A 59-year-old man with metastatic an esophageal tumor from hepatocellular carcinoma(HCC) presented with progressive dysphagia.He had undergone liver transplantation for HCC three and a half years prevously.At presenta...A 59-year-old man with metastatic an esophageal tumor from hepatocellular carcinoma(HCC) presented with progressive dysphagia.He had undergone liver transplantation for HCC three and a half years prevously.At presentation,his radiological and endoscopic examinations suggested a submucosal tumor in the lower esophagus,causing a luminal stricture.We performed complete resection of the esophageal metastases and esophagogastrostomy reconstruction using the da Vinci robotic system.Recovery was uneventful and he was been doing well 2 mo after surgery.α-fetoprotein level decreased from 510 ng/mL to 30 ng/mL postoperatively.During the follow-up period,he developed a recurrent esophageal stricture at the anastomosis site and this was successfully treated by endoscopic esophageal dilatation.展开更多
BACKGROUND Traditional methods cannot clearly visualize esophageal cancer(EC)tumor contours and metastases,which limits the clinical application of da Vinci robotassisted surgery.AIM To investigate the efficacy of the...BACKGROUND Traditional methods cannot clearly visualize esophageal cancer(EC)tumor contours and metastases,which limits the clinical application of da Vinci robotassisted surgery.AIM To investigate the efficacy of the da Vinci robot in combination with nanocarbon lymph node tracers in radical surgery of EC.METHODS In total,104 patients with early-stage EC who were admitted to Liuzhou worker's Hospital from January 2020 to June 2023 were enrolled.The patients were assigned to an observation group(n=52),which underwent da Vinci robot-assisted minimally invasive esophagectomy(RAMIE)with the intraoperative use of nanocarbon tracers,and a control group(n=52),which underwent traditional surgery treatment.The operation time,intraoperative blood loss,postoperative drainage tube indwelling time,hospital stay,number of lymph nodes dissected,incidence of complications,and long-term curative effects were comparatively analyzed.The postoperative stress response C-reactive protein(CRP),cortisol,epinephrine(E)and inflammatory response interleukin(IL)-6,IL-8,IL-10,and tumor necrosis factor-alpha(TNF-α)were evaluated.RESULTS Compared with the control group,the observation group had significantly lower postoperative CRP,cortisol,and E levels(P<0.05)with a milder inflammatory response,as indicated by lower IL-6,IL-10,and TNF-αlevels(P<0.05).Patients who underwent RAMIE had less intraoperative blood loss and shorter operation times and hospital stays than those who underwent traditional surgery.The average number of dissected lymph nodes,time of lymph node dissection,and mean smallest lymph node diameter were all significantly lower in the observation group(P<0.05).The rate of postoperative complications was 5.77%in the observation group,significantly lower than the 15.38%observed in the control group.Furthermore,the lymphatic metastasis rate,reoperation rate,and 12-and 24-month cumulative mortality in the observation group were 1.92%,0%,0%,and 0%,respectively,all of which were significantly lower than those in the control group(P<0.05).CONCLUSION The treatment of EC using the da Vinci robot combined with nanocarbon lymph node tracers can achieve good surgical outcomes and demonstrates promising clinical applications.展开更多
Objective: Kanazawa University introduced the da Vinci surgical system and the Radius surgical system. In this study, we compared the advantages and disadvantages of each system. Methods: The da Vinci system is a mast...Objective: Kanazawa University introduced the da Vinci surgical system and the Radius surgical system. In this study, we compared the advantages and disadvantages of each system. Methods: The da Vinci system is a master-slave tele-manipulation system, which provides hi-resolution 3D images. The Radius system is pair of hand-guided surgical manipulators. In this study we focus on the operability of both instruments rather than their 3D optical systems. Results: The Radius was originally developed specifically focused on ligation and suturing with suture sizes bigger than 4-0, it is more effective, less expensive