Robotic surgical systems in maxillofacial surgery:a review

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.

The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy： experience of a single surgeon with 500 cases in Taiwan, China

To analyze the learning curve for cancer control from an initial 250 cases （Group I） and subsequent 250 cases （Group II） of robotic-assisted laparoscopic radical prostatectomy （RALP） performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups, Positive surgical margin （PSM） and biochemical recurrence （BCR） were assessed as cancer control outcomes. Patients in Group II had significantly more advanced prostate cancer than those in Group I （22.2% vs 14.2%, respectively, with Gleason score 8-10, P = 0.033; 12.8% vs 5.6%, respectively, with clinical stage T3, P = 0.017）. The incidence of PSM in pT3 was decreased significantly from 49% in Group I to 32.6% in Group Ih A meaningful trend was noted for a decreasing PSM rate with each consecutive group of 50 cases, including pT3 and high-risk patients. Neurovascular bundle （NVB） preservation was significantly influenced by the PSM in high-risk patients （84.1% in the preservation group vs 43.9% in the nonpreservation group）. The 3-year, 5-year, and 7-year BCR-free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased significantly after 250 cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50 cases. NVB preservation during RALP for the high-risk group is not suggested due to increasing PSM.

Evolutions and Future Directions of Surgical Robotics: A Review

Although the robotics firstly appeared as an entertainment form, its capabilities have continuously advanced from the world’s first industrial robot to the surgical robotic systems which are today capable of performing many surgical maneuvers unaided. However, these surgical robots are not autonomous systems;they are designed to complete a surgeon’s abilities and converting surgeon’s movements into incredibly steady and accurate robotic movements that finally manipulate surgical instruments to assist delicate operations. This novel type of surgery is carried out in the form of minimally invasive surgical procedure and has offered valuable alternatives to enhance traditional open surgery approach. Although the surgical robotic systems began as external robots, technological progresses are directing the surgical robotic systems to endoluminal robots which consist of doing surgical maneuvers by navigating of robot through lumens of human body. Here, we will briefly review different applications of robotic systems in various fields of medicine. Then, we will discuss minimally invasive surgical systems and their role in progressing of minimally invasive surgery as a modern surgery method. By thoroughly investigating a considerable amount of published materials about the minimally invasive surgical technologies, we will study the recent research activities and commercially available samples of surgical robotic systems.

The robot-assisted ureteral reconstruction in adult:A narrative review on the surgical techniques and contemporary outcomes

Despite the rapid increase in the use of robotic surgery in urology,the majority of ureteric reconstruction procedures are still performed using laparoscopic or open approaches.This is primarily due to uncertainty regarding the advantages of robotic approaches over conventional ones,and the unique difficulty in identifying the specific area of interest due to the lack of tactile feedback from the current robotic systems.However,with the potential benefits of minimal invasiveness,several pioneering reports have been published on robotic surgery in urology.By reviewing the literature on this topic,we aimed to summarize the techniques,considerations,and consistent findings regarding robotic ureteral reconstruction in adults.Robotic applications for ureteral surgery have been primarily reported for pediatric urology,especially in the context of relieving a congenital obstruction in the ureteral pelvic junction.However,contemporary studies have also consistently demonstrated that robotic surgery could be a reliable option for malignant,iatrogenic,and traumatic conditions,which generally occur in adult patients.Nevertheless,the lack of comparative studies on heterogeneous hosts and disease conditions make it difficult to determine the benefit of the robotic approach over the conventional approach in the general population;thus,qualified prospective trials are needed for wider acceptance.However,contemporary reports have demonstrated that the robotic approach could be an alternative option for ureteral construction,even in the absence of haptic feedback,which can be compensated by various surgical techniques and enhanced three-dimensional visualization.

