Robotic systems have become popular in modern surgical procedures.The option of telesurgery has effectively addressed geographic limitations.These systems are offered by numerous companies worldwide.In this review art...Robotic systems have become popular in modern surgical procedures.The option of telesurgery has effectively addressed geographic limitations.These systems are offered by numerous companies worldwide.In this review article,we discuss four models of robotic systems to determine their advantages:the Sina flex system from Iran and the da Vinci Xi,SP,and 5 systems from the USA.We compared aspects such as architecture,instruments,visualizations,clinical use,and costs.Our findings suggest that the da Vinci robot,which was introduced earlier than the Sina system,utilizes proprietary and limited-use EndoWrist instruments with diameters ranging from 8 to 12 mm and features advanced imaging capabilities,including three-dimensional optical,tomographic,and fluorescence imaging.It is well established and widely utilized in various surgical procedures.Conversely,the Sina flex system employs single-use 5 mm instruments and is equipped with two-dimensional optical imaging as a standard,with optional three-dimensional and fluorescence imaging upgrades available.Despite its affordability,the Sina flex system is relatively new and has not yet been clinically tested.Additionally,the Sina flex system is more user-friendly.展开更多
BACKGROUND Pylorus and vagus nerve-preserving gastrectomy(PPG)is a function-preserving surgery for early gastric cancer(GC)that has gained considerable interest in the recent years.The operative technique performed us...BACKGROUND Pylorus and vagus nerve-preserving gastrectomy(PPG)is a function-preserving surgery for early gastric cancer(GC)that has gained considerable interest in the recent years.The operative technique performed using the Da Vinci Xi robot system is considered ideal for open and laparoscopic surgery.AIM To introduce Da Vinci Xi robot-assisted PPG(RAPPG)-based operative procedure and technical points as well as report the initial experience based on the clinical pathology data of eight cases of early GC.METHODS Da Vinci Xi robot-assisted pylorus and vagus nerve-preserving gastrectomy(RAPPG)was performed for 11 consecutive patients with middle GC from December 2020 to July 2021.Outcome measures were postoperative morbidity,operative time,blood loss,number of lymph nodes harvested,postoperative hospital stay,time to first flatus,time to diet,and resection margins.RESULTS Eight of the 11 patients who were pathologically diagnosed with early GC were enrolled in a retrospective study to assess the feasibility and safety of RAPPG.The mean operative time,mean blood loss,mean number of lymph nodes harvested,length of preserved pylorus canal,distal margin,and proximal margin were 330.63±47.24 min,57.50±37.70 mL,18.63±10.57,3.63±0.88 cm,3.50±1.31 cm,and 3.63±1.19 cm,respectively.None of the cases required conversion to laparotomy.Postoperative complications occurred in two(25.0%)patients.Postoperative complications were hyperamylasemia and gastric stasis in one case and incision infection in the other.Time to first flatus was 3.75±2.49 d after the operation,andpostoperative hospital stay was 10.13±4.55 d.CONCLUSIONThe core technique in the Da Vinci Xi RAPPG is lymph node dissection and the anatomic methodof the nerve.Robotic surgical procedures are feasible and safe.With the progress of surgicaltechnology,optimization of medical insurance structure,and emergence of evidence-basedmedicine,automated surgery systems will have a broad application in clinical treatment.展开更多
Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the ...Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the acceptance of this technology in Europe and the rest of the world has been somewhat slower. This article reviews the current literature on RARP with regard to oncological, continence and potency outcomes-the so-called ＇trifecta＇. Preliminary data appear to show an advantage of RARP over open prostatectomy, with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most studies show good postoperative continence and potency with RARP; however, this needs to be viewed in the context of the paucity of randomized data available in the literature. There is no definitive evidence to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging. Finally, evolving techniques of single-port robotic prostatectomy, laser- guided robotics, catheter-free prostatectomy and image-guided robotics are discussed.展开更多
