BACKGROUND Hemolymphangioma of the jejunum is rare and lacks clinical specificity,and can manifest as gastrointestinal bleeding,abdominal pain,and intestinal obstruction.Computed tomography,magnetic resonance imaging,...BACKGROUND Hemolymphangioma of the jejunum is rare and lacks clinical specificity,and can manifest as gastrointestinal bleeding,abdominal pain,and intestinal obstruction.Computed tomography,magnetic resonance imaging,and other examinations show certain characteristics of the disease,but lack accuracy.Although capsule endoscopy and enteroscopy make up for this deficiency,the diagnosis also still re-quires pathology.CASE SUMMARY A male patient was admitted to the hospital due to abdominal distension and abdominal pain,but a specific diagnosis by computed tomography examination was not obtained.Partial resection of the small intestine was performed by robotic surgery,and postoperative pathological biopsy confirmed the diagnosis of hemo-lymphangioma.No recurrence in the follow-up examination was observed.CONCLUSION Robotic surgery is an effective way to treat hemolymphangioma through minima-lly invasive techniques under the concept of rapid rehabilitation.展开更多
BACKGROUND Da Vinci Robotics-assisted total mesorectal excision(TME)surgery for rectal cancer is becoming more widely used.There is no strong evidence that roboticassisted surgery and laparoscopic surgery have similar...BACKGROUND Da Vinci Robotics-assisted total mesorectal excision(TME)surgery for rectal cancer is becoming more widely used.There is no strong evidence that roboticassisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for rectal cancer.AIM To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME surgery.METHODS A retrospective study of the clinical pathology and follow-up of elderly patients who underwent TME surgery at the Department of Gastrointestinal Oncology at the Affiliated Hospital of Nanjing University of Chinese Medicine was conducted from March 2020 through September 2023.The patients were divided into a robotassisted group(the R-TME group)and a laparoscopic group(the L-TME group),and the short-term efficacy of the two groups was compared.RESULTS There were 45 elderly patients(≥60 years)in the R-TME group and 50 elderly patients(≥60 years)in the L-TME group.There were no differences in demographics,conversion rates,or postoperative complication rates.The L-TME group had a longer surgical time than the R-TME group[145(125,187.5)vs 180(148.75,206.25)min,P=0.005),and the first postoperative meal time in the L-TME group was longer than that in the R-TME(4 vs 3 d,P=0.048).Among the sex and body mass index(BMI)subgroups,the R-TME group had better out-comes than did the L-TME group in terms of operation time(P=0.042)and intraoperative assessment of bleeding(P=0.042).In the high BMI group,catheter removal occurred earlier in the R-TME group than in the L-TME group(3 vs 4 d,P=0.001),and autonomous voiding function was restored.CONCLUSION The curative effect and short-term efficacy of robot-assisted TME surgery for elderly patients with rectal cancer are similar to those of laparoscopic TME surgery;however,robotic-assisted surgery has better short-term outcomes for individuals with risk factors such as obesity and pelvic stenosis.Optimizing the learning curve can shorten the operation time,reduce the recovery time of gastrointestinal function,and improve the prognosis.展开更多
Background: Epiphrenic Diverticulum is frequently associated with esophageal motility disorders, such as nutcrackers esophagus. The diagnosis is usually made using imaging studies such as a Barium esophagogram, and es...Background: Epiphrenic Diverticulum is frequently associated with esophageal motility disorders, such as nutcrackers esophagus. The diagnosis is usually made using imaging studies such as a Barium esophagogram, and esophageal manometry. Surgical treatment options for epiphrenic diverticulum and EN include diverticulectomy and wide myotomy. Aim: The resection of three epiphrenic diverticula and extensive myotomy were performed by robotic thoracoscopy uneventfully. Case presentation: A 65-year-old female complaining of dysphagia for solid foods, Chest pain and regurgitation. Esophagogastroduodenoscopy (EDG) with difficulty in advancing the endoscope at 25 cm and demonstrating an ED, no hiatal hernia and normal stomach and duodenum. Barium Esophagogram showed multiple diverticula and tortuosity throughout the esophagus. Conclusion: With robotic surgery, surgeons can perform highly precise operations with enhanced 3D vision and control. Through this cutting-edge approach, the treatment of ED associated with EN can be drastically changed, promising better outcomes for patients.展开更多
Aim:The goal of this research was to create a mathematical model to evaluate the short-term effectiveness of laparoscopic and robotic surgeries and to apply this model to surgeries with laparoscopic and robotic varian...Aim:The goal of this research was to create a mathematical model to evaluate the short-term effectiveness of laparoscopic and robotic surgeries and to apply this model to surgeries with laparoscopic and robotic variants to evaluate their performance.Materials and methods:A mathematical model was developed in this study to compare the short-term effectiveness of six different surgical procedures:ventral hernia repairs,hysterectomies,lung lobectomies,pancreatectomies,gastric bypass,and prostatectomies.The criteria analyzed to compare these procedures included morbidity rate,readmission rate,mortality rate,cost,length of hospitalization and operative time.These criteria were scaled based on their significance when considering a surgery,such that more important criteria,those that directly impact patient health,are more heavily weighted than less important criteria.Results:The mathematical model indicated that robotic surgery was the preferred option for lung lobectomies and prostatectomies.Laparoscopy was preferred for all other procedures.In the case of gastric bypass,laparoscopy was heavily preferred,and there was only a marginal preference in laparoscopy for hysterectomies and ventral hernia repairs.Conclusion:The mathematical model developed in this research serves as a robust definitive standard that can continue to be utilized to compare robotic and laparoscopic surgeries.With new technologies,preferences are likely to change in favor of robotic surgery,and this model can be employed to predict the impact of those advancements.展开更多
BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the curre...BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the current literature on this method is limited to case reports,and further investigation into its safety and feasibility is warranted.AIM To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.METHODS From September 2018 to February 2022,206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis.Of these patients,22 underwent R-NOSES I-F surgery(RNOSES I-F group)and 76 underwent conventional robotic-assisted low rectal cancer resection(RLRC group).Clinicopathological data of all patients were collected and analyzed.Postoperative outcomes and prognoses were compared between the two groups.Statistical analysis was performed using SPSS software.RESULTS Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1(1.7±0.7 vs 2.2±0.6,P=0.003)and shorter postoperative anal venting time(2.7±0.6 vs 3.5±0.7,P<0.001)than those in the RLRC group.There were no significant differences between the two groups in terms of sex,age,body mass index,tumor size,TNM stage,operative time,intrao-perative bleeding,postoperative complications,or inflammatory response(P>0.05).Postoperative anal and urinary functions,as assessed by Wexner,low anterior resection syndrome,and International Prostate Symptom Scale scores,were similar in both groups(P>0.05).Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups(P>0.05).CONCLUSION R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer.It improves pain relief,promotes gastrointestinal function recovery,and helps avoid incision-related complications.展开更多
