD=-1.72 hours,95%CI:-5.27 to 1.83,P=0.34).CONCLUSION Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs,suggesting enhanced recovery without compromising safety.展开更多
The integration of artificial intelligence(AI)into the realm of robotic urologic surgery represents a remarkable paradigm shift in the field of urology and surgical healthcare.AI,with its advanced data analysis and ma...The integration of artificial intelligence(AI)into the realm of robotic urologic surgery represents a remarkable paradigm shift in the field of urology and surgical healthcare.AI,with its advanced data analysis and machine learning capabilities,has not only expedited the evolution of robotic surgical procedures but also significantly improved diagnostic accuracy and surgical outcomes.展开更多
BACKGROUND Hemolymphangioma of the jejunum is rare and lacks clinical specificity,and can manifest as gastrointestinal bleeding,abdominal pain,and intestinal obstruction.Computed tomography,magnetic resonance imaging,...BACKGROUND Hemolymphangioma of the jejunum is rare and lacks clinical specificity,and can manifest as gastrointestinal bleeding,abdominal pain,and intestinal obstruction.Computed tomography,magnetic resonance imaging,and other examinations show certain characteristics of the disease,but lack accuracy.Although capsule endoscopy and enteroscopy make up for this deficiency,the diagnosis also still re-quires pathology.CASE SUMMARY A male patient was admitted to the hospital due to abdominal distension and abdominal pain,but a specific diagnosis by computed tomography examination was not obtained.Partial resection of the small intestine was performed by robotic surgery,and postoperative pathological biopsy confirmed the diagnosis of hemo-lymphangioma.No recurrence in the follow-up examination was observed.CONCLUSION Robotic surgery is an effective way to treat hemolymphangioma through minima-lly invasive techniques under the concept of rapid rehabilitation.展开更多
Objective:To compare the efficacy of transoral robotic surgery(TORS)and non-robotic surgery(NRS)in the treatment of tongue base tumors.Methods:A total of 45 patients with tongue base tumors treated in our hospital wer...Objective:To compare the efficacy of transoral robotic surgery(TORS)and non-robotic surgery(NRS)in the treatment of tongue base tumors.Methods:A total of 45 patients with tongue base tumors treated in our hospital were selected,and they were divided into the TORS group and NRS group according to different surgical methods.The surgical indicators and postoperative complications of patients in the two groups were compared and analyzed.Results:Compared with the NRS group,the operative time,bleeding volume and length of hospital stay were less in the TORS group,and the postoperative recurrence rate was less in the TORS group than that in the NRS group.The incidence rate of dysphagia and restricted mouth opening in the TORS group was lower than that in the NRS group within 30 d after surgery,and the difference was statistically significant(P<0.05).Conclusion:TORS has better minimally invasive advantages in the treatment of tongue base tumors,including less intraoperative bleeding,smaller trauma,shorter length of hospital stay and faster recovery.展开更多
Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,whi...Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,which makes it a burden for institutes and unaffordable for patients.This systematic literature review(SLR)focused on the various RAS training methods applied in different surgical specialties,as well as the cost elements of RAS,and was to summarize the opportunities and challenges associated with scaling up RAS.Methods An SLR was carried out based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines.The PubMed,EBSCO,and Scopus databases were searched for reports from January 2018 through January 2024.Full-text reviews and research articles in the English language from Asia-Pacific countries were included.Articles that outlined training and costs associated with RAS were chosen.Results The most common training system is the da Vinci system.The simulation technique,which includes dry-lab,wet-lab,and virtual reality training,was found to be a common and important practice.The cost of RAS encompasses the installation and maintenance costs of the robotic system,the operation theatre rent,personnel cost,surgical instrument and material cost,and other miscellaneous charges.The synthesis of SLR revealed the challenges and opportunities regarding RAS training and cost.Conclusions The results of this SLR will help stakeholders such as decision-makers,influencers,and end users of RAS to understand the significance of training and cost in scaling up RAS from a managerial perspective.For any healthcare innovation to reach a vast population,cost-effectiveness and standard training are crucial.展开更多
There have been nearly 60 years since Thomas Starzl’s first liver transplant.During this period,advancements in medical technology have progressively enabled the adoption of new methods for transplantation.Among thes...There have been nearly 60 years since Thomas Starzl’s first liver transplant.During this period,advancements in medical technology have progressively enabled the adoption of new methods for transplantation.Among these innovations,robotic surgery has emerged in recent decades and is gradually being integrated into transplant medicine.Robotic hepatectomy and liver implantation represent significant advancements in the field of transplant surgery.The precision and minimally invasive nature of robotic surgery offer substantial benefits for both living donors and recipients.In living donors,robotic hepatectomy reduces postoperative pain,minimizes scarring,and accelerates recovery.For liver recipients,robotic liver implantation enhances surgical accuracy,leading to better graft positioning and vascular anastomosis.Robotic systems provide more precise and maneuverable control of instruments,allowing surgeons to perform complex procedures with greater accuracy and reduced risk to patients.This review encompasses publications on minimally invasive donor liver surgery,with a specific focus on robotic liver resection in transplantation,and aims to summarize current knowledge and the development status of robotic surgery in liver transplantation,focusing on liver resection in donors and graft implantation in recipients.展开更多
