{"title":"Robot-assisted ureteroureterostomy in pediatric patients: current perspectives.","authors":"Jonathan S Ellison, Thomas S Lendvay","doi":"10.2147/RSRR.S99536","DOIUrl":"https://doi.org/10.2147/RSRR.S99536","url":null,"abstract":"<p><p>Developments in pediatric robotic surgery have increased the feasibility of minimally invasive surgery for complex urinary tract reconstruction. Ureteroureterostomy is a commonly employed strategy for the management of a duplicated ureteral system with either upper pole obstruction or lower pole vesicoureteral reflux, and this approach minimizes the risk to a healthy ureter as might be seen in a common sheath ureteral reimplant and avoids complex dissection around the renal hilum as with a heminephrectomy. The robotic platform enables optimum instrument manipulation for an end-to-side ureteral anastomosis as well as excellent visualization deep into the pelvis for excision of the distal ureteral stump. In this study, the indications and preoperative evaluation for pediatric robotic ureteroureterostomy (RUU) were described and intraoperative considerations for a successful repair were highlighted. In order to assess the outcomes, a PubMed search was performed to find the articles focusing on RUU in the pediatric population. The institutional experience of the authors was also reviewed. As with an open procedure, both minimizing dissection on the recipient ureter and ensuring a tension-free, watertight anastomosis are key principles to minimize complications. Although port placement is similar to that in robotic pyeloplasty, small adjustments may need to be made to ensure access to the pelvis. An assistant port and/or traction sutures is often used to aid in the dissection and anastomosis. RUU was first described in 2008, and several reports have demonstrated positive short-term results. However, median follow-up times are limited with most series reporting outcomes <1 year postoperatively. A future study is required to establish the long-term efficacy of this procedure and define the optimum patient population for a robotic approach.</p>","PeriodicalId":92137,"journal":{"name":"Robotic surgery (Auckland)","volume":"4 ","pages":"45-55"},"PeriodicalIF":0.0,"publicationDate":"2017-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/RSRR.S99536","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36909985","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":"Training the next generation of surgeons in robotic surgery.","authors":"Benjamin T Carpenter, Chandru P Sundaram","doi":"10.2147/RSRR.S70552","DOIUrl":"https://doi.org/10.2147/RSRR.S70552","url":null,"abstract":"<p><strong>Context: </strong>Robotic surgery has been used with rapidly increasing frequency within urology and across many other surgical specialties. A standardized curriculum for the training and credentialing of robotic surgeons has unfortunately trailed far behind the adoption of this surgical technology.</p><p><strong>Objective: </strong>To review the current available surgical skills training models, assessments, and curricula for the purpose of training resident, fellow, and practicing surgeons in an effort to promote surgical skill proficiency and mastery and to minimize the risk of patient harm.</p><p><strong>Evidence acquisition: </strong>We performed a thorough review of available literature through a PubMed database search in February 2015.</p><p><strong>Evidence synthesis: </strong>In this article, we compiled and scrutinized the available relevant literature regarding past and present robotic surgical training techniques and credentialing criteria. This review details the basic surgical skills (both technical and nontechnical) that are necessary for individuals and teams to be successful in the operative setting. We go on to discuss the role of current robotic surgical training techniques including dry lab and virtual simulators. Finally, we offer current validated training curricula, the Global Evaluative Assessment of Robotic Skills and Fundamentals of Robotic Surgery models, which have laid the groundwork for a future standardized model that could be applied on a national and international level and across several surgical subspecialties. The ultimate goal of the review is to provide a foundation from which a future standardized training and credentialing curriculum could be based.</p><p><strong>Conclusion: </strong>There is currently a great need for a standardized curriculum to be developed and employed for the use of training and credentialing future and current robotic surgeons.</p>","PeriodicalId":92137,"journal":{"name":"Robotic surgery (Auckland)","volume":"4 ","pages":"39-44"},"PeriodicalIF":0.0,"publicationDate":"2017-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/RSRR.S70552","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36909983","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}
Thomas E J Ind, Chris Marshall, Matthew Hacking, Selina Chiu, Michelle Harris, Marielle Nobbenhuis