Objective To report the outcomes of intra-and extra-peritoneal robot-assisted radical prostatectomy(RARP)and robot-assisted radical cystectomy(RARC)with Hugo™robot-assisted surgery(RAS)system(Medtronic,Minneapolis,MN,...Objective To report the outcomes of intra-and extra-peritoneal robot-assisted radical prostatectomy(RARP)and robot-assisted radical cystectomy(RARC)with Hugo™robot-assisted surgery(RAS)system(Medtronic,Minneapolis,MN,USA).Methods Data of twenty patients who underwent RARP and one RARC at our institution between February 2022 and January 2023 were reported.The primary endpoint of the study was to report the surgical setting of Hugo™RAS system to perform RARP and RARC.The secondary endpoint was to assess the feasibility of RARP and RARC with this novel robotic platform and report the outcomes.Results Seventeen patients underwent RARP with a transperitoneal approach,and three with an extraperitoneal approach;and one patient underwent RARC with intracorporeal ileal conduit.No intraoperative complications occurred.Median docking and console time were 12(interquartile range[IQR]7-16)min and 185(IQR 177-192)min for transperitoneal RARP,15(IQR 12-17)min and 170(IQR 162-185)min for extraperitoneal RARP.No intraoperative complications occurred.One patient submitted to extraperitoneal RARP had a urinary tract infection in the postoperative period that required an antibiotic treatment(Clavien-Dindo Grade 2).In case of transperitoneal RARP,two minor complications occurred(one pelvic hematoma and one urinary tract infection;both Clavien-Dindo Grade 2).Conclusion Hugo™RAS system is a novel promising robotic platform that allows to perform major oncological pelvic surgery.We showed the feasibility of RARP both intra-and extra-peritoneally and RARC with intracorporeal ileal conduit with this novel platform.展开更多
Objective Although robotic surgery adoption and its indications are growing worldwide,for multiple factors,including costs,there is a lack of training and experience.Our aim was to study the impact of a robotic introd...Objective Although robotic surgery adoption and its indications are growing worldwide,for multiple factors,including costs,there is a lack of training and experience.Our aim was to study the impact of a robotic introduction training program on gesture performance,such as suturing,in robot-naive individuals.Methods Using the DaVinci robot,a 2-hour program was based on virtual reality and anatomical model exercises.All participants performed 3 repetitions of virtual reality exercises on the virtual simulator,and then performed and were assessed on 2 tests,ie robot and laparoscopic training box.After the course,the participants were surveyed for this training program.Results Twenty-seven residents and surgeons were enrolled in the training program.With only 2 hours of training,all of the participants were able to complete the training program,thus learning generic and specific skills in robotic surgery.In virtual reality exercise,the scores of the 3 exercises increased significantly with every repetition(p<0.001)and the size of the increase was large.The completion time on the robot platform was 2.6 times faster(169.33±28.28 s vs.447.96±156.55 s,p<0.001)than that in the laparoscopic box,and the difference between both types of tests was large(pη2=0.797).The centralization and passage of the needle were significantly better on the robot platform(5 vs.3,p<0.001,r=0.47;5 vs.4,p<0.001,r=0.59)than in the laparoscopic box.For the intracorporeal stitch+knot test,every participant was able to perform the exercise on the robot but only 85.2%(23/27)in the laparoscopic box.Twenty-one participants answered the survey,and 13(61.9%)of them considered robotic performance independent of laparoscopic experience.Conclusions Surgeons are interested and seek training in robotic surgery.We implemented the first hands-on robotic surgery training program in Portugal and participants considered it was important and adequate for its purpose.All participants,even without robotic experience,learned quicker,performed better,faster and more precisely on the robot over laparoscopy.展开更多
BACKGROUND In recent years,minimally invasive liver resection has become a standard of care for liver tumors.Considering the need to treat increasingly fragile patients,general anesthesia is sometimes avoided due to r...BACKGROUND In recent years,minimally invasive liver resection has become a standard of care for liver tumors.Considering the need to treat increasingly fragile patients,general anesthesia is sometimes avoided due to respiratory complications.Therefore,surgical treatment with curative intent is abandoned in favor of a less invasive and less radical approach.Epidural anesthesia has been shown to reduce respiratory complications,especially in elderly patients with pre-existing lung disease.CASE SUMMARY A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular carcinoma.The patient was suffering from hypertension,diabetes and chronic obstructive pulmonary disease.The National Surgical Quality Improvement Program score for developing pneumonia was 9.2%.We planned a combined spinal–epidural anesthesia with conscious sedation to avoid general anesthesia.No modification of the standard surgical technique was necessary.Hemodynamics were stable and bleeding was minimal.The postoperative course was uneventful.CONCLUSION Robotic surgery in locoregional anesthesia with conscious sedation could be considered a safe and suitable approach in specialized centers and in selected patients.展开更多
With an ageing global population,we will see an increasing number of elderly patients with colorectal cancer(CRC)requiring surgery.However,it should be recognized that the elderly are a heterogenous group,with varying...With an ageing global population,we will see an increasing number of elderly patients with colorectal cancer(CRC)requiring surgery.However,it should be recognized that the elderly are a heterogenous group,with varying physiological and functional status.While traditionally viewed to be associated with frailty,comorbidities,and a higher risk of post operative morbidity,the advancements in minimally invasive surgery(MIS)and improvements in perioperative care have allowed CRC surgery to be safe and feasible in the elderly-chronological age alone should therefore not strictly be an exclusion criterion for curative surgery.However,as a form of MIS,laparoscopic assisted colorectal surgery(LACS)has the inherent disadvantages of:(1)Dependence on a trained assistant for retraction and laparoscope control;(2)The loss of wristed movement with reduced dexterity and suboptimal ergonomics;(3)A lack of intuitive movement due to the levering effect of trocars;and(4)An amplification of physiological tremors.Representing a technical evolution of LACS,robotic assisted colorectal surgery was introduced to overcome these limitations.In this minireview,we examine the evidence for robotic surgery in the elderly with CRC.展开更多
