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Aksoy ME, Izzetoglu K, Utkan NZ, Agrali A, Yoner SI, Bishop A, Shewokis PA. Comparing Behavioral and Neural Activity Changes During Laparoscopic and Robotic Surgery Trainings. JOURNAL OF SURGICAL EDUCATION 2025; 82:103486. [PMID: 40069994 DOI: 10.1016/j.jsurg.2025.103486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 02/12/2025] [Accepted: 02/13/2025] [Indexed: 04/14/2025]
Abstract
OBJECTIVE This study aims to compare the cognitive workload levels of general surgery residents by measuring prefrontal cortex hemodynamic activity while performing a similar task using robotic-assisted surgery (RAS) and laparoscopic surgery simulators. DESIGN The study was conducted with 22 general surgery residents who completed a peg transfer task in simulated laparoscopic and RAS training environments. Participants' performance and neurophysiological data were collected over a 1-month period. SETTING The study was conducted at Acibadem Mehmet Ali Aydinlar University- CASE (Center of Advanced Simulation and Education), utilizing a laparoscopic training simulator (CAE Lap VR) and robotic surgery simulator (Da Vinci Surgical System Si console with Backpack). PARTICIPANTS Twenty-two general surgery residents (mean [SD] age, 29.45 [2.40] years; 18 [81.82%] male) volunteered for the study. None of the participants had prior experience with RAS or RAS simulators, whereas most had varying degrees of laparoscopic surgery experience. RESULTS Significant differences were observed between RAS and laparoscopic simulations in terms of performance time and neural activity. Peg transfer times were shorter in RAS simulations compared to laparoscopic simulations (χ2(3) = 134.805, p < 0.001). Mean oxygenated hemoglobin (ΔHbO) levels in the prefrontal cortex were lower in RAS simulations (χ2(3) = 20.695, p < 0.001), indicating reduced cognitive workload. Relative Neural Efficiency (RNE) and Relative Neural Involvement (RNI) scores were higher in RAS tasks (χ2(1) = 55.765, p < 0.001), suggesting greater efficiency and involvement during robotic-assisted procedures. CONCLUSIONS The findings indicate that RAS tasks are associated with lower cognitive workload and improved efficiency compared to laparoscopic tasks. Incorporating neural indices alongside performance metrics may enhance training assessments and provide deeper insights into trainees' experiences in simulation-based surgical education.
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Affiliation(s)
- Mehmet Emin Aksoy
- Department of Biomedical Device Technology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye; CASE (Center of Advanced Simulation and Education), Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye.
| | - Kurtulus Izzetoglu
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - Nihat Zafer Utkan
- Department of General Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye
| | - Atahan Agrali
- Department of Biomedical Device Technology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Serhat Ilgaz Yoner
- Department of Biomedical Device Technology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye
| | - Ashley Bishop
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - Patricia A Shewokis
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania
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South C, Megafu O, Moore C, Williams T, Hobson L, Danner O, Johnson S. Robotic Surgery in Safety-Net Hospitals: Addressing Health Disparities and Improving Access to Care. Am Surg 2025; 91:639-643. [PMID: 39749432 DOI: 10.1177/00031348241312121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
Minimally invasive surgery (MIS) has demonstrated significant clinical and economic benefits that have been consistently validated and reproduced in practice and the literature for the past few decades. These benefits include improved patient outcomes, reduced complications, shorter hospital stays, decreased narcotic use, quicker recovery times, and lower rates of wound infections. However, safety-net hospitals, which historically serve a larger percentage of underserved and marginalized populations, often lack the resources to invest in high capital equipment. This limitation decreases access for these marginalized groups to the advantages of MIS, particularly robotic surgery and a wider range of surgical operations. This disparity in access to care highlights a critical shortfall in the delivery of health care for these patients and other vulnerable populations.
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Affiliation(s)
- Chevar South
- General Surgery Department, Morehouse School of Medicine, Atlanta, GA, USA
| | - Olajumoke Megafu
- University of Massachusetts Chan Medical School Department of Surgery, Worcester, MA, USA
| | - Carolyn Moore
- General Surgery Department, Morehouse School of Medicine, Atlanta, GA, USA
| | - Taylor Williams
- General Surgery Department, Morehouse School of Medicine, Atlanta, GA, USA
| | - Larry Hobson
- General Surgery Department, Morehouse School of Medicine, Atlanta, GA, USA
| | - Omar Danner
- General Surgery Department, Morehouse School of Medicine, Atlanta, GA, USA
| | - Shaneeta Johnson
- General Surgery Department, Morehouse School of Medicine, Atlanta, GA, USA
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Gomez ED, Husin HM, Dumon KR, Williams NN, Kuchenbecker KJ. Simulation training with haptic feedback of instrument vibrations reduces resident workload during live robot-assisted sleeve gastrectomy. Surg Endosc 2025; 39:1523-1535. [PMID: 39741192 PMCID: PMC11870985 DOI: 10.1007/s00464-024-11459-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 12/01/2024] [Indexed: 01/02/2025]
Abstract
BACKGROUND New surgeons experience heavy workload during robot-assisted surgery partially because they must use vision to compensate for the lack of haptic feedback. We hypothesize that providing realistic haptic feedback during dry-lab simulation training may accelerate learning and reduce workload during subsequent surgery on patients. METHODS We conducted a single-blinded study with 12 general surgery residents (third and seventh post-graduate year, PGY) randomized into haptic and control groups. Participants performed five simulated bariatric surgeries on a custom inanimate simulator followed by live robot-assisted sleeve gastrectomies (RASGs) using da Vinci robots. The haptic group received naturalistic haptic feedback of instrument vibrations during their first four simulated procedures. Participants completed pre-/post-procedure STAI and post-procedure NASA-TLX questionnaires in both simulation and the operating room (OR). RESULTS Higher PGY level (simulation: p < 0.001, OR p = 0.004), shorter operative time (simulation: p < 0.001, OR p = 0.003), and lower pre-procedure STAI (simulation: p = 0.003, OR p < 0.001) were significantly associated with lower self-reported overall workload in both operative settings; PGY-7 s reported about 10% lower workload than PGY-3 s. The haptic group had significantly lower overall covariate-adjusted NASA-TLX during the fourth (p = 0.03) and fifth (p = 0.04) simulated procedures and across all OR procedures (p = 0.047), though not for only the first three OR procedures. Haptic feedback reduced physical demand (simulation: p < 0.001, OR p = 0.001) and increased perceived performance (simulation: p = 0.031, OR p < 0.001) in both settings. CONCLUSION Haptic feedback of instrument vibrations provided during robotic surgical simulation reduces trainee workload during both simulation and live OR cases. The implications of workload reduction and its potential effects on patient safety warrant further investigation.