BACKGROUND Da Vinci Robotics-assisted total mesorectal excision(TME)surgery for rectal cancer is becoming more widely used.There is no strong evidence that roboticassisted surgery and laparoscopic surgery have similar...BACKGROUND Da Vinci Robotics-assisted total mesorectal excision(TME)surgery for rectal cancer is becoming more widely used.There is no strong evidence that roboticassisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for rectal cancer.AIM To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME surgery.METHODS A retrospective study of the clinical pathology and follow-up of elderly patients who underwent TME surgery at the Department of Gastrointestinal Oncology at the Affiliated Hospital of Nanjing University of Chinese Medicine was conducted from March 2020 through September 2023.The patients were divided into a robotassisted group(the R-TME group)and a laparoscopic group(the L-TME group),and the short-term efficacy of the two groups was compared.RESULTS There were 45 elderly patients(≥60 years)in the R-TME group and 50 elderly patients(≥60 years)in the L-TME group.There were no differences in demographics,conversion rates,or postoperative complication rates.The L-TME group had a longer surgical time than the R-TME group[145(125,187.5)vs 180(148.75,206.25)min,P=0.005),and the first postoperative meal time in the L-TME group was longer than that in the R-TME(4 vs 3 d,P=0.048).Among the sex and body mass index(BMI)subgroups,the R-TME group had better out-comes than did the L-TME group in terms of operation time(P=0.042)and intraoperative assessment of bleeding(P=0.042).In the high BMI group,catheter removal occurred earlier in the R-TME group than in the L-TME group(3 vs 4 d,P=0.001),and autonomous voiding function was restored.CONCLUSION The curative effect and short-term efficacy of robot-assisted TME surgery for elderly patients with rectal cancer are similar to those of laparoscopic TME surgery;however,robotic-assisted surgery has better short-term outcomes for individuals with risk factors such as obesity and pelvic stenosis.Optimizing the learning curve can shorten the operation time,reduce the recovery time of gastrointestinal function,and improve the prognosis.展开更多
Background: Epiphrenic Diverticulum is frequently associated with esophageal motility disorders, such as nutcrackers esophagus. The diagnosis is usually made using imaging studies such as a Barium esophagogram, and es...Background: Epiphrenic Diverticulum is frequently associated with esophageal motility disorders, such as nutcrackers esophagus. The diagnosis is usually made using imaging studies such as a Barium esophagogram, and esophageal manometry. Surgical treatment options for epiphrenic diverticulum and EN include diverticulectomy and wide myotomy. Aim: The resection of three epiphrenic diverticula and extensive myotomy were performed by robotic thoracoscopy uneventfully. Case presentation: A 65-year-old female complaining of dysphagia for solid foods, Chest pain and regurgitation. Esophagogastroduodenoscopy (EDG) with difficulty in advancing the endoscope at 25 cm and demonstrating an ED, no hiatal hernia and normal stomach and duodenum. Barium Esophagogram showed multiple diverticula and tortuosity throughout the esophagus. Conclusion: With robotic surgery, surgeons can perform highly precise operations with enhanced 3D vision and control. Through this cutting-edge approach, the treatment of ED associated with EN can be drastically changed, promising better outcomes for patients.展开更多
Objective:This study aimed to assess the feasibility and safety of the SHURUI single-port robotic surgical system for a range of major urological surgeries.Methods:In this prospective,multicenter clinical trial,we exa...Objective:This study aimed to assess the feasibility and safety of the SHURUI single-port robotic surgical system for a range of major urological surgeries.Methods:In this prospective,multicenter clinical trial,we examined the effectiveness of the SHURUI single-port robotic surgical system in urological interventions.The first 50 patients from four centers in China underwent single-port surgeries including partial nephrectomy,radical prostatectomy,partial adrenalectomy,and pyeloureteroplasty,exclusively by the SHURUI single-port robotic surgical system.The study's primary endpoints focused on the success of surgeries,defined as no deviations from planned procedures,no need for more than one port,and no re-operations within 24 h after surgery.Secondary endpoints encompassed a range of surgical metrics,functional outcomes,and patient demographic data.Clinical assessments were conducted before surgery,before discharge,and 1 month after discharge.Results:The surgical procedures were executed successfully without requiring intraoperative conversions or transfusions.Both estimated blood loss and operation durations were maintained within satisfactory limits.For each type of surgery,the mean console times and estimated blood loss were 179.8(standard deviation[SD]39.4)min and 125.6(SD 126.0)mL for radical prostatectomy,126.7(SD 47.8)min and 39.2(SD 54.4)mL for partial nephrectomy,112.6(SD 37.4)min and 20.0(SD 13.2)mL for partial adrenalectomy,and 148.0(SD 18.2)min and 18.0(SD 17.9)mL for pyeloureteroplasty,respectively.Across the cohort,17 patients experienced a total of 25 adverse events,while 10 postoperative complications,all rated as Clavien-Dindo grade I,were encountered by eight patients.All patients had shown recovery or improvement from these events before the end of this trial.Conclusion:The SHURUI single-port robotic surgical system demonstrated feasibility and safety in the performance of major urological surgeries.These initial findings highlight the system's potential,though further research and longer follow-up are required to assess long-term outcomes.展开更多
The increasing use of robotic surgery has seen a wave of technology ripple through global healthcare.Similar changes occurred in aviation several decades ago.New robot types have increased access for both patients and...The increasing use of robotic surgery has seen a wave of technology ripple through global healthcare.Similar changes occurred in aviation several decades ago.New robot types have increased access for both patients and surgeons.The modern robotic curriculum therefore needs to train surgeons of varying experience,gaining access to several robot types,and based in centres around the world.Drawing on this analogy with aviation helps to derive principles for curriculum design,and considers humanemachine interface,non-technical skills,team training,and simulation.The components of the curriculum could be core(cross-platform),platform-specific,specialty-specific,and platform-transitional.Analogous concepts also emerge,including type rating,control as surgery-by-wire,spatio-haptic envelope,and virtual operations.The fourth industrial revolution sets anticipation for progress.展开更多