compared with the da Vinci. Although the da Vinci system is bulky, it allows surgeons to perform endoscopic surgeries only if ports are properly placed to prevent each arm from colliding with the other arms. A crucial difference between the Radius and the da Vinci is not limited to anastomose small vessels but is extended to multidirectional dissection. Currently, the cost including initial investment is the biggest issue;however, the da Vinci is absolutely necessary to implement delicate cardiac surgeries endoscopically and less-invasively. Early approval of robotic surgery by the government is urgently required in Japan. Conclusions: Although both the da Vinci and the Radius have endoscopic instruments with a multi-degree of freedom, applications need to be differentiated depending on the procedures and indications. Therefore, it can be clearly said that these unique innovative systems will never compete against each other.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
Introduction:Robotic systems are designed to address the limitations of laparoscopic surgery,leading to a growing interest in robotic rectal surgery.However,certain technical limitations associated with the previous s...Introduction:Robotic systems are designed to address the limitations of laparoscopic surgery,leading to a growing interest in robotic rectal surgery.However,certain technical limitations associated with the previous systems(da Vinci S&Si)have arguably slowed down its wholesale adoption.The latest robotic platform,the da Vinci Xi,addresses these limitations.This study aims to examine the short-term surgical outcomes of 240 single-docking fully-robotic rectal cancer resections and compare the outcomes of cases performed with the da Vinci Xi vs Si systems.Materials and methods:All consecutive patients receiving robotic rectal cancer resections from three centres between 2013 and 2018 were identified from prospectively collated databases.The baseline characteristics and short-term surgical outcomes are presented and the da Vinci Xi vs Si system outcomes are analysed.Results:A total of 240 patients were identified(124 Si,116 Xi).Median operation-time and length-of-stay were 260 minutes and 6 days respectively.Conversion and 30-day mortality rates were 0.The da Vinci Si vs Xi system analysis shows that operation-time was lower in the Si group(230 vs 300 min,p=0.000)but length-of-stay,lymph node yield and circumferential resection margin favoured the Xi group(7 vs 5 days,p=0.010;17 vs 21,p=0.000;92.7%vs 99.1%,p=0.020).Conclusion:Single-docking fully-robotic rectal cancer surgery is safe,feasible and can lead to good shortterm outcomes,making it a good alternative to laparoscopic rectal cancer surgery.The new systems technological advances may result in better short-term outcomes but further larger scale observational studies are required if we are to reach such a conclusion.展开更多
Robotic systems have become popular in modern surgical procedures.The option of telesurgery has effectively addressed geographic limitations.These systems are offered by numerous companies worldwide.In this review art...Robotic systems have become popular in modern surgical procedures.The option of telesurgery has effectively addressed geographic limitations.These systems are offered by numerous companies worldwide.In this review article,we discuss four models of robotic systems to determine their advantages:the Sina flex system from Iran and the da Vinci Xi,SP,and 5 systems from the USA.We compared aspects such as architecture,instruments,visualizations,clinical use,and costs.Our findings suggest that the da Vinci robot,which was introduced earlier than the Sina system,utilizes proprietary and limited-use EndoWrist instruments with diameters ranging from 8 to 12 mm and features advanced imaging capabilities,including three-dimensional optical,tomographic,and fluorescence imaging.It is well established and widely utilized in various surgical procedures.Conversely,the Sina flex system employs single-use 5 mm instruments and is equipped with two-dimensional optical imaging as a standard,with optional three-dimensional and fluorescence imaging upgrades available.Despite its affordability,the Sina flex system is relatively new and has not yet been clinically tested.Additionally,the Sina flex system is more user-friendly.展开更多
Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,whi...Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,which makes it a burden for institutes and unaffordable for patients.This systematic literature review(SLR)focused on the various RAS training methods applied in different surgical specialties,as well as the cost elements of RAS,and was to summarize the opportunities and challenges associated with scaling up RAS.Methods An SLR was carried out based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines.The PubMed,EBSCO,and Scopus databases were searched for reports from January 2018 through January 2024.Full-text reviews and research articles in the English language from Asia-Pacific countries were included.Articles that outlined training and costs associated with RAS were chosen.Results The most common training system is the da Vinci system.The simulation technique,which includes dry-lab,wet-lab,and virtual reality training,was found to be a common and important practice.The cost of RAS encompasses the installation and maintenance costs of the robotic system,the operation theatre rent,personnel cost,surgical instrument and material cost,and other miscellaneous charges.The synthesis of SLR revealed the challenges and opportunities regarding RAS training and cost.Conclusions The results of this SLR will help stakeholders such as decision-makers,influencers,and end users of RAS to understand the significance of training and cost in scaling up RAS from a managerial perspective.For any healthcare innovation to reach a vast population,cost-effectiveness and standard training are crucial.展开更多
BACKGROUND Situs inversus totalis(SIT)is an extremely rare congenital malformation characterized by mirror displacement of the thoracoabdominal organs such as the heart,liver,spleen,and stomach.Herein,we describe a pa...BACKGROUND Situs inversus totalis(SIT)is an extremely rare congenital malformation characterized by mirror displacement of the thoracoabdominal organs such as the heart,liver,spleen,and stomach.Herein,we describe a patient with SIT complicated with cholangiocarcinoma who underwent successful pancreaticoduodenectomy with the assistance of a da Vinci robot.CASE SUMMARY A 58-year-old female presented to the hospital with paroxysmal pain in her left upper abdomen,accompanied by jaundice and staining of the sclera as chief complaints.Imaging examination detected a mass at the distal end of the common bile duct,with inverted thoracic and abdominal organs.Endoscopic retrograde cholangiopancreatography forceps biopsy revealed the presence of a well-differentiated adenocarcinoma.The patient successfully underwent robotic-assisted pancreaticoduodenectomy;the operation lasted 300 min,the intraoperative blood loss was 500 mL,and there were no intraoperative and postoperative complications.CONCLUSION SIT is not directly related to the formation of cholangiocarcinoma.Detailed preoperative imaging examination is conducive to disease diagnosis and also convenient for determining the feasibility of tumor resection.Robot-assisted pancreaticoduodenectomy for SIT complicated with cholangiocarcinoma provides a safe,feasible,minimally invasive,and complication-free alternative with adequate preoperative planning combined with meticulous intraoperative procedures.展开更多
检索了美国食品药品监督管理局(Food and Drug Administration,FDA)制造商和用户设施设备体验(Manufa-cturer and User Facility Device Experience,MAUDE)数据库中2000—2021年的达芬奇机器人手术系统不良事件数据,利用Python对所有不...检索了美国食品药品监督管理局(Food and Drug Administration,FDA)制造商和用户设施设备体验(Manufa-cturer and User Facility Device Experience,MAUDE)数据库中2000—2021年的达芬奇机器人手术系统不良事件数据,利用Python对所有不良事件进行了智能化处理与分析,重点阐述了达芬奇机器人手术系统的不良事件变化趋势、应用科室分布和各类不良事件占比、主要设备故障类型、2013—2019年的手术量及分布科室,为达芬奇机器人手术系统安全性评价提供了临床证据。展开更多
