BMJ Surgery Interventions Health Technologies最新文献

{"title":"Novel approach to meniscal vascularity evaluation using indocyanine green fluorescence-guided knee arthroscopy.","authors":"Tamiko Kamimura","doi":"10.1136/bmjsit-2024-000351","DOIUrl":"10.1136/bmjsit-2024-000351","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to use indocyanine green (ICG) fluorescence-guided knee arthroscopy to observe the meniscus and surrounding tissue vascularity and determine correlation with the patients' backgrounds. Currently, no data are available on the clinical application of ICG fluorescence-guided knee arthroscopy in assessing meniscal vascularity.</p><p><strong>Design: </strong>Prospective, case series.</p><p><strong>Setting: </strong>In-hospital settings.</p><p><strong>Participants: </strong>41 knees of 34 patients were examined. 4 knees of 4 patients were included in a pilot study for technique refinement only, while the remaining 37 knees of 30 patients were included in the study.</p><p><strong>Main outcome measures: </strong>The times from ICG administration to fluorescence onset and fluorescence duration from onset to complete attenuation were recorded. The fluorescence intensity at the anterior, middle, and posterior segments of the meniscus was evaluated on a 4-point scale. The younger and older and smoker and non-smoker groups were compared.</p><p><strong>Results: </strong>The average fluorescence onset time was 32.05 s, whereas the average fluorescence duration was 11 min 14 s. The age groups aged≤45 and ≥46 years showed an onset of 30±24.9 and 33.17±16.2 s and a duration of 12 min 54 s and 10 min 20 s, respectively. The smoking and non-smoking groups exhibited an onset of 28.33±14.4 and 33.84±21.5 s and a duration of 10 min 37 s and 11 min 32 s, respectively. All segments of the lateral meniscus showed higher fluorescence intensities than the medial. The posterior segment of the lateral meniscus at ≤45 was markedly more fluorescent and significantly different from ≥46.</p><p><strong>Conclusions: </strong>Fluorescence was observed for approximately 30 s after intravenous ICG injection and lasted approximately 10 min. Fluorescence intensity was brighter in the posterior segment of the lateral meniscus, particularly at ≤45. ICG fluorescence-guided knee arthroscopy may assist in case-specific hemodynamics and real-time surgical evaluation of the meniscus in living humans.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000351"},"PeriodicalIF":2.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508718","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":"Correction: Factors associated with symptom-to-surgery time in patients undergoing surgical repair for acute type A aortic dissection: an exploratory analysis from a prospective cohort study.","authors":"","doi":"10.1136/bmjsit-2024-000304corr1","DOIUrl":"https://doi.org/10.1136/bmjsit-2024-000304corr1","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1136/bmjsit-2024-000304.].</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000304corr1"},"PeriodicalIF":2.1,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477098","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":"Role of indocyanine green to look for vascularity of the pancreatic stump during Whipple's procedure and its clinical implications in terms of post-pancreatectomy acute pancreatitis and postoperative pancreatic fistula.","authors":"Dhiresh Kumar Maharjan, Prabir Maharjan, Yugal Limbu, Roshan Ghimire, Prabin Bikram Thapa","doi":"10.1136/bmjsit-2024-000318","DOIUrl":"10.1136/bmjsit-2024-000318","url":null,"abstract":"<p><strong>Objectives: </strong>Post-pancreatectomy acute pancreatitis (PPAP) has been a well-defined entity by the International Study Group of Pancreatic Surgery. Underlying cause may be hypoperfusion at remnant stump of pancreas, which has been linked with additional post-pancreatectomy complications like postoperative pancreatic fistula. The primary goal was to assess the vascularity of remnant pancreas utilizing indocyanine green with near-infrared fluorescence. Indocyanine Green could aid in objectively mitigating hypoperfusion status of the pancreatic stump.</p><p><strong>Design: </strong>Hospital-based descriptive study conducted as per the revised Strengthening the Reporting of Observational Studies in Epidemiology guidelines between 1 August 2022 and 2 August 2023.</p><p><strong>Setting: </strong>This study was conducted in tertiary care centers of Kathmandu.