Objective:To present a modified technique for robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy(RLESS-RNU)with bladder cuff excision and evaluate its effectiveness as a minimally invasive ...Objective:To present a modified technique for robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy(RLESS-RNU)with bladder cuff excision and evaluate its effectiveness as a minimally invasive approach for managing upper tract urothelial carcinoma(UTUC).Methods:Fifteen patients who underwent RLESS-RNU for UTUC between April 2020 and June 2021 were reviewed at our medical institution(The Second Affiliated Hospital of Nanjing Medical University,Nanjing,China),from our prospectively maintained institutional database.The da Vinci^(®)Xi system(Intuitive Surgical,Sunnyvale,CA,USA)was utilized for surgical procedures in all patients.An in-depth analysis was conducted on their baseline demographic characteristics,pathological factors,and perioperative details.The complete surgical process and details are elaborated.Results:The median age of 15 patients was 67 years.The final pathology demonstrated 47%(7/15)patients with pT1 or lower and 47%(7/15)with pT3;one patient could not undergo pathological staging because of preoperative chemotherapy.The perioperative outcomes revealed that the mean operative time was 185(standard deviation[SD]23.05)min.The mean times of the trocar placement for primary and second docking were 15.00(SD 0.85)min and 8.00(SD 0.52)min,respectively.The median estimated blood loss was 55 mL.The mean drainage tube duration and postoperative hospital stay were 7.50 days and 11.00 days,respectively.After a mean follow-up period of 24.20 months,the relapse-free survival rate was 87%.Two patients experienced disease progression:one patient exhibited multifocal evidence of non-muscle invasive bladder cancer,and the other patient developed systemic recurrence.Conclusion:This study demonstrates that the modified technique for RLESS-RNU is safe and satisfactory for UTUC.展开更多
BACKGROUND Internal mammary(IM)lymphadenopathies in breast cancer indicate a worse prognosis than axillary metastases,yet they are rarely assessed.Accurate staging is essential for treatment planning.Robotic biopsy of...BACKGROUND Internal mammary(IM)lymphadenopathies in breast cancer indicate a worse prognosis than axillary metastases,yet they are rarely assessed.Accurate staging is essential for treatment planning.Robotic biopsy offers a promising alternative to video-assisted thoracic surgery for precise histological sampling.This article outlines a systematic robot-assisted dissection approach to enhance staging accuracy and optimize breast cancer management.CASE SUMMARY At our institution,robotic lymphadenectomy of the IM chain was performed in 5 patients between July 2020 and December 2024.Patients were positioned in a 30°semi-supine position with a roll under the shoulder to elevate the chest.The camera port was inserted in the fifth intercostal space along the mid-axillary line,allowing a 0°,12 mm robotic camera to inspect the chest cavity;CO_(2) insufflation(8 L/minute,8-10 mmHg)facilitated lung collapse and pneumo-mediastinum formation for improved dissection.Under direct vision,two additional operative ports were placed:One in the third intercostal space(anterior axillary line)and another in the fifth intercostal space(3-4 cm lateral to the parasternal line).The mean operative time was 118 minutes,with a median hospital stay of two days.No major complications occurred.Histology confirmed breast carcinoma metas tases in three patients,while two had benign disease.CONCLUSION Robotic biopsy of IM lymph nodes is safe,feasible,and provides key information on breast cancer management,with very rare contraindications.展开更多
BACKGROUND Gastroesophageal junction(GEJ)or gastrointestinal stromal tumor(GIST)are located in unfavorable parts of the stomach,due to the anatomical complexity of these regions,protecting the cardia while ensuring R0...BACKGROUND Gastroesophageal junction(GEJ)or gastrointestinal stromal tumor(GIST)are located in unfavorable parts of the stomach,due to the anatomical complexity of these regions,protecting the cardia while ensuring R0 resection is a major challenge for surgeons.CASE SUMMARY Two cases of GEJ stromal tumors were reported.Abdominal computed tomography scans revealed that both tumors were located at the GEJ,close to the posterior wall,with one tumor measuring greater than 5 cm.Both patients successfully underwent robot-assisted laparoscopic wedge resection of the stomach.The surgeries achieved R0 resection while preserving the cardia sphincter and maximizing gastric tissue preservation.Postoperatively,no symptoms such as gastroesophageal reflux or cardia stenosis were observed.Case 1:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD34,CD117,and DOG1,and negative for SMA,desmin,S-100,and SDHB(normal expression).The Ki-67 proliferation index was approximately 5%.Case 2:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD117(++),CD34(++),DOG1(+++),and focal positivity for SMA.Negative for desmin,S-100(few cells positive),and SDHB(preserved expression).The Ki-67 proliferation index was approximately 10%.CONCLUSION The gastric tube-guided robotic-assisted laparoscopic resection is a safe and effective method for tumor resection while preserving the cardia,and it is worth further promotion in clinical practice.展开更多
Robotic distal pancreatectomy(RDP)is being increasingly used in centres with access to the robot and offers technological improvements over conventional laparoscopy.Some studies have also shown superior outcomes compa...Robotic distal pancreatectomy(RDP)is being increasingly used in centres with access to the robot and offers technological improvements over conventional laparoscopy.Some studies have also shown superior outcomes compared with laparoscopic and open approaches.However,robotic technology is not widely available currently.This review aims to compare RDP with open and laparoscopic distal pancreatectomy,covering the basics of the RDP technique and highlighting the current nuances of the evidence pertaining to RDP with respect to clinical effectiveness and cost‒benefit analysis.展开更多
Objective To report our preliminary clinical experience and outcomes of uro-oncology procedures conducted utilizing the SSI Mantra^(TM)surgical robotic system.Methods Data of consecutive patients who underwent various...Objective To report our preliminary clinical experience and outcomes of uro-oncology procedures conducted utilizing the SSI Mantra^(TM)surgical robotic system.Methods Data of consecutive patients who underwent various robot-assisted uro-oncology procedures using the SSI Mantra^(TM)surgical robotic system at our institution between July 2022 and September 2023 were recorded.The specific surgical configurations employed with the SSI Mantra^(TM)for these procedures were duly noted.We assessed the feasibility of these procedures with this novel surgical robotic system and report the outcomes.Results A total of 156 patients were operated with the SSI Mantra^(TM)surgical robotic system.The spectrum of procedures performed comprised robot-assisted laparoscopic radical prostatectomy with bilateral extended pelvic lymph node dissection(n=77),robot-assisted