Background Many studies have shown the operative feasibility and safety of robotic gastrectomy.Surgeons are pursuing single-port(SP)surgery to leverage the advantages of minimally invasive gastrectomy.The purpose of t...Background Many studies have shown the operative feasibility and safety of robotic gastrectomy.Surgeons are pursuing single-port(SP)surgery to leverage the advantages of minimally invasive gastrectomy.The purpose of this study was to describe technical considerations and short-term outcomes from the first reported SP robotic total gastrectomy(RTG)using the da Vinci SP platform.Methods A 75-year-old patient with a body-mass index of 19.8 kg/m^(2) and clinical stage III cancer(cT3NtM0)underwent SP RTG on 22 January 2022 at the Department of General Surgery,the Chinese PLA General Hospital.All procedures were performed successfully using the da Vinci SP robotic platform.Results The SP RTG was successfully performed with D2 lymphadenectomy including No.10 lymph-nodes dissection and extracorporeal Roux-en-Y anastomosis.Except for subcutaneous emphysema,no severe adverse events occurred during the operation.According to a visual analogue scale(VAS),the subjective feeling of post-operative pain was given a VAS score of 3 of 10 on Post-Operative Day 1(POD 1),1 of 10 on POD 3,and 1 of 10 on POD 7.We removed the gastric tube on POD 2 and advised sipping water,a liquid diet,and a soft diet on PODs 2,4,and 6,respectively.The patient was discharged without any complications on POD 8.Conclusion RTG is technically feasible and safe using the da Vinci SP robotic platform.To our knowledge,this is the first study using the da Vinci SP platform in RTG for advanced gastric cancer in elderly patients.To verify its superior operative outcomes,further clinical trials are needed.展开更多
目的:评价加速康复外科(enhanced recovery after surgery,ERAS)在达芬奇机器人胃癌根治术中的可行性及有效性。方法:选取西安交通大学第一附属医院行达芬奇机器人胃癌根治术患者50例,其中25例采用胃癌术后常规围手术期护理模式,25例采...目的:评价加速康复外科(enhanced recovery after surgery,ERAS)在达芬奇机器人胃癌根治术中的可行性及有效性。方法:选取西安交通大学第一附属医院行达芬奇机器人胃癌根治术患者50例,其中25例采用胃癌术后常规围手术期护理模式,25例采用快速康复外科护理模式干预。比较两组患者手术时间、术中出血量、肛门排气时间、术后住院时间、术后炎症指标、术后住院费用、术后并发症情况等。结果:两组患者的一般病理特征并无显著差异(P>0.05)。在手术时间、术中出血量上比较,差异无统计学意义(P>0.05)。ERAS组在肛门排气时间、术后营养状态、术后炎症指标方面、术后住院时间、术后住院费用方面均较对照组显示出优势(均P<0.01);两组在术后并发症上并无统计学差异(P=0.554)。结论:ERAS理念在达芬奇机器人胃癌根治术中应用是安全、可靠的,且其与传统围手术期护理模式相比,在促进患者胃肠功能恢复、降低住院费用上具有一定优势。展开更多
文摘Robotic systems have become popular in modern surgical procedures.The option of telesurgery has effectively addressed geographic limitations.These systems are offered by numerous companies worldwide.In this review article,we discuss four models of robotic systems to determine their advantages:the Sina flex system from Iran and the da Vinci Xi,SP,and 5 systems from the USA.We compared aspects such as architecture,instruments,visualizations,clinical use,and costs.Our findings suggest that the da Vinci robot,which was introduced earlier than the Sina system,utilizes proprietary and limited-use EndoWrist instruments with diameters ranging from 8 to 12 mm and features advanced imaging capabilities,including three-dimensional optical,tomographic,and fluorescence imaging.It is well established and widely utilized in various surgical procedures.Conversely,the Sina flex system employs single-use 5 mm instruments and is equipped with two-dimensional optical imaging as a standard,with optional three-dimensional and fluorescence imaging upgrades available.Despite its affordability,the Sina flex system is relatively new and has not yet been clinically tested.Additionally,the Sina flex system is more user-friendly.
文摘BACKGROUND Pylorus and vagus nerve-preserving gastrectomy(PPG)is a function-preserving surgery for early gastric cancer(GC)that has gained considerable interest in the recent years.The operative technique performed using the Da Vinci Xi robot system is considered ideal for open and laparoscopic surgery.AIM To introduce Da Vinci Xi robot-assisted PPG(RAPPG)-based operative procedure and technical points as well as report the initial experience based on the clinical pathology data of eight cases of early GC.METHODS Da Vinci Xi robot-assisted pylorus and vagus nerve-preserving gastrectomy(RAPPG)was performed for 11 consecutive patients with middle GC from December 2020 to July 2021.Outcome measures were postoperative morbidity,operative time,blood loss,number of lymph nodes harvested,postoperative hospital stay,time to first flatus,time to diet,and resection margins.RESULTS Eight of the 11 patients who were pathologically diagnosed with early GC were enrolled in a retrospective study to assess the feasibility and safety of RAPPG.The mean operative time,mean blood loss,mean number of lymph nodes harvested,length of preserved pylorus canal,distal margin,and proximal margin were 330.63±47.24 min,57.50±37.70 mL,18.63±10.57,3.63±0.88 cm,3.50±1.31 cm,and 3.63±1.19 cm,respectively.None of the cases required conversion to laparotomy.Postoperative complications occurred in two(25.0%)patients.Postoperative complications were hyperamylasemia and gastric stasis in one case and incision infection in the other.Time to first flatus was 3.75±2.49 d after the operation,andpostoperative hospital stay was 10.13±4.55 d.CONCLUSIONThe core technique in the Da Vinci Xi RAPPG is lymph node dissection and the anatomic methodof the nerve.Robotic surgical procedures are feasible and safe.With the progress of surgicaltechnology,optimization of medical insurance structure,and emergence of evidence-basedmedicine,automated surgery systems will have a broad application in clinical treatment.