BACKGROUND Lymphangiomas are a group of benign swellings which are commonly seen in children.The most common sites of presentation is the head and neck region,less commonly seen in axilla,chest,liver,spleen,etc.The id...BACKGROUND Lymphangiomas are a group of benign swellings which are commonly seen in children.The most common sites of presentation is the head and neck region,less commonly seen in axilla,chest,liver,spleen,etc.The ideal modality of treatment has always been surgical excision irrespective of the site and age group.But with the advent of minimally invasive surgical techniques,it is now possible to perform excision of parapharyngeal space lesions with minimal morbidity and good clearance.CASE SUMMARY A 42-year-old male patient who presented with difficulty in swallowing and had undergone surgery twice outside,where Transcervical approach was attempted to remove the parapharyngeal mass,but failed.Magnetic resonance imaging scan demonstrated a 6 cm x 5 cm x 4 cm left parapharyngeal mass.He underwent transoral robotic surgery for the excision of the parapharyngeal lesion and had an uneventful post-operative recovery.CONCLUSION Lymphangiomas are hamartomatous swellings which are benign in nature.The symptoms of the patient with large parapharyngeal mass include dysphagia,dyspnoea and neck swelling.Clinicoradiological evaluation is of utmost importance to determine the adjacent vital structures and the approach to the tumor.With the advent of robotics in oncology,transoral robotic excision is one of the best approaches to perform such a surgery.展开更多
Objective:To evaluate the perioperative as well as early oncological outcomes of patients undergoing robotic retroperitoneal lymph node dissection for treatment of testicular cancer.Methods:We conducted a prospective ...Objective:To evaluate the perioperative as well as early oncological outcomes of patients undergoing robotic retroperitoneal lymph node dissection for treatment of testicular cancer.Methods:We conducted a prospective consecutive case series of patients undergoing robotic assisted retroperitoneal lymph node dissection for metastatic testicular cancer between May 2018 and July 2021 at our institution.Data were collected on patient and tumour characteristics,intraoperative and postoperative parameters,and functional and oncological outcomes.Descriptive statistics are presented.Results:Nineteen patients were identified;18(94.7%)completed the procedure robotically and one was converted to open surgery;78.9%of patients had stage≥IIB and 12(63.2%)patients had undergone prior chemotherapy.The median operative time was 300(interquartile range[IQR]240-315)min.Median blood loss was 100(IQR 50-175)mL.Median length of stay was 2(range 1-11)days.All robotically completed patients commenced diet and passed flatus on Day 1 and were discharged by Day 3.The median lymph node yield was 40.5(IQR 38-51)nodes.All patients undergoing nerve-sparing procedures recovered antegrade ejaculatory function.One patient had a Clavien-Dindo III complication(chylous ascites requiring drainage).At a median follow-up of 22.3(IQR 16.3-24.9)months,one patient developed retroperitoneal recurrence,which was successfully treated with second-line chemotherapy;no other patients have had recurrences.Conclusion:Robotic retroperitoneal lymph node dissection is a safe and feasible alternative to open surgery in appropriately selected patients,offering low morbidity.Early oncological outcomes are promising.Larger cohorts and longer follow-ups are required to validate our institution's findings.展开更多
BACKGROUND Robotic surgery(RS)is gaining popularity;however,evidence for abdominoperineal resection(APR)of rectal cancer(RC)is scarce.AIM To compare the efficacy of RS and laparoscopic surgery(LS)in APR for RC.METHODS...BACKGROUND Robotic surgery(RS)is gaining popularity;however,evidence for abdominoperineal resection(APR)of rectal cancer(RC)is scarce.AIM To compare the efficacy of RS and laparoscopic surgery(LS)in APR for RC.METHODS We retrospectively identified patients with RC who underwent APR by RS or LS from April 2016 to June 2022.Data regarding short-term surgical outcomes were compared between the two groups.To reduce the effect of potential confounding factors,propensity score matching was used,with a 1:1 ratio between the RS and LS groups.A meta-analysis of seven trials was performed to compare the efficacy of robotic and laparoscopic APR for RC surgery.RESULTS Of 133 patients,after propensity score matching,there were 42 patients in each group.The postoperative complication rate was significantly lower in the RS group(17/42,40.5%)than in the LS group(27/42,64.3%)(P=0.029).There wasno significant difference in operative time(P=0.564),intraoperative transfusion(P=0.314),reoperation rate(P=0.314),lymph nodes harvested(P=0.309),or circumferential resection margin(CRM)positive rate(P=0.314)between the two groups.The meta-analysis showed patients in the RS group had fewer positive CRMs(P=0.04),lesser estimated blood loss(P<0.00001),shorter postoperative hospital stays(P=0.02),and fewer postoperative complications(P=0.002)than patients in the LS group.CONCLUSION Our study shows that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS.展开更多
Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical sys...Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery.However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless,robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.展开更多
Rectal cancer is one of the most common malignancies worldwide.Surgical resection for rectal cancer usually requires a proctectomy with respective lymphadenectomy(total mesorectal excision).This has traditionally been...Rectal cancer is one of the most common malignancies worldwide.Surgical resection for rectal cancer usually requires a proctectomy with respective lymphadenectomy(total mesorectal excision).This has traditionally been performed transabdominally through an open incision.Over the last thirty years,minimally invasive surgery platforms have rapidly evolved with the goal to accomplish the same quality rectal resection through a less invasive approach.There are currently three resective modalities that complement the traditional open operation:(1)Laparoscopic surgery;(2)Robotic surgery;and(3)Transanal total mesorectal excision.In addition,there are several platforms to carry out transluminal local excisions(without lymphadenectomy).Evidence on the various modalities is of mixed to moderate quality.It is unreasonable to expect a randomized comparison of all options in a single trial.This review aims at reviewing in detail the various techniques in regard to intra-/perioperative benchmarks,recovery and complications,oncological and functional outcomes.展开更多
Background:Over the past two decades robotic surgery has been introduced to many areas including liver surgery.Laparoscopic liver surgery is an alternative minimally invasive approach.However,moving on to the complexi...Background:Over the past two decades robotic surgery has been introduced to many areas including liver surgery.Laparoscopic liver surgery is an alternative minimally invasive approach.However,moving on to the complexity of living donor hepatectomies,the advantages of robotic versus laparoscopic approach have convinced us to establish the robotic platform as a standard for living donor hepatectomy.Methods:From November 2018 to January 2022,501 fully robotic donor hepatectomies,including 177 left lateral donor lobes,112 full left lobes and 212 full right lobes were performed.Grafts were donated to 296 adult recipients and 205 pediatric recipients.Donor age,sex,body weight,body mass index(BMI),graft weight,graft to body weight ratio(GBWR),operative time,blood loss,first warm ischemic time,pain score,length of intensive care unit(ICU)stay and hospital stay,and complications were retrospectively analyzed based on a prospectively kept database.Recipients were evaluated for graft and patient survival,age,sex,BMI,body weight,model of end-stage