radical cystectomy with bilateral extended pelvic lymph node dissection with extracorporeal urinary diversion(n=39),robot-assisted radical nephrectomy(n=32),robot-assisted partial nephrectomy(n=6),robot-assisted radical nephroureterectomy with bladder cuff excision(n=1),and bilateral robot-assisted video endoscopic inguinal lymph node dissection(n=1).One robot-assisted laparoscopic radical prostatectomy had to be converted to open in view of system malfunction.However,no system-related intraoperative complications or injuries were encountered.Conclusion The SSI Mantra^(TM)surgical robotic system demonstrates significant promise as an innovative robotic platform.In this single-center experience,we have demonstrated the feasibility of a diverse array of surgical procedures using this platform.Further research,involving a larger cohort of patients,is imperative to refine the operative techniques and comprehensively understand the perioperative outcomes of the SSI Mantra^(TM)surgical robotic system,particularly in comparison to other robotic surgical platforms.展开更多
1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Nota...1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Notably,robot-assisted surgery(RAS)has led to its extensive adoption in the surgical management of urinary system tumors due to its enhanced maneuverability,precision in suturing,and anastomotic capabilities.展开更多
AIM: To conduct a meta-analysis to determine the relative merits of robotic surgery (RS) and laparoscopic surgery (LS) for rectal cancer. METHODS: A literature search was performed to identify comparative studies repo...AIM: To conduct a meta-analysis to determine the relative merits of robotic surgery (RS) and laparoscopic surgery (LS) for rectal cancer. METHODS: A literature search was performed to identify comparative studies reporting perioperative outcomes for RS and LS for rectal cancer. Pooled odds ratios and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or random effects model. RESULTS: Eight studies matched the selection criteria and reported on 661 subjects, of whom 268 underwent RS and 393 underwent LS for rectal cancer. Compared the perioperative outcomes of RS with LS, reports of RS indicated favorable outcomes considering conversion(WMD: 0.25; 95% CI: 0.11-0.58; P = 0.001). Meanwhile, operative time (WMD: 27.92, 95% CI: -13.43 to 69.27; P = 0.19); blood loss (WMD: -32.35, 95% CI: -86.19 to 21.50; P = 0.24); days to passing flatus (WMD: -0.18, 95% CI: -0.96 to 0.60; P = 0.65); length of stay (WMD: -0.04; 95% CI: -2.28 to 2.20; P = 0.97); complications (WMD: 1.05; 95% CI: 0.71-1.55; P = 0.82) and pathological details, including lymph nodes harvested (WMD: 0.41, 95% CI: -0.67 to 1.50; P = 0.46), distal resection margin (WMD: -0.35, 95% CI: -1.27 to 0.58; P = 0.46), and positive circumferential resection margin (WMD: 0.54, 95% CI: 0.12-2.39; P = 0.42) were similar between RS and LS. CONCLUSION: RS for rectal cancer is superior to LS in terms of conversion. RS may be an alternative treatment for rectal cancer. Further studies are required.展开更多
AIM: To compare the short- and long-term outcomes of laparoscopic and robotic surgery for middle and low rectal cancer.METHODS: This is a retrospective study on a prospectively collected database containing 111 patien...AIM: To compare the short- and long-term outcomes of laparoscopic and robotic surgery for middle and low rectal cancer.METHODS: This is a retrospective study on a prospectively collected database containing 111 patients who underwent minimally invasive rectal resection with total mesorectal excision (TME) with curative intent between January 2008 and December 2014 (robot, n = 53; laparoscopy, n = 58). The patients all had a diagnosis of middle and low rectal adenocarcinoma with stage I-III disease. The median follow-up period was 37.4 mo. Perioperative results, morbidity a pathological data were evaluated and compared. The 3-year overall survival and disease-free survival rates were calculated and compared.RESULTS: Patients were comparable in terms of preoperative and demographic parameters. The median surgery time was 192 min for laparoscopic TME (L-TME) and 342 min for robotic TME (R-TME) (P < 0.001). There were no differences found in the rates of conversion to open surgery and morbidity. The patients who underwent laparoscopic surgery stayed in the hospital two days longer than the robotic group patients (8 d for L-TME and 6 d for R-TME, P < 0.001). The pathologic evaluation showed a higher number of harvested lymph nodes in the robotic group (18 for R-TME, 11 for L-TME, P < 0.001) and a shorter distal resection margin for laparoscopic patients (1.5 cm for L-TME, 2.5 cm for R-TME, P < 0.001). The three-year overall survival and disease-free survival rates were similar between groups.CONCLUSION: Both L-TME and R-TME achieved acceptable clinical and oncologic outcomes. The robotic technique showed some advantages in rectal surgery that should be validated by further studies.展开更多
Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical sys...Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery.However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless,robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.展开更多
文摘As robotic surgery provides clinical benefits and increases on a global scale,it also signifies the transition from direct manual control of surgical instruments to digital connectivity and teleoperation.The digital coupling between human control inputs and surgical motion replaces the previous physical link.Robotic surgery is therefore in effect‘surgery-by-wire’,the term capturing the engineering phenomenon that has also occurred in the‘fly-by-wire’of aviation and‘drive-by-wire’of cars.This paper reviews the fundamental commonality across domains.Intrinsic to‘by-wire’control is digital processing,which generates the control signal to the effector.This processing enables a progressive spectrum of motion modulation,from precision and stability of motion,through assistance and envelope protection,to automation.Precision now manifests in all three domains.In modern aircraft and cars,higher-order assistance is commonplace,such as flight envelope protection,with analogous support in driving,as well as significant automation.In robotic surgery,such assistance and automation have not yet entered wider clinical practice,with concepts such as envelope protection requiring further definition.The digital interface combined with telecommunication has also enabled teleoperation in all domains.Therefore,motion‘by-wire’has enhanced performance across industries.A cross-domain perspective will be increasingly useful to facilitate technology transfer and catalyse progress in robotic surgery.As the pan-industry digital transformation evolves,important principles can be derived for application in robotic surgery.
