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. .

Current trends in three-dimensional visualization and real-time navigation as well as robot-assisted technologies in hepatobiliary surgery

With the continuous development of digital medicine,minimally invasive precision and safety have become the primary development trends in hepatobiliary surgery.Due to the specificity and complexity of hepatobiliary surgery,traditional preoperative imaging techniques such as computed tomography and magnetic resonance imaging cannot meet the need for identification of fine anatomical regions.Imaging-based three-dimensional(3D)reconstruction,virtual simulation of surgery and 3D printing optimize the surgical plan through preoperative assessment,improving the controllability and safety of intraoperative operations,and in difficult-to-reach areas of the posterior and superior liver,assistive robots reproduce the surgeon’s natural movements with stable cameras,reducing natural vibrations.Electromagnetic navigation in abdominal surgery solves the problem of conventional surgery still relying on direct visual observation or preoperative image assessment.We summarize and compare these recent trends in digital medical solutions for the future development and refinement of digital medicine in hepatobiliary surgery.

Robot-assisted lobectomy in a patient with poor lung function:Another advantage of robot-assisted thoracoscopic surgery

Patients with poor lung function have a high-risk for pulmonary complications following lobectomy.The development of minimally invasive thoracic surgical techniques allows sicker patients to safely undergo lung resection.Robotic lobectomy could benefit these higher risk patients.Here we present a case of a 58-year-old female patient with poor lung function presented with a 3-cm mass in her lower left pulmonary lobe,who successfully underwent lobectomy via robot-assisted thoracoscopic surgery.Her forced expiratory volume in one second was slightly improved compared to the preoperative value.Her forced vital capacity continued to improve in the follow-up period.There was no recorded recurrence during the three years follow-up period.

MARKER-BASED MAPPING BETWEEN MEDICAL IMAGE AND ROBOT SPACE IN ROBOT-ASSISTED SURGERY

This paper focuses on the problems of matching a virtual and a real environments by means of hardware and software tools. The real space is represented by a patient’s bone where a set of cuts by means of robot system is to be made. The virtual space is a 3D model of the bone reconstructed from a set of CT slices. Robot system is then not only to machine bones but also to perform the fundamental step of registration between the two spaces. An external force sensor is used to adjust robot stiffness in order to perform the tactile searching necessary for the registration. A simple but reliable software algorithm is used to control the robot for matching between medical image and robot space in robot-assisted surgery. The results show the system proposed is precise enough for application, and tests been made also clarify the way to improve it.

Combining robot-assisted surgical system and 3D visualization system for teaching minimally invasive vitreoretinal surgery

AIM:To investigate the feasibility of teaching minimally invasive vitreoretinal surgery with a robot-assisted surgical system and a three-dimensional(3D) visualization system.METHODS:Enucleated porcine eyes were established as an animal model for removing foreign bodies.Forty medical students were recruited to remove foreign bodies to compare the traditional microscope and the 3D system.One junior resident performed the surgical task with manual and robot-assisted operations on 20 porcine eyes for each group.One senior surgeon evaluated the retinal invasion by a graded injury degree.The learning curve for minimally invasive vitreoretinal surgery was described.RESULTS:Compared with the robot-assisted group,the injury degree was higher in the manual group.For the first ten surgeries,the manual and robot-assisted groups had injuries of 2.60±1.35(4 to 0) and 1.80±1.62(4 to 0),respectively.For the last ten surgeries,the injury degrees were 1.90±1.20(3 to 0) and 0.80±0.42(1 to 0).Considering the manual and robot-assisted groups together,95%,75% and 60% of the students considered surgical manipulation with the 3D visualization system to be more comfortable,easier and clearer,respectively.CONCLUSION:The robot-assisted surgical system and 3D visualization system may have value in teaching minimally invasive vitreoretinal surgery.

Miniature 6-axis force/torque sensor for force feedback in robot-assisted minimally invasive surgery

In order to restore force sensation to robot-assisted minimally invasive surgery(RMIS),design and performance evaluation of a miniature 6-axis force/torque sensor for force feedback is presented.Based on the resistive sensing method,a flexural-hinged Stewart platform is designed as the flexible structure,and a straightforward optimization method considering the force and sensitivity isotropy of the sensor is proposed to determine geometric parameters which are best suited for the given external loads.The accuracy of this method is preliminarily discussed by finite element methods(FEMs).The sensor prototype is fabricated with the development of the electronic system.Calibration and dynamic loading tests for this sensor prototype are carried out.The working ranges of this sensor prototype are 30 N and 300 N·mm,and resolutions are 0.08 N in radial directions,0.25 N in axial direction,and 2.4 N·mm in rotational directions.It also exhibits a good capability for a typical dynamic force sensing at a frequency close to the normal heart rate of an adult.The sensor is compatible with surgical instruments for force feedback in RMIS.