The role of minimally invasive liver surgery as a bridge to transplantation is very promising but still underestimated. However, it should be noted that surgical approach for hepatocellular carcinomas(HCC) is not mere...The role of minimally invasive liver surgery as a bridge to transplantation is very promising but still underestimated. However, it should be noted that surgical approach for hepatocellular carcinomas(HCC) is not merely a technical or technological issue. Nowadays, the epidemiology of HCC is evolving due to the increasing role of non-alcoholic fatty-liver-disease, and the emerging concerns on direct-acting antivirals against hepatitis C virus in terms of HCC incidence. Therefore, a fully multidisciplinary study of the cirrhotic patient is currently more important than ever before, and the management of those patients should be reserved to tertiary referral hepatobiliary centers. In particular, minimally invasive approach to the liver showed several advantages compared to the classical open procedure, in terms of:(1) the small impact on abdominal wall;(2) the gentle manipulation on the liver;(3) the limited surgical trauma; and(4) the respect of venous shunts. Therefore, more direct indications should be outlined also in the Barcelona Clinic Liver Cancer model. We believe that treatment of HCC in cirrhotic patients should be reserved to tertiary referral hepatobiliary centers, that should offer patient-tailored approaches to the liver disease, in order to provide the best care for each case, according to the individual comorbidities, risk factors, and personal quality of life expectations.展开更多
文摘A 59-year-old man with metastatic an esophageal tumor from hepatocellular carcinoma(HCC) presented with progressive dysphagia.He had undergone liver transplantation for HCC three and a half years prevously.At presentation,his radiological and endoscopic examinations suggested a submucosal tumor in the lower esophagus,causing a luminal stricture.We performed complete resection of the esophageal metastases and esophagogastrostomy reconstruction using the da Vinci robotic system.Recovery was uneventful and he was been doing well 2 mo after surgery.α-fetoprotein level decreased from 510 ng/mL to 30 ng/mL postoperatively.During the follow-up period,he developed a recurrent esophageal stricture at the anastomosis site and this was successfully treated by endoscopic esophageal dilatation.
基金Supported by Guangxi Health Department Scientific Research Program,No.Z20200206Project of Guangxi Liuzhou Science and Technology Bureau,No.2024YB0101B010。
文摘BACKGROUND Traditional methods cannot clearly visualize esophageal cancer(EC)tumor contours and metastases,which limits the clinical application of da Vinci robotassisted surgery.AIM To investigate the efficacy of the da Vinci robot in combination with nanocarbon lymph node tracers in radical surgery of EC.METHODS In total,104 patients with early-stage EC who were admitted to Liuzhou worker's Hospital from January 2020 to June 2023 were enrolled.The patients were assigned to an observation group(n=52),which underwent da Vinci robot-assisted minimally invasive esophagectomy(RAMIE)with the intraoperative use of nanocarbon tracers,and a control group(n=52),which underwent traditional surgery treatment.The operation time,intraoperative blood loss,postoperative drainage tube indwelling time,hospital stay,number of lymph nodes dissected,incidence of complications,and long-term curative effects were comparatively analyzed.The postoperative stress response C-reactive protein(CRP),cortisol,epinephrine(E)and inflammatory response interleukin(IL)-6,IL-8,IL-10,and tumor necrosis factor-alpha(TNF-α)were evaluated.RESULTS Compared with the control group,the observation group had significantly lower postoperative CRP,cortisol,and E levels(P<0.05)with a milder inflammatory response,as indicated by lower IL-6,IL-10,and TNF-αlevels(P<0.05).Patients who underwent RAMIE had less intraoperative blood loss and shorter operation times and hospital stays than those who underwent traditional surgery.The average number of dissected lymph nodes,time of lymph node dissection,and mean smallest lymph node diameter were all significantly lower in the observation group(P<0.05).The rate of postoperative complications was 5.77%in the observation group,significantly lower than the 15.38%observed in the control group.Furthermore,the lymphatic metastasis rate,reoperation rate,and 12-and 24-month cumulative mortality in the observation group were 1.92%,0%,0%,and 0%,respectively,all of which were significantly lower than those in the control group(P<0.05).CONCLUSION The treatment of EC using the da Vinci robot combined with nanocarbon lymph node tracers can achieve good surgical outcomes and demonstrates promising clinical applications.