文摘BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as a potential alternative,offe-ring reduced trauma and faster recovery.This meta-analysis compares the effi-cacy and safety of robotic surgery vs conventional sternotomy for cardiac myxo-ma excision.We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery,such as shorter hospital stays and reduced transfusion rates,despite potentially longer operative times.METHODS A systematic review was performed using EMBASE,OVID,Scopus,PubMed,Cochrane,and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision.Continuous outcomes were analyzed using mean differences(MDs),and categorical outcomes with odds ratios(ORs)and 95%confidence intervals(95%CIs).A random-effects model was used to pool data,accounting for study heterogeneity.RESULTS Six studies involving 425 patients(180 robotic,245 conventional)were included.Robotic surgery significantly increased cross-clamp time(MD=12.03 minutes,95%CI:2.14-21.92,P=0.02)and cardiopulmonary bypass time(MD=28.37 minutes,95%CI:11.85-44.89,P=0.001).It reduced hospital stay(MD=-1.86 days,95%CI:-2.45 to-1.27,P<0.00001)and blood transfusion requirements(OR=0.30,95%CI:0.13-0.69,P=0.007).No significant differences were observed in atrial arrhythmia(OR=0.55,95%CI:0.27-1.12)or ventilation time(MD=-1.72 hours,95%CI:-5.27 to 1.83,P=0.34).CONCLUSION Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs,suggesting enhanced recovery without compromising safety.
文摘The integration of artificial intelligence(AI)into the realm of robotic urologic surgery represents a remarkable paradigm shift in the field of urology and surgical healthcare.AI,with its advanced data analysis and machine learning capabilities,has not only expedited the evolution of robotic surgical procedures but also significantly improved diagnostic accuracy and surgical outcomes.
基金Supported by Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-015A and No.TJYXZDXK-058B.
文摘BACKGROUND Hemolymphangioma of the jejunum is rare and lacks clinical specificity,and can manifest as gastrointestinal bleeding,abdominal pain,and intestinal obstruction.Computed tomography,magnetic resonance imaging,and other examinations show certain characteristics of the disease,but lack accuracy.Although capsule endoscopy and enteroscopy make up for this deficiency,the diagnosis also still re-quires pathology.CASE SUMMARY A male patient was admitted to the hospital due to abdominal distension and abdominal pain,but a specific diagnosis by computed tomography examination was not obtained.Partial resection of the small intestine was performed by robotic surgery,and postoperative pathological biopsy confirmed the diagnosis of hemo-lymphangioma.No recurrence in the follow-up examination was observed.CONCLUSION Robotic surgery is an effective way to treat hemolymphangioma through minima-lly invasive techniques under the concept of rapid rehabilitation.
文摘Objective:To compare the efficacy of transoral robotic surgery(TORS)and non-robotic surgery(NRS)in the treatment of tongue base tumors.Methods:A total of 45 patients with tongue base tumors treated in our hospital were selected,and they were divided into the TORS group and NRS group according to different surgical methods.The surgical indicators and postoperative complications of patients in the two groups were compared and analyzed.Results:Compared with the NRS group,the operative time,bleeding volume and length of hospital stay were less in the TORS group,and the postoperative recurrence rate was less in the TORS group than that in the NRS group.The incidence rate of dysphagia and restricted mouth opening in the TORS group was lower than that in the NRS group within 30 d after surgery,and the difference was statistically significant(P<0.05).Conclusion:TORS has better minimally invasive advantages in the treatment of tongue base tumors,including less intraoperative bleeding,smaller trauma,shorter length of hospital stay and faster recovery.
基金The authors are the awardees of the Indian Council of Social Science Research(ICSSR)Research Program(F.No.G-11/2021-22/ICSSR/RP)This paper is largely an outcome of the research program sponsored by the ICSSR.However,the responsibility for the facts stated,opinions expressed,and conclusions drawn is entirely that of the authors.
文摘Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,which makes it a burden for institutes and unaffordable for patients.This systematic literature review(SLR)focused on the various RAS training methods applied in different surgical specialties,as well as the cost elements of RAS,and was to summarize the opportunities and challenges associated with scaling up RAS.Methods An SLR was carried out based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines.The PubMed,EBSCO,and Scopus databases were searched for reports from January 2018 through January 2024.Full-text reviews and research articles in the English language from Asia-Pacific countries were included.Articles that outlined training and costs associated with RAS were chosen.Results The most common training system is the da Vinci system.The simulation technique,which includes dry-lab,wet-lab,and virtual reality training,was found to be a common and important practice.The cost of RAS encompasses the installation and maintenance costs of the robotic system,the operation theatre rent,personnel cost,surgical instrument and material cost,and other miscellaneous charges.The synthesis of SLR revealed the challenges and opportunities regarding RAS training and cost.Conclusions The results of this SLR will help stakeholders such as decision-makers,influencers,and end users of RAS to understand the significance of training and cost in scaling up RAS from a managerial perspective.For any healthcare innovation to reach a vast population,cost-effectiveness and standard training are crucial.
