Intelligent Surgery最新文献

{"title":"Current applications of da vinci SP surgical system in gynecologic surgery","authors":"Johnny Yi","doi":"10.1016/j.isurg.2024.06.001","DOIUrl":"https://doi.org/10.1016/j.isurg.2024.06.001","url":null,"abstract":"<div><p>Single incision surgery is a form of minimally invasive surgery performed typically through a 2–3 ​cm incision in the umbilicus. Single incision laparoscopy has significant challenges and a long learning curve due to the difficulties in triangulation and the lack of articulating instrumentation. Single site robotics attempted to overcome this with advantages of 3-D visualization and some introduction to articulating instrumentation. In 2019, the single port robotic platform (SPORT) was introduced, which has significant advantages in single incision surgery. Applications in gynecologic surgery have been described for benign, reconstructive and malignant conditions. This technology shows promise in further minimizing surgical approach for gynecologic surgery, but further level 1 studies are needed to demonstrate its place compared to other existing technologies.</p></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"7 ","pages":"Pages 43-46"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666676624000085/pdfft?md5=19f05aa1018d7efa53f909d6c065b77c&pid=1-s2.0-S2666676624000085-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141480520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted surgery for gynecological cancer","authors":"Hao Liang,&nbsp;Hang Yu,&nbsp;Jiangtao Fan","doi":"10.1016/j.isurg.2024.11.002","DOIUrl":"10.1016/j.isurg.2024.11.002","url":null,"abstract":"<div><div>With the advancements in technology and the progression of modern times, robotic surgical systems have emerged as a new trend in minimally invasive surgery and, have been applied to a variety of gynecological surgery. Robotic surgery has become a crucial treatment for gynecological cancer due to its unique advantages. This article outlines the history of minimally invasive surgery in common gynecological surgery, analyzes and summarizes the scope and current status of its application in gynecological tumor surgery. Based on the author's experience with thousands of robotic-assisted surgeries and the latest research progress, this article compares the learning curve and postoperative complications of robotic-assisted laparoscopic surgery versus traditional laparoscopic surgery. The strengths, weaknesses, and challenges faced by robotic-assisted systems in gynecological tumor surgery are also discussed. This comprehensive guidance provides valuable insights for young or novice gynecological oncologic surgeons in choosing appropriate surgical techniques for tumor procedures.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"7 ","pages":"Pages 95-100"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143148481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancements in robotic pancreaticoduodenectomy: Innovations and future directions","authors":"Hao Hu ,&nbsp;Keke Lv ,&nbsp;Tianlin He","doi":"10.1016/j.isurg.2024.10.001","DOIUrl":"10.1016/j.isurg.2024.10.001","url":null,"abstract":"<div><div>In recent years, robot-assisted surgery has advanced significantly and has emerged as a vital approach for the treatment of benign and malignant pancreatic diseases. Robotic pancreaticoduodenectomy, one of the most critical pancreatic surgical modalities, is distinguished by its high surgical difficulty and risk. The focus of recent scholarly discussions has been on ensuring the safety and feasibility of the procedure. Drawing from the expertise of our unit's primary diagnostic team, this article provides an overview of the progress in robotic pancreaticoduodenectomy, encompassing patient selections, surgical approaches, identification of significant anatomical structures, and pancreaticojejunostomy techniques.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"7 ","pages":"Pages 85-89"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A visual walkthrough of robotic partial mesorectal excision using the Versius surgical system","authors":"Amro Mureb","doi":"10.1016/j.isurg.2024.04.001","DOIUrl":"https://doi.org/10.1016/j.isurg.2024.04.001","url":null,"abstract":"<div><h3>Study objective</h3><p>To demonstrate a step-by-step surgical technique for partial mesorectal excision using the Versius robotic platform.</p></div><div><h3>Design</h3><p>Stepwise demonstration with narrated video footage.</p></div><div><h3>Setting</h3><p>Our patient is a 62-year-old male with locally advanced rectal cancer involving the middle rectum. The radiological staging was T3N2M0. The multidisciplinary team's recommendation was to give total neoadjuvant chemoradiotherapy (TNT). Post-TNT magnetic resonance image (MRI) showed significant tumour regression and flexible sigmoidoscopy showed stricture around 11 cm from the anal verge. The patient had an uneventful postoperative course and was discharged on postoperative day 3. Final histopathology staging showed a complete response, ypT0N0.