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Affiliation(s)
- Ernest D Gomez
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
- Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, USA
| | - Haliza Mat Husin
- Haptic Intelligence Department, Max Planck Institute for Intelligent Systems, Heisenbergstraße 3, 70569, Stuttgart, Germany
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Penn Medicine Clinical Simulation Center, Penn Medicine Rittenhouse, Philadelphia, USA
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Penn Medicine Clinical Simulation Center, Penn Medicine Rittenhouse, Philadelphia, USA
| | - Katherine J Kuchenbecker
- Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, USA.
- Haptic Intelligence Department, Max Planck Institute for Intelligent Systems, Heisenbergstraße 3, 70569, Stuttgart, Germany.
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Budden AK, Song S, Henry A, Wakefield CE, Abbott JA. A scoping review of participant reported outcome measures assessed during live and simulated surgical procedures. Am J Surg 2025; 240:116131. [PMID: 39671970 DOI: 10.1016/j.amjsurg.2024.116131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 10/17/2024] [Accepted: 12/02/2024] [Indexed: 12/15/2024]
Abstract
BACKGROUND The study aims to describe current use of participant-reported outcome measures (PROM) to assess stress in surgeons that may impact patient and surgeon wellbeing. METHODS Medline, Embase, Cochrane library, and clinical trial registries were searched. Articles reporting PROM of stress in live or simulated surgery were included. RESULTS Of 10,160 articles screened, 67 were included in the review. PROM tools identified include task load index (TLX), State-Trait Anxiety Inventory (STAI), Dundee Stress State Questionnaire (DSSQ), and single question scales. PROM scores increased from baseline to procedure in single question scales and DSSQ. STAI increased by ≥ 1 point in 37-75 %. TLX scores were greater at laparoscopy vs robot, single incision laparoscopy and open surgery vs conventional laparoscopy. Residents showed higher mental demand than attendings. Music lowered TLX scores. CONCLUSIONS Anxiety, stress, and workload have been measured in surgeons although the most appropriate to monitor surgeon wellbeing is not clear.
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Affiliation(s)
- Aaron K Budden
- Gynaecological Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, Australia; School of Clinical Medicine, UNSW, Sydney, Australia.
| | - Sophia Song
- Gynaecological Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, Australia; School of Clinical Medicine, UNSW, Sydney, Australia
| | - Amanda Henry
- School of Clinical Medicine, UNSW, Sydney, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia
| | - Claire E Wakefield
- School of Clinical Medicine, UNSW, Sydney, Australia; Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Jason A Abbott
- Gynaecological Research and Clinical Evaluation (GRACE) Group, Royal Hospital for Women, Sydney, Australia; School of Clinical Medicine, UNSW, Sydney, Australia
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Al-Hakim L, Wang M, Zhang Z, Xiao J, Sengupta S. Comparative analysis of disruptive events in robotic and laparoscopic radical prostatectomy. J Robot Surg 2025; 19:44. [PMID: 39760830 DOI: 10.1007/s11701-024-02194-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Accepted: 12/15/2024] [Indexed: 01/07/2025]
Abstract
This study compares laparoscopic (LRP) and robotic-assisted (RARP) radical prostatectomy to identify external and internal disruptive events, focusing on tasks that require heightened attention and coordination among the surgical team. Observations conducted across three hospitals in Australia and China. Data collection was rigorously ensured through the analysis of video recordings and consultations with surgeons, followed by statistical analysis using the Wilcoxon Signed Rank test. In a sample of 54 surgeries (27 RARP, 27 LRP), 15 activities were analysed, identifying 23 internal and 38 external disruption types. The findings indicate that RARP significantly reduces both external and internal disruptions compared to LRP, with decreases of around 41% and 33%, respectively. Notably, neurovascular bundle release showed the highest internal disruptions, with 123 events in RARP and 160 in LRP, and minor vessel bleeding led to the most internal disruptions, with 200 in RARP and 251 in LRP. RARP advantages include fewer disruptions due to pre-dissection inspections for visibility, improved blood management, and a skilled assistant, reducing the need for direct eye contact and repeated instructions. This study adds new dimensions to existing research by comparing internal and external disruptions in complex surgeries-specifically radical prostatectomy-performed using two approaches: robotic-assisted and laparoscopic.
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Affiliation(s)
- Latif Al-Hakim
- School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China.
- Hakim Management, Melbourne, Vic, Australia.
| | - Ming Wang
- Department of Urology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Zhewei Zhang
- Department of Urology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jiaquan Xiao
- Department of Urology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Shomik Sengupta
- Sengupta Urology, Glen Waverley, Vic, Australia
- Urology Department, Eastern Health, Box Hill, Vic, Australia
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Katsuragi R, Ozturk CN, Chida K, Mann GK, Roy AM, Hakamada K, Takabe K, Satake T. Updates on Breast Reconstruction: Surgical Techniques, Challenges, and Future Directions. World J Oncol 2024; 15:853-870. [PMID: 39697427 PMCID: PMC11650608 DOI: 10.14740/wjon1935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 09/13/2024] [Indexed: 12/20/2024] Open
Abstract
The increasing global incidence of breast cancer underscores the significance of breast reconstruction in enhancing patients' quality of life. Breast reconstruction primarily falls into two categories: implant-based techniques and autologous tissue transfers. In this study, we present a comprehensive review of various aspects of implant-based reconstruction, including different types of implants, surgical techniques, and their respective advantages and disadvantages. For autologous breast reconstruction, we classified flaps and optimal harvest sites and provided detailed insights into the characteristics, benefits, and potential complications associated with each flap type. In addition, this review explores the emerging role of fat grafting, which has received increasing attention in recent years. Despite advancements, there remains substantial scope for further improvements in breast reconstruction, emphasizing not only aesthetic outcomes, but also a reduction in complications and postoperative recovery. By offering a comprehensive overview of the historical evolution, current landscape, and future prospects of breast reconstruction, this review aims to provide readers with a comprehensive understanding of breast cancer management strategies.