文摘There have been nearly 60 years since Thomas Starzl’s first liver transplant.During this period,advancements in medical technology have progressively enabled the adoption of new methods for transplantation.Among these innovations,robotic surgery has emerged in recent decades and is gradually being integrated into transplant medicine.Robotic hepatectomy and liver implantation represent significant advancements in the field of transplant surgery.The precision and minimally invasive nature of robotic surgery offer substantial benefits for both living donors and recipients.In living donors,robotic hepatectomy reduces postoperative pain,minimizes scarring,and accelerates recovery.For liver recipients,robotic liver implantation enhances surgical accuracy,leading to better graft positioning and vascular anastomosis.Robotic systems provide more precise and maneuverable control of instruments,allowing surgeons to perform complex procedures with greater accuracy and reduced risk to patients.This review encompasses publications on minimally invasive donor liver surgery,with a specific focus on robotic liver resection in transplantation,and aims to summarize current knowledge and the development status of robotic surgery in liver transplantation,focusing on liver resection in donors and graft implantation in recipients.
基金National Natural Science Foundation of China,NO.82174466.
文摘BACKGROUND Da Vinci Robotics-assisted total mesorectal excision(TME)surgery for rectal cancer is becoming more widely used.There is no strong evidence that roboticassisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for rectal cancer.AIM To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME surgery.METHODS A retrospective study of the clinical pathology and follow-up of elderly patients who underwent TME surgery at the Department of Gastrointestinal Oncology at the Affiliated Hospital of Nanjing University of Chinese Medicine was conducted from March 2020 through September 2023.The patients were divided into a robotassisted group(the R-TME group)and a laparoscopic group(the L-TME group),and the short-term efficacy of the two groups was compared.RESULTS There were 45 elderly patients(≥60 years)in the R-TME group and 50 elderly patients(≥60 years)in the L-TME group.There were no differences in demographics,conversion rates,or postoperative complication rates.The L-TME group had a longer surgical time than the R-TME group[145(125,187.5)vs 180(148.75,206.25)min,P=0.005),and the first postoperative meal time in the L-TME group was longer than that in the R-TME(4 vs 3 d,P=0.048).Among the sex and body mass index(BMI)subgroups,the R-TME group had better out-comes than did the L-TME group in terms of operation time(P=0.042)and intraoperative assessment of bleeding(P=0.042).In the high BMI group,catheter removal occurred earlier in the R-TME group than in the L-TME group(3 vs 4 d,P=0.001),and autonomous voiding function was restored.CONCLUSION The curative effect and short-term efficacy of robot-assisted TME surgery for elderly patients with rectal cancer are similar to those of laparoscopic TME surgery;however,robotic-assisted surgery has better short-term outcomes for individuals with risk factors such as obesity and pelvic stenosis.Optimizing the learning curve can shorten the operation time,reduce the recovery time of gastrointestinal function,and improve the prognosis.
文摘Background: Epiphrenic Diverticulum is frequently associated with esophageal motility disorders, such as nutcrackers esophagus. The diagnosis is usually made using imaging studies such as a Barium esophagogram, and esophageal manometry. Surgical treatment options for epiphrenic diverticulum and EN include diverticulectomy and wide myotomy. Aim: The resection of three epiphrenic diverticula and extensive myotomy were performed by robotic thoracoscopy uneventfully. Case presentation: A 65-year-old female complaining of dysphagia for solid foods, Chest pain and regurgitation. Esophagogastroduodenoscopy (EDG) with difficulty in advancing the endoscope at 25 cm and demonstrating an ED, no hiatal hernia and normal stomach and duodenum. Barium Esophagogram showed multiple diverticula and tortuosity throughout the esophagus. Conclusion: With robotic surgery, surgeons can perform highly precise operations with enhanced 3D vision and control. Through this cutting-edge approach, the treatment of ED associated with EN can be drastically changed, promising better outcomes for patients.
基金funded by the National Key Research and Development Program of China(Grant No.2022YFB4700904 to Wang L)the Shanghai Shenkang Hospital Development Center's project for the Promotion of Clinical Skills and Clinical Innovation Three-Year Action Plan(Project No.SHDC2022CRT006 to Wang L and SHDC2022CRS010B to Tang S).
文摘Objective:This study aimed to assess the feasibility and safety of the SHURUI single-port robotic surgical system for a range of major urological surgeries.Methods:In this prospective,multicenter clinical trial,we examined the effectiveness of the SHURUI single-port robotic surgical system in urological interventions.The first 50 patients from four centers in China underwent single-port surgeries including partial nephrectomy,radical prostatectomy,partial adrenalectomy,and pyeloureteroplasty,exclusively by the SHURUI single-port robotic surgical system.The study's primary endpoints focused on the success of surgeries,defined as no deviations from planned procedures,no need for more than one port,and no re-operations within 24 h after surgery.Secondary endpoints encompassed a range of surgical metrics,functional outcomes,and patient demographic data.Clinical assessments were conducted before surgery,before discharge,and 1 month after discharge.Results:The surgical procedures were executed successfully without requiring intraoperative conversions or transfusions.Both estimated blood loss and operation durations were maintained within satisfactory limits.For each type of surgery,the mean console times and estimated blood loss were 179.8(standard deviation[SD]39.4)min and 125.6(SD 126.0)mL for radical prostatectomy,126.7(SD 47.8)min and 39.2(SD 54.4)mL for partial nephrectomy,112.6(SD 37.4)min and 20.0(SD 13.2)mL for partial adrenalectomy,and 148.0(SD 18.2)min and 18.0(SD 17.9)mL for pyeloureteroplasty,respectively.Across the cohort,17 patients experienced a total of 25 adverse events,while 10 postoperative complications,all rated as Clavien-Dindo grade I,were encountered by eight patients.All patients had shown recovery or improvement from these events before the end of this trial.Conclusion:The SHURUI single-port robotic surgical system demonstrated feasibility and safety in the performance of major urological surgeries.These initial findings highlight the system's potential,though further research and longer follow-up are required to assess long-term outcomes.