Learning curves of robot-assisted pedicle screw fixations based on the cumulative sum test

BACKGROUND In robot-assisted(RA)spine surgery,the relationship between the surgical outcome and the learning curve remains to be evaluated.AIM To analyze the learning curve of RA pedicle screw fixation(PSF)through fitting the operation time curve based on the cumulative summation method.METHODS RA PSFs that were initially completed by two surgeons at the Beijing Jishuitan Hospital from July 2016 to March 2019 were analyzed retrospectively.Based on the cumulative sum of the operation time,the learning curves of the two surgeons were drawn and fit to polynomial curves.The learning curve was divided into the early and late stages according to the shape of the fitted curve.The operation time and screw accuracy were compared between the stages.RESULTS The turning point of the learning curves from Surgeons A and B appeared in the 18th and 17th cases,respectively.The operation time[150(128,188)min vs 120(105,150)min,P=0.002]and the screw accuracy(87.50%vs 96.30%,P=0.026)of RA surgeries performed by Surgeon A were significantly improved after he completed 18 cases.In the case of Surgeon B,the operation time(177.35±28.18 min vs 150.00±34.64 min,P=0.024)was significantly reduced,and the screw accuracy(91.18%vs 96.15%,P=0.475)was slightly improved after the surgeon completed 17 RA surgeries.CONCLUSION After completing 17 to 18 cases of RA PSFs,surgeons can pass the learning phase of RA technology.The operation time is reduced afterward,and the screw accuracy shows a trend of improvement.

Removal of pediatric stage Ⅳ neuroblastoma by robot-assisted laparoscopy: A case report and literature review

BACKGROUND Neuroblastoma (NB) is the most common extracranial solid tumor in children, with an incidence of approximately 1/10000. Surgical resection is an effective treatment for children with NB. Robot-assisted laparoscopic surgery is a new method and is superior to conventional laparoscopic surgery, since it has been preliminarily applied in clinical practice with a significant curative effect. This paper discusses significance and feasibility of complete resection of stage IV NB using robot-assisted laparoscopic surgery, while comparing its safety and effectiveness with conventional laparoscopic surgery. CASE SUMMARY In June 2018, a girl with stage IV retroperitoneal NB, aged 3 years and 5 mo, was admitted. Her weight was 15 kg, and her height was 100 cm. Robot-assisted, fiveport laparoscopic resection of NB was performed. Starting from the middle point between the navel and the anterior superior iliac spine to the left lower abdomen, the pneumoperitoneum and observation hole (10 mm) were established using the Hasson technique. Operation arm #1 was located between the left anterior axillary line, the navel, and the costal margin (8 mm);operation arm #2 was located at the intersection of the right anterior axillary line and Pfannenstiel line (8 mm);one auxiliary hole was located between arm #2 (on the Pfannenstiel line) and the observation hole (12 mm);and another auxiliary hole (5 mm) was located slightly below the left side of the xiphoid. Along the right line of Toldt and the hepatic flexure of the transverse colon, the colon was turned to the left and below with a hook electrode. Through Kocher's incision, the duodenum and the pancreatic head were turned to the left to expose the inferior vena cava and the abdominal aorta. The vein was separated along the right external iliac, and the inferior vena cava was then lifted to expose the right renal vein from the bottom to the top. The tumor was transected horizontally below the renal vein, and it was first cut into pieces and then resected. The right renal artery and the left renal vein were also exposed, and the retrohepatic inferior vena cava was isolated. The tumor was resected along the surface of the psoas muscle, the back of the inferior vena cava, and the right side of the abdominal aorta. Finally, the lymph node metas-tases in front of the abdominal aorta and left renal vein were completely removed. The specimens were loaded into a disposable specimen retrieval bag and removed from the enlarged auxiliary hole. T-tube drainage was placed and brought out through a hole in the right lower quadrant of the abdomen. The operative time was 389 min, the time of pneumoperitoneum was 360 min, the intraoperative blood loss was approximately 200 mL, and the postoperative recovery was smooth. There were no complications, such as lymphatic fistula, diarrhea, bleeding, and paralytic ileus. Two months after discharge, there were no other complications. The literature on the application of robot-assisted laparoscopic surgery in the treatment of NB in children was reviewed CONCLUSION The robot has the advantages of a three-dimensional view and flexible operation, and it can operate finely along blood vessels. The successful experience of this case confirmed that robot-assisted laparoscopic surgery can skeletonize the abdominal blood vessels in the tumor and cut the tumor into pieces, indicating that robot-assisted laparoscopic surgery is feasible.