{"title":"The effect of obesity on clinical and economic outcomes in robotic endometrial cancer surgery.","authors":"Thomas E J Ind, Chris Marshall, Matthew Hacking, Selina Chiu, Michelle Harris, Marielle Nobbenhuis","doi":"10.2147/RSRR.S123108","DOIUrl":"https://doi.org/10.2147/RSRR.S123108","url":null,"abstract":"<p><p>The aim of this study was to compare the financial and clinical outcomes in robotic-assisted laparoscopic surgery for primary endometrial cancer between obese and nonobese women. The hospital finance department assessed the total admission costs for robotic surgery for endometrial cancer in 54 women. This included a subanalysis for costs over nine areas (ward and clinics, drugs and pharmacy, medical staff, theaters, blood products, imaging, pathology, rehabilitation therapy, and high dependency costs). Furthermore, a prospective collection of morbidity and surgical outcome data was performed. The study group included 21 nonobese and 33 obese women (body mass index >30). Obese women were more likely to stay for more than one night in hospital (20/33 [60.6%] compared to 4/21 [19.0%], <i>P</i>=0.032) and to have high dependency care (25/33 [75.8%] compared to 10/21 [47.6%], <i>P</i>=0.032). Theater time was on average 35 min longer (95% confidence interval [CI] 5-65 min, <i>P</i>=0.0252). Both the groups were comparable for comorbidities except for the presence of diabetes being present in the obese group (13/33 [39.4%] compared to 0/21 [0.0%], <i>P</i>=0.007). There were six Clavien-Dindo grade II complications in the obese group and two in the nonobese group. The average overall costs were £1,852 greater (95% CI £431-£3,277, <i>P</i>=0.012) in the obese group. Diabetes and hypertension were associated with increased costs, but obesity was the only independent variable. In conclusion, greater resource should be allocated to obese women undergoing primary surgery for endometrial cancer.</p>","PeriodicalId":92137,"journal":{"name":"Robotic surgery (Auckland)","volume":"4 ","pages":"33-37"},"PeriodicalIF":0.0,"publicationDate":"2017-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/RSRR.S123108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36909981","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":"Robotics in reproduction, fertility preservation, and ovarian transplantation.","authors":"Enes Taylan, Kutluk H Oktay","doi":"10.2147/RSRR.S123703","DOIUrl":"https://doi.org/10.2147/RSRR.S123703","url":null,"abstract":"<p><p>Robotic technology is one of the most promising and rapidly developing advancements of the twenty-first century with a potential to make significant contributions to reproductive surgery and preservation of fertility. Along with the major advances in cancer therapy, the number of female cancer survivors of reproductive age has dramatically increased. As a consequence, fertility preservation has gained more emphasis in reproductive science in the last few decades. A broad range of surgical procedures such as tubal reanastomosis, ovarian transposition, radical trachelectomy, and ovarian transplantation has been introduced to restore or preserve fertility in selected patients. These procedures can be accomplished through various surgical routes, including open surgery and minimally invasive approaches. In this review, we aim to present the current applications, advantages, and disadvantages of robotic technology in the field of reproductive surgery with a special interest in ovarian transplantation for fertility preservation.</p>","PeriodicalId":92137,"journal":{"name":"Robotic surgery (Auckland)","volume":"4 ","pages":"19-24"},"PeriodicalIF":0.0,"publicationDate":"2017-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/RSRR.S123703","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36909982","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}
Sara E Arian, Jessian L Munoz, Suejin Kim, Tommaso Falcone
{"title":"Robot-assisted laparoscopic myomectomy: current status.","authors":"Sara E Arian, Jessian L Munoz, Suejin Kim, Tommaso Falcone","doi":"10.2147/RSRR.S102743","DOIUrl":"https://doi.org/10.2147/RSRR.S102743","url":null,"abstract":"<p><p>Robotic-assisted surgery has seen a rapid development and integration in the field of gynecology. Since the approval of the use of robot for gynecological surgery and considering its several advantages over conventional laparoscopy, it has been widely incorporated especially in the field of reproductive surgery. Uterine fibroids are the most common benign tumors of the female reproductive tract. Many reproductive-aged women with this condition demand uterine-sparing surgery to preserve their fertility. Myomectomy, the surgical excision of uterine fibroids, remains the only surgical management option for fibroids that entails preservation of fertility. In this review, we focus on the role of robotic-assisted laparoscopic myomectomy and its current status, in comparison with other alternative approaches for myomectomy, including open, hysteroscopic, and traditional laparoscopic techniques. Several different surgical techniques have been demonstrated for robotic myomectomy. This review endeavors to share and describe our surgical experience of using the standard laparoscopic equipment for robotic-assisted myomectomy, together with the da Vinci Robot system. For the ideal surgical candidate, robotic-assisted myomectomy is a safe minimally invasive surgical procedure that can be offered as an alternative to open surgery. The advantages of using the robot system compared to open myomectomy include a shorter length of hospital stay, less postoperative pain and analgesic use, faster return to normal activities, more rapid return of the bowel function, and enhanced cosmetic results due to smaller skin incision sizes. Some of the disadvantages of this technique include high costs of the robotic surgical system and equipment, the steep learning curve of this novel system, and prolonged operative and anesthesia times. Robotic technology is a novel and innovative minimally invasive approach with demonstrated feasibility in gynecological and reproductive surgery. This technology is expected to take the lead in gynecological surgery in the upcoming decade.