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Affiliation(s)
- Ryohei Katsuragi
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Toyama, Toyama 930-0152, Japan
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
- Department of Breast Surgery, Nakagami Hospital, Okinawa 904-2142, Japan
| | - Cemile Nurdan Ozturk
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Kohei Chida
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Gabriella Kim Mann
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Arya Mariam Roy
- Department of Hematology and Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, The State University of New York, Buffalo, NY 14263, USA
- Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo 160-8402, Japan
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
- Department of Breast Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
- Department of Breast Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Toshihiko Satake
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Toyama, Toyama 930-0152, Japan
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Kim SS, Mitzman B, Lui NS, Rochefort M, D'Souza D, Sancheti M, Manerikar A, Logan C, Yang S. Robotic Surgery in Thoracic Training Programs: A National Needs Assessment. Ann Thorac Surg 2024; 118:1154-1160. [PMID: 39067629 DOI: 10.1016/j.athoracsur.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/05/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Cardiothoracic surgical trainees perceive a need for more instruction and exposure to robotic-assisted thoracoscopic surgery during their training. We sought to assess use and trainee exposure to robotic surgery in thoracic residency programs to identify areas for improvement. METHODS A voluntary electronic survey of 10 questions was distributed to surgeons working in all thoracic surgery residency programs in the United States. The survey asked respondents to provide the size of the residency, the availability and use of robots, and the trainee's adoption of robotic surgery in their practice after graduation. Multivariable logistic regression was performed. RESULTS Of a total of 76 cardiothoracic surgery training programs, surgeons from 69 training programs (90.8%) completed the survey. Most pulmonary lobectomy was performed using robotic surgery (55%). Approximately half of the training programs (35 of 69) have a formal robotic curriculum for the residents. Of 121 thoracic track trainees, 118 (97.5%) performed robotic surgery as part of their practice, whereas 62 of 110 (56.4%) cardiothoracic track and 16 of 158 (10.1%) cardiac track trainees performed robotic surgery. In a multivariate analysis, the adoption of robotic surgery was associated with having an established robotic training curriculum (odds ratio, 5.82; 95% CI, 1.32-35.7) and a larger training program (odds ratio, 3.78; 95% CI, 1.34-10.6). CONCLUSIONS A disparity exists in robotic surgical training among the training programs. A standardized curriculum and formal case requirements may be needed to ensure optimal preparation for future graduates.
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Affiliation(s)
- Samuel S Kim
- Division of Thoracic Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
| | - Brian Mitzman
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Natalie S Lui
- Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Matthew Rochefort
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Desmond D'Souza
- Division of Thoracic Surgery, Ohio State University Medical Center, Columbus, Ohio
| | - Manu Sancheti
- Division of Thoracic Surgery, Emory University Medical Center, Atlanta, Georgia
| | - Adwaiy Manerikar
- Division of Thoracic Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | - Charles Logan
- Division of Thoracic Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | - Stephen Yang
- Division of Thoracic Surgery, Johns Hopkins University Medical Center, Baltimore, Maryland
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Lengyel BC, Chinnadurai P, Corr SJ, Lumsden AB, Bavare CS. Robot-assisted vascular surgery: literature review, clinical applications, and future perspectives. J Robot Surg 2024; 18:328. [PMID: 39174843 PMCID: PMC11341614 DOI: 10.1007/s11701-024-02087-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 08/17/2024] [Indexed: 08/24/2024]
Abstract
Although robot-assisted surgical procedures using the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA) have been performed in more than 13 million procedures worldwide over the last two decades, the vascular surgical community has yet to fully embrace this approach (Intuitive Surgical Investor Presentation Q3 (2023) https://investor.intuitivesurgical.com/static-files/dd0f7e46-db67-4f10-90d9-d826df00554e . Accessed February 22, 2024). In the meantime, endovascular procedures revolutionized vascular care, serving as a minimally invasive alternative to traditional open surgery. In the pursuit of a percutaneous approach, shorter postoperative hospital stay, and fewer perioperative complications, the long-term durability of open surgical vascular reconstruction has been compromised (in Lancet 365:2179-2186, 2005; Patel in Lancet 388:2366-2374, 2016; Wanhainen in Eur J Vasc Endovasc Surg 57:8-93, 2019). The underlying question is whether the robotic-assisted laparoscopic vascular surgical approaches could deliver the robustness and longevity of open vascular surgical reconstruction, but with a minimally invasive delivery system. In the meantime, other surgical specialties have embraced robot-assisted laparoscopic technology and mastered the essential vascular skillsets along with minimally invasive robotic surgery. For example, surgical procedures such as renal transplantation, lung transplantation, and portal vein reconstruction are routinely being performed with robotic assistance that includes major vascular anastomoses (Emerson in J Heart Lung Transplant 43:158-161, 2024; Fei in J Vasc Surg Cases Innov Tech 9, 2023; Tzvetanov in Transplantation 106:479-488, 2022; Slagter in Int J Surg 99, 2022). Handling and dissection of major vascular structures come with the inherent risk of vascular injury, perhaps the most feared complication during such robotic procedures, possibly requiring emergent vascular surgical consultation. In this review article, we describe the impact of a minimally invasive, robotic approach covering the following topics: a brief history of robotic surgery, components and benefits of the robotic system as compared to laparoscopy, current literature on "vascular" applications of the robotic system, evolving training pathways and future perspectives.
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Affiliation(s)
- Balazs C Lengyel
- Department of Cardiovascular Surgery, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030, USA.