liver disease score,blood loss,transfusions,operative time,cold ischemic time,length of hospital stay and complications.Results:There was no donor mortality.Two cases needed to be converted to open surgery.The median blood loss was 60 mL(range 20-800),median donor operative time was 6.77 h(range 2.93-11.53),median length of hospital stay was 4 days(range 2-22).Complication rate in donors classified following ClavienDindo was 6.4%(n=32)with one grade Ⅲ complication.Three-year actual recipient overall survival was 91.4%;87.5% for adult recipients and 97.1% for pediatric recipients.Three-year actual graft overall survival was 90.6%;87.5% for adult recipients and 95.1% for pediatric recipients.In-hospital mortality was 6%,9.1%(27/296)for adult recipients and 1.4%(3/205)for pediatric recipients.The recipients’morbidity was 19.8%(n=99).Twenty-eight recipients(5.6%)had biliary and 22(4.4%)vascular complications.Six(12.0%)recipients needed to be re-transplanted.Conclusions:With growing experience it is nowadays possible to perform any donor hepatectomy by robotic approach regardless of anatomical variations and graft size.Donor morbidity and quality for life results are encouraging and should motivate other transplant centers with interest in minimally invasive donor surgery to adopt this robotic technique.展开更多
Thoracic Surgery is a continuous evolving specialty. In the past, thoracic surgeons had to make large incisions in order to operate any pathology inside the chest. This often meant big, painful and ugly scars and long...Thoracic Surgery is a continuous evolving specialty. In the past, thoracic surgeons had to make large incisions in order to operate any pathology inside the chest. This often meant big, painful and ugly scars and long recovery times after surgery. But he history of thoracic surgery changed since the begining of video-assisted thoracoscoDic surgery (VATg3展开更多
BACKGROUND Giant multilocular cystadenoma(GMC)of the prostate gland is a very rare benign tumor.Although the benign nature has been known,complete surgical excision is the major treatment consensus because of its high...BACKGROUND Giant multilocular cystadenoma(GMC)of the prostate gland is a very rare benign tumor.Although the benign nature has been known,complete surgical excision is the major treatment consensus because of its high recurrence rate.We report a rare case of GMC with accompanying lower urinary tract symptoms and repeated urine retention initially thought to be symptoms of benign prostatic hyperplasia,which was treated with robot-assisted laparoscopic radical prostatectomy.CASE SUMMARY A 65-year-old man presented with a 2-year history of lower urinary tract symptoms that had deteriorated gradually within the previous six months,even though he had received treatment with a selective alpha-blocking agent.He had undergone two transurethral resections of the prostate(TURP)at a local hospital during a 4-mo interval because initial ultrasound imaging and prostatic core needle biopsy showed benign prostate hyperplasia.Upon the third recurrence,the patient underwent TURP with a green-light laser at our institution.The diagnosis was a tumor composed of variously sized dilated glandular and cystic structures lined by blended prostatic type epithelia positive for prostate-specific antigen;the final diagnosis was giant multilocular cystadenoma.Magnetic resonance imaging showed a large multilocular retrovesical mass 8.0 cm×7.3 cm×6.4 cm,with heterogeneous enhancement.A coexisting malignant part could not be excluded.Considering the high recurrence rate,risk of coexisting malignancy,and possible sequelae of open surgery for radical excision,the patient decided to undergo robot-assisted radical prostatectomy,with good outcomes at the 2-year follow-up.CONCLUSION Robot-assisted surgery for the treatment of prostate GMC provides another choice for simultaneous attention to disease-control and postoperative quality of life.展开更多
Objective: While interest in elective robotic surgery is growing, use in emergency setting remainslimited due to challenges posed by sicker patients, advanced pathology and logistical issues. During theCOVID-19 pandem...Objective: While interest in elective robotic surgery is growing, use in emergency setting remainslimited due to challenges posed by sicker patients, advanced pathology and logistical issues. During theCOVID-19 pandemic, robotic surgery could provide the benefit of having the surgeon away from thebedside and reducing the number of directly exposed medical staff. The objective of this study was toreport patient outcomes and initial learning experience of emergency robotic colorectal surgery duringthe COVID-19 pandemic.Methods: A case series study was conducted, including patients undergoing emergency robotic colorectalsurgery between February 2020 and February 2021 at Queen Alexandra Hospital in Portsmouth, UK.Patient data were collected from an ethics approved prospective database. Patient demographics,operative time, conversions and postoperative complications were recorded. In addition, readmissions,length of stay and short-term oncological outcomes were analyzed.Results: Ten patients with median age 64 y (range, 36-83 y) were included. Four patients had roboticcomplete mesocolic resection for obstructing cancers. Six had colorectal resections for benign disease inemergency setting. All were R0 with a mean lymph node harvest of 54 ± 13. Mean operative time was249 ± 117 min, the median length of stay was 9.4 d (range, 5-22 d). Only one patient was given atemporary diverting ileostomy. There were no grade III/V complications and no 30-day mortality.Conclusions: Provided an experienced team and peri-operative planning, emergency robotic colorectalsurgery can achieve favorable outcomes with benefits of radical lymph node dissection in oncologicalcases and avoidance of diverting stoma.展开更多
Unlike other surgical residency training programs including thoracic surgery, robotic cardiac surgery skilltraining is minimal or absent in residency curricula. A review was conducted to identify residents'exposur...Unlike other surgical residency training programs including thoracic surgery, robotic cardiac surgery skilltraining is minimal or absent in residency curricula. A review was conducted to identify residents'exposure to robotic cardiac surgery training based on databases including PubMed, MEDLINE and GoogleScholar. Published papers and cardiothoracic surgical societies with robotic cardiac surgery trainingcourses were reviewed. Robotic cardiac surgery training for residents is almost non-existent. Strategies toestablish proper robotic cardiac surgical training for residents include implementing simulation training,implementing hour requirements and establishing wet/dry lab model training in a progressive fashion.As robot-assisted cardiac surgery becomes increasingly commonplace, it will be imperative to providetraining for residents with dedicated opportunities to develop their skills in robotic cardiac surgery.展开更多
Surgeries performed with traditionally available robotic systems have many well-documented anesthetic implications. In this observational report, new and unique anesthetic considerations encountered with the introduct...Surgeries performed with traditionally available robotic systems have many well-documented anesthetic implications. In this observational report, new and unique anesthetic considerations encountered with the introduction of the da Vinci Xi robot related to positioning operating room equipment, patient access and chance for unintended patient contact are described.展开更多
基金Supported by Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-015A and No.TJYXZDXK-058B.