</p><p><strong>Participants: </strong>All 43 participants who underwent pancreaticoduodenectomies were included who completed the study.</p><p><strong>Intervention: </strong>Blood supply to the remnant of the pancreas during pancreaticoduodenectomy was assessed utilizing indocyanine green, capturing distinct arterial, venous, and port venous phases, which were analyzed after 10 to 15 s of administration.</p><p><strong>Main outcome measures: </strong>In three instances, indocyanine green dye revealed unequal vascular supply at the pancreatic remnant, requiring adjustments to the margins before completing the anastomosis of the remnant pancreas and the jejunum.</p><p><strong>Results: </strong>PPAP was noticed in eight patients (18.6%), among which five patients (11.6 %) had postoperative hyperamylasemia, and three had grade B PPAP. The outcomes revealed that in the 40 patients with adequate perfusion, PPAP occurred in seven patients(16.3%), and grade B clinically relevant postoperative pancreatic fistula occurred in one patient. In contrast, among the three patients with inadequate perfusion, after revision of the pancreatic margin, PPAP was observed in one patient, and none of them had clinically relevant post-operative pancreatic fistula.</p><p><strong>Conclusion: </strong>Postoperative acute pancreatitis, ultimately exhibiting the possibility of postoperative pancreatic fistula, must be monitored with vigilance. While several elements contribute to fistula formation, ensuring sufficient vascular supply at the pancreatic remnant using indocyanine green may alleviate presumed PPAP and associated complications. The dye could aid in enhancing surgical outcomes following pancreaticoduodenectomy.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000318"},"PeriodicalIF":2.1,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303021","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":"Economic analysis of triclosan-coated versus uncoated sutures at preventing surgical site infection in patients undergoing abdominal surgery.","authors":"Mwayi Kachapila, Dmitri Nepogodiev, Bryar Kadir, Maria Picciochi, Sivesh K Kamarajah, Aneel Bhangu, Raymond Oppong","doi":"10.1136/bmjsit-2025-000383","DOIUrl":"10.1136/bmjsit-2025-000383","url":null,"abstract":"<p><strong>Objectives: </strong>A recent meta-analysis of high-quality randomized trials casts doubt on the effectiveness of triclosan-coated sutures in reducing surgical site infection (SSI). This economic analysis is aimed at assessing whether triclosan-coated sutures, compared with uncoated sutures, can reduce costs from a healthcare perspective.</p><p><strong>Design: </strong>This was a model-based economic analysis mainly informed by baseline SSI rates, effect size CIs from a recent meta-analysis of high-quality trials (OR 0.90, 95% CI 0.74 to 1.09, p=0.29), and country-specific cost data.</p><p><strong>Setting: </strong>This was a worldwide analysis that estimated average cost savings aggregated for high, middle, and low Human Development Index (HDI) countries and country-specific cost savings for the 193 countries on the HDI list.</p><p><strong>Participants: </strong>Participants were patients undergoing abdominal surgery. The analysis was informed by baseline SSI rates from an international cohort study (12 539 patients).</p><p><strong>Main outcome measures: </strong>Results are reported in 2022 US dollars as average cost differences associated with SSI between coated and uncoated sutures. Deterministic sensitivity analyses examined variations in suture cost, hospital stay costs, and effect size, with best and worst-case scenario analyses.</p><p><strong>Results: </strong>SSI-related cost differences per patient ranged from -$466 to $171 in high-HDI, -$23 to $18 in middle-HDI, and -$34 to $22 in low-HDI countries when triclosan-coated sutures were used. The largest potential savings and expenditure occurred in contaminated-dirty wounds. Similar results were observed at the national level in 184 of 193 countries. Best-case to worst-case analyses showed a range of -$533 to $192 in high-HDI, -$57 to $49 in middle-HDI and -$69 to $52 in low-HDI countries.</p><p><strong>Conclusions: </strong>This analysis highlights significant uncertainty regarding cost savings with routine use of triclosan-coated sutures, emphasizing the need for high-quality data and CI-based economic analysis in policy making.