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary.
| | - Ponraj Chinnadurai
- Department of Cardiovascular Surgery, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030, USA
| | - Stuart J Corr
- Department of Cardiovascular Surgery, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030, USA
| | - Alan B Lumsden
- Department of Cardiovascular Surgery, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030, USA
| | - Charudatta S Bavare
- Department of Cardiovascular Surgery, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030, USA
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Chilvers NJ, Evans ZM, Clark AW, Mydin MI, Clark SC. Quantifying the effects of training in lung transplantation: Lessons from NASA. JHLT OPEN 2024; 5:100102. [PMID: 40143906 PMCID: PMC11935496 DOI: 10.1016/j.jhlto.2024.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/28/2025]
Abstract
Background Sequential lung transplantation is a complex procedure. The traditional training model continues to center around operative experience with progressively increasing delegation of stages of the procedure. However, little evidence exists on the effects this has on surgical trainers. The NASA-TLX is a subjective, multidimensional assessment tool that rates perceived workload. We sought to employ this as a means of assessing the impact that training in lung transplantation has on trainers. Methods We prospectively collected the NASA-TLX data for 60 patients undergoing bilateral sequential lung transplantation. In 30 cases, the operation was performed entirely by the senior surgeon (SS) who implanted both lungs. In 30 operations, the senior surgeon implanted the right lung (SSR) and supervised a trainee implanting the left lung (TL). Results The overall weighted rating was significantly lower for the surgeons undertaking the case themselves rather than training (p < 0.001). Cases were comparable in terms of case type, donor ischemic time, and peri-operative characteristics. Mental and temporal demands were greater throughout training cases (p < 0.001, p < 0.05). There was less effect on frustration, physical demand, and effort. Perceived performance showed no significant difference between the groups. Conclusions The NASA task load index can be used to inform the effects of training in lung transplantation on trainers. Training leads to greater mental and temporal demands with less effect on other factors. Crucially, there was no significant difference in perceived performance. As the specialty continues to be confronted with diverse challenges, this study should give confidence to those training the transplant surgeons of the future, as well as provide them with a mechanism to reflect on their own training performance. ACGME Competencies Interpersonal and communication skills.Practice-based learning and improvement.
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Affiliation(s)
| | - Zachariah M. Evans
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
| | - Alexander W. Clark
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
| | - Muhammad I. Mydin
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
| | - Stephen C. Clark
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
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Long SX, Wang XN, Tian SB, Bi YF, Gao SS, Wang Y, Guo XB. Robotic-assisted low anterior resection for rectal cancer shows similar clinical efficacy to laparoscopic surgery: A propensity score matched study. World J Gastrointest Surg 2024; 16:1558-1570. [PMID: 38983340 PMCID: PMC11230029 DOI: 10.4240/wjgs.v16.i6.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 06/27/2024] Open
Abstract
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 techniques 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 favorable 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.
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Affiliation(s)
- Shen-Xiang Long
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Xin-Ning Wang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Shu-Bo Tian
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Yu-Fang Bi
- Department of Nursing, The People’s Hospital of Zhangqiu Area, Jinan 250200, Shandong Province, China
| | - Shen-Shuo Gao
- Medical Center for Gastrointestinal Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Yu Wang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Xiao-Bo Guo
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
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Choi JH, Diab AR, Tsay K, Kuruvilla D, Ganam S, Saad A, Docimo S, Sujka JA, DuCoin CG. The evidence behind robot-assisted abdominopelvic surgery: a meta-analysis of randomized controlled trials. Surg Endosc 2024; 38:2371-2382. [PMID: 38528261 DOI: 10.1007/s00464-024-10773-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/24/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Despite recent advancements, the advantage of robotic surgery over other traditional modalities still harbors academic inquiries. We seek to take a recently published high-profile narrative systematic review regarding robotic surgery and add meta-analytic tools to identify further benefits of robotic surgery. METHODS Data from the published systematic review were extracted and meta-analysis were performed. A fixed-effect model was used when heterogeneity was not significant (Chi2 p ≥ 0.05, I2 ≤ 50%) and a random-effects model was used when heterogeneity was significant (Chi2 p < 0.05, I2 > 50%). Forest plots were generated using RevMan 5.3 software. RESULTS Robotic surgery had comparable overall complications compared to laparoscopic surgery (p = 0.85), which was significantly lower compared to open surgery (odds ratio 0.68, p = 0.005). Compared to laparoscopic surgery, robotic surgery had fewer open conversions (risk difference - 0.0144, p = 0.03), shorter length of stay (mean difference - 0.23 days, p = 0.01), but longer operative time (mean difference 27.98 min, p < 0.00001). Compared to open surgery, robotic surgery had less estimated blood loss (mean difference - 286.8 mL, p = 0.0003) and shorter length of stay (mean difference - 1.69 days, p = 0.001) with longer operative time (mean difference 44.05 min, p = 0.03). For experienced robotic surgeons, there were less overall intraoperative complications (risk difference - 0.02, p = 0.02) and open conversions (risk difference - 0.03, p = 0.04), with equivalent operative duration (mean difference 23.32 min, p = 0.1) compared to more traditional modalities. CONCLUSION Our study suggests that compared to laparoscopy, robotic surgery may improve hospital length of stay and open conversion rates, with added benefits in experienced robotic surgeons showing lower overall intraoperative complications and comparable operative times.