文摘BACKGROUND Hemolymphangioma of the jejunum is rare and lacks clinical specificity,and can manifest as gastrointestinal bleeding,abdominal pain,and intestinal obstruction.Computed tomography,magnetic resonance imaging,and other examinations show certain characteristics of the disease,but lack accuracy.Although capsule endoscopy and enteroscopy make up for this deficiency,the diagnosis also still re-quires pathology.CASE SUMMARY A male patient was admitted to the hospital due to abdominal distension and abdominal pain,but a specific diagnosis by computed tomography examination was not obtained.Partial resection of the small intestine was performed by robotic surgery,and postoperative pathological biopsy confirmed the diagnosis of hemo-lymphangioma.No recurrence in the follow-up examination was observed.CONCLUSION Robotic surgery is an effective way to treat hemolymphangioma through minima-lly invasive techniques under the concept of rapid rehabilitation.
基金National Natural Science Foundation of China,NO.82174466.
文摘BACKGROUND Da Vinci Robotics-assisted total mesorectal excision(TME)surgery for rectal cancer is becoming more widely used.There is no strong evidence that roboticassisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for rectal cancer.AIM To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME surgery.METHODS A retrospective study of the clinical pathology and follow-up of elderly patients who underwent TME surgery at the Department of Gastrointestinal Oncology at the Affiliated Hospital of Nanjing University of Chinese Medicine was conducted from March 2020 through September 2023.The patients were divided into a robotassisted group(the R-TME group)and a laparoscopic group(the L-TME group),and the short-term efficacy of the two groups was compared.RESULTS There were 45 elderly patients(≥60 years)in the R-TME group and 50 elderly patients(≥60 years)in the L-TME group.There were no differences in demographics,conversion rates,or postoperative complication rates.The L-TME group had a longer surgical time than the R-TME group[145(125,187.5)vs 180(148.75,206.25)min,P=0.005),and the first postoperative meal time in the L-TME group was longer than that in the R-TME(4 vs 3 d,P=0.048).Among the sex and body mass index(BMI)subgroups,the R-TME group had better out-comes than did the L-TME group in terms of operation time(P=0.042)and intraoperative assessment of bleeding(P=0.042).In the high BMI group,catheter removal occurred earlier in the R-TME group than in the L-TME group(3 vs 4 d,P=0.001),and autonomous voiding function was restored.CONCLUSION The curative effect and short-term efficacy of robot-assisted TME surgery for elderly patients with rectal cancer are similar to those of laparoscopic TME surgery;however,robotic-assisted surgery has better short-term outcomes for individuals with risk factors such as obesity and pelvic stenosis.Optimizing the learning curve can shorten the operation time,reduce the recovery time of gastrointestinal function,and improve the prognosis.
文摘Background: Epiphrenic Diverticulum is frequently associated with esophageal motility disorders, such as nutcrackers esophagus. The diagnosis is usually made using imaging studies such as a Barium esophagogram, and esophageal manometry. Surgical treatment options for epiphrenic diverticulum and EN include diverticulectomy and wide myotomy. Aim: The resection of three epiphrenic diverticula and extensive myotomy were performed by robotic thoracoscopy uneventfully. Case presentation: A 65-year-old female complaining of dysphagia for solid foods, Chest pain and regurgitation. Esophagogastroduodenoscopy (EDG) with difficulty in advancing the endoscope at 25 cm and demonstrating an ED, no hiatal hernia and normal stomach and duodenum. Barium Esophagogram showed multiple diverticula and tortuosity throughout the esophagus. Conclusion: With robotic surgery, surgeons can perform highly precise operations with enhanced 3D vision and control. Through this cutting-edge approach, the treatment of ED associated with EN can be drastically changed, promising better outcomes for patients.
文摘Aim:The goal of this research was to create a mathematical model to evaluate the short-term effectiveness of laparoscopic and robotic surgeries and to apply this model to surgeries with laparoscopic and robotic variants to evaluate their performance.Materials and methods:A mathematical model was developed in this study to compare the short-term effectiveness of six different surgical procedures:ventral hernia repairs,hysterectomies,lung lobectomies,pancreatectomies,gastric bypass,and prostatectomies.The criteria analyzed to compare these procedures included morbidity rate,readmission rate,mortality rate,cost,length of hospitalization and operative time.These criteria were scaled based on their significance when considering a surgery,such that more important criteria,those that directly impact patient health,are more heavily weighted than less important criteria.Results:The mathematical model indicated that robotic surgery was the preferred option for lung lobectomies and prostatectomies.Laparoscopy was preferred for all other procedures.In the case of gastric bypass,laparoscopy was heavily preferred,and there was only a marginal preference in laparoscopy for hysterectomies and ventral hernia repairs.Conclusion:The mathematical model developed in this research serves as a robust definitive standard that can continue to be utilized to compare robotic and laparoscopic surgeries.With new technologies,preferences are likely to change in favor of robotic surgery,and this model can be employed to predict the impact of those advancements.