文摘Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the acceptance of this technology in Europe and the rest of the world has been somewhat slower. This article reviews the current literature on RARP with regard to oncological, continence and potency outcomes-the so-called ＇trifecta＇. Preliminary data appear to show an advantage of RARP over open prostatectomy, with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most studies show good postoperative continence and potency with RARP; however, this needs to be viewed in the context of the paucity of randomized data available in the literature. There is no definitive evidence to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging. Finally, evolving techniques of single-port robotic prostatectomy, laser- guided robotics, catheter-free prostatectomy and image-guided robotics are discussed.
基金supported by the National Basic Research Programof China(973 Program)[grant number 2019YFB1311505]the National Natural Science Foundation of China[grant number 82073192].
文摘Background Many studies have shown the operative feasibility and safety of robotic gastrectomy.Surgeons are pursuing single-port(SP)surgery to leverage the advantages of minimally invasive gastrectomy.The purpose of this study was to describe technical considerations and short-term outcomes from the first reported SP robotic total gastrectomy(RTG)using the da Vinci SP platform.Methods A 75-year-old patient with a body-mass index of 19.8 kg/m^(2) and clinical stage III cancer(cT3NtM0)underwent SP RTG on 22 January 2022 at the Department of General Surgery,the Chinese PLA General Hospital.All procedures were performed successfully using the da Vinci SP robotic platform.Results The SP RTG was successfully performed with D2 lymphadenectomy including No.10 lymph-nodes dissection and extracorporeal Roux-en-Y anastomosis.Except for subcutaneous emphysema,no severe adverse events occurred during the operation.According to a visual analogue scale(VAS),the subjective feeling of post-operative pain was given a VAS score of 3 of 10 on Post-Operative Day 1(POD 1),1 of 10 on POD 3,and 1 of 10 on POD 7.We removed the gastric tube on POD 2 and advised sipping water,a liquid diet,and a soft diet on PODs 2,4,and 6,respectively.The patient was discharged without any complications on POD 8.Conclusion RTG is technically feasible and safe using the da Vinci SP robotic platform.To our knowledge,this is the first study using the da Vinci SP platform in RTG for advanced gastric cancer in elderly patients.To verify its superior operative outcomes,further clinical trials are needed.
文摘目的:评价加速康复外科(enhanced recovery after surgery,ERAS)在达芬奇机器人胃癌根治术中的可行性及有效性。方法:选取西安交通大学第一附属医院行达芬奇机器人胃癌根治术患者50例,其中25例采用胃癌术后常规围手术期护理模式,25例采用快速康复外科护理模式干预。比较两组患者手术时间、术中出血量、肛门排气时间、术后住院时间、术后炎症指标、术后住院费用、术后并发症情况等。结果:两组患者的一般病理特征并无显著差异(P>0.05)。在手术时间、术中出血量上比较,差异无统计学意义(P>0.05)。ERAS组在肛门排气时间、术后营养状态、术后炎症指标方面、术后住院时间、术后住院费用方面均较对照组显示出优势(均P<0.01);两组在术后并发症上并无统计学差异(P=0.554)。结论:ERAS理念在达芬奇机器人胃癌根治术中应用是安全、可靠的,且其与传统围手术期护理模式相比,在促进患者胃肠功能恢复、降低住院费用上具有一定优势。
文摘目的:随着微创外科技术的发展,达芬奇机器人技术的应用越来越广泛。本研究通过分析机器人辅助胃切除术(robotic-assisted gastrectomy,RAG)与腹腔镜辅助胃切除术(laparoscopic-assisted gastrectomy,LAG)2种不同外科技术初期阶段学习曲线的比较,探讨先进手术机器人技术对外科手术学习曲线的可能影响。方法:选取在2017年9月至2020年12月一名主刀医师从初始阶段开始实施RAG或LAG手术的远端胃癌根治术的108例患者,分为行达芬奇Si机器人系统RAG的RAG组(n=27)和行LAG的LAG组(n=81),胃癌区域淋巴结分组参照日本胃癌治疗指南实施,分析其围手术期结果、术后并发症、术后肿瘤学结果和外科手术学习曲线等相关情况。结果:2组患者在一般资料、肿瘤大小、组织学分级和临床分期上的差异均无统计学意义(均P>0.05);RAG组术后严重并发症的发生率低于LAG组(P=0.003);RAG组术中的失血量低于LAG组的失血量(P=0.046);RAG组清扫淋巴结数量更多(P=0.003),其中在第9组(P=0.038)和11p组(P=0.015)淋巴结清扫中表现出明显优势;RAG组手术时间明显比LAG组长(P=0.015);学习曲线分析发现,RAG组的累积和分析(cumulative sum analysis,CUSUM)值从第10例开始下降,而LAG组的CUSUM值从第28例开始下降,RAG的学习曲线比LAG的学习曲线具有更少的截止案例。手术机器人的独特设计可能有助于提高手术效率和缩短外科手术学习曲线。结论:先进机器人技术有助于经验丰富的外科医生快速学习掌握RAG技能,超越机器人学习曲线达到熟练阶段需要的最少手术例数为10例,并在第9组和11p组淋巴结清扫和减轻手术创伤方面优于LAG。RAG手术比LAG手术能清扫出更多的淋巴结,有更好的围手术期疗效。