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000383"},"PeriodicalIF":2.1,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303020","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":"Brightening the path to safe liver transplants: the role of ICG fluorescence in biliary anastomosis.","authors":"Martín Huerta, Mar Dalmau, Nair Fernandes, Cristina Dopazo, Mireia Caralt, Laura Vidal, Ramón Charco, Itxarone Bilbao, Concepción Gómez-Gavara","doi":"10.1136/bmjsit-2024-000322","DOIUrl":"10.1136/bmjsit-2024-000322","url":null,"abstract":"<p><strong>Objectives: </strong>Evaluate the effectiveness of indocyanine green (ICG) fluorescence in enhancing the safety and precision of biliary anastomosis during liver transplantation (LT). The primary research question was whether ICG could provide real-time, objective assessment of bile duct vascularization to reduce postoperative biliary complications.</p><p><strong>Design: </strong>Prospective, observational case series. IDEAL Stage 1 study.</p><p><strong>Setting: </strong>Tertiary care academic medical center in Barcelona, Spain.</p><p><strong>Participants: </strong>10 adult patients who underwent LT between January 2023 and July 2024. Patients were selected based on the indication for LT with varying etiologies of liver failure. Donors included those with brain death and circulatory death (DCD).</p><p><strong>Interventions: </strong>ICG was administered intravenously as a 3 mg bolus dose to evaluate the vascularization of the bile duct stumps. Fluorescence was visualized using a high-definition camera system during surgery, and adjustments to the anastomosis site were made based on the fluorescence patterns observed.</p><p><strong>Main outcome measures: </strong>The primary outcome was the identification of non-vascularized (non-fluorescent) bile duct tissue and subsequent adjustments to the anastomosis site. Secondary outcomes included the incidence of biliary complications and patient survival during the follow-up period.</p><p><strong>Results: </strong>ICG fluorescence successfully identified non-fluorescent areas in the bile duct stumps, leading to surgical adjustments in five cases (50%), particularly in DCD grafts. The procedure was well-tolerated with no adverse events related to ICG administration. The use of ICG fluorescence added an average of 3-5 min to the operative time. No biliary complications were reported during follow-up, and patient survival was 100%.</p><p><strong>Conclusions: </strong>ICG fluorescence provides a valuable, objective tool for assessing bile duct vascularization during LT, potentially reducing biliary complications. This technique's integration into clinical practice could enhance surgical precision and improve patient outcomes. Further research is needed to confirm these findings in larger, more diverse populations.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000322"},"PeriodicalIF":2.1,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303019","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":"Factors associated with symptom-to-surgery time in patients undergoing surgical repair for acute type A aortic dissection: an exploratory analysis from a prospective cohort study.","authors":"Wilson Fandino, Tom Gilbey, Benjamin Milne, Joe Arrowsmith, Seema Agarwal, Matthew Dodd, Tim C Clayton, Gudrun Kunst","doi":"10.1136/bmjsit-2024-000304","DOIUrl":"10.1136/bmjsit-2024-000304","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Objectives: </strong>The primary objective of this study was to investigate perioperative factors associated with symptom-to-surgery (STS) time in patients diagnosed with hyper-acute aortic dissection (AAD). The secondary objective was to develop a causal model to understand the relationship between STS times and hospital mortality in this population.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Exploratory analysis of a national audit conducted by the Association of Cardiothoracic Anaesthesia and Critical Care.</p><p><strong>Participants: </strong>From a total of 270 participants diagnosed with AAD with an STS time <72 hours, 218 were included in the multivariate analysis, after excluding 52 participants with missing covariates.</p><p><strong>Main outcome measures: </strong>STS time, measured in hours. Hospital mortality at 30 days.