基金National Natural Science Foundation of China,No.81860519.
文摘BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the current literature on this method is limited to case reports,and further investigation into its safety and feasibility is warranted.AIM To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.METHODS From September 2018 to February 2022,206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis.Of these patients,22 underwent R-NOSES I-F surgery(RNOSES I-F group)and 76 underwent conventional robotic-assisted low rectal cancer resection(RLRC group).Clinicopathological data of all patients were collected and analyzed.Postoperative outcomes and prognoses were compared between the two groups.Statistical analysis was performed using SPSS software.RESULTS Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1(1.7±0.7 vs 2.2±0.6,P=0.003)and shorter postoperative anal venting time(2.7±0.6 vs 3.5±0.7,P<0.001)than those in the RLRC group.There were no significant differences between the two groups in terms of sex,age,body mass index,tumor size,TNM stage,operative time,intrao-perative bleeding,postoperative complications,or inflammatory response(P>0.05).Postoperative anal and urinary functions,as assessed by Wexner,low anterior resection syndrome,and International Prostate Symptom Scale scores,were similar in both groups(P>0.05).Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups(P>0.05).CONCLUSION R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer.It improves pain relief,promotes gastrointestinal function recovery,and helps avoid incision-related complications.
文摘Objective To report the outcomes of intra-and extra-peritoneal robot-assisted radical prostatectomy(RARP)and robot-assisted radical cystectomy(RARC)with Hugo™robot-assisted surgery(RAS)system(Medtronic,Minneapolis,MN,USA).Methods Data of twenty patients who underwent RARP and one RARC at our institution between February 2022 and January 2023 were reported.The primary endpoint of the study was to report the surgical setting of Hugo™RAS system to perform RARP and RARC.The secondary endpoint was to assess the feasibility of RARP and RARC with this novel robotic platform and report the outcomes.Results Seventeen patients underwent RARP with a transperitoneal approach,and three with an extraperitoneal approach;and one patient underwent RARC with intracorporeal ileal conduit.No intraoperative complications occurred.Median docking and console time were 12(interquartile range[IQR]7-16)min and 185(IQR 177-192)min for transperitoneal RARP,15(IQR 12-17)min and 170(IQR 162-185)min for extraperitoneal RARP.No intraoperative complications occurred.One patient submitted to extraperitoneal RARP had a urinary tract infection in the postoperative period that required an antibiotic treatment(Clavien-Dindo Grade 2).In case of transperitoneal RARP,two minor complications occurred(one pelvic hematoma and one urinary tract infection;both Clavien-Dindo Grade 2).Conclusion Hugo™RAS system is a novel promising robotic platform that allows to perform major oncological pelvic surgery.We showed the feasibility of RARP both intra-and extra-peritoneally and RARC with intracorporeal ileal conduit with this novel platform.
文摘Objective Although robotic surgery adoption and its indications are growing worldwide,for multiple factors,including costs,there is a lack of training and experience.Our aim was to study the impact of a robotic introduction training program on gesture performance,such as suturing,in robot-naive individuals.Methods Using the DaVinci robot,a 2-hour program was based on virtual reality and anatomical model exercises.All participants performed 3 repetitions of virtual reality exercises on the virtual simulator,and then performed and were assessed on 2 tests,ie robot and laparoscopic training box.After the course,the participants were surveyed for this training program.Results Twenty-seven residents and surgeons were enrolled in the training program.With only 2 hours of training,all of the participants were able to complete the training program,thus learning generic and specific skills in robotic surgery.In virtual reality exercise,the scores of the 3 exercises increased significantly with every repetition(p<0.001)and the size of the increase was large.The completion time on the robot platform was 2.6 times faster(169.33±28.28 s vs.447.96±156.55 s,p<0.001)than that in the laparoscopic box,and the difference between both types of tests was large(pη2=0.797).The centralization and passage of the needle were significantly better on the robot platform(5 vs.3,p<0.001,r=0.47;5 vs.4,p<0.001,r=0.59)than in the laparoscopic box.For the intracorporeal stitch+knot test,every participant was able to perform the exercise on the robot but only 85.2%(23/27)in the laparoscopic box.Twenty-one participants answered the survey,and 13(61.9%)of them considered robotic performance independent of laparoscopic experience.Conclusions Surgeons are interested and seek training in robotic surgery.We implemented the first hands-on robotic surgery training program in Portugal and participants considered it was important and adequate for its purpose.All participants,even without robotic experience,learned quicker,performed better,faster and more precisely on the robot over laparoscopy.
文摘BACKGROUND In recent years,minimally invasive liver resection has become a standard of care for liver tumors.Considering the need to treat increasingly fragile patients,general anesthesia is sometimes avoided due to respiratory complications.Therefore,surgical treatment with curative intent is abandoned in favor of a less invasive and less radical approach.Epidural anesthesia has been shown to reduce respiratory complications,especially in elderly patients with pre-existing lung disease.CASE SUMMARY A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular carcinoma.The patient was suffering from hypertension,diabetes and chronic obstructive pulmonary disease.The National Surgical Quality Improvement Program score for developing pneumonia was 9.2%.We planned a combined spinal–epidural anesthesia with conscious sedation to avoid general anesthesia.No modification of the standard surgical technique was necessary.Hemodynamics were stable and bleeding was minimal.The postoperative course was uneventful.CONCLUSION Robotic surgery in locoregional anesthesia with conscious sedation could be considered a safe and suitable approach in specialized centers and in selected patients.