文摘The increasing use of robotic surgery has seen a wave of technology ripple through global healthcare.Similar changes occurred in aviation several decades ago.New robot types have increased access for both patients and surgeons.The modern robotic curriculum therefore needs to train surgeons of varying experience,gaining access to several robot types,and based in centres around the world.Drawing on this analogy with aviation helps to derive principles for curriculum design,and considers humanemachine interface,non-technical skills,team training,and simulation.The components of the curriculum could be core(cross-platform),platform-specific,specialty-specific,and platform-transitional.Analogous concepts also emerge,including type rating,control as surgery-by-wire,spatio-haptic envelope,and virtual operations.The fourth industrial revolution sets anticipation for progress.
文摘Objective:To present a modified technique for robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy(RLESS-RNU)with bladder cuff excision and evaluate its effectiveness as a minimally invasive approach for managing upper tract urothelial carcinoma(UTUC).Methods:Fifteen patients who underwent RLESS-RNU for UTUC between April 2020 and June 2021 were reviewed at our medical institution(The Second Affiliated Hospital of Nanjing Medical University,Nanjing,China),from our prospectively maintained institutional database.The da Vinci^(®)Xi system(Intuitive Surgical,Sunnyvale,CA,USA)was utilized for surgical procedures in all patients.An in-depth analysis was conducted on their baseline demographic characteristics,pathological factors,and perioperative details.The complete surgical process and details are elaborated.Results:The median age of 15 patients was 67 years.The final pathology demonstrated 47%(7/15)patients with pT1 or lower and 47%(7/15)with pT3;one patient could not undergo pathological staging because of preoperative chemotherapy.The perioperative outcomes revealed that the mean operative time was 185(standard deviation[SD]23.05)min.The mean times of the trocar placement for primary and second docking were 15.00(SD 0.85)min and 8.00(SD 0.52)min,respectively.The median estimated blood loss was 55 mL.The mean drainage tube duration and postoperative hospital stay were 7.50 days and 11.00 days,respectively.After a mean follow-up period of 24.20 months,the relapse-free survival rate was 87%.Two patients experienced disease progression:one patient exhibited multifocal evidence of non-muscle invasive bladder cancer,and the other patient developed systemic recurrence.Conclusion:This study demonstrates that the modified technique for RLESS-RNU is safe and satisfactory for UTUC.
文摘BACKGROUND Internal mammary(IM)lymphadenopathies in breast cancer indicate a worse prognosis than axillary metastases,yet they are rarely assessed.Accurate staging is essential for treatment planning.Robotic biopsy offers a promising alternative to video-assisted thoracic surgery for precise histological sampling.This article outlines a systematic robot-assisted dissection approach to enhance staging accuracy and optimize breast cancer management.CASE SUMMARY At our institution,robotic lymphadenectomy of the IM chain was performed in 5 patients between July 2020 and December 2024.Patients were positioned in a 30°semi-supine position with a roll under the shoulder to elevate the chest.The camera port was inserted in the fifth intercostal space along the mid-axillary line,allowing a 0°,12 mm robotic camera to inspect the chest cavity;CO_(2) insufflation(8 L/minute,8-10 mmHg)facilitated lung collapse and pneumo-mediastinum formation for improved dissection.Under direct vision,two additional operative ports were placed:One in the third intercostal space(anterior axillary line)and another in the fifth intercostal space(3-4 cm lateral to the parasternal line).The mean operative time was 118 minutes,with a median hospital stay of two days.No major complications occurred.Histology confirmed breast carcinoma metas tases in three patients,while two had benign disease.CONCLUSION Robotic biopsy of IM lymph nodes is safe,feasible,and provides key information on breast cancer management,with very rare contraindications.
基金Supported by Jiangsu Provincial Administration of Traditional Chinese Medicine,No.MS2023017 and No.SLJ0311the Jiangsu Provincial Health Commission,No.ZDXK202251.
文摘BACKGROUND Gastroesophageal junction(GEJ)or gastrointestinal stromal tumor(GIST)are located in unfavorable parts of the stomach,due to the anatomical complexity of these regions,protecting the cardia while ensuring R0 resection is a major challenge for surgeons.CASE SUMMARY Two cases of GEJ stromal tumors were reported.Abdominal computed tomography scans revealed that both tumors were located at the GEJ,close to the posterior wall,with one tumor measuring greater than 5 cm.Both patients successfully underwent robot-assisted laparoscopic wedge resection of the stomach.The surgeries achieved R0 resection while preserving the cardia sphincter and maximizing gastric tissue preservation.Postoperatively,no symptoms such as gastroesophageal reflux or cardia stenosis were observed.Case 1:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD34,CD117,and DOG1,and negative for SMA,desmin,S-100,and SDHB(normal expression).The Ki-67 proliferation index was approximately 5%.Case 2:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD117(++),CD34(++),DOG1(+++),and focal positivity for SMA.Negative for desmin,S-100(few cells positive),and SDHB(preserved expression).The Ki-67 proliferation index was approximately 10%.CONCLUSION The gastric tube-guided robotic-assisted laparoscopic resection is a safe and effective method for tumor resection while preserving the cardia,and it is worth further promotion in clinical practice.