</p></div><div><h3>Interventions</h3><p>The required distal margin in partial mesorectal excision (PME) is controversial. Several publications have shown that partial excision of the mesorectum, also called tumour-specific mesorectal excision (TSME), with the division of mesorectum 5 cm below the tumour could be a reasonable approach although total mesorectal excision (TME) is still considered the gold standard for all rectal cancer in many studies. A recent systematic review on distal mesorectal spread and PME showed that for partial mesorectal excision, substantial overtreatment is present if a distal margin of more than 5 cm is routinely utilized; in addition, PME has good oncological results and leads to the best-fitted functional results possible for the patient's condition.<span>1</span>, <span>2</span> Regarding the morbidity and oncological outcomes after PME, Kanso et al. showed that PME can be performed safely, with a low risk of definitive stoma and local recurrence and the survival rate that was observed, indicates that the prognosis is not altered compared with TME in the treatment of upper and some middle rectal tumour.<span>³</span> Another study evaluating the oncological outcomes of PME in patients with upper and middle rectal cancer showed that PME and shorter resection margins do not jeopardize the oncological outcomes.<span>⁴</span> Robotic colorectal surgery has gained popularity in the last few years as it overcomes most of the limitations of conventional laparoscopic surgery, especially when working in a confined, narrow pelvis. The robotic platform uses multiple technologies like 3-D and stable, precise vision, tremor filtration, and a wide range of instrument tip movement. All these features help the colorectal surgeon complete the rectal surgery more safely and effectively, and like any surgical procedure, standardization of the technique can lead to a shorter learning curve and better outcomes. In this video, we demonstrated a step-by-step approach to tumour-specific mesorectal excision operation using the Versius robotic system platform, starting the mesorectal dissection posteriorly along the plane","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"7 ","pages":"Pages 41-42"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666676624000073/pdfft?md5=bfed0bad1dd0300b44ab5e9e03889556&pid=1-s2.0-S2666676624000073-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140901430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RETML-4: Advancements in esophageal cancer surgery with four-arm robotic thoracic esophagectomy with total mediastinal lymphadenectomy","authors":"Xuefeng Leng ,&nbsp;Koshiro Ishiyama ,&nbsp;Hiroyuki Daiko","doi":"10.1016/j.isurg.2023.12.001","DOIUrl":"10.1016/j.isurg.2023.12.001","url":null,"abstract":"<div><p>Surgery remains a primary treatment for esophageal cancer. As the field has progressed from open esophagectomy (OE) to minimally invasive esophagectomy (MIE) and further to robot-assisted minimally invasive esophagectomy (RAMIE), not only has the surgeon's understanding and perception of the disease deepened, but the advancements in operative techniques have also led to improved post-operative recovery and oncological outcomes for patients. The esophageal surgery team at the National Cancer Center Hospital has elevated RAMIE to a new theoretical and practical level with their technique: esophageal cancer surgery with four-arm robotic esophagectomy with total mediastinal lymphadenectomy (RETML-4), rooted in the robotically enhanced surgical anatomy (RESA) philosophy. This article provides a comprehensive overview of the conceptual foundation and operative process of this innovative surgical approach.</p></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"7 ","pages":"Pages 7-11"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666676623000273/pdfft?md5=e19bcea7058061aa41664e6e2403bbed&pid=1-s2.0-S2666676623000273-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139015403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical technique of da Vinci robotic-assisted minimally invasive esophagectomy(RAMIE) expert experiences","authors":"Chengyuan Fang,&nbsp;Luquan Zhang,&nbsp;Hao Liang,&nbsp;Yanzhong Xin,&nbsp;Wei Zheng,&nbsp;Jianqun Ma","doi":"10.1016/j.isurg.2024.01.001","DOIUrl":"10.1016/j.isurg.2024.01.001","url":null,"abstract":"<div><p>Esophageal cancer is a prevalent disease in thoracic surgery, and surgery is currently the main treatment method. It can completely remove the tumor and improve the patient's quality of life. The da Vinci robot-assisted McKeown surgery for esophageal cancer has the advantages of less trauma, less pain, good results, faster postoperative recovery, and beautiful incisions. The da Vinci robotic system has a three-dimensional enlarged actual surgical field of view and can perform all-round operations. It has been gradually accepted to clearly observe the lesion and its relationship with surrounding tissues, nerves, and lymph nodes, safely remove the lesion, reduce nerve damage, and remove enough lymph nodes. This article will introduce the surgical experience of our center in detail.