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Affiliation(s)
- Jae Hwan Choi
- Department of Surgery, University of South Florida, Tampa, FL, 33620, USA
| | - Abdul-Rahman Diab
- Department of Surgery, University of South Florida, Tampa, FL, 33620, USA
| | - Katherine Tsay
- Department of Surgery, University of South Florida, Tampa, FL, 33620, USA
| | - Davis Kuruvilla
- Department of Surgery, University of South Florida, Tampa, FL, 33620, USA
| | - Samer Ganam
- Department of Surgery, University of South Florida, Tampa, FL, 33620, USA
| | - Adham Saad
- Department of Surgery, University of South Florida, Tampa, FL, 33620, USA
| | - Salvatore Docimo
- Department of Surgery, University of South Florida, Tampa, FL, 33620, USA
| | - Joseph A Sujka
- Department of Surgery, University of South Florida, Tampa, FL, 33620, USA
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12
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Fujimoto D, Yonemura Y, Taniguchi K, Kobayashi H. Feasibility of Robot-Assisted Cytoreductive Surgery With Upper-Abdominal Peritonectomy for Pseudomyxoma Peritonei With Low Peritoneal Carcinomatosis Index: A Pilot Study. Surg Laparosc Endosc Percutan Tech 2024; 34:196-200. [PMID: 38417107 DOI: 10.1097/sle.0000000000001267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/18/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Our study's objective was to provide the method for, and preliminary findings from, robot-assisted cytoreductive surgery (r-CRS) combined with upper-abdominal peritonectomy in pseudomyxoma peritonei (PMP) with limited peritoneal surface malignancy (PSM). MATERIALS AND METHODS We conducted a retrospective pilot study on consecutive patients with PSM secondary to pseudomyxoma peritonei with a peritoneal cancer index (PCI) of under 10 who were indicated for r-CRS combined with upper-abdominal peritectomy. Perioperative and 30-day major morbidity and mortality characteristics were analyzed and compared with cases in which laparoscopic CRS (l-CRS) was performed under the same conditions. RESULTS Six patients underwent r-CRS combined with an upper-abdominal partial peritonectomy. Their mean PCI was 4.83. Complete cytoreduction was achieved in all patients. The mean duration of the operation was 156.8 minutes. There was no major complication and no mortality. The mean length of hospital stay after surgery was 6.33 days. r-CRS resulted in less blood loss, a lower C-reactive protein level, and a shorter length of hospital stay that were significantly different compared with those of l-CRS. CONCLUSIONS This is the initial technical report of a robotic approach for CRS combined with upper-abdominal peritonectomy. r-CRS with a combined upper-abdominal peritonectomy was shown to be safe and feasible for PMP with limited PSM.
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Affiliation(s)
| | - Yutaka Yonemura
- Department of Regional Cancer Therapy, Peritoneal Dissemination Center, Kishiwada Tokushukai Hospital, Kishiwada-city, Japan
| | - Keizo Taniguchi
- Department of Surgery, Teikyo University Hospital, Mizonokuchi
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13
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Han J. Can robotic surgery lead the way in the treatment of rectal cancer? Ann Coloproctol 2024; 40:87-88. [PMID: 38576078 PMCID: PMC11082543 DOI: 10.3393/ac.2024.00234.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/06/2024] Open
Affiliation(s)
- Jeonghee Han
- Department of Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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14
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Zeng K, Zhang F, Yang H, Zha X, Fang S. Laparoscopic versus open surgery in obstructive colorectal cancer patients following stents placement: a comprehensive meta-analysis of cohort studies. Surg Endosc 2024; 38:1740-1757. [PMID: 38443501 PMCID: PMC10978680 DOI: 10.1007/s00464-024-10710-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/21/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Over the past decade, the use of stent placement as a bridge to surgery (BTS) has emerged as an alternative to emergency surgery for patients with (OCRC). However, the optimal surgical approach remains indeterminate. This study seeks to evaluate the safety and feasibility of a combined treatment modality involving stent placement and laparoscopic surgery for OCRC presenting with malignant obstruction. METHODS A comprehensive search of PubMed, Cochrane Library, EMBASE, Web of Science, and ClinicalTrials.gov was conducted until June 2023 to identify studies that compared laparoscopic to open surgery in patients with OCBC following stent insertion. RESULTS The meta-analysis incorporated 12 cohort studies, encompassing 933 patients. There was no statistically significant difference in the 30-day mortality rates between the two groups (relative risk [RR], 1.09; 95% confidence interval [CI] 0.26 to 4.48; P = 0.95). Compared to the laparoscopic approach group, the open approach group had a higher rate of overall postoperative complications (POCs) (RR 0.52; 95% CI 0.37 to 0.72, P < 0.0001). There was no significant variance in lymph node (LN) dissection number between the groups (mean differences [MD], 1.64; 95% CI - 1.51 to 4.78; P = 0.31). Notably, laparoscopic surgery resulted in less intraoperative blood loss (MD, - 25.84 ml; 95% CI - 52.16 to 0.49; P = 0.05) and a longer operation time (MD, 20.99 mins; 95% CI 2.31 to 39.44; P = 0.03). The laparoscopic approach was associated with a shorter length of hospital stay (LOS) (MD - 3.29 days; 95% CI - 5.27 to 1.31; P = 0.001). Conversely, the open approach group had a higher rate of postoperative surgical site infection (SSI) (RR 0.47; 95% CI 0.23 to 0.96, P = 0.04). Although the number of included studies was insufficient to conduct a meta-analysis, several of them imply that laparoscopic surgery may yield more favorable outcomes in terms of the 3-year overall survival rate (OS), 3-year disease-free survival rate (DFS), 5-year OS, and 5-year DFS when compared to open surgery. It is worth noting that these differences lack statistical significance. CONCLUSION In patients with OCRC subjected to stent insertion, laparoscopic surgery arguably presents a modest superiority over open surgery by diminishing the overall postoperative risk and potentially reducing the LOS.
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Affiliation(s)
- Kerui Zeng
- Department of Colorectal Anal Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China.
- Department of General Surgery, Zigong Fourth People's Hospital, No.282, Dangui Street, Ziliujing District, Zigong, 643000, Sichuan, People's Republic of China.
| | - Faqiang Zhang
- Department of Colorectal Anal Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Hua Yang
- Department of Colorectal Anal Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Xiaoying Zha
- Department of Wound Care Center, Department of Colorectal Anal Surgery, Zigong Fourth Hospital, Zigong, Sichuan, China
| | - Shixu Fang
- Department of Colorectal Anal Surgery, Zigong First People's Hospital, Zigong, Sichuan, China
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Abstract
Cognitive ergonomics refer to mental resources and is associated with memory, sensory motor response, and perception. Cognitive workload (CWL) involves use of working memory (mental strain and effort) to complete a task. The three types of cognitive loads have been divided into intrinsic (dependent on complexity and expertise), extraneous (the presentation of tasks) and germane (the learning process) components. The effect of robotic surgery on CWL is complex because the postural, visualisation, and manipulation ergonomic benefits for the surgeon may be offset by the disadvantages associated with team separation and reduced situation awareness. Physical fatigue and workflow disruptions have a negative impact on CWL. Intraoperative CWL can be measured subjectively post hoc with the use of self-reported instruments or objectively with real-time physiological response metrics. Cognitive training can play a crucial role in the process of skill acquisition during the three stages of motor learning: from cognitive to integrative and then to autonomous. Mentorship, technical practice and watching videos are the most common traditional cognitive training methods in surgery. Cognitive training can also occur with computer-based cognitive simulation, mental rehearsal, and cognitive task analysis. Assessment of cognitive skills may offer a more effective way to differentiate robotic expertise level than automated performance (tool-based) metrics.