Method for Latency Measurement of Visual Feedback-Based Master–Slave Minimally Invasive Surgical Robot

To measure the latency between human motion stimulation and stereo image display response in a visual feedback-based minimally invasive surgical(MIS) robotic system,a method was proposed by comparing the orientations of input and output events through image-processing technology. This method used a black bar to keep pace with the measured joint rotating at a number of speeds. During tests,an external camera was placed in front of the apparatus with a proper visual field,so that it can simultaneously view orientations of both bars fixed on the corresponding joints. After quantitatively analyzing the accuracy of the proposed measurement method,the method was applied to a visual feedback-based master–slave robotic system with two-degrees-of-freedom. Experimental results show that the latency of the overall system was approximately 250 ms,and the opposite clearance of the measured joint was in the range of 1.7°–1.9°.

Robot-assisted adrenalectomy:Step-by-step technique and surgical outcomes at a high-volume robotic center

Objective In the last years,robotic surgery was introduced in several different settings with good perioperative results.However,its role in the management of adrenal masses is still debated.In order to provide a contribution to this field,we described our step-by-step technique for robotic adrenalectomy(RA)and related modifications according to the type of adrenal mass treated.Methods We retrospectively analyzed 27 consecutive patients who underwent RA at Onze-Lieve-Vrouw hospital(Aalst,Belgium)between January 2009 and October 2022.Demographic,intra-and post-operative,and pathological data were retrieved from our prospectively maintained institutional database.Continuous variables are summarized as median and interquartile range(IQR).Categorical variables are reported as frequencies(percentages).Results Twenty-seven patients underwent RA were included in the study.Median age,body mass index,and Charlson's comorbidity index were 61(IQR:49-71)years,26(IQR:24-29)kg/m^(2),and 2(IQR:0-3),respectively,and 16(59.3%)patients were male.Median tumor size at computed tomography scan was 6.0(IQR:3.5-8.0)cm.Median operative time and blood loss were 105(IQR:82-120)min and 175(IQR:94-250)mL,respectively.No intraoperative complications were recorded.Overall postoperative complications rate was 11.1%,with a postoperative transfusion rate of 3.7%.A total of 10(37.0%)patients harbored malignant adrenal masses.Among them,3(11.1%)had adrenocortical carcinoma,6(22.2%)secondary metastasis,and 1(3.7%)malignant pheochromocytoma on final pathological exam.Only 1(10.0%)patient had positive surgical margins.Conclusion We described our step-by-step technique for RA,which can be safely performed even in case of high challenging settings as malignant tumors,pheochromocytoma,and large masses.The standardization of perioperative protocol should be encouraged to maximize the outcomes of this complex surgical procedure.

Least Squares Support Vector Machine Kalman Filter for Physiological Tremor Suppression in Minimally Invasive Surgical Robot

This paper studies the physiological tremor filtering in minimally invasive surgical robot.The surgeon􀆳s physiological tremor of the hand can cause the vibration of the tip of the surgical instrument,which may reduce operative accuracy and limit the application of surgical robots.Aiming at the vibration caused by physiological tremor of hand,we propose a Least Squares Support Vector Machine Kalman Filter(LSSVMKF),which can filter the tremor by estimating and modeling the tremor signal by Kalman filter and then superimposing it reversely in the control signal.When estimating and modeling the tremor signal,the filter uses the Least Squares Support Vector Machine(LS⁃SVM)to build the regression model of the constant parameters(Process Noise Covariance and Measurement Noise Covariance)of the traditional Kalman filter,which can dynamically adjust these parameters during the operation and improve the accuracy of Kalman filter.The simulation results show that the LSSVMKF can effectively filter out the tremor signal,thereby improving the accuracy of surgery.

Spondylodiscitis, epidural abscess, and meningitis after transoral robotic surgical resection of a squamous cell carcinoma of the posterior pharyngeal wall

Transoral robotic surgery(TORS)is a minimally invasive technique for resection of tumors of the posterior pharyngeal wall.Rarely,post-TORS cervical spondylodiscitis has been reported in the literature,with high morbidity and mortality.A 64-year-old female with underlying cervical disk disease underwent TORS resection of a posterior pharyngeal wall carcinoma without reconstruction in April 2020.Roughly one month post-operatively,the patient presented with clinical and radiographic signs of spondylodiscitis,epidural abscess,and meningitis.The patient was treated with antibiotic therapy and anterior cervical discectomy and fusion.The patient recovered without neurologic deficit.A three-month post-treatment PET-CT scan showed no evidence of residual disease.Post-operative cervical spondylodiscitis and meningitis are rare complications of TORS resection for posterior pharyngeal wall carcinomas,but the risk is increased in patients with underlying cervical disk disease.In such patients,perioperative antibiotic treatment and/or reconstruction should be considered to prevent neurologic complications and death.