Robot-assisted retroperitoneal laparoscopic excision of perirenal vascular tumor: A case report

BACKGROUND A vascular tumor is a benign tumor with unique clinical and pathological features.Perirenal vascular tumor is extremely rare and has not yet been reported.Clinically,it manifests as soreness and swelling.Color ultrasound and renal angiography illustrated the perirenal mass,which was closely connected with the kidney and the surrounding tissues and organs.Histology showed extensive embedded perirenal fat,and thin-walled vascular tissue displayed a pink stain due to red blood cells.CASE SUMMARY Herein,a case of robot-assisted retroperitoneal laparoscopic excision of a perirenal vascular tumor is reported.Analysis of the clinical,biological,and histological features of the perirenal vascular tumor can provide an in-depth understanding of the disease,which provides a theoretical and practical basis for better diagnosis and treatment.CONCLUSION This study contributes to a practical basis for the diagnosis and treatment of perirenal hemangiom.

Wedge gastrectomy:Robot-assisted with a hand-sewn repair versus a laparoscopic linear stapler technique for gastric subepithelial tumors

Objective:Minimally invasive surgery has become common in surgical resections of gastric subepithelial tumors.An endostapler technique is simple and easy to perform when cutting the stomach.Gastrotomy using a hand-sewn repair is a new approach for identifying and removing gastric subepithelial tumors,but few studies have evaluated its efficacy.In this study,we demonstrated the safety and effectiveness of this novel technique using a robot-assisted approach.Materials and methods:A retrospective cohorts of all patients who presented with gastric subepithelial tumors and underwent robotic or laparoscopic resection at Ramathibodi Hospital from 2012 to 2018 was reviewed.Surgical outcomes and complications of the robot-assisted approach with a hand-sewn repair were analyzed and compared to those of the laparoscopic linear stapler technique.Results:In total,25 patients were included in this study.Most of the subepithelial tumors were gastrointestinal stromal tumors(17 patients,68%).Ten patients(40%)underwent a robot-assisted procedure with a hand-sewing technique,and 15 patients underwent a laparoscopic linear stapler procedure.Mean tumor size was 3.79±1.35 cm in the robot-assisted procedure with a hand-sewing technique group and 3.52±1.88 cm in the laparoscopic linear stapler procedure group.The former experienced a longer operative time(261±54 vs 144±64 minutes,p<0.001)and a longer time to return to a normal diet(5.7±2.0 vs 4.0±1.4 days,p=0.028).Neither group experienced perioperative complications or mortality.Conclusion:Although the time to return to a normal diet and operative time were significantly longer compared to a laparoscopic procedure using a linear stapler,the robot-assisted approach using a handsewn repair for gastric subepithelial tumors is feasible,effective,and safe.This can be an alternative for the surgical treatment of gastric subepithelial lesions.

Trend of robot-assisted surgery system in gastrointestinal and liver surgery: A bibliometric analysis

BACKGROUND Robot-assisted gastrointestinal and liver surgery has been an important development direction in the field of surgery in recent years and it is also one of the fastest developing and most concerning fields in surgical operations.AIM To illustrate the major areas of research and forward-looking directions over the past twenty-six years.METHODS Using the Web of Science Core Collection database,a comprehensive review of scholarly articles pertaining to robot-assisted gastrointestinal and liver surgery was researched out between 2000 and 2023.We used Citespace(Version 6.2.4)and Bibliometrix package(Version 4.3.0)to visualize the analysis of all publications including country,institutional affiliations,authors,and keywords.RESULTS In total,346 articles were retrieved.Surgical Endoscopy had with the largest number of publications and was cited in this field.The United States was a core research country in this field.Yonsei University was the most productive institution.The current focus of this field is on rectal surgery,long-term prognosis,perioperative management,previous surgical experience,and the learning curve.CONCLUSION The scientific interest in robot-assisted gastrointestinal and liver surgery has experienced a significant rise since 1997.This study provides new perspectives and ideas for future research in this field.

Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery

AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODS This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy(RG), laparoscopic gastrectomy(LG), open gastrectomy(OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients(RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery(P = 0.42) and stage of the disease(P = 0.16). Intraoperative blood loss was significantly lower in the LG(95.93 ± 119.22) and RG(117.91 ± 68.11) groups compared to the OG(127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG(27.78 ± 11.45), LG(24.58 ± 13.56) and OG(25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P < 0.0001). A similar complications rate was found(P = 0.13). The leakage rate was not different(P = 0.78) between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.

Outcomes of robotic surgery for pancreatic ductal adenocarcinoma

Authors introduction： Qian Zhan, female, who was born in Sept, 1979. She studied in the Shanghai Second Medical University during 1998 to 2005. She majored in Clinical Medicine, and earned her master degree in 2005. In 2005, she went to the Beaujon Hospital of Paris 7th Universit3. in France, as a foreign intern. Later, she came to postgraduate work and residencies in the general surgery department of Shanghai Ruijin Hospital. Her clinical work is focused on multidisciplinary especially postoperative management for the patients with pancreatic cancer. In addition, she is a lead researcher in the pancreatic cancer group for nano based drug delivery, systems. Chenghong Peng, male, who was born in Apr, 1957. He worked in the 2nd Affiliated Hospital of Zhejiang University School of Medicine during 1989 to 2002. In 2002, Chenghong Peng came m Shanghai Ruiiin Hospital and began to take charge of general surgery department. As a pioneer in the hepatobifiopancreatic field, Chenghong Peng devoted himself in the basic and clinical research of pancreatic tmnors. He brings forth new ideas by creating ＂Pancreatic multiple treatment collaborating groups＂, which integrate the advantages of gasn＇oenterology, department, endoscopy department, radiology department, pathology deparnnent and SICU. He constantly strives for excellence in pancreatic surgery. In the previous five years, he performed more than 300 cases of pancreatectomy each year, and has accomplished more than 2,000 cases of pancreatectomy altogether, among which the resectable rate is 74%. Besides, he is also committed to laparoscopic surgery and robotic surgeD,. He has achieved more than 200 laparoscopic hepatectomies, 150 laparoscopic pancreatectomies and 500 robotic hepatobiliopancreatic surgeries （350 robotic pancreatic surgeries included）, which keeps leading position in China. In 2011, Chenghong Peng has won the first prize in 3rd international congress of CRSA, which marked that our achievement in robotic surgery was recognized by oversea peers.Background： To explore the effectiveness, safety, and efficacy of the robot-assisted surgery in the radical resection of pancreatic ductal adenocarcinoma （PDAC）. Methods： The clinical data of 72 patients with PDAC who underwent radical resection using the da Vinci Surgical System from April 2010 to December 2014 were retrospectively analyzed. Results： Among these 72 patients, three were converted to conventional laparotomy due to the vascular invasion or due to the difficulties in tissue isolation from the surrounding organs. Among 39 patients who underwent the pancreatoduodenectomy, the average operative time was 395.3±118.8 min, and the mean intra-operative blood loss was 447.3±269.9 mL. Among 31 patients who underwent the distal pancreatectomy （DP）, the average operative time was 185.5±74.1 min, and the mean intra-operative blood loss was 267.1±305.3 mL. In two patients who received the middle pancreatectomy （NIP）, the average operative time was 225 rain and mean intra-operative blood loss was 100 mL. Among all the 72 patients, an average of 4.2±2.6 lymph nodes were dissected, with an average hospital stay of 22.6±10.7 days. Complications were observed in 18 patients, which included pancreatic fistula （n=11）, bile leak （n=5）, anastomotic bleeding （n：2）, pancreatic fistula complicated with portal vein thrombosis （n=1）, and anastomotic bleeding complicated with acute renal failure （n=l）. Except that one patient died due to post-operative bleeding and acute renal failure, all the other patients were cured after conservative treatment. These 72 patients were followed for 1-45 （15.6±5.8） months, during which 10 patients died. Eleven patients suffered from recurrence or metastasis, among which 6 had local recurrence, 4 had liver metastasis, and 1 had ascites accompnaied with incision site tumor metastasis. Conclusions- Radical resection of PDAC by robotic surgical system is safe and feasible. It has less surgical trauma and enables faster post-operative recovery, and therefore can achieve the lymph node dissection scope and tumor resection margin required by the standards of radical resection for pancreatic cancer. Nevertheless, its long-term efficacy requires further validation.