</p><p><strong>Results: </strong>In the multivariate analysis, mean STS time for misdiagnosed patients was nearly twice as high when compared with patients who initially had the correct diagnosis (estimated proportion of change=1.9, 95% CI 1.5 to 2.3, p<0.001). STS time decreased when patients were accompanied by a medical doctor in the ambulance transfer, had mean arterial blood pressure below 70 mm Hg or presented to the emergency department (ED) with a Glasgow Coma Scale (GCS) <15. Estimated ED-to-surgery (ETS) times were 1.8 hours longer for women than for men (10.5 hours, 95% CI 9.0 to 12.0 hours vs 8.7 hours, 95% CI 7.8 to 9.6 hours). From a total of 334 patients, 64 (19.2%) died. Mortality was higher in older patients and when STS time was ≥6 and <24 hours, compared with STS time <6 hours.</p><p><strong>Conclusions: </strong>Potentially modifiable factors that may reduce STS times include avoidance of misdiagnosis and provision of a medical doctor for the ambulance transfer. Younger women had longer STS and ETS times, but further research is warranted to investigate the impact of age and sex on these times. The relationship between STS time and hospital mortality among these patients remains unclear.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000304"},"PeriodicalIF":2.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209692","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":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/bmjsit-2025-000412","DOIUrl":"10.1136/bmjsit-2025-000412","url":null,"abstract":"","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000412"},"PeriodicalIF":2.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095088","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":"Developing an innovative interventional approach for stenting trachea.","authors":"Maryam Mazraehei Farahani, Abdol-Mohammad Kajbafzadeh, Arda Kiani, Hossein Kazemizadeh, Mostafa Baghani","doi":"10.1136/bmjsit-2022-000180","DOIUrl":"10.1136/bmjsit-2022-000180","url":null,"abstract":"<p><strong>Objectives: </strong>Stenting is a method of controlling airway occlusions (CAO) that can be used alone or in combination with other treatments. There are different types of airway stents. One of the most widely used types is silicone stent. These stents are flexible and firm enough cylinders inserted into the airway by a rigid scope to relieve dyspnoea caused by CAO in malignant and non-malignant diseases. We have developed a method that can be applied quickly in remote urgent cases without a rigid scope.</p><p><strong>Design: </strong>We used two endotracheal tubes with a size of 8.5 for stenting.</p><p><strong>Setting: </strong>This research was conducted at Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Animal Lab Tehran University of Medical Sciences, Tehran, Iran (IR).</p><p><strong>Participants instead of patients or subjects: </strong>Two certified mature sheep (ewes).</p><p><strong>Interventions: </strong>Silicone stent placement for 2 months.</p><p><strong>Main outcome measures: </strong>A method with minimal facilities for stenting without limitation of trachea size.</p><p><strong>Results: </strong>A pilot animal study has been performed on two mature certified sheep to test a stenting procedure. Stenting procedures have been successfully implemented on the animals' trachea.</p><p><strong>Conclusions: </strong>We have developed a new simple, fast and cheap procedure for stenting silicon stents with minimum risk. We can easily place and rotate the stent during the procedure.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000180"},"PeriodicalIF":2.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102757","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":"Incomplete reperfusion and the presence of distal emboli in predicting clinical outcome after endovascular thrombectomy.","authors":"Amir Molaie, Salvador Miralbes, Bharath Naravetla, Alejandro M Spiotta, Christian Loehr, Mario Martínez-Galdámez, Ryan A McTaggart, Luc Defreyne, Pedro Vega, Osama O Zaidat, Paul Jenkins, Markus Möhlenbruch, Rishi Gupta, David S Liebeskind","doi":"10.1136/bmjsit-2024-000345","DOIUrl":"https://doi.org/10.1136/bmjsit-2024-000345","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the relationship between final expanded treatment in cerebral infarction (eTICI) score and the presence or absence of distal emboli on final angiography on clinical outcome after endovascular thrombectomy (EVT) for acute ischaemic stroke (AIS). Persistent distal emboli on angiography are commonly noted, yet not all patients with intermediate eTICI scores demonstrate clear angiographic emboli, raising the possibility that these angiographic differences may correlate with distinct mechanisms of 'no-reflow'. Therefore, we sought to better understand the potential clinical impact of such angiographic markers in cases of incomplete reperfusion.