文摘Objective: Kanazawa University introduced the da Vinci surgical system and the Radius surgical system. In this study, we compared the advantages and disadvantages of each system. Methods: The da Vinci system is a master-slave tele-manipulation system, which provides hi-resolution 3D images. The Radius system is pair of hand-guided surgical manipulators. In this study we focus on the operability of both instruments rather than their 3D optical systems. Results: The Radius was originally developed specifically focused on ligation and suturing with suture sizes bigger than 4-0, it is more effective, less expensive compared with the da Vinci. Although the da Vinci system is bulky, it allows surgeons to perform endoscopic surgeries only if ports are properly placed to prevent each arm from colliding with the other arms. A crucial difference between the Radius and the da Vinci is not limited to anastomose small vessels but is extended to multidirectional dissection. Currently, the cost including initial investment is the biggest issue;however, the da Vinci is absolutely necessary to implement delicate cardiac surgeries endoscopically and less-invasively. Early approval of robotic surgery by the government is urgently required in Japan. Conclusions: Although both the da Vinci and the Radius have endoscopic instruments with a multi-degree of freedom, applications need to be differentiated depending on the procedures and indications. Therefore, it can be clearly said that these unique innovative systems will never compete against each other.
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.
文摘Introduction:Robotic systems are designed to address the limitations of laparoscopic surgery,leading to a growing interest in robotic rectal surgery.However,certain technical limitations associated with the previous systems(da Vinci S&Si)have arguably slowed down its wholesale adoption.The latest robotic platform,the da Vinci Xi,addresses these limitations.This study aims to examine the short-term surgical outcomes of 240 single-docking fully-robotic rectal cancer resections and compare the outcomes of cases performed with the da Vinci Xi vs Si systems.Materials and methods:All consecutive patients receiving robotic rectal cancer resections from three centres between 2013 and 2018 were identified from prospectively collated databases.The baseline characteristics and short-term surgical outcomes are presented and the da Vinci Xi vs Si system outcomes are analysed.Results:A total of 240 patients were identified(124 Si,116 Xi).Median operation-time and length-of-stay were 260 minutes and 6 days respectively.Conversion and 30-day mortality rates were 0.The da Vinci Si vs Xi system analysis shows that operation-time was lower in the Si group(230 vs 300 min,p=0.000)but length-of-stay,lymph node yield and circumferential resection margin favoured the Xi group(7 vs 5 days,p=0.010;17 vs 21,p=0.000;92.7%vs 99.1%,p=0.020).Conclusion:Single-docking fully-robotic rectal cancer surgery is safe,feasible and can lead to good shortterm outcomes,making it a good alternative to laparoscopic rectal cancer surgery.The new systems technological advances may result in better short-term outcomes but further larger scale observational studies are required if we are to reach such a conclusion.
文摘Robotic systems have become popular in modern surgical procedures.The option of telesurgery has effectively addressed geographic limitations.These systems are offered by numerous companies worldwide.In this review article,we discuss four models of robotic systems to determine their advantages:the Sina flex system from Iran and the da Vinci Xi,SP,and 5 systems from the USA.We compared aspects such as architecture,instruments,visualizations,clinical use,and costs.Our findings suggest that the da Vinci robot,which was introduced earlier than the Sina system,utilizes proprietary and limited-use EndoWrist instruments with diameters ranging from 8 to 12 mm and features advanced imaging capabilities,including three-dimensional optical,tomographic,and fluorescence imaging.It is well established and widely utilized in various surgical procedures.Conversely,the Sina flex system employs single-use 5 mm instruments and is equipped with two-dimensional optical imaging as a standard,with optional three-dimensional and fluorescence imaging upgrades available.Despite its affordability,the Sina flex system is relatively new and has not yet been clinically tested.Additionally,the Sina flex system is more user-friendly.
基金The authors are the awardees of the Indian Council of Social Science Research(ICSSR)Research Program(F.No.G-11/2021-22/ICSSR/RP)This paper is largely an outcome of the research program sponsored by the ICSSR.However,the responsibility for the facts stated,opinions expressed,and conclusions drawn is entirely that of the authors.