Current status of minimally invasive liver surgery for cancers

Hepatocellular carcinoma(HCC)patients have chronic liver disease with functional deterioration and multicentric oncogenicity.Liver surgeries for the patients should be planned on both oncological effects and sparing liver function.In colorectal patients with post-chemotherapy liver injury and multiple bilateral tumors,handling multiple tumors in a fragile/easy-to-bleed liver is an important issue.Liver surgery for biliary tract cancers is often performed as a resection of large-volume functioning liver with extensive lymphadenectomy and bile duct resection/reconstruction.Minimally invasive liver surgery(MILS)for HCC is applied with the advantages of laparoscopic for cases of cirrhosis or repeat resections.Small anatomical resections using the Glissonian,indocyanine greenguided,and hepatic vein-guided approaches are under discussion.In many cases of colorectal liver metastases,MILS is applied combined with chemotherapy owing to its advantage of better hemostasis.Two-stage hepatectomy and indocyanine green-guided tumor identification for multiple bilateral tumors are under discussion.In the case of biliary tract cancers,MILS with extensive lymphadenectomy and bile duct resection/reconstruction are developing.A robotassisted procedure for dissection of major vessels and handling fragile livers may have advantages,and well-simulated robot-assisted procedure may decrease the difficulty for biliary tract cancers.

Present and future of robot-assisted endoscopic thyroid surgery

Objective Robot-assisted endoscopic surgery has been increasingly accepted because of its unique three-dimensional vision and precise simulation-based technology. However, the utilization of robotic systems in thyroid surgery is limited. We conducted a systematic review to assess the application and development of robot-assisted endoscopic surgical technique in thyroid surgery.

Primary seminal vesicle adenocarcinoma with a history of seminal vesicle cyst:A case report and review of literature

BACKGROUND Primary seminal vesicle adenocarcinoma is a rare malignancy that is difficult to diagnose.CASE SUMMARY A 54-year-old man with an 18-year history of a seminal vesicle cyst presented with worsening hematospermia that had persisted for one month.Dynamic contrast-enhanced computed tomography and pelvic magnetic resonance imaging indicated a mass with a cystic-solid component.Robot-assisted seminal vesicle tumor resection was performed,and primary seminal vesicle adenocarcinoma was confirmed pathologically.The patient received pelvic radiotherapy for six weeks,and to date,no evidence of recurrence has been found.CONCLUSION Seminal vesicle cysts should be monitored long-term.Seminal vesicle adenocarcinoma presents with non-specific symptoms and can be diagnosed by immunohistochemistry.

Robot-assisted surgery in total knee arthroplasty:trauma maker or trauma savior?A prospective,randomized cohort study

Background:Robotic assistance has been increasingly employed to improve the operative precision in modern knee surgery.The purpose of the study was to evaluate the trauma effect of one of the first domestically developed orthopedic surgical robots in China in a clinical trial of robot-assisted total knee arthroplasty(RA-TKA).Methods:A total of 33 patients who underwent unilateral TKA for end-stage osteoarthritis were randomized to receive RA-TKA(17 cases)or conventional manual TKA(CM-TKA)in our institution in 2020.The trauma effects of the 4 main indicators with 48 sub-indicators in terms of subsectional operative time,inflammation and coagulation markers,physical and radiographical analyses of osteotomy deviation,and postoperative comfort were analyzed.Results:Subsectional operative time analysis showed that the times for bone cutting and gap balancing with RA-TKA were 5.3 and 2.2 min shorter than those with CM-TKA(p=0.010,p=0.02),respectively.Arterial blood gas indicators(partial pressure of carbon dioxide,partial pressure of oxygen and SO2)24 h after RA-TKA,as well as the white blood cell count and neutrophil ratio,were significantly lower than those after CM-TKA(p<0.05).Inflammatory markers at 72 h after surgery showed the increments of C-reactive protein,erythrocyte sedimentation rate and D-dimer of RA-TKA declined by 180.7,22.0 and 1050.0%(p<0.05),respectively,referenced to the preoperative baseline values,as compared to CM-TKA.Mechanical deviation distribution exhibited percentages of region I errors for RA-TKA and CM-TKA of 76.5%and 27.1%(p=0.000),respectively,and the success rates of one-time osteotomy were 94.1%and 62.5%(p=0.039),respectively.Radiographi-cal verification showed RA-TKA was more conducive to achieving mechanical alignment and ideal tibial component azimuths.Postoperative efficacy showed that patients were more comfortable after RA-TKA in terms of reduced administration of tranexamic acid,hydrocortisone and the utilization rate of temporary intensive opioid analgesics.No statistical difference in patient-reported outcome measures and complications were recorded between the two groups during continuous observation.Conclusions:Compared with CM-TKA,RA-TKA decreases rather than increases trauma.It might shorten the time required for bone cutting and gap balancing,reduce mechanical errors related to the osteotomy and prosthesis position,and improve the accuracy of the mechanical alignment reconstruction.RA-TKA is also favorable in promoting postoperative comfort and minimizing inflammatory response and drug consumption.