</p><p><strong>Design: </strong>We performed an exploratory retrospective analysis of a prospectively collected group of AIS patients who underwent EVT for M1 occlusions using the ASSIST Registry.</p><p><strong>Setting: </strong>71 sites in 11 countries participated in the registry.</p><p><strong>Participants: </strong>A total of 650 patients with M1 occlusions were included.</p><p><strong>Main outcome measures: </strong>We compared 90-day modified Rankin scale (mRS) scores based on eTICI score as well as the presence or absence of distal emboli on final angiography.</p><p><strong>Results: </strong>Clinical outcome based only on eTICI score revealed a shift in 90-day mRS, with a significant difference across eTICI scores in predicting 90-day mRS 0-2. In the intermediate eTICI grades 2b67 and 2c, there was a trend towards better 90-day mRS when emboli were present on final angiography than when emboli were absent. However, pairwise comparisons between these levels were non-significant.</p><p><strong>Conclusion: </strong>In patients with final eTICI 2b67 or 2c, those with persistent emboli trended towards better clinical outcomes. With intermediate eTICI reperfusion, identifying the presence or absence of distal emboli on final angiography may be useful in distinguishing patterns of incomplete reperfusion. These findings should be followed by investigations on correlation between angiography and other markers of microcirculatory 'no-reflow'.</p><p><strong>Trial registration number: </strong>NCT03845491.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000345"},"PeriodicalIF":2.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015305","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":"Early clinical evaluation of the Hugo robotic-assisted surgery (RAS) for performing radical prostatectomy: an IDEAL stage 2 study.","authors":"Andrew Shepherd, Ata Jaffer, Angus Bruce, Daniel Chia, Prokar Dasgupta, Ben Challacombe","doi":"10.1136/bmjsit-2024-000360","DOIUrl":"10.1136/bmjsit-2024-000360","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the feasibility and safety of the new Hugo robotic-assisted surgery (RAS) system for robotic-assisted radical prostatectomy (RARP), describing iterative changes in our operative technique-IDEAL stage 2.</p><p><strong>Design: </strong>Prospective, single-centre series.</p><p><strong>Setting: </strong>Tertiary urological unit in London, UK.</p><p><strong>Participants: </strong>Male patients diagnosed with clinically localised prostate cancer and suitable for RARP from February 2023 to May 2024.</p><p><strong>Main outcome measures: </strong>The primary outcome was to assess the safety of using the device without converting to the existing robotic platform (da Vinci), laparoscopy or open. Secondary outcomes assessed surgical (operative time, blood loss, time to catheter removal, complications), oncologic (surgical pathology and margin status) and early functional (continence) outcomes.</p><p><strong>Results: </strong>50 patients were included in the study. No cases required conversion to an existing robotic platform, laparoscopy or open, and there were no intraoperative surgical complications. Mean age was 60 years and mean prostate-specific antigen was 12.2 ng/mL. The mean operative time was 148 min and estimated blood loss was 168 mL. Mean length of stay was 1.5 days and mean length of catheter duration was 13 days. On final pathology, 18 patients (36%) had T3 disease and four had positive surgical margins (8%). The mean International Consultation on Incontinence Questionnaire-Urinary Incontinence score for urinary continence at 3 months was 7. There were six Clavien-Dindo grade 2 complications and two Clavien-Dindo 3a complications. There were four instances of recoverable, temporary device failure. Iterative improvements were made to docking setup, use of robotic instruments and reduction in robotic arm collisions.</p><p><strong>Conclusions: </strong>We demonstrated feasibility and the safe introduction of the Hugo RAS for RARP into an experienced robotic urological programme. Perioperative, early oncological and functional outcomes were similar to other early series. Further studies will aim to describe the learning curve with this robot and optimisation of surgical quality.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"7 1","pages":"e000360"},"PeriodicalIF":2.1,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804438","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}