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Affiliation(s)
- Shing Wai Wong
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia.
- School of Clinical Medicine, The University of New South Wales, Randwick Campus, Sydney, NSW, Australia.
| | - Philip Crowe
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- School of Clinical Medicine, The University of New South Wales, Randwick Campus, Sydney, NSW, Australia
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16
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Menke V, Hansen O, Schmidt J, Dechantsreiter G, Staib L, Davliatov M, Schilcher F, Hübner B, Bianco F, Kastelan Z, Kulis T, Hudolin T, Penezic L, Zekulic T, Andelic J, Juric I, Puda I, Siaulys R, Venckus R, Jasenus M, Eismontas V, Samalavicius NE. The stress for surgeons: exploring stress entities with the robotic senhance surgical system. J Robot Surg 2024; 18:94. [PMID: 38413542 DOI: 10.1007/s11701-024-01853-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/28/2024] [Indexed: 02/29/2024]
Abstract
Robotic surgery is on its way to revolutionizing traditional surgical procedures, offering precise and minimally invasive techniques hypothesized to shorten recovery times and improve patient outcomes. While there have been multiple publications on robotic systems' medical and procedural achievements, more emphasis should be put on the surgeon's experience, especially in comparison with laparoscopic surgery. The present report aims to systematically examine the stress impact on surgeons by comparing the robotic Senhance Surgical System (Asensus Surgical, Durham, North Carolina, U.S.A) to laparoscopic surgery. The well-established "SURG-TLX" survey is used to measure distinct stress entities. The "SURG-TLX" survey is a modified version of the NASA-TLX, validated for surgery by M. Willson. Based on a comprehensive database from six centers encompassing various disciplines and surgical procedures, our analysis indicates significantly reduced "overall stress" levels for robotic (cockpit) compared to laparoscopic surgeons. Exploring the "SURG-TLX" stress dimensions further between methods (robotic vs. laparoscopic) and surgeon position (laparoscopic, (robotic) bedside, or (robotic) cockpit) resulted in significantly more Mental (p.value < 0.015), less Physical Demands (p.value < 0.001) and less Distraction (p.value < 0.009) for robotic surgery, especially regarding the robotic cockpit surgeons. This finding suggests that robotic surgery with the Senhance Surgical System contributes to a favorable stress profile for surgeons, potentially enhancing their overall well-being and performance.
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Affiliation(s)
- Vivianda Menke
- Department of Surgery, Evangelisches Hospital Wesel, Wesel, Germany.
| | - Olaf Hansen
- Department of Surgery, Evangelisches Hospital Wesel, Wesel, Germany
| | - Johannes Schmidt
- Department of Surgery, Hospital Landshut-Achdorf, Landshut, Germany
| | | | - Ludger Staib
- Department of General and Visceral Surgery, Hospital Esslingen, Esslingen, Germany
| | - Mukhammad Davliatov
- Department of General and Visceral Surgery, Hospital Esslingen, Esslingen, Germany
| | - Florian Schilcher
- Department of General and Visceral Surgery, Hospital Esslingen, Esslingen, Germany
| | - Bodo Hübner
- Department of General and Visceral Surgery, Hospital Esslingen, Esslingen, Germany
| | - Francesco Bianco
- Department of Surgery, General, Minimally Invasive & Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Zeljko Kastelan
- Department of Urology, University Hospital Center, Zagreb, Croatia
| | - Tomislav Kulis
- Department of Urology, University Hospital Center, Zagreb, Croatia
| | - Tvrtko Hudolin
- Department of Urology, University Hospital Center, Zagreb, Croatia
| | - Luka Penezic
- Department of Urology, University Hospital Center, Zagreb, Croatia
| | - Toni Zekulic
- Department of Urology, University Hospital Center, Zagreb, Croatia
| | - Jerko Andelic
- Department of Urology, University Hospital Center, Zagreb, Croatia
| | - Ilija Juric
- Department of Urology, University Hospital Center, Zagreb, Croatia
| | - Ivan Puda
- Department of Urology, University Hospital Center, Zagreb, Croatia
| | - Raimondas Siaulys
- Department of Surgery, Urology and Gynaecology, Klaipeda University Hospital, Klaipeda, Lithuania
| | - Raimundas Venckus
- Department of Surgery, Urology and Gynaecology, Klaipeda University Hospital, Klaipeda, Lithuania
| | - Marius Jasenus
- Department of Surgery, Urology and Gynaecology, Klaipeda University Hospital, Klaipeda, Lithuania
| | - Vitalijus Eismontas
- Department of Surgery, Urology and Gynaecology, Klaipeda University Hospital, Klaipeda, Lithuania
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17
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Han J, Lee JH, Park Y, Kwak BJ, Song KB, Lee W, Hwang DW, Kim SC. Comparison of Surgical Outcomes of Laparoscopic and Robotic Surgery in Adult Choledochal Cysts. J Laparoendosc Adv Surg Tech A 2024; 34:55-60. [PMID: 38126893 DOI: 10.1089/lap.2023.0376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background: Minimally invasive surgery (MIS) for cyst excision and Roux-en-Y hepaticojejunostomy (HJ) is widely performed for adult choledochal cysts. Few articles compared the robotic and laparoscopic approaches for choledochal cysts. Methods: Between 2014 and 2022, 157 patients who underwent MIS for choledochal cysts were retrospectively analyzed. Perioperative outcomes of patients who underwent totally robotic surgery, robot-assisted surgery, and laparoscopic surgery were compared, respectively. Also, postoperative outcomes of patients with robotic reconstruction and laparoscopic reconstruction during HJ were compared. Results: Perioperative outcomes were comparable between robotic and laparoscopic groups. The suturing technique for the anterior and posterior walls of the HJ differed significantly between the robotic and laparoscopic reconstruction groups (P = .001). However, there were no significant differences in postoperative outcomes, including total complications (P = .304), major complications (P = .411), and postoperative interventions (P = .411), between the two groups. Conclusions: The robotic and laparoscopic approaches for adult choledochal cysts have comparable surgical outcomes. In the MIS era, robotic surgery could be an alternative surgical option for adult choledochal cysts.