Does robotic surgical staging of endometrial cancer compromise outcomes?

Objective: To compare intra-operative and post-operative complications as well as recurrence in women withendometrial cancer undergoing surgical stagingwith robotic-assisted laparoscopic hysterectomy (RALH)versus total abdominal hysterectomy (TAH). Methods: A retrospective review was performed of 416 patients who underwent surgical staging for endometrial adenocarcinoma from January 1, 2008 to December 31, 2010. Demographics,intraand post-operative complications, surgical-pathologic data, subsequent treatments, and recurrence were compared in women treated with TAH versus RALH. A Student’st-test, Mann Whitney U analysis, or chi-squared analysis were used for statistical analysis. Results: One hundred thirty seven and 279 patients underwent TAH and RALH, respectively. Post-operative complications were lower in the RALH group (16.8% vs 8.2%, p = 0.009) and mean hospital stay for the TAH group versus the RALH group was 3 days versus 1 day (p < 0.001). Demographics and intra-operative complications were similar (p = 0.94). Uterine weight (108 gvs103 g, p = 0.36), pelvic lymph nodes retrieved (9 vs 9, p = 0.18), and presence of lymph-vascular involvement (11.7% vs 10.8%, p = 0.38) were similar between groups, as were aggressive histologic subtypes (p = 0.52) and grade (p = 0.15). Recurrence occurred in 4.4% of the TAH group and 4.3% of the RALH group (p = 0.97) with death from disease occurring in 1.5% of the TAH group and 2.2% of the RALH group (p = 0.64). Conclusions: RALH for endometrial adenocarcinoma is associated with fewer post-operative complications and a shorter hospital stay than TAH. Recurrence and death due to disease are not compromised by this minimally invasive approach.

Single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy (spRALP): Initial experience

Objective:To assess the feasibility of single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy(spRALP)and discuss its surgical technique.Methods:A 60-year-old male was admitted with an elevated prostate-specific antigen(PSA)level of 13.89 ng/mL and confirmed with prostate cancer on biopsy showing three of 22 positive cores with a Gleason score of 3þ4=7.Multiparametric magnetic resonance(MR)and bone scintigraphy showed organ-confined disease.spRALP was performed using da Vinci Si HD surgical system,with access of a quadri-channel laparoscopic port placed supraumbilically.Two drainage tubes were placed before wound closure.The surgical procedure was largely in consistence with a conventional robotic-assisted laparoscopic radical prostatectomy.Results:The surgery was successfully carried out with a duration of 152 min and an estimated blood loss of 100 mL.The patient was discharged on postoperative Day 4 after removal of both pelvic drainage tubes.Foley catheter was removed on postoperative Day 14.No major complications were encountered.Postoperative pathology showed a Gleason score of 3þ4=7 with no extraprostatic extension and negative surgical margins.Conclusion:Single-port robotic prostatectomy is feasible using the currently available robotic instruments in most Chinese robotic urological centers.Meticulous preoperative planning and careful patient selection are mandatory.Further studies concerning perioperative complications and pentafecta outcome compared with the conventional multi-port robotic prostatectomy is required.

