Objective:Robotic-assisted surgery(RAS)is continuing to expand in use in surgical specialties,including foregut surgery.The available data on its use in large hiatal hernia(HH)repair are limited and conflicting.This s...Objective:Robotic-assisted surgery(RAS)is continuing to expand in use in surgical specialties,including foregut surgery.The available data on its use in large hiatal hernia(HH)repair are limited and conflicting.This study sought to determine whether there are significant differences in adverse outcomes following HH repair performed with a robotic approach vs.a laparoscopic approach.This study was limited to outcomes in patients with type II,III,and IV HHs,as these hernias are typically more challenging to repair.Methods:A retrospective analysis was performed from data obtained from TriNetX,a large deidentified clinical database,over a 10-year period.Adult patients who underwent type II,III,or IV HH repair were included in the study.HH with robotic repair was compared to laparoscopic repair.Cohorts were propensity score matched for demographic information and comorbidities.Risk ratios,risk differences(RDs)with 95%confidence intervals(CIs),and t test for each examined adverse outcome were used to estimate the effects of robotic repair vs.laparoscopic repair.Results:In total,20,016 patients who met the inclusion criteria were identified;1,515 patients utilized RAS,and 18,501 used laparoscopy.Prior to matching,there were significant differences in age,sex,comorbidity,and BMI between the two cohorts.After 1:1 propensity score matching,analyses of 1,514 well-matched patient pairs revealed no significant differences in demographics or comorbidities.Patients who underwent robotic repair were more likely to experience major complications,including venous thromboembolism(RD:0.007,95%CI:0.003,0.011;p?0.002),critical care(RD:0.023,95%CI:0.007,0.039;p?0.004),urinary/renal complications(RD:0.027,95%CI:0.014,0.041;p<0.001),and respiratory complications(RD:0.046,95%CI:0.028,0.064;p<0.001).RAS was associated with a significantly shorter length of stay(32.4±27.5 h vs.35.7±50.1 h,p?0.031),although this finding indicated a reduction in the length of stay of less than 4 hours.No statistically significant differences in risk of esophageal perforation,infection,postprocedural shock,bleeding,mortality,additional emergency room visits,cardiac complications,or wound disruption were found.Conclusions:Patients who undergo robotic-assisted large HH repair are at increased risk of venous thromboembolism,need critical care,urinary or renal complications and respiratory complications.Due to variations in RAS technique,experience,and surgical volumes,further study of this surgical approach and complication rates is warranted.展开更多
Background: The mechanism of the development of acquired inguinal hernia, especially indirect inguinal hernia, is not well known. Although anatomical studies have been performed to explain development of inguinal hern...Background: The mechanism of the development of acquired inguinal hernia, especially indirect inguinal hernia, is not well known. Although anatomical studies have been performed to explain development of inguinal hernia, they have mainly involved autopsy or temporal findings at the time of hernioplasty. To elucidate the pattern of development of acquired inguinal hernia, we studied the occurrence of inguinal hernia after robotic-assisted laparoscopic prostatectomy (RALP). Methods: From March 2009 to November 2011, RALP for prostatic cancer was performed on 60 patients in our institute. The RALP was performed by one urologist using the da Vinci Surgical System. The postsurgical development of inguinal hernia was diagnosed based on patients’ symptoms. Seven patients were treated with laparoscopic hernioplasty, and one underwent mesh-plug repair. Using video recordings, the laparoscopic findings during RALP and laparoscopic hernioplasty were compared among all patients. Results: Seven of 59 patients (11.9%) developed an inguinal hernia. One patient had a pre-existing pantaloon inguinal hernia at the time of RALP. Eleven inguinal lesions in the seven patients who underwent laparoscopic hernioplasty were reviewed, and all were indirect inguinal hernias. Conclusion: A main factor in the development of inguinal hernia after RALP could be a combination of outer-side intact layers and inner-side hard scar of the inguinal ring, which seems like “out swing door”.展开更多