</p>","PeriodicalId":92137,"journal":{"name":"Robotic surgery (Auckland)","volume":"4 ","pages":"7-18"},"PeriodicalIF":0.0,"publicationDate":"2017-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/RSRR.S102743","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36909980","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 adrenalectomy: current perspectives.","authors":"Mrinal Pahwa","doi":"10.2147/RSRR.S100887","DOIUrl":"https://doi.org/10.2147/RSRR.S100887","url":null,"abstract":"<p><p>Laparoscopy has established itself as the procedure of choice for performing adrenalectomy in benign adrenal disorders. Although laparoscopy scores heavily over open approach in terms of lesser blood loss, pain, shorter hospital stay and better cosmesis, it is riddled with certain shortcomings such as the need of dexterity, two-dimensional vision, dependence on an assistant for camera, etc. Robotic surgery promises to overcome these limitations. Multiple series have established that robotic adrenalectomy is a safe and effective procedure as conventional laparoscopy. Recently, robotic surgery has been found to be precise and accurate in performing partial adrenalectomy in hereditary adrenal syndrome cases. Other advances like single-port surgery have expanded the horizon and indications of robotic surgery. This review aims at studying the current evidence available for the effectiveness of robot-assisted adrenalectomy and defining its current status in managing adrenal disorders.</p>","PeriodicalId":92137,"journal":{"name":"Robotic surgery (Auckland)","volume":"4 ","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2017-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/RSRR.S100887","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36958003","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}
Craig A Lehocky, Wendy Fellows-Mayle, Johnathan A Engh, Cameron N Riviere
{"title":"Tip Design for Safety of Steerable Needles for Robot-Controlled Brain Insertion.","authors":"Craig A Lehocky, Wendy Fellows-Mayle, Johnathan A Engh, Cameron N Riviere","doi":"10.2147/RSRR.S141085","DOIUrl":"https://doi.org/10.2147/RSRR.S141085","url":null,"abstract":"<p><strong>Background: </strong>Current practice in neurosurgical needle insertion is limited by the straight trajectories inherent with rigid probes. One technique allowing curvilinear trajectories involves flexible bevel-tipped needles, which bend during insertion due to their asymmetry. In the brain, safety will require avoidance of the sharp tips often used in laboratory studies, in favor of a more rounded profile. Steering performance, on the other hand, requires maximal asymmetry. Design of safe bevel-tipped brain needles thus involves management of this tradeoff by adjusting needle gauge, bevel angle, and fillet (or tip) radius to arrive at a design that is suitably asymmetrical while producing strain, strain rate, and stress below the levels that would damage brain tissue.</p><p><strong>Methods: </strong>Designs with a variety of values of needle radius, bevel angle, and fillet radius were evaluated in finite-element simulations of simultaneous insertion and rotation. Brain tissue was modeled as a hyperelastic, linear viscoelastic material. Based on the literature available, safety thresholds of 0.19 strain, 10 s<sup>-1</sup> strain rate, and 120 kPa stress were used. Safe values of needle radius, bevel angle, and fillet radius were selected, along with an appropriate velocity envelope for safe operation. The resulting needle was fabricated and compared with a Sedan side-cutting brain biopsy needle in a study in the porcine model in vivo (<i>N</i>=3).</p><p><strong>Results: </strong>The prototype needle selected was 1.66 mm in diameter, with bevel angle of 10° and fillet radius of 0.25 mm. Upon examination of postoperative CT and histological images, no differences in tissue trauma or hemorrhage were noted between the prototype needle and the Sedan needle.</p><p><strong>Conclusions: </strong>The study indicates a general design technique for safe bevel-tipped brain needles based on comparison with relevant damage thresholds for strain, strain rate, and stress. The full potential of the technique awaits the determination of more exact safety thresholds.</p>","PeriodicalId":92137,"journal":{"name":"Robotic surgery (Auckland)","volume":"4 ","pages":"107-114"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/RSRR.S141085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35639195","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}
Brian M Shinder, Nicholas J Farber, Robert E Weiss, Thomas L Jang, Isaac Y Kim, Eric A Singer, Sammy E Elsamra