</p></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"7 ","pages":"Pages 12-20"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666676624000012/pdfft?md5=73b3d1f0c3461195cce6fd9fd5f8eb8f&pid=1-s2.0-S2666676624000012-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139454329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can \"membrane bridge\" be used to describe the connective tissue between two different embryonic compartments? An exploratory attempt to standardize the description of embryonic compartment hysterectomy","authors":"Ya Li ,&nbsp;Jing Na ,&nbsp;Xinyou Wang,&nbsp;Jun Wang,&nbsp;Shichao Han","doi":"10.1016/j.isurg.2024.09.002","DOIUrl":"10.1016/j.isurg.2024.09.002","url":null,"abstract":"<div><div>Standardized surgical procedures are crucial for preventing recurrence and ensuring a favorable prognosis in cervical cancer patients. The primary surgical challenge lies in the circumferential en bloc resection of the tissues surrounding the cervix and paravaginal area. This region's complex vascular and neural distribution increases the risk of bleeding, injury, and other surgical complications, which in turn heightens the risk of local tumor recurrence. Recently, the concept of total mesometrial resection (TMMR) guided by embryonic origin principles has shown promise in reducing postoperative recurrence rates. The technique focuses on using embryonic boundaries as surgical margins and entering through avascular planes, thereby minimizing complications while achieving favorable oncological outcomes. However, due to inconsistencies with traditional anatomical terms and surgical approaches, this method has yet to gain widespread adoption. Our team has conducted preliminary explorations into embryonic compartmental-based hysterectomy, yielding encouraging results. We have introduced the concept of the \"membrane bridge\" to standardize surgical procedures, facilitating the broader adoption of this technique. Due to the unique advantage of the three-dimensional view provided by robotic surgery, we utilized images from robotic procedures to illustrate the different \"membrane bridges.\"</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"7 ","pages":"Pages 80-84"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666676624000140/pdfft?md5=9cf58769aff8d9f6ed209dd65630acfd&pid=1-s2.0-S2666676624000140-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Totally robotic total gastrectomy with D2 lymphadenectomy for gastric cancer via da Vinci Xi platform: Technical details and perioperative outcomes","authors":"Chengcai Liang ,&nbsp;Jianrong Guo ,&nbsp;Guoming Chen ,&nbsp;Zhiwei Zhou ,&nbsp;Shuqiang Yuan","doi":"10.1016/j.isurg.2024.03.001","DOIUrl":"10.1016/j.isurg.2024.03.001","url":null,"abstract":"<div><h3>Background</h3><p>This study reported the surgical details and outcomes in a case of totally robotic total gastrectomy (TRTG) using the da Vinci Xi robotic system, aiming to share surgical experience in difficult procedures during TRTG and add evidence supporting the feasibility and safety of TRTG.</p></div><div><h3>Methods</h3><p>A 55-year-old male patient diagnosed with adenocarcinoma of gastroesophageal junction underwent TRTG via the da Vinci Xi robotic system in Sun Yat-sen University Cancer Center on January 10, 2024. The surgical details and perioperative outcomes were summarized.</p></div><div><h3>Results</h3><p>With an estimated blood loss of 100 ​ml, the operation lasted 210 ​min, including an anastomosis time of 36 ​min. During a postoperative hospital stay of 7 days, the patient started liquid diet after the removal of gastric tube on the third day. There were no perioperative complications. Postoperative radiography demonstrated no evidence of anastomotic fistulas or luminal narrowing. The final pathology revealed a 4.5∗1.5 ​cm gastric adenocarcinoma with 10/61 positive lymph nodes. The pathological stage of this patient was pT3N3aM0 IIIB.</p></div><div><h3>Conclusions</h3><p>This successful surgery reflected the effectiveness of minimally invasive surgery for total gastrectomy through a totally intracorporeal robotic approach. Future research is warranted to further validate the feasibility and safety of performing TRTG.