Robotic-assisted cholecystectomy(RC)is increasingly common.However,its exact role remains unde-fined,with multiport conventional laparoscopic cholecystectomy(LC)being regarded as the established gold standard.This rev...Robotic-assisted cholecystectomy(RC)is increasingly common.However,its exact role remains unde-fined,with multiport conventional laparoscopic cholecystectomy(LC)being regarded as the established gold standard.This review aims to provide an overview of the evidence for RC and to define its current and future role.A literature search was performed on the PubMed and Medline databases to identify relevant articles published between 1994 and February 2022.The evidence obtained was summarised in a narrative style.Greater emphasis was placed on recent 10-year articles and studies of higher meth-odological quality.RC is noninferior to LC.The robotic platform facilitates the application of minimally invasive surgery in a way conventional laparoscopy cannot.LC remains appropriate for the majority of patients requiring cholecystectomy.The advantages of RC include inherent technical benefits,facilitating the learning of new surgical technology and its potential to reduce the risk of open conversion and bile leakage in certain populations(Mirizzi syndrome,complicated calculous disease,chronic liver disease and possibly malignancy).It also has increasing applicability to related biliary surgery.The limitations include cost,loss of tactile feedback and the learning curve associated with initial implementation.Future applications of robotic surgical systems include utilisation in difficult cholecystectomy,cases of biliary malignancy,telerobotic surgery and telementoring.展开更多
Numerous surgical modalities are available to treat adrenal lesions. Minimally-invasive approaches for adrenalectomy are indicated in most circumstances, and new evidence continues to be accumulated. In this context, ...Numerous surgical modalities are available to treat adrenal lesions. Minimally-invasive approaches for adrenalectomy are indicated in most circumstances, and new evidence continues to be accumulated. In this context, current indications for open surgical adrenalectomy(OS-A), minimally-invasive adrenalectomy(MI-A), and laparoendoscopic single-site adrenalectomy(LESS-A) remain unclear. A comprehensive Englishlanguage literature review was performed using MEDLINE/Pub MED to identify articles and guidelines pertinent to the surgical management of adrenal tumors. A comprehensive chart review was performed for three illustrative cases. Clinical recommendations were generated based on relevant literature and the expertise of the investigator group. MI-A offers advantages over OS-A in properly selected patients, who experience fewer complications, lower blood loss, and shorter hospital stays. Robot-assisted laparoscopic and retroperitoneoscopic adrenalectomy may offer advantages over transperitoneal surgery, and LESS-A may be an even less-invasive option that will require further evaluation. MI-A remains the surgical treatment of choice for most adrenal lesions. Tumor size and stage are the primary indications for selecting alternative treatment modalities. OS-A remains the gold standard for large tumors(> 10 cm) and suspected or known advanced stage malignancy. LESS-A appears to be an appropriate initial approach for small tumors(< 4-5 cm), including pheochromocytoma and isolated adrenal metastases.展开更多
Objective:A vesicourethral anastomotic leak(VUAL)is a known complication following robotic-assisted radical prostatectomy.The natural history of a VUAL has been well described and is frequently managed with prolonged ...Objective:A vesicourethral anastomotic leak(VUAL)is a known complication following robotic-assisted radical prostatectomy.The natural history of a VUAL has been well described and is frequently managed with prolonged catheterization.With increasing emphasis on patient reported outcomes,catheter duration and VUAL are associated with significant short-term quality of life impairment.We aimed to present a case series of our robotic early post-prostatectomy anastomotic repair technique,defined as revision within 6 weeks from index surgery.Methods:A single institution prospective database identified eleven patients with a VUAL from July 2016 to October 2022 who underwent robotic early post-prostatectomy anastomotic repair by a single surgeon.Patients were diagnosed with a VUAL on pre-operative CT urogram or CT/fluoroscopic cystogram.The primary outcome was resolution of the anastomotic leak,defined as no contrast extravasation on post-operative cystography.Secondary outcomes included post-repair catheter duration and continence on the last follow-up defined as pad(s)per day.Results:The mean time to intervention after robotic-assisted radical prostatectomy was 21 days.Eight of the eleven(72.7%)patients had no evidence of extravasation on postrepair cystogram.The range from intervention to first cystogram was 7e20 days.The median catheter duration for those with successful