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Affiliation(s)
- Janghun Han
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yejong Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Bong Jun Kwak
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Woohyung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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18
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Yao Q, Sun QN, Ren J, Wang LH, Wang DR. Comparison of robotic‑assisted versus conventional laparoscopic surgery for mid-low rectal cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2023; 149:15207-15217. [PMID: 37580404 DOI: 10.1007/s00432-023-05228-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE Scarce research has reported the comparison between robotic and laparoscopic surgery in mid-low rectal cancer. Therefore, this meta-analysis is aimed to compare the safety and efficacy of the two surgical approaches. METHODS A comprehensive search of the databases (PubMed, EMBASE, Cochrane, and Web of Science) was performed for studies comparing robotic and laparoscopic surgery. The outcomes of interest acquired from eight articles included three aspects: intraoperative conditions, postoperative status of patients, and complications. All data (robotic = 1350 patients, laparoscopic = 1330 patients) enrolled were analyzed using Rev Man 5.4. RESULTS Compared to the laparoscopic group, the robotic group indicated a noticeable superiority in estimated blood loss (P < 0.0001), number of lymph nodes dissected (P = 0.004), time to first flatus (P = 0.001), time to first fluid diet (P = 0.001), hospital stay (P < 0.0001), conversion (P = 0.009), and urinary retention (P = 0.0006), but devoted much more operation time (P = 0.0004). CONCLUSION Robotic surgery was associated with superiority over laparoscopic surgery in increasing surgical safety, accelerating postoperative recovery, and reducing complications, which suggested that robotic surgery could be a safe and effective method for treating mid-low rectal cancer.
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Affiliation(s)
- Qing Yao
- Northern Jiangsu People's Hospital Affiliated to Dalian Medical University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Qian-Nan Sun
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
- Medical Research Center of Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Jun Ren
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Liu-Hua Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Dao-Rong Wang
- Northern Jiangsu People's Hospital Affiliated to Dalian Medical University, Yangzhou, 225001, China.
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China.
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Hider AM, Johanson H, Bonham AJ, Ghaferi AA, Finks J, Ehlers AP, Carlin AM, Varban OA. Evaluating outcomes among surgeons who changed their technique for gastric bypass: a state-wide analysis from 2011 to 2021. Surg Endosc 2023; 37:8464-8472. [PMID: 37740112 DOI: 10.1007/s00464-023-10434-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Technical variation exists when performing the gastrojejunostomy during Roux-en-Y gastric bypass (RYGB). However, it is unclear whether changing technique results in improved outcomes or patient harm. METHODS Surgeons participating in a state-wide bariatric surgery quality collaborative who completed a survey on how they perform a typical RYGB in 2011 and again in 2021 were included in the analysis (n = 31). Risk-adjusted 30-day complication rates and case characteristics for cases in 2011 were compared to those in 2021 among surgeons who changed their gastrojejunostomy technique from end-to-end anastomosis (EEA) to either a linear staple or handsewn anastomosis (LSA/HSA). In addition, case characteristics and outcomes among surgeons who maintained an EEA technique throughout the study period were assessed. RESULTS A total of 15 surgeons (48.3%) changed their technique from EEA to LSA/HSA while 7 surgeons (22.3%) did not. Nine surgeons did LSA or HSA the entire period and therefore were not included. Surgeons who changed their technique had significantly lower rates of surgical complications in 2021 when compared to 2011 (1.9% vs 5.1%, p = 0.0015), including lower rates of wound complications (0.5% vs 2.1%, p = 0.0030) and stricture (0.1% vs 0.5%, p = 0.0533). Likewise, surgeons who did not change their EEA technique, also experienced a decrease in surgical complications (1.8% vs 5.8%, p < 0.0001), wound complications (0.7% vs 2.1%, p < 0.0001) and strictures (0.2% vs 1.2%, p = 0.0006). Surgeons who changed their technique had a significantly higher mean annual robotic bariatric volume in 2021 (30.0 cases vs 4.9 cases, p < 0.0001) when compared to those who did not. CONCLUSIONS Surgeons who changed their gastrojejunostomy technique from circular stapled to handsewn demonstrated greater utilization of the robotic platform than those who did not and experienced a similar decrease in adverse events during the study period, despite altering their technique. Surgeons who chose to modify their operative technique may be more likely to adopt newer technologies.
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Affiliation(s)
- Ahmad M Hider
- Department of Surgery, Michigan Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, 2210 Taubman Center, Ann Arbor, MI, 48109, USA.