Summarizing the evidence for robotic-assisted bladder neck reconstruction: Systematic review of patency and incontinence outcomes

Objective:Bladder neck contracture and vesicourethral anastomotic stenosis are difficult to manage endoscopically,and open repair is associated with high rates of incontinence.In recent years,there have been increasing reports of robotic-assisted bladder neck reconstruction in the literature.However,existing studies are small,heterogeneous case series.The objective of this study was to perform a systematic review of robotic-assisted bladder neck reconstruction to better evaluate patency and incontinence outcomes.Methods:We performed a systematic review of PubMed from first available date to May 2023 for all studies evaluating robotic-assisted reconstructive surgery of the bladder neck in adult men.Articles in non-English,author replies,editorials,pediatric-based studies,and reviews were excluded.Outcomes of interest were patency and incontinence rates,which were pooled when appropriate.Results:After identifying 158 articles on initial search,we included only ten studies that fit all aforementioned criteria for robotic-assisted bladder neck reconstruction.All were case series published from March 2018 to March 2022 ranging from six to 32 men,with the median follow-up of 5e23 months.A total of 119 patients were included in our analysis.A variety of etiologies and surgical techniques were described.Patency rates ranged from 50%to 100%,and pooled patency was 80%(95/119).De novo incontinence rates ranged from 0%to 33%,and pooled incontinence was 17%(8/47).Our findings were limited by small sample sizes,relatively short follow-ups,and heterogeneity between studies.

Robotic versus laparoscopic surgery for sporadic benign insulinoma:Short-and long-term outcomes

Background:Minimally invasive surgery is the optimal treatment for insulinoma.The present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign insulinoma.Methods:A retrospective analysis of patients who underwent laparoscopic or robotic surgery for insulinoma at our center between September 2007 and December 2019 was conducted.The demographic,perioperative and postoperative follow-up results were compared between the laparoscopic and robotic groups.Results:A total of 85 patients were enrolled,including 36 with laparoscopic approach and 49 with robotic approach.Enucleation was the preferred surgical procedure.Fifty-nine patients(69.4%)underwent enucleation;among them,26 and 33 patients underwent laparoscopic and robotic surgery,respectively.Robotic enucleation had a lower conversion rate to laparotomy(0 vs.19.2%,P=0.013),shorter operative time(102.0 vs.145.5 min,P=0.008)and shorter postoperative hospital stay(6.0 vs.8.5 d,P=0.002)than laparoscopic enucleation.There were no differences between the groups in terms of intraoperative blood loss,the rates of postoperative pancreatic fistula and complications.After a median follow-up of 65 months,two patients in the laparoscopic group developed a functional recurrence and none of the patients in the robotic group had a recurrence.Conclusions:Robotic enucleation can reduce the conversion rate to laparotomy and shorten operative time,which might lead to a reduction in postoperative hospital stay.

Robotic-assisted low anterior resection for rectal cancer shows similar clinical efficacy to laparoscopic surgery: A propensity score matched study

BACKGROUND Rectal cancer ranks as the second leading cause of cancer-related mortality worldwide,necessitating surgical resection as the sole treatment option.Over the years,there has been a growing adoption of minimally invasive surgical techni-ques such as robotic and laparoscopic approaches.Robotic surgery represents an innovative modality that effectively addresses the limitations associated with traditional laparoscopic techniques.While previous studies have reported favo-rable perioperative outcomes for robot-assisted radical resection in rectal cancer patients,further evidence regarding its oncological safety is still warranted.AIM To conduct a comparative analysis of perioperative and oncological outcomes between robot-assisted and laparoscopic-assisted low anterior resection(LALAR)procedures.METHODS The clinical data of 125 patients who underwent robot-assisted low anterior resection(RALAR)and 279 patients who underwent LALAR resection at Shandong Provincial Hospital Affiliated to Shandong First Medical University from December 2019 to November 2022 were retrospectively analyzed.After performing a 1:1 propensity score matching,the patients were divided into two groups:The RALAR group and the LALAR group(111 cases in each group).Subsequently,a comparison was made between the short-term outcomes within 30 d after surgery and the 3-year survival outcomes of these two groups.RESULTS Compared to the LALAR group,the RALAR group exhibited a significantly earlier time to first flatus[2(2-2)d vs 3(3-3)d,P=0.000],as well as a shorter time to first fluid diet[4(3-4)d vs 5(4-6)d,P=0.001].Additionally,the RALAR group demonstrated reduced postoperative indwelling catheter time[2(1-3)d vs 4(3-5)d,P=0.000]and decreased length of hospital stay after surgery[5(5-7)d vs 7(6-8)d,P=0.009].Moreover,there was an observed increase in total cost of hospitalization for the RALAR group compared to the LALAR group[10777(10780-11850)dollars vs 10550(8766-11715)dollars,P=0.012].No significant differences were found in terms of conversion rate to laparotomy or incidence of postoperative complications between both groups.Furthermore,no significant disparities were noted regarding the 3-year overall survival rate and 3-year disease-free survival rate between both groups.CONCLUSION Robotic surgery offers potential advantages in terms of accelerated recovery of gastrointestinal and urologic function compared to LALAR resection,while maintaining similar perioperative and 3-year oncological outcomes.

