Journal of Robotic Surgery最新文献

{"title":"Development and validation of a novel comorbidity score specific for prostate cancer patients treated with robotic platform and its implication on DaVinci single-port system.","authors":"Donato Cannoletta, Elio Mazzone, Paolo Dell'Oglio, Greta Pettenuzzo, Matteo Pacini, Luca Lambertini, Antony Angelo Pellegrino, Ruben Calvo Sauer, Juan R Torres-Anguiano, Armando Stabile, Francesco Pellegrino, Giorgio Gandaglia, Riccardo Bartoletti, Andrea Minervini, Alessandro Antonelli, Francesco Montorsi, Alberto Briganti, Simone Crivellaro","doi":"10.1007/s11701-024-02152-w","DOIUrl":"https://doi.org/10.1007/s11701-024-02152-w","url":null,"abstract":"<p><p>To develop and validate a novel Comorbidity score for Robotic Surgery (CRS) in predicting severe complications after robot-assisted radical prostatectomy (RARP). Furthermore, we investigated the impact of the surgical platform (Multi-Port - MP vs Single-Port - SP) according to this score. We included 2085 (\"development cohort\") and 595 (\"validation cohort\") patients undergoing RARP at two tertiary referral centers between 2014 and March 2024 in a retrospective study. Statistical analyses included validation of the Charlson Comorbidity Index (CCI) to predict 30-day severe complications (Clavien-Dindo ≥ 3a), development and external validation of CRS using calibration plots and decision curve analysis. Lastly, locally weighted scatterplot smoothing (LOWESS) analysis was used to graphically explore the impact of the robotic platform according to novel CRS. CCI exhibited limited predictive ability for severe complications (60% in the validation cohort). In multivariable logistic regression analyses testing the correlation between each condition included in CCI and severe complications, diabetes and myocardial infarction resulted as independent predictors (OR 1.75 [95%CI 1.05-2.82]; OR 1.92 [95%CI 1.26-2.88]) and were subsequently fitted into a multivariable logistic model including age, previous abdominal surgery and obesity (BMI > 30). The resulting predictive model demonstrated superior discrimination and clinical net benefit in predicting severe complications compared to CCI (AUC 64 vs 60%). At LOWESS analysis, SP platform was associated with lower risk of severe complications as CRS increased compared to MP system. The validated CRS showed better accuracy compared to CCI in predicting severe complications after RARP. Additionally, the use of SP robotic platform may reduce the risk of severe complications in highly comorbid patients according to CRS.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"18 1","pages":"400"},"PeriodicalIF":2.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual cues of soft-tissue behaviour in minimal-invasive and robotic surgery.","authors":"Robin Julia Trute, Afshin Alijani, Mustafa Suphi Erden","doi":"10.1007/s11701-024-02150-y","DOIUrl":"10.1007/s11701-024-02150-y","url":null,"abstract":"<p><p>Minimal-invasive surgery (MIS) and robotic surgery (RS) offer multiple advantages over open surgery (Vajsbaher et al. in Cogn Syst Res 64:08, 2020). However, the lack of haptic feedback is still a limitation. Surgeons learn to adapt to this lack of haptic feedback using visual cues to make judgements about tissue deformation. Experienced robotic surgeons use the visual interpretation of tissue as a surrogate for tactile feedback. The aim of this review is to identify the visual cues that are consciously or unconsciously used by expert surgeons to manipulate soft tissue safely during Minimally Invasive Surgery (MIS) and Robotic Surgery (RS). We have conducted a comprehensive literature review with papers on visual cue identification and their application in education, as well as skill assessment and surgeon performance measurement with respect to visual feedback. To visualise our results, we provide an overview of the state-of-the-art in the form of a matrix across identified research features, where papers are clustered and grouped in a comparative way. The clustering of the papers showed explicitly that state-of-the-art research does not in particular study the direct effects of visual cues in relation to the manipulation of the tissue and training for that purpose, but is more concentrated on tissue identification. We identified a gap in the literature about the use of visual cues for educational design solutions, that aid the training of soft-tissue manipulation in MIS and in RS. There appears to be a need RS education to make visual cue identification more accessible and set it in the context of manipulation tasks.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"18 1","pages":"401"},"PeriodicalIF":2.