A Novel Cable-Driven Soft Robot for Surgery

Robot-assisted laparoscopic radical prostatectomy(RARP)is widely used to treat prostate cancer.The rigid instruments primarily used in RARP cannot overcome the problem of blind areas in surgery and lead to more trauma such as more incision for the passage of the instrument and additional tissue damage caused by rigid instruments.Soft robots are relatively fexible and theoretically have infinite degrees of freedom which can overcome the problem of the rigid instrument.A soft robot system for single-port transvesical robot-assisted radical prostatectomy(STvRARP)is developed in this study.The soft manipulator with 10 mm in diameter and a maximum bending angle of 270°has good fexibility and dexterity.The design and mechanical structure of the soft robot are described.The kinematics of the soft manipulator is established and the inverse kinematics is compensated based on the characteristics of the designed soft manipulator.The master-slave control system of soft robot for surgery is built and the feasibility of the designed soft robot is verified.

Pheochromocytoma with delayed tumor thrombus detection in renal vein: A case report

BACKGROUND Pheochromocytomas with inferior vena cava(IVC)or renal vein tumor thrombus are rare.Surgical management is the first choice.CASE SUMMARY We presented a 42-year-old man with adrenal pheochromocytoma and delayed tumor thrombus detection in the renal vein at the entrance of the IVC three months after adrenalectomy.We performed laparoscopic adrenalectomy during the first surgery and robot-assisted laparoscopic nephrectomy and resection of tumor thrombus during the second surgery.CONCLUSION We report the surgical management of a patient with adrenal pheochromocytoma with tumor thrombus at the entrance of the IVC.Robot-assisted laparoscopic surgery is safe and efficient.

Donor defects after lymph vessel transplantation and free vascularized lymph node transfer:A comparison and evaluation of complications

BACKGROUND Secondary lymphedema after surgical interventions is a progressive,chronic disease that is still not completely curable.Over the past years,a multitude of surgical therapy options have been described.AIM To summarize the single-center complications in lymph vessel(LVTx)and free vascularized lymph node transfer(VLNT).METHODS In total,the patient collective consisted of 87 patients who were undergoing treatment for secondary leg lymphedema during the study period from March 2010 to April 2020.The data collection was performed preoperatively during consultations,as well as three weeks,six months and twelve months after surgical treatment.In the event of complications,more detailed follow-up checks were carried out.In total n=18 robot-assisted omental lymph node transplantations,n=33 supraclavicular lymph node transplantations and n=36 Lymph vessel transplantations were analyzed.An exemplary drawing is shown in Figure 1.A graphical representation of patient selection is shown in Figure 2.Robotic harvest was performed with the Da Vinci Xi Robot Systems(Intuitive Surgical,CA,United States).RESULTS In total,11 male and 76 female patients were operated on.The mean age of the patients at study entry was:omental VLNT:57.45±8.02 years;supraclavicular VLNT:49.76±4.16 years and LVTx:49.75±4.95 years.The average observation time postoperative was:omental VLNT:18±3.48 mo;supraclavicular VLNT:14.15±4.9 and LVTx:14.84±4.46 mo.In our omental VLNT,three patients showed a slight abdominal sensation of tension within the first 12 postoperative days.No other donor side morbidities occurred.No intraoperative conversion to open technique was needed.Our supraclavicular VLNT collective showed 10 lift defect morbidities with one necessary surgical intervention.In our LVTx collective,12 cases of donor side morbidity were registered.In one case,surgical intervention was necessary.CONCLUSION Concerning donor side morbidity,robot-assisted omental VLNT is clearly superior to supraclavicular lymph node transplantation and LVTx.