Impact of the Rapid Recovery Concept on Complications and Patient Quality of Life in the Perioperative Nursing of Robot-Assisted Radical Oesophageal Cancer

Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE). Methods: A total of 150 patients who underwent RAMIE from January 2020 to January 2022 at our hospital were randomly assigned to either the observation group or the control group, with 75 patients in each. The control group received standard perioperative management and nursing care, while the observation group was treated with ERAS nursing strategies. Interventions continued until discharge, and outcomes such as postoperative complications, quality of life, and nutritional status were compared between the groups. Results: The observation group exhibited a significantly lower incidence of postoperative adverse reactions compared to the control group (P ionally, all dimension scores of the Short-Form 36 Health Survey (SF-36), including the total score, were higher in the observation group (P < 0.05). Furthermore, the Nutritional Risk Screening (NRS) scores for impaired nutritional status and disease severity, along with the total NRS score, were significantly lower in the observation group compared to the control group (P Conclusion: Implementing ERAS nursing in the perioperative care of patients undergoing RAMIE is associated with reduced postoperative complications and enhanced postoperative quality of life and nutritional status. .

脊柱手术机器人治疗脊柱疾病的研究发展趋势及热点剖析

背景:近年来在脊柱外科领域,手术机器人的应用已成为研究热点,但目前中国尚缺乏脊柱手术机器人的的文献可视化分析相关研究。目的:对脊柱手术机器人治疗脊柱疾病的研究热点进行文献可视化分析,以期为中国脊柱手术机器人的研究和发展提供有益的参考。方法:在Web of Science核心集数据库中检索脊柱手术机器人治疗脊柱疾病的相关文献,最终纳入900篇文献。采用VOSviewer 1.6.19软件对纳入文献的发文量、期刊、机构、国家、关键词、共被引文献和高被引文献进行可视化分析。结果与结论:(1)脊柱手术机器人治疗脊柱疾病研究领域的文献呈逐年上升趋势,尤其在2023年达到了发文量的高峰。美国、中国和德国是该领域的研究热点国家。中国国家自然科学基金是该领域的主要资助基金。(2)中国北京积水潭医院和美国特殊外科医院在该领域的研究具有较高的发文量。(3)《World Neurosurgery》《Spine》和《Operative Neurosurgery》是该领域的主要发文期刊。(4)关键词分析显示,研究主要集中在机器人辅助脊柱手术的准确性、微创手术、机器人脊柱手术和导航技术等方面。(5)文献共被引分析结果显示了机器人辅助技术在脊柱手术中具有显著优势,与传统手术相比,脊柱手术机器人如ROSA?Spine,ExcelsiusGPS,Mazor X及TiRobot等,具有高精度导航、精确椎弓根螺钉置入及实时反馈等优点,它们通过减少手术中X射线辐射暴露,降低患者并发症风险,提高手术成功率,显示出其在脊柱外科领域的应用前景。(6)尽管如此,相关技术的应用和精确度仍需不断积累经验以提高;机器人手术技术在降低手术辐射暴露和提高手术精度方面显示出成本效益,但还需深入探讨其在椎弓根螺钉置入过程中的精确度、手术时间影响及经济效益。(7)2021-2024年的高被引文献分析结果进一步显示,目前该领域最新研究热点主要集中在虚拟现实和增强现实技术的应用、机器人辅助椎弓根螺钉置入的准确性提升以及导航机器人脊柱手术平台的应用等。例如,通过创新技术如有机电化学神经元为脑机接口、假肢和智能软机器人技术提供了新的集成方案。同时,虚拟现实和增强现实技术在脊柱畸形矫正等领域展示了广泛应用前景。