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11543711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for conversion from minimally invasive surgery to thoracotomy in patients with lung cancer: outcomes from a pooled analysis.","authors":"Zhigang Lu, Jia-Yang Sun","doi":"10.1007/s11701-024-02131-1","DOIUrl":"10.1007/s11701-024-02131-1","url":null,"abstract":"<p><p>The purpose of this study is to explore the risk factors for conversion from minimally invasive surgery to thoracotomy in patients with lung cancer through meta-analytic approach, and provide a better evidence-based basis for clinicians to perform surgery. We conducted a comprehensive search across databases including PubMed, Embase, Web of Science, and the Cochrane Library database to identify relevant English-language studies published up to February 2024. The pooled effect estimate was calculated using the odds ratio (OR) and a 95% confidence interval (CI). We also conducted sensitivity, subgroup, and publication bias tests. Meta-analysis was performed by using stata18MP software. The study was registered with PROSPERO(ID: CRD42024524790). We included a total of 8 studies. We discovered that gender (OR: 1.58; 95% CI: 1.23-2.03; P < 0.001), chronic obstructive pulmonary disease (COPD) (OR: 1.13; 95% CI: 1.04-1.23; P = 0.005), location of the tumor (OR: 1.21; 95% CI: 1.12-1.31; P < 0.001) were all linked to an increased risk of conversion. Additionally, the type of surgery (OR: 0.14; 95% CI: 0.05-0.39; P < 0.001) was associated with a reduced risk of conversion. Nevertheless, age, smoking, and obesity showed no association with the risk of conversion. The current meta-analysis suggests that the male gender, COPD, upper lobe tumor location, and the video-assisted approach are risk factors for conversion from minimally invasive surgery to thoracotomy in patients with lung cancer. More high-quality studies are required to validate the above results due to the limited number and types of studies included.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"18 1","pages":"399"},"PeriodicalIF":2.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel low-cost high-fidelity porcine model of liver metastases for simulation training in robotic parenchyma-preserving liver resection.","authors":"R M O'Connell, S Horne, D A O'Keeffe, N Murphy, M Voborsky, C Condron, C A Fleming, J B Conneely, B B McGuire","doi":"10.1007/s11701-024-02151-x","DOIUrl":"https://doi.org/10.1007/s11701-024-02151-x","url":null,"abstract":"<p><p>In the era of minimally invasive surgery (MIS), parenchyma-preserving liver resections are gaining prominence with the potential to offer improved perioperative outcomes without compromising oncological safety. The surgeon learning curve remains challenging, and simulation plays a key role in surgical training. Existing simulation models can be limited by suboptimal fidelity and high cost. We describe a novel, reproducible, high-fidelity, low-cost liver metastases model using porcine livers from adult Landrace pigs, with porcine perinephric fat used to simulate subcapsular metastases. This model was then utilised in a training session for surgical trainees performing robotic parenchyma-preserving surgery (PPS) under the guidance of expert robotic surgeons, with feedback being recorded. Trainees rated the model highly on its fidelity to human liver simulation (median score 9), tissue handling (median score 8), and overall usefulness (median score 9). Tissue handling was felt to simulate in vivo liver resection closely, while suggestions for improvement included adding simulated blood flow. This is a novel, low-cost, high-fidelity simulation model of liver metastases with high acceptability to surgical trainees, which could be readily adopted by other training centres.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"18 1","pages":"394"},"PeriodicalIF":2.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subcutaneous emphysema in patients undergoing robotic cardiac surgery: risk factors and clinical outcome.","authors":"Martin Winter, Thomas E Rubino, Danielle Miller, Gabin Yun, Keith Dufendach, Nicholas Hess, Sarah Yousef, Ernest Chan, Veronica Garvia Bianchini, Christina Thorngren, Holt Murray, Stephen Waterford, David Kaczorowski, Ibrahim Sultan, Johannes Bonatti","doi":"10.1007/s11701-024-02112-4","DOIUrl":"https://doi.org/10.1007/s11701-024-02112-4","url":null,"abstract":"<p><p>Little is known about the incidence of subcutaneous emphysema (SE) after robotic cardiac surgery. The aim of this study was to describe the incidence, identify risk factors, and assess its influence on postoperative outcomes. Patients undergoing robotic mitral valve repair (n = 63, 54.3%), robotic minimally invasive direct coronary artery bypass grafting (n = 23, 19.8%), and robotic totally endoscopic coronary artery bypass grafting (n = 30,25.9%) were included in the analysis (total n = 116). Subcutaneous emphysema occurred in 53/116 patients (45.7%). It was mild in 30/53 patients (56.6%), moderate in one patient (1.9%), and severe in 22/53 patients (41.5%). Low body weight (p = 0.009), low BMI (p = 0.006), small body surface area (p = 0.01), and older age (p = 0.041) significantly correlated with SE. Patients undergoing robotic mitral valve repair were affected more often than patients undergoing robotic coronary artery bypass grafting (p = 0.04). Severe subcutaneous emphysema resulted in an increased need for CT-chest imaging (p = 0.026), and additional chest tubes (p = 0.029). Severe emphysema was highly associated with pneumothorax (p < 0.001) and increased duration of chest tube drainage (p = 0.003). Subcutaneous emphysema after robotic heart surgery occurs preferentially in patients with low body weight, low BMI, a small body surface area, and older age and is more common in robotic MVR than in robotic coronary artery bypass surgery. It leads to an increased need for thoracic imaging and additional chest tube insertion. Clinical outcomes are not affected.