文摘With an ageing global population,we will see an increasing number of elderly patients with colorectal cancer(CRC)requiring surgery.However,it should be recognized that the elderly are a heterogenous group,with varying physiological and functional status.While traditionally viewed to be associated with frailty,comorbidities,and a higher risk of post operative morbidity,the advancements in minimally invasive surgery(MIS)and improvements in perioperative care have allowed CRC surgery to be safe and feasible in the elderly-chronological age alone should therefore not strictly be an exclusion criterion for curative surgery.However,as a form of MIS,laparoscopic assisted colorectal surgery(LACS)has the inherent disadvantages of:(1)Dependence on a trained assistant for retraction and laparoscope control;(2)The loss of wristed movement with reduced dexterity and suboptimal ergonomics;(3)A lack of intuitive movement due to the levering effect of trocars;and(4)An amplification of physiological tremors.Representing a technical evolution of LACS,robotic assisted colorectal surgery was introduced to overcome these limitations.In this minireview,we examine the evidence for robotic surgery in the elderly with CRC.
文摘BACKGROUND Lymphangiomas are a group of benign swellings which are commonly seen in children.The most common sites of presentation is the head and neck region,less commonly seen in axilla,chest,liver,spleen,etc.The ideal modality of treatment has always been surgical excision irrespective of the site and age group.But with the advent of minimally invasive surgical techniques,it is now possible to perform excision of parapharyngeal space lesions with minimal morbidity and good clearance.CASE SUMMARY A 42-year-old male patient who presented with difficulty in swallowing and had undergone surgery twice outside,where Transcervical approach was attempted to remove the parapharyngeal mass,but failed.Magnetic resonance imaging scan demonstrated a 6 cm x 5 cm x 4 cm left parapharyngeal mass.He underwent transoral robotic surgery for the excision of the parapharyngeal lesion and had an uneventful post-operative recovery.CONCLUSION Lymphangiomas are hamartomatous swellings which are benign in nature.The symptoms of the patient with large parapharyngeal mass include dysphagia,dyspnoea and neck swelling.Clinicoradiological evaluation is of utmost importance to determine the adjacent vital structures and the approach to the tumor.With the advent of robotics in oncology,transoral robotic excision is one of the best approaches to perform such a surgery.
文摘Objective:To evaluate the perioperative as well as early oncological outcomes of patients undergoing robotic retroperitoneal lymph node dissection for treatment of testicular cancer.Methods:We conducted a prospective consecutive case series of patients undergoing robotic assisted retroperitoneal lymph node dissection for metastatic testicular cancer between May 2018 and July 2021 at our institution.Data were collected on patient and tumour characteristics,intraoperative and postoperative parameters,and functional and oncological outcomes.Descriptive statistics are presented.Results:Nineteen patients were identified;18(94.7%)completed the procedure robotically and one was converted to open surgery;78.9%of patients had stage≥IIB and 12(63.2%)patients had undergone prior chemotherapy.The median operative time was 300(interquartile range[IQR]240-315)min.Median blood loss was 100(IQR 50-175)mL.Median length of stay was 2(range 1-11)days.All robotically completed patients commenced diet and passed flatus on Day 1 and were discharged by Day 3.The median lymph node yield was 40.5(IQR 38-51)nodes.All patients undergoing nerve-sparing procedures recovered antegrade ejaculatory function.One patient had a Clavien-Dindo III complication(chylous ascites requiring drainage).At a median follow-up of 22.3(IQR 16.3-24.9)months,one patient developed retroperitoneal recurrence,which was successfully treated with second-line chemotherapy;no other patients have had recurrences.Conclusion:Robotic retroperitoneal lymph node dissection is a safe and feasible alternative to open surgery in appropriately selected patients,offering low morbidity.Early oncological outcomes are promising.Larger cohorts and longer follow-ups are required to validate our institution's findings.
文摘BACKGROUND Robotic surgery(RS)is gaining popularity;however,evidence for abdominoperineal resection(APR)of rectal cancer(RC)is scarce.AIM To compare the efficacy of RS and laparoscopic surgery(LS)in APR for RC.METHODS We retrospectively identified patients with RC who underwent APR by RS or LS from April 2016 to June 2022.Data regarding short-term surgical outcomes were compared between the two groups.To reduce the effect of potential confounding factors,propensity score matching was used,with a 1:1 ratio between the RS and LS groups.A meta-analysis of seven trials was performed to compare the efficacy of robotic and laparoscopic APR for RC surgery.RESULTS Of 133 patients,after propensity score matching,there were 42 patients in each group.The postoperative complication rate was significantly lower in the RS group(17/42,40.5%)than in the LS group(27/42,64.3%)(P=0.029).There wasno significant difference in operative time(P=0.564),intraoperative transfusion(P=0.314),reoperation rate(P=0.314),lymph nodes harvested(P=0.309),or circumferential resection margin(CRM)positive rate(P=0.314)between the two groups.The meta-analysis showed patients in the RS group had fewer positive CRMs(P=0.04),lesser estimated blood loss(P<0.00001),shorter postoperative hospital stays(P=0.02),and fewer postoperative complications(P=0.002)than patients in the LS group.CONCLUSION Our study shows that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS.
文摘Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery.However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless,robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.
文摘Rectal cancer is one of the most common malignancies worldwide.Surgical resection for rectal cancer usually requires a proctectomy with respective lymphadenectomy(total mesorectal excision).This has traditionally been performed transabdominally through an open incision.Over the last thirty years,minimally invasive surgery platforms have rapidly evolved with the goal to accomplish the same quality rectal resection through a less invasive approach.There are currently three resective modalities that complement the traditional open operation:(1)Laparoscopic surgery;(2)Robotic surgery;and(3)Transanal total mesorectal excision.In addition,there are several platforms to carry out transluminal local excisions(without lymphadenectomy).Evidence on the various modalities is of mixed to moderate quality.It is unreasonable to expect a randomized comparison of all options in a single trial.This review aims at reviewing in detail the various techniques in regard to intra-/perioperative benchmarks,recovery and complications,oncological and functional outcomes.