文摘Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,which makes it a burden for institutes and unaffordable for patients.This systematic literature review(SLR)focused on the various RAS training methods applied in different surgical specialties,as well as the cost elements of RAS,and was to summarize the opportunities and challenges associated with scaling up RAS.Methods An SLR was carried out based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines.The PubMed,EBSCO,and Scopus databases were searched for reports from January 2018 through January 2024.Full-text reviews and research articles in the English language from Asia-Pacific countries were included.Articles that outlined training and costs associated with RAS were chosen.Results The most common training system is the da Vinci system.The simulation technique,which includes dry-lab,wet-lab,and virtual reality training,was found to be a common and important practice.The cost of RAS encompasses the installation and maintenance costs of the robotic system,the operation theatre rent,personnel cost,surgical instrument and material cost,and other miscellaneous charges.The synthesis of SLR revealed the challenges and opportunities regarding RAS training and cost.Conclusions The results of this SLR will help stakeholders such as decision-makers,influencers,and end users of RAS to understand the significance of training and cost in scaling up RAS from a managerial perspective.For any healthcare innovation to reach a vast population,cost-effectiveness and standard training are crucial.
文摘BACKGROUND Situs inversus totalis(SIT)is an extremely rare congenital malformation characterized by mirror displacement of the thoracoabdominal organs such as the heart,liver,spleen,and stomach.Herein,we describe a patient with SIT complicated with cholangiocarcinoma who underwent successful pancreaticoduodenectomy with the assistance of a da Vinci robot.CASE SUMMARY A 58-year-old female presented to the hospital with paroxysmal pain in her left upper abdomen,accompanied by jaundice and staining of the sclera as chief complaints.Imaging examination detected a mass at the distal end of the common bile duct,with inverted thoracic and abdominal organs.Endoscopic retrograde cholangiopancreatography forceps biopsy revealed the presence of a well-differentiated adenocarcinoma.The patient successfully underwent robotic-assisted pancreaticoduodenectomy;the operation lasted 300 min,the intraoperative blood loss was 500 mL,and there were no intraoperative and postoperative complications.CONCLUSION SIT is not directly related to the formation of cholangiocarcinoma.Detailed preoperative imaging examination is conducive to disease diagnosis and also convenient for determining the feasibility of tumor resection.Robot-assisted pancreaticoduodenectomy for SIT complicated with cholangiocarcinoma provides a safe,feasible,minimally invasive,and complication-free alternative with adequate preoperative planning combined with meticulous intraoperative procedures.
文摘检索了美国食品药品监督管理局(Food and Drug Administration,FDA)制造商和用户设施设备体验(Manufa-cturer and User Facility Device Experience,MAUDE)数据库中2000—2021年的达芬奇机器人手术系统不良事件数据,利用Python对所有不良事件进行了智能化处理与分析,重点阐述了达芬奇机器人手术系统的不良事件变化趋势、应用科室分布和各类不良事件占比、主要设备故障类型、2013—2019年的手术量及分布科室,为达芬奇机器人手术系统安全性评价提供了临床证据。
文摘The role of minimally invasive liver surgery as a bridge to transplantation is very promising but still underestimated. However, it should be noted that surgical approach for hepatocellular carcinomas(HCC) is not merely a technical or technological issue. Nowadays, the epidemiology of HCC is evolving due to the increasing role of non-alcoholic fatty-liver-disease, and the emerging concerns on direct-acting antivirals against hepatitis C virus in terms of HCC incidence. Therefore, a fully multidisciplinary study of the cirrhotic patient is currently more important than ever before, and the management of those patients should be reserved to tertiary referral hepatobiliary centers. In particular, minimally invasive approach to the liver showed several advantages compared to the classical open procedure, in terms of:(1) the small impact on abdominal wall;(2) the gentle manipulation on the liver;(3) the limited surgical trauma; and(4) the respect of venous shunts. Therefore, more direct indications should be outlined also in the Barcelona Clinic Liver Cancer model. We believe that treatment of HCC in cirrhotic patients should be reserved to tertiary referral hepatobiliary centers, that should offer patient-tailored approaches to the liver disease, in order to provide the best care for each case, according to the individual comorbidities, risk factors, and personal quality of life expectations.