intervention was 10 days.The median catheter duration for those with the leak on initial post-operative cystogram was 20 days.At a mean follow-up time of 25 months,eight(72.7%)patients reported using no pads per day,and three(27.3%)patients reported one pad per day.Conclusion:Management of a VUAL has traditionally relied on prolonged catheter drainage and the tincture of time.As the role of robotic reconstruction has been shown to be a viable modality for management of bladder neck contracture,it is important to reconsider prior dogmas of urologic care.Our case series suggests that an early repair is safe and has a high success rate.Early robotic intervention gives providers an additional tool in aiding patient recovery.展开更多
文摘Objective:Robotic-assisted surgery(RAS)is continuing to expand in use in surgical specialties,including foregut surgery.The available data on its use in large hiatal hernia(HH)repair are limited and conflicting.This study sought to determine whether there are significant differences in adverse outcomes following HH repair performed with a robotic approach vs.a laparoscopic approach.This study was limited to outcomes in patients with type II,III,and IV HHs,as these hernias are typically more challenging to repair.Methods:A retrospective analysis was performed from data obtained from TriNetX,a large deidentified clinical database,over a 10-year period.Adult patients who underwent type II,III,or IV HH repair were included in the study.HH with robotic repair was compared to laparoscopic repair.Cohorts were propensity score matched for demographic information and comorbidities.Risk ratios,risk differences(RDs)with 95%confidence intervals(CIs),and t test for each examined adverse outcome were used to estimate the effects of robotic repair vs.laparoscopic repair.Results:In total,20,016 patients who met the inclusion criteria were identified;1,515 patients utilized RAS,and 18,501 used laparoscopy.Prior to matching,there were significant differences in age,sex,comorbidity,and BMI between the two cohorts.After 1:1 propensity score matching,analyses of 1,514 well-matched patient pairs revealed no significant differences in demographics or comorbidities.Patients who underwent robotic repair were more likely to experience major complications,including venous thromboembolism(RD:0.007,95%CI:0.003,0.011;p?0.002),critical care(RD:0.023,95%CI:0.007,0.039;p?0.004),urinary/renal complications(RD:0.027,95%CI:0.014,0.041;p<0.001),and respiratory complications(RD:0.046,95%CI:0.028,0.064;p<0.001).RAS was associated with a significantly shorter length of stay(32.4±27.5 h vs.35.7±50.1 h,p?0.031),although this finding indicated a reduction in the length of stay of less than 4 hours.No statistically significant differences in risk of esophageal perforation,infection,postprocedural shock,bleeding,mortality,additional emergency room visits,cardiac complications,or wound disruption were found.Conclusions:Patients who undergo robotic-assisted large HH repair are at increased risk of venous thromboembolism,need critical care,urinary or renal complications and respiratory complications.Due to variations in RAS technique,experience,and surgical volumes,further study of this surgical approach and complication rates is warranted.
文摘Background: The mechanism of the development of acquired inguinal hernia, especially indirect inguinal hernia, is not well known. Although anatomical studies have been performed to explain development of inguinal hernia, they have mainly involved autopsy or temporal findings at the time of hernioplasty. To elucidate the pattern of development of acquired inguinal hernia, we studied the occurrence of inguinal hernia after robotic-assisted laparoscopic prostatectomy (RALP). Methods: From March 2009 to November 2011, RALP for prostatic cancer was performed on 60 patients in our institute. The RALP was performed by one urologist using the da Vinci Surgical System. The postsurgical development of inguinal hernia was diagnosed based on patients’ symptoms. Seven patients were treated with laparoscopic hernioplasty, and one underwent mesh-plug repair. Using video recordings, the laparoscopic findings during RALP and laparoscopic hernioplasty were compared among all patients. Results: Seven of 59 patients (11.9%) developed an inguinal hernia. One patient had a pre-existing pantaloon inguinal hernia at the time of RALP. Eleven inguinal lesions in the seven patients who underwent laparoscopic hernioplasty were reviewed, and all were indirect inguinal hernias. Conclusion: A main factor in the development of inguinal hernia after RALP could be a combination of outer-side intact layers and inner-side hard scar of the inguinal ring, which seems like “out swing door”.