</p></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"7 ","pages":"Pages 36-40"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666676624000061/pdfft?md5=e036fb253d85553f31ea550a0f97911d&pid=1-s2.0-S2666676624000061-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140274819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and safety evaluation of ultra-remote robot-assisted laparoscopic hysterectomy","authors":"Juyuan Huang ,&nbsp;Li'an Li ,&nbsp;Jing Cheng ,&nbsp;Jing Liao ,&nbsp;Yurou Chen ,&nbsp;Yi Peng ,&nbsp;Sha Wang ,&nbsp;Qiongyan Zou ,&nbsp;Guoyan Zhao ,&nbsp;Wei Zhao ,&nbsp;Mengya You ,&nbsp;Jingying Yang ,&nbsp;Yan Xiong ,&nbsp;Kunxian Zhang ,&nbsp;Chang Chen ,&nbsp;Jiaqiang Xiong ,&nbsp;Haotong Guan ,&nbsp;Renjie Liu ,&nbsp;Peng Zhou ,&nbsp;Wuyi Zhao ,&nbsp;Yuanguang Meng","doi":"10.1016/j.isurg.2024.09.001","DOIUrl":"10.1016/j.isurg.2024.09.001","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the safety and feasibility of ultra-remote robot-assisted laparoscopic hysterectomy using the Edge Multi-Port Endoscopic Surgical Robot MP1000 (Shenzhen Edge Medical Co., Ltd., Shenzhen, China) combined with 5G communication technology.</p></div><div><h3>Methods</h3><p>A case of remote robot-assisted laparoscopic hysterectomy was successfully completed on May 2024 by using the Edge Multi-Port Endoscopic Surgical Robot MP1000 at Zhongnan Hospital of Wuhan University and the People's Liberation Army General Hospital, approximately 1, 200 ​km apart. The procedure was simultaneously broadcast during the 36th Annual Meeting of the International Society for Gynecologic Endoscopy in Conjuction with the Peking University Gynecologic Oncology Summit Forum.</p></div><div><h3>Results</h3><p>A 49-year-old female was hospitalized in the Department of Gynecology of Zhongnan Hospital of Wuhan University for frequent urination for half a year and increased menstrual flow for over a month. The patient was diagnosed with abnormal uterine bleeding caused by multiple uterine leiomyoma and endometrial polyps, combined with moderate anemia. There were no contraindications for surgery, and the patient had surgical indications. On May 2024, the patient underwent a 5G remote robot-assisted laparoscopic hysterectomy and bilateral salpingectomy under general anesthesia. The procedure was successful, with no surgical complications and no interruptions during the live broadcast. The intraoperative blood loss was approximately 20 ​mL, and the surgery lasted about 70 ​min. The bidirectional latency during the operation was around 19 ​ms, with no adverse events related to the robot or the network. The patient recovered well postoperatively and was discharged on the fourth day with no postoperative complications.</p></div><div><h3>Conclusion</h3><p>Preliminary findings indicate that ultra-remote robot-assisted laparoscopic hysterectomy is safe and feasible with the support of 5G communication technology. This surgery represents the first globally broadcast remote procedure in the field of gynecology, marking a new milestone in the stability and safety of China's remote medical technology. Remote robotic surgery is expected to be widely promoted in the future, providing services to patients in areas with limited medical resources.</p></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"7 ","pages":"Pages 74-79"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666676624000139/pdfft?md5=41aa34e3adf031b4da9a0cc32471606d&pid=1-s2.0-S2666676624000139-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142243317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards an optimization of catheter guidance in vascular surgery: A comparative analysis of the contribution of reinforcement learning","authors":"Cheima Bouden","doi":"10.1016/j.isurg.2024.07.002","DOIUrl":"10.1016/j.isurg.2024.07.002","url":null,"abstract":"<div><h3>Background</h3><p>Precision in catheter guidance is essential for the success of vascular surgeries, yet current methods often need more accuracy due to the complex anatomy and dynamics of blood vessels.</p></div><div><h3>Methods</h3><p>This study evaluates the efficacy of advanced reinforcement learning (RL) techniques to enhance catheter navigation. We compare different RL approaches within simulated vascular environments, focusing on their success rates, operational efficiency, and adaptability to varied clinical scenarios.</p></div><div><h3>Results</h3><p>Advanced reinforcement learning techniques display exceptional performance, yielding high success rates and improved precision in catheter guidance. Integrating specific enhancements has notably increased learning speeds and strengthened operational robustness.</p></div><div><h3>Conclusion</h3><p>The study indicates that reinforcement learning could significantly improve the precision and safety of catheter navigation in vascular surgery. By adopting these techniques, medical practices could see more accurate and less invasive procedures, enhancing patient outcomes. Future research should aim to refine these algorithms for wider clinical use and integration.</p></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"7 ","pages":"Pages 53-61"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666676624000103/pdfft?md5=0f3cdcc44d34ed2f9c653d8069a2d199&pid=1-s2.0-S2666676624000103-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}