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"18 1","pages":"395"},"PeriodicalIF":2.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telesurgery: humanitarian and surgical benefits while navigating technologic and administrative challenges.","authors":"Shady Saikali, Marcio Covas Moschovas, Ahmed Gamal, Sumeet Reddy, Travis Rogers, Vipul Patel","doi":"10.1007/s11701-024-02156-6","DOIUrl":"10.1007/s11701-024-02156-6","url":null,"abstract":"<p><p>Telesurgery, the remote execution of surgical procedures through telecommunication and robotic systems, has witnessed substantial growth in recent years, promising to address global healthcare disparities and enhance surgical expertise. This paper explores the humanitarian and surgical benefits of telesurgery, emphasizing its potential to provide expert surgical care to underserved regions. Despite its transformative potential, telesurgery faces significant technologic challenges, including issues of data transmission, latency, and the need for advanced robotic platforms. The advent of 5G networks and innovative robotic systems provides a promising technological landscape, yet global disparities in 5G coverage remain a concern. Ethical considerations, ranging from preserving the surgeon-patient relationship to addressing patient vulnerability and conflicts of interest, are pivotal aspects that demand attention. The paper underscores the importance of clear regulatory frameworks and international collaboration to navigate legal complexities and ensure ethical standards. As telesurgery progresses, integrating artificial intelligence, augmented reality, and haptic feedback technologies holds promise for further advancements. Despite these challenges, telesurgery has the potential to achieve equitable access to expert surgical care; however, it requires a collective effort to overcome its intricate technologic and administrative hurdles.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"18 1","pages":"393"},"PeriodicalIF":2.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Delphi-based exploration of factors impacting blood loss and operative time in robotic prostatectomy.","authors":"Latif Al-Hakim, Zhewei Zhang, Jiaquan Xiao, Shomik Sengupta, Benjamin W Lamb","doi":"10.1007/s11701-024-02145-9","DOIUrl":"https://doi.org/10.1007/s11701-024-02145-9","url":null,"abstract":"<p><p>This study aims to investigate factors influencing the implementation of robotic-assisted radical surgery, with a specific focus on their effects on blood loss and operative time. Radical prostatectomy was chosen as the case study due to its complexity and diverse surgical activities. The study employed a three-round Delphi approach involving 25 surgeons from three countries: UK, Australia, and China. The collected data were analysed using non-parametric tests. The Delphi study showed significant correlations between the degree of difficulty and blood loss (Z = 2.698, ρ < 0.007), as well as between team coordination and blood loss (Z = 3.499, ρ < 0.0001). However, no significant relationship was found between operative time and blood loss. Surgeons reported that neurovascular bundle (NVB) release and pelvic lymph node dissection require high team coordination. NVB release is particularly challenging and poses a higher risk of blood loss. Additionally, a large prostate increases the difficulty of prostate dissection, prolongs operative time for bladder neck and NVB dissection, and leads to a considerable overall increase in operative time. The manuscript shows that effective team coordination plays a crucial role in reducing blood loss and operative time during surgical activities. When the team coordinates well, clear and efficient verbal communication suffices, reducing the need for physical proximity during robotic-assisted surgeries.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"18 1","pages":"392"},"PeriodicalIF":2.2,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the feasibility and acceptability of a hands-on surgical robotics workshop for medical students and early-career doctors.","authors":"Nyi Tun San, Khandakar Rezwanur Rahman, Joseph Ryan Wong Sik Hee, Krupali Brahmbhatt, Jefferson George, Amna Mahmood, Max Seabrook, David James Bowrey","doi":"10.1007/s11701-024-02134-y","DOIUrl":"https://doi.org/10.1007/s11701-024-02134-y","url":null,"abstract":"<p><p>Despite the increased adoption of robotic surgery across various specialities, medical students and early-career doctors have limited exposure. This study aims to assess the feasibility and acceptability of a hands-on surgical robotics workshop for those early-career medics. 