Non-robotic minimally invasive gastrectomy as an independent risk factor for postoperative intra-abdominal infectious complications: A single-center, retrospective and propensity score-matched analysis

BACKGROUND Minimally invasive surgery for gastric cancer(GC) has gained widespread use as a safe curative procedure especially for early GC.AIM To determine risk factors for postoperative complications after minimally invasive gastrectomy for GC.METHODS Between January 2009 and June 2019, 1716 consecutive patients were referred to our division for primary GC. Among them, 1401 patients who were diagnosed with both clinical and pathological Stage Ⅲ or lower GC and underwent robotic gastrectomy(RG) or laparoscopic gastrectomy(LG) were enrolled. Retrospective chart review and multivariate analysis were performed for identifying risk factors for postoperative morbidity.RESULTS Morbidity following minimally invasive gastrectomy was observed in 7.5% of the patients. Multivariate analyses demonstrated that non-robotic minimally invasive surgery, male gender, and an operative time of ≥ 360 min were significant independent risk factors for morbidity. Therefore, morbidity was compared between RG and LG. Accordingly, propensity-matched cohort analysis revealed that the RG group had significantly fewer intra-abdominal infectious complications than the LG group(2.5% vs 5.9%, respectively;P = 0.038), while no significant differences were noted for other local or systemic complications.Multivariate analyses of the propensity-matched cohort revealed that non-robotic minimally invasive surgery [odds ratio = 2.463(1.070–5.682);P = 0.034] was a significant independent risk factor for intra-abdominal infectious complications.CONCLUSION The findings showed that robotic surgery might improve short-term outcomes following minimally invasive radical gastrectomy by reducing intra-abdominal infectious complications.

Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

AIM To analyses the current literature regarding the urogenital functional outcomes of patients receiving robotic rectal cancer surgery. METHODS A comprehensive literature search of electronic databases was performed in October 2015. The following search terms were applied: "rectal cancer" or "colorectal cancer" and robot* or "da Vinci" and sexual or urolog* or urinary or erect* or ejaculat* or impot* or incontinence. All original studies examining the urological and/or sexual outcomes of male and/or female patients receiving robotic rectal cancer surgery were included. Reference lists of all retrieved articles were manually searched for further relevant articles. Abstracts were independently searched by two authors. RESULTS Fifteen original studies fulfilled the inclusion criteria. A total of 1338 patients were included; 818 received robotic, 498 laparoscopic and 22 open rectal cancer surgery. Only 726(54%) patients had their urogenital function assessed via means of validated functional questionnaires. From the included studies, three found that robotic rectal cancer surgery leads to quicker recovery of male urological function and five of male sexual function as compared to laparoscopic surgery. It is unclear whether robotic surgery offers favourable urogenital outcomes in the long run for males. In female patients only two studies assessed urological and threesexual function independently to that of males. In these studies there was no difference identified between patients receiving robotic and laparoscopic rectal cancer surgery. However, in females the presented evidence was very limited making it impossible to draw any substantial conclusions. CONCLUSION There seems to be a trend towards earlier recovery of male urogenital function following robotic surgery. To evaluate this further, larger well designed studies are required.

A comparison of perioperative outcomes between extraperitoneal robotic single-port and multiport radical prostatectomy with the da Vinci Si Surgical System