文摘Robotic-assisted cholecystectomy(RC)is increasingly common.However,its exact role remains unde-fined,with multiport conventional laparoscopic cholecystectomy(LC)being regarded as the established gold standard.This review aims to provide an overview of the evidence for RC and to define its current and future role.A literature search was performed on the PubMed and Medline databases to identify relevant articles published between 1994 and February 2022.The evidence obtained was summarised in a narrative style.Greater emphasis was placed on recent 10-year articles and studies of higher meth-odological quality.RC is noninferior to LC.The robotic platform facilitates the application of minimally invasive surgery in a way conventional laparoscopy cannot.LC remains appropriate for the majority of patients requiring cholecystectomy.The advantages of RC include inherent technical benefits,facilitating the learning of new surgical technology and its potential to reduce the risk of open conversion and bile leakage in certain populations(Mirizzi syndrome,complicated calculous disease,chronic liver disease and possibly malignancy).It also has increasing applicability to related biliary surgery.The limitations include cost,loss of tactile feedback and the learning curve associated with initial implementation.Future applications of robotic surgical systems include utilisation in difficult cholecystectomy,cases of biliary malignancy,telerobotic surgery and telementoring.
文摘Numerous surgical modalities are available to treat adrenal lesions. Minimally-invasive approaches for adrenalectomy are indicated in most circumstances, and new evidence continues to be accumulated. In this context, current indications for open surgical adrenalectomy(OS-A), minimally-invasive adrenalectomy(MI-A), and laparoendoscopic single-site adrenalectomy(LESS-A) remain unclear. A comprehensive Englishlanguage literature review was performed using MEDLINE/Pub MED to identify articles and guidelines pertinent to the surgical management of adrenal tumors. A comprehensive chart review was performed for three illustrative cases. Clinical recommendations were generated based on relevant literature and the expertise of the investigator group. MI-A offers advantages over OS-A in properly selected patients, who experience fewer complications, lower blood loss, and shorter hospital stays. Robot-assisted laparoscopic and retroperitoneoscopic adrenalectomy may offer advantages over transperitoneal surgery, and LESS-A may be an even less-invasive option that will require further evaluation. MI-A remains the surgical treatment of choice for most adrenal lesions. Tumor size and stage are the primary indications for selecting alternative treatment modalities. OS-A remains the gold standard for large tumors(> 10 cm) and suspected or known advanced stage malignancy. LESS-A appears to be an appropriate initial approach for small tumors(< 4-5 cm), including pheochromocytoma and isolated adrenal metastases.
文摘Objective:A vesicourethral anastomotic leak(VUAL)is a known complication following robotic-assisted radical prostatectomy.The natural history of a VUAL has been well described and is frequently managed with prolonged catheterization.With increasing emphasis on patient reported outcomes,catheter duration and VUAL are associated with significant short-term quality of life impairment.We aimed to present a case series of our robotic early post-prostatectomy anastomotic repair technique,defined as revision within 6 weeks from index surgery.Methods:A single institution prospective database identified eleven patients with a VUAL from July 2016 to October 2022 who underwent robotic early post-prostatectomy anastomotic repair by a single surgeon.Patients were diagnosed with a VUAL on pre-operative CT urogram or CT/fluoroscopic cystogram.The primary outcome was resolution of the anastomotic leak,defined as no contrast extravasation on post-operative cystography.Secondary outcomes included post-repair catheter duration and continence on the last follow-up defined as pad(s)per day.Results:The mean time to intervention after robotic-assisted radical prostatectomy was 21 days.Eight of the eleven(72.7%)patients had no evidence of extravasation on postrepair cystogram.The range from intervention to first cystogram was 7e20 days.The median catheter duration for those with successful intervention was 10 days.The median catheter duration for those with the leak on initial post-operative cystogram was 20 days.At a mean follow-up time of 25 months,eight(72.7%)patients reported using no pads per day,and three(27.3%)patients reported one pad per day.Conclusion:Management of a VUAL has traditionally relied on prolonged catheter drainage and the tincture of time.As the role of robotic reconstruction has been shown to be a viable modality for management of bladder neck contracture,it is important to reconsider prior dogmas of urologic care.Our case series suggests that an early repair is safe and has a high success rate.Early robotic intervention gives providers an additional tool in aiding patient recovery.