文摘Robotic distal pancreatectomy(RDP)is being increasingly used in centres with access to the robot and offers technological improvements over conventional laparoscopy.Some studies have also shown superior outcomes compared with laparoscopic and open approaches.However,robotic technology is not widely available currently.This review aims to compare RDP with open and laparoscopic distal pancreatectomy,covering the basics of the RDP technique and highlighting the current nuances of the evidence pertaining to RDP with respect to clinical effectiveness and cost‒benefit analysis.
文摘Objective To report our preliminary clinical experience and outcomes of uro-oncology procedures conducted utilizing the SSI Mantra^(TM)surgical robotic system.Methods Data of consecutive patients who underwent various robot-assisted uro-oncology procedures using the SSI Mantra^(TM)surgical robotic system at our institution between July 2022 and September 2023 were recorded.The specific surgical configurations employed with the SSI Mantra^(TM)for these procedures were duly noted.We assessed the feasibility of these procedures with this novel surgical robotic system and report the outcomes.Results A total of 156 patients were operated with the SSI Mantra^(TM)surgical robotic system.The spectrum of procedures performed comprised robot-assisted laparoscopic radical prostatectomy with bilateral extended pelvic lymph node dissection(n=77),robot-assisted radical cystectomy with bilateral extended pelvic lymph node dissection with extracorporeal urinary diversion(n=39),robot-assisted radical nephrectomy(n=32),robot-assisted partial nephrectomy(n=6),robot-assisted radical nephroureterectomy with bladder cuff excision(n=1),and bilateral robot-assisted video endoscopic inguinal lymph node dissection(n=1).One robot-assisted laparoscopic radical prostatectomy had to be converted to open in view of system malfunction.However,no system-related intraoperative complications or injuries were encountered.Conclusion The SSI Mantra^(TM)surgical robotic system demonstrates significant promise as an innovative robotic platform.In this single-center experience,we have demonstrated the feasibility of a diverse array of surgical procedures using this platform.Further research,involving a larger cohort of patients,is imperative to refine the operative techniques and comprehensively understand the perioperative outcomes of the SSI Mantra^(TM)surgical robotic system,particularly in comparison to other robotic surgical platforms.
基金supported by grants from the National Natural Science Foundation of China(No.82172741 to Ye D)Shanghai Municipal Health Bureau(No.2020CXJQ03 to Ye D)Xuhui District Hospital Local Cooperation Project(No.23XHYD-14 to Ye D).
文摘1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Notably,robot-assisted surgery(RAS)has led to its extensive adoption in the surgical management of urinary system tumors due to its enhanced maneuverability,precision in suturing,and anastomotic capabilities.
基金Supported by The National Natural Science Foundation of China, No. 81071964Zhejiang Provincial Natural Science Foundation of China, No. Y2110019
文摘AIM: To conduct a meta-analysis to determine the relative merits of robotic surgery (RS) and laparoscopic surgery (LS) for rectal cancer. METHODS: A literature search was performed to identify comparative studies reporting perioperative outcomes for RS and LS for rectal cancer. Pooled odds ratios and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or random effects model. RESULTS: Eight studies matched the selection criteria and reported on 661 subjects, of whom 268 underwent RS and 393 underwent LS for rectal cancer. Compared the perioperative outcomes of RS with LS, reports of RS indicated favorable outcomes considering conversion(WMD: 0.25; 95% CI: 0.11-0.58; P = 0.001). Meanwhile, operative time (WMD: 27.92, 95% CI: -13.43 to 69.27; P = 0.19); blood loss (WMD: -32.35, 95% CI: -86.19 to 21.50; P = 0.24); days to passing flatus (WMD: -0.18, 95% CI: -0.96 to 0.60; P = 0.65); length of stay (WMD: -0.04; 95% CI: -2.28 to 2.20; P = 0.97); complications (WMD: 1.05; 95% CI: 0.71-1.55; P = 0.82) and pathological details, including lymph nodes harvested (WMD: 0.41, 95% CI: -0.67 to 1.50; P = 0.46), distal resection margin (WMD: -0.35, 95% CI: -1.27 to 0.58; P = 0.46), and positive circumferential resection margin (WMD: 0.54, 95% CI: 0.12-2.39; P = 0.42) were similar between RS and LS. CONCLUSION: RS for rectal cancer is superior to LS in terms of conversion. RS may be an alternative treatment for rectal cancer. Further studies are required.
文摘AIM: To compare the short- and long-term outcomes of laparoscopic and robotic surgery for middle and low rectal cancer.METHODS: This is a retrospective study on a prospectively collected database containing 111 patients who underwent minimally invasive rectal resection with total mesorectal excision (TME) with curative intent between January 2008 and December 2014 (robot, n = 53; laparoscopy, n = 58). The patients all had a diagnosis of middle and low rectal adenocarcinoma with stage I-III disease. The median follow-up period was 37.4 mo. Perioperative results, morbidity a pathological data were evaluated and compared. The 3-year overall survival and disease-free survival rates were calculated and compared.RESULTS: Patients were comparable in terms of preoperative and demographic parameters. The median surgery time was 192 min for laparoscopic TME (L-TME) and 342 min for robotic TME (R-TME) (P < 0.001). There were no differences found in the rates of conversion to open surgery and morbidity. The patients who underwent laparoscopic surgery stayed in the hospital two days longer than the robotic group patients (8 d for L-TME and 6 d for R-TME, P < 0.001). The pathologic evaluation showed a higher number of harvested lymph nodes in the robotic group (18 for R-TME, 11 for L-TME, P < 0.001) and a shorter distal resection margin for laparoscopic patients (1.5 cm for L-TME, 2.5 cm for R-TME, P < 0.001). The three-year overall survival and disease-free survival rates were similar between groups.CONCLUSION: Both L-TME and R-TME achieved acceptable clinical and oncologic outcomes. The robotic technique showed some advantages in rectal surgery that should be validated by further studies.
文摘Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery.However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless,robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.