To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy(epR-spRP)and extraperitoneal robotic multiport radical prostatectomy(epR-mpRP)performed with the da Vinci Si Surgical System,comparison was performed between 30 single-port(SP group)and 26 multiport(MP group)cases.Comparisons included operative time,estimated blood loss(EBL),hospital stay,peritoneal violation,pain scores,scar satisfaction,continence,and erectile function.The median operation time and EBL were not different between the two groups.In the SP group,the median operation time of the first 10 patients was obviously longer than that of the latter 20 patients(P<0.001).The median postoperative hospital stay in the SP group was shorter than that in the MP group(P<0.001).The rate of peritoneal damage in the SP group was less than that in the MP group(P=0.017).The pain score and overall need for pain medications in the SP group were lower than those in the MP group(P<0.001 and P=0.015,respectively).Patients in the SP group were more satisfied with their scars than those in the MP group 3 months postoperatively(P=0.007).At 3 months,the cancer control,recovery of erectile function,and urinary continence rates were similar between the two groups.It is safe and feasible to perform epR-spRP using the da Vinci Si surgical system.Therefore,epR-spRP can be a treatment option for localized prostate cancer.Although epR-spRP still has a learning curve,it has advantages for postoperative pain and self-assessed cosmesis.In the absence of the single-port robotic surgery platform,we can still provide minimally invasive surgery for patients.

Robotic surgery for rectal cancer: Current immediate clinical and oncological outcomes

Laparoscopic rectal surgery continues to be a challenging operation associated to a steep learning curve. Robotic surgical systems have dramatically changed minimally invasive surgery. Three-dimensional, magnified and stable view, articulated instruments, and reduction of physiologic tremors leading to superior dexterity and ergonomics. Therefore, robotic platforms could potentially address limitations of laparoscopic rectal surgery. It was aimed at reviewing current literature on short-term clinical and oncological(pathological) outcomes after robotic rectal cancer surgery in comparison with laparoscopic surgery. A systematic review was performed for the period 2002 to 2014. A total of 1776 patients with rectal cancer underwent minimally invasive robotic treatment in 32 studies. After robotic and laparoscopic approach to oncologic rectal surgery, respectively, mean operating time varied from 192-385 min, and from 158-297 min; mean estimated blood loss was between 33 and 283 mL, and between 127 and 300 mL; mean length of stay varied from 4-10 d; and from 6-15 d. Conversion after robotic rectal surgery varied from 0% to 9.4%, and from 0 to 22% after laparoscopy. There was no difference between robotic(0%-41.3%) and laparoscopic(5.5%-29.3%) surgery regarding morbidity and anastomotic complications(respectively, 0%-13.5%, and 0%-11.1%). Regarding immediate oncologic outcomes, respectively among robotic and laparoscopic cases, positive circumferential margins varied from 0% to 7.5%, and from 0% to 8.8%; the mean number of retrieved lymph nodes was between 10 and 20, and between 11 and 21; and the mean distal resection margin was from 0.8 to 4.7 cm, and from 1.9 to 4.5 cm. Robotic rectal cancer surgery is being undertaken by experienced surgeons. However, the quality of the assembled evidence does not support definite conclusions about most studies variables. Robotic rectal cancer surgery is associated to increased costs and operating time. It also seems to be associated to reduced conversion rates. Other short-term outcomes are comparable to conventional laparoscopy techniques, if not better. Ultimately, pathological data evaluation suggests that oncologic safety may be preserved after robotic total mesorectal excision. However, further studies are required to evaluate oncologic safety and functional results.

Single-port technique evolution and current practice in urologic procedures

Different groups described the single-port surgery since its first report in laparoscopic procedures.However,the acceptance of this technique among urologists,even after the robotic approach,was reduced in the past years.Therefore,to overcome the challenges related to the single-port surgery,a new robotic platform named da Vinci SP was created with exclusive single port technology.We performed a non-systematic literature review regarding the single port technique in urologic surgeries since the first laparoscopic report until the da Vinci SP robotic platform.Three different periods were described(laparoscopy,robotic,and da Vinci SP),and we focused in our experience with this new single port robot.We selected different articles and summarized the information regarding the use of single-site surgery in laparoscopic procedures and the challenges of this approach.We also reported the experience of different groups using the single port robotic technique and some recent reports of the da Vinci SP approach.In our experience with this new console,we described some critical points related to our radical prostatectomy technique and the lessons learned during the introduction of this novel platform.Previous single-site procedures described some common challenges that limited the technique expansion.However,our experience with the da Vinci SP described feasible and safe procedures with acceptable intraoperative outcomes.The introduction of this platform is recent in the market,and the literature still lacks a high level of evidence describing the long-term outcomes of this new technology.