| | | | - Aaron J Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Amir A Ghaferi
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jonathan Finks
- Department of Surgery, Michigan Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Anne P Ehlers
- Department of Surgery, Michigan Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Oliver A Varban
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
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Steinhilber B, Conte L, Seibt R, Herlan S, Tatagiba M, Ebner FH. Musculoskeletal demands in microsurgery-an explorative study comparing the ergonomics of microscope and 3D exoscope. Neurosurg Rev 2023; 46:164. [PMID: 37402848 DOI: 10.1007/s10143-023-02076-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/06/2023]
Abstract
To assess neurosurgeons' physical demands and investigate ergonomic aspects when using microsurgical visualization devices. Six neurosurgeons performed micro-surgical procedures on cadaveric specimens using the prototype of a digital 3D exoscope system (Aeos®, Aesculap, Tuttlingen, Germany) and a standard operating microscope (Pentero 900, Zeiss, Oberkochen, Germany) at two different patient positions (semisitting (SS), supine (SP)). The activities of the bilateral upper trapezius (UTM), anterior deltoid (ADM), and lumbar erector spinae (LEM) muscles were recorded using bipolar surface electromyography and neck flexion, arm abduction, and arm anteversion angles by gravimetrical posture sensors. Perceived discomfort frequency was assessed and subjects compared the two systems in terms of usability, posture, physical and mental demands, and working precision. Using the exoscope led to reduced ADM activity and increased UTM and LEM activity during SS position. The neck was extended when using the exoscope system with lower arm anteversion and abduction angles during the SS position. Subjects reported discomfort at the shoulder-neck area less frequently and lower physical demands when using the Aeos®. However, mental demands were slightly higher and two subjects reported lower working precision. The exoscope system has the potential to reduce the activity of the ADM by changing surgeons arm posture which may be accompanied by less discomfort in the shoulder-neck area. However, dependent on the applied patient position higher muscle activities could occur in the UTM and LEM.
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Affiliation(s)
- Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
| | - Laura Conte
- Department of Neurosurgery, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Robert Seibt
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
| | - Stephan Herlan
- Department of Neurosurgery, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
- Institute of Clinical Anatomy and Cell Analysis, University Hospital Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Florian H Ebner
- Department of Neurosurgery, Alfried Krupp Hospital Rüttenscheid, Alfried-Krupp-Straße 21, 45131, Essen, Germany.
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Park JS, Lee SM, Choi GS, Park SY, Kim HJ, Song SH, Min BS, Kim NK, Kim SH, Lee KY. Comparison of Laparoscopic Versus Robot-Assisted Surgery for Rectal Cancers: The COLRAR Randomized Controlled Trial. Ann Surg 2023; 278:31-38. [PMID: 36594748 DOI: 10.1097/sla.0000000000005788] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate whether robotic for middle or low rectal cancer produces an improvement in surgical outcomes compared with laparoscopic surgery in a randomized controlled trial (RCT). BACKGROUND There is a lack of proven clinical benefit of robotic total mesorectal excision (TME) compared with a laparoscopic approach in the setting of multicenter RCTs. METHODS Between July 2011 and February 2016, patients diagnosed with an adenocarcinoma located <10 cm from the anal verge and clinically rated T1-4aNxM0 were enrolled. The primary outcome was the completeness of TME assessed by a surgeon and a pathologist. RESULTS The RCT was terminated prematurely because of poor accrual of data. In all, 295 patients were assigned randomly to a robot-assisted TME group (151 in R-TME) or a laparoscopy-assisted TME group (144 in L-TME). The rates of complete TME were not different between groups (80.7% in R-TME, 77.1% in L-TME). Pathologic outcomes including the circumferential resection margin and the numbers of retrieved lymph nodes were not different between groups. In a subanalysis, the positive circumferential resection margin rate was lower in the R-TME group (0% vs 6.1% for L-TME; P =0.031). Among the recovery parameters, the length of opioid use was shorter in the R-TME group ( P =0.028). There was no difference in the postoperative complication rate between the groups (12.0% for R-TME vs 8.3% for L-TME). CONCLUSIONS In patients with middle or low rectal cancer, robotic-assisted surgery did not significantly improve the TME quality compared with conventional laparoscopic surgery (ClinicalTrial.gov ID: NCT01042743).
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Affiliation(s)
- Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sung Min Lee
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Ho Song
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Byung Soh Min
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Kyu Kim
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seon Hahn Kim
- Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kang Young Lee
- Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim JH, Toesca A, Pozzi G, Gazzetta G, Marrazzo E, Park HS. Controversies and strengths of robot-assisted mastectomy. Eur J Cancer Prev 2023; 32:388-390. [PMID: 37302018 DOI: 10.1097/cej.0000000000000812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Nipple-sparing mastectomy (NSM) is used to improve cosmetic outcomes while maintaining oncological safety in patients with early breast cancer; however, NSM requires a higher level of skill and workload than mastectomy and is associated with long, visible scars. Robotic surgical systems reduce surgeon workload and facilitate precise surgery. Considering the increasing support of robot-assisted NSM (RNSM), this paper aims to discuss the current controversies based on the research findings reported thus far. There are four concerns regarding RNSM; increased cost, oncological outcomes, the level of experience and skill, and standardization. It should be noted that RNSM is not a surgery performed on all patients but rather a procedure performed on selected patients who meet specific indications. A large-scale randomized clinical trial comparing robotic and conventional NSM has recently begun in Korea; therefore, it is necessary to wait for these results for more insight into oncological outcomes. Although the level of experience and skill required for robotic mastectomy may not be easily achieved by all surgeons, the learning curve for RNSM appears manageable and can be overcome with appropriate training and practice. Training programs and standardization efforts will help improve the overall quality of RNSM. There are some advantages to RNSM. The robotic system provides improved precision and accuracy, helping remove breast tissue more effectively. RNSM has advantages such as smaller scars, less blood loss, and a lower rate of surgical complications. Patients who undergo RNSM report better quality of life.
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Affiliation(s)
- Joo Heung Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Antonio Toesca
- Department of Breast Surgery, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy and
| | - Giada Pozzi
- Department of Breast Surgery, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy and
| | - Guglielmo Gazzetta
- Department of Breast Surgery, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy and
| | - Emilia Marrazzo
- Breast Unit, Department of Surgery, Ospedale Maggiore di Lodi, Lodi, Italy
| | - Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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23
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Erskine J, Abrishami P, Charter R, Cicchetti A, Culbertson R, Faria E, Hiatt JC, Khan J, Maddern G, Patel A, Rha KH, Shah P, Sooriakumaran P, Tackett S, Turchetti G, Chalkidou A. Best practice considerations on the assessment of robotic assisted surgical systems: results from an international consensus expert panel. Int J Technol Assess Health Care 2023; 39:e39. [PMID: 37272397 PMCID: PMC11570098 DOI: 10.1017/s0266462323000314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/21/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Health technology assessments (HTAs) of robotic assisted surgery (RAS) face several challenges in assessing the value of robotic surgical platforms