26 participants with minimal prior exposure to robotic surgery attended a workshop using the Versius^© robotic surgical system and Virtual Reality simulation platforms. We analysed pre-workshop registration form and post-workshop feedback form utilising mixed quantitative and qualitative approach. Pre-workshop registration revealed motivations and barriers to attending surgical robotics courses. Post-workshop evaluations showed significant improvements in self-assessment scores, familiarity with robotic surgery, and confidence in using the technology. All participants expressed a strong enthusiasm for greater access to robotic surgery education and 84% of participants strongly agreed this workshop increased their interests in surgical specialities. The study also highlighted the perceived ease of use of robotic systems compared to laparoscopic instruments and explored the potential of virtual reality in surgical training. Further efforts are needed for better integration of robotic surgery training into medical curricula to prepare future surgeons for the evolving surgical landscape.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"18 1","pages":"390"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning curve of multiple surgeons for robot-assisted radical prostatectomy using the cumulative sum method: a retrospective single-institution study.","authors":"Takashi Nagai, Toshiki Etani, Nobuhiko Shimizu, Masakazu Gonda, Maria Aoki, Toshiharu Morikawa, Shoichiro Iwatsuki, Kazumi Taguchi, Taku Naiki, Kentaro Mizuno, Ryosuke Ando, Atsushi Okada, Noriyasu Kawai, Keiichi Tozawa, Takahiro Yasui","doi":"10.1007/s11701-024-02122-2","DOIUrl":"https://doi.org/10.1007/s11701-024-02122-2","url":null,"abstract":"<p><p>Prostate cancer (PC) is common among men and has become a significant societal issue. Localized PC has a good prognosis with appropriate treatment. Prostatectomy, particularly robot-assisted radical prostatectomy (RARP), has become a common treatment since the da Vinci prostatectomy was approved by the FDA in 2001. The current study aimed to assess the learning curve for RARP, focusing on anastomosis time, using the cumulative sum (CUSUM) method. Data were collected from Nagoya City University Hospital between May 2011 and December 2018 and included 469 surgeries performed by experienced surgeons. Our findings indicated that, on average, 11 patients were required to complete the initial phase and 24 patients were required to complete the consolidation phase of anastomosis. Additionally, for complete resection of pT2c cases, 16 cases were required for the initial phase and 27 cases were required for the consolidation phase. The CUSUM method proved useful for visualizing trends in surgical proficiency, although the study noted potential confounding biases and limitations in evaluating surgical proficiency based solely on surgical time or positive surgical margins.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"18 1","pages":"389"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the efficacy of telesurgery with dual console SSI Mantra Surgical Robotic System: experiment on animal model and clinical trials.","authors":"Sudhir Prem Srivastava, Vishwajyoti Pascual Srivastava, Avinesh Singh, Suraj Dwivedi, Munish Batra, Shivam Gupta, Sonu Singh, Shubhankar Sanjiv Kulkarni, Anson Paul, Amit Kumar, Manjusha Agwan","doi":"10.1007/s11701-024-02148-6","DOIUrl":"10.1007/s11701-024-02148-6","url":null,"abstract":"<p><p>The field of robotic surgery has grown exponentially over the past few decades. Surgical robots offer numerous benefits that enhance surgical precision, improve patient outcomes, and expand the capabilities of surgeons. Telesurgery, also known as a remote surgery, is a branch of telemedicine, which offers to perform surgical procedures requiring expertise of a surgeon located at a distance from a patient by using robotic systems and telecommunications technology. In a previous reported case, an animal experiment and clinical trial telesurgery using a dual console were performed. However, the mean latency time and data packet loss were considerably high. As a result, the performance of the telesurgery got severely impacted. This paper evaluates the feasibility, safety, and efficacy of remote telesurgery to precisely carryout predetermined surgical procedures using dual console SSI Mantra Surgical Robotic System. The trials were registered prospectively with trial registration number CTRI-2024-06-068361.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"18 1","pages":"391"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}