{"title":"Performing all major surgical procedures robotically will prolong wait times for surgery.","authors":"Brian M Shinder, Nicholas J Farber, Robert E Weiss, Thomas L Jang, Isaac Y Kim, Eric A Singer, Sammy E Elsamra","doi":"10.2147/RSRR.S135713","DOIUrl":"https://doi.org/10.2147/RSRR.S135713","url":null,"abstract":"<p><p>This article aimed to assess the burden of scheduling major urologic oncology procedures if all cases were performed robotically and to determine whether this would increase the time a patient would have to wait for surgery. We retrospectively determined the number of prostatectomies, radical nephrectomies, partial nephrectomies, and cystectomies at a single institution for one calendar year. A hypothetical situation was then constructed where all procedures were performed robotically. Using the allotted number of days that each surgeon was able to schedule robotic procedures, we analyzed the amount of time it would take to schedule and complete all cases. Five fellowship-trained surgeons were included in the study and accounted for 317 surgical cases. Three of the surgeons had dedicated robotic surgery (RS) time (block time), while two surgeons scheduled when there was non-dedicated RS time (open time) available. If all cases were performed robotically an additional 32 days would be needed, which could significantly increase the wait time to surgery. The limited number of robotic systems available in most hospitals creates a bottleneck effect; whereby increasing the number of cases would considerably lengthen the waiting time patients have for surgery. As RS becomes increasingly more commonplace in urology and other surgical fields, this could create a significant problem for health care systems.</p>","PeriodicalId":92137,"journal":{"name":"Robotic surgery (Auckland)","volume":"4 ","pages":"87-91"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/RSRR.S135713","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35340130","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}
Dwight A Meglan, Wener Lv, Richard J Cohen, Cameron N Riviere
{"title":"Techniques for epicardial mapping and ablation with a miniature robotic walker.","authors":"Dwight A Meglan, Wener Lv, Richard J Cohen, Cameron N Riviere","doi":"10.2147/RSRR.S127047","DOIUrl":"https://doi.org/10.2147/RSRR.S127047","url":null,"abstract":"<p><strong>Background: </strong>Present treatments for ventricular tachycardia have significant drawbacks. To ameliorate these drawbacks, it may be advantageous to employ an epicardial robotic walker that performs mapping and ablation with precise control of needle insertion depth. This paper examines the feasibility of such a system.</p><p><strong>Methods: </strong>This paper describes techniques for epicardial mapping and depth-controlled ablation with the robotic walker. The mapping technique developed for the current form of the system uses a single equivalent moving dipole model combined with the navigation capability of the walker. The intervention technique provides saline-enhanced radio frequency ablation, with sensing of needle penetration depth. The mapping technique was demonstrated in an artificial heart model with a simulated arrhythmia focus, followed by preliminary testing in the porcine model in vivo. The ablation technique was demonstrated in an artificial tissue model, and then in chicken breast tissue ex vivo.</p><p><strong>Results: </strong>The walker located targets to within 2 mm using the SEMDM technique. No epicardial damage was found subsequent to the porcine trial in vivo. Needle insertion for ablation was controlled to within 2 mm of the target depth. Lesion size was repeatable, with diameter varying consistently in proportion to volume of saline injected.</p><p><strong>Conclusions: </strong>The experiments demonstrated the general feasibility of the techniques for mapping and depth-controlled ablation with the robotic walker.</p>","PeriodicalId":92137,"journal":{"name":"Robotic surgery (Auckland)","volume":"4 ","pages":"25-31"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/RSRR.S127047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35459038","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":"Management of pelvic organ prolapse in the elderly - is there a role for robotic-assisted sacrocolpopexy?","authors":"Hadley Narins, Teresa L Danforth","doi":"10.2147/RSRR.S81584","DOIUrl":"https://doi.org/10.2147/RSRR.S81584","url":null,"abstract":"<p><p>Abdominal sacrocolpopexy is considered the gold standard treatment for symptomatic pelvic organ prolapse (POP). Since its introduction, robotic-assisted sacrocolpopexy has emerged as a popular minimally invasive alternative to open repair. Epidemiologic data suggest that the number of women seeking surgical treatment for POP will increase to ~50% by 2050, and many of these women will be elderly. Advanced age should not preclude elective POP surgery. Substantial data suggest that medical comorbidities and other preoperative markers may be more important than age in predicting adverse surgical outcomes. POP surgery in the elderly has been extensively studied and found to be safe, but there is a paucity of information regarding robotic-assisted sacrocolpopexy in this population. Data are only beginning to emerge regarding the safety and efficacy of robotic surgery in the elderly, with most studies focusing on oncologic procedures. Preliminary studies in this setting suggest that elderly patients may benefit from a minimally invasive approach, although given their limited physiologic reserves, appropriate patient selection is essential. The purpose of this review article is to evaluate the stepwise management of POP in the elderly female, with a focus on the safety and feasibility of a robotic approach.</p>","PeriodicalId":92137,"journal":{"name":"Robotic surgery (Auckland)","volume":"3 ","pages":"65-73"},"PeriodicalIF":0.0,"publicationDate":"2016-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/RSRR.S81584","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36958002","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}