文摘Background:Over the past two decades robotic surgery has been introduced to many areas including liver surgery.Laparoscopic liver surgery is an alternative minimally invasive approach.However,moving on to the complexity of living donor hepatectomies,the advantages of robotic versus laparoscopic approach have convinced us to establish the robotic platform as a standard for living donor hepatectomy.Methods:From November 2018 to January 2022,501 fully robotic donor hepatectomies,including 177 left lateral donor lobes,112 full left lobes and 212 full right lobes were performed.Grafts were donated to 296 adult recipients and 205 pediatric recipients.Donor age,sex,body weight,body mass index(BMI),graft weight,graft to body weight ratio(GBWR),operative time,blood loss,first warm ischemic time,pain score,length of intensive care unit(ICU)stay and hospital stay,and complications were retrospectively analyzed based on a prospectively kept database.Recipients were evaluated for graft and patient survival,age,sex,BMI,body weight,model of end-stage liver disease score,blood loss,transfusions,operative time,cold ischemic time,length of hospital stay and complications.Results:There was no donor mortality.Two cases needed to be converted to open surgery.The median blood loss was 60 mL(range 20-800),median donor operative time was 6.77 h(range 2.93-11.53),median length of hospital stay was 4 days(range 2-22).Complication rate in donors classified following ClavienDindo was 6.4%(n=32)with one grade Ⅲ complication.Three-year actual recipient overall survival was 91.4%;87.5% for adult recipients and 97.1% for pediatric recipients.Three-year actual graft overall survival was 90.6%;87.5% for adult recipients and 95.1% for pediatric recipients.In-hospital mortality was 6%,9.1%(27/296)for adult recipients and 1.4%(3/205)for pediatric recipients.The recipients’morbidity was 19.8%(n=99).Twenty-eight recipients(5.6%)had biliary and 22(4.4%)vascular complications.Six(12.0%)recipients needed to be re-transplanted.Conclusions:With growing experience it is nowadays possible to perform any donor hepatectomy by robotic approach regardless of anatomical variations and graft size.Donor morbidity and quality for life results are encouraging and should motivate other transplant centers with interest in minimally invasive donor surgery to adopt this robotic technique.
文摘Thoracic Surgery is a continuous evolving specialty. In the past, thoracic surgeons had to make large incisions in order to operate any pathology inside the chest. This often meant big, painful and ugly scars and long recovery times after surgery. But he history of thoracic surgery changed since the begining of video-assisted thoracoscoDic surgery (VATg3
文摘BACKGROUND Giant multilocular cystadenoma(GMC)of the prostate gland is a very rare benign tumor.Although the benign nature has been known,complete surgical excision is the major treatment consensus because of its high recurrence rate.We report a rare case of GMC with accompanying lower urinary tract symptoms and repeated urine retention initially thought to be symptoms of benign prostatic hyperplasia,which was treated with robot-assisted laparoscopic radical prostatectomy.CASE SUMMARY A 65-year-old man presented with a 2-year history of lower urinary tract symptoms that had deteriorated gradually within the previous six months,even though he had received treatment with a selective alpha-blocking agent.He had undergone two transurethral resections of the prostate(TURP)at a local hospital during a 4-mo interval because initial ultrasound imaging and prostatic core needle biopsy showed benign prostate hyperplasia.Upon the third recurrence,the patient underwent TURP with a green-light laser at our institution.The diagnosis was a tumor composed of variously sized dilated glandular and cystic structures lined by blended prostatic type epithelia positive for prostate-specific antigen;the final diagnosis was giant multilocular cystadenoma.Magnetic resonance imaging showed a large multilocular retrovesical mass 8.0 cm×7.3 cm×6.4 cm,with heterogeneous enhancement.A coexisting malignant part could not be excluded.Considering the high recurrence rate,risk of coexisting malignancy,and possible sequelae of open surgery for radical excision,the patient decided to undergo robot-assisted radical prostatectomy,with good outcomes at the 2-year follow-up.CONCLUSION Robot-assisted surgery for the treatment of prostate GMC provides another choice for simultaneous attention to disease-control and postoperative quality of life.
文摘Objective: While interest in elective robotic surgery is growing, use in emergency setting remainslimited due to challenges posed by sicker patients, advanced pathology and logistical issues. During theCOVID-19 pandemic, robotic surgery could provide the benefit of having the surgeon away from thebedside and reducing the number of directly exposed medical staff. The objective of this study was toreport patient outcomes and initial learning experience of emergency robotic colorectal surgery duringthe COVID-19 pandemic.Methods: A case series study was conducted, including patients undergoing emergency robotic colorectalsurgery between February 2020 and February 2021 at Queen Alexandra Hospital in Portsmouth, UK.Patient data were collected from an ethics approved prospective database. Patient demographics,operative time, conversions and postoperative complications were recorded. In addition, readmissions,length of stay and short-term oncological outcomes were analyzed.Results: Ten patients with median age 64 y (range, 36-83 y) were included. Four patients had roboticcomplete mesocolic resection for obstructing cancers. Six had colorectal resections for benign disease inemergency setting. All were R0 with a mean lymph node harvest of 54 ± 13. Mean operative time was249 ± 117 min, the median length of stay was 9.4 d (range, 5-22 d). Only one patient was given atemporary diverting ileostomy. There were no grade III/V complications and no 30-day mortality.Conclusions: Provided an experienced team and peri-operative planning, emergency robotic colorectalsurgery can achieve favorable outcomes with benefits of radical lymph node dissection in oncologicalcases and avoidance of diverting stoma.
文摘Unlike other surgical residency training programs including thoracic surgery, robotic cardiac surgery skilltraining is minimal or absent in residency curricula. A review was conducted to identify residents'exposure to robotic cardiac surgery training based on databases including PubMed, MEDLINE and GoogleScholar. Published papers and cardiothoracic surgical societies with robotic cardiac surgery trainingcourses were reviewed. Robotic cardiac surgery training for residents is almost non-existent. Strategies toestablish proper robotic cardiac surgical training for residents include implementing simulation training,implementing hour requirements and establishing wet/dry lab model training in a progressive fashion.As robot-assisted cardiac surgery becomes increasingly commonplace, it will be imperative to providetraining for residents with dedicated opportunities to develop their skills in robotic cardiac surgery.
文摘Surgeries performed with traditionally available robotic systems have many well-documented anesthetic implications. In this observational report, new and unique anesthetic considerations encountered with the introduction of the da Vinci Xi robot related to positioning operating room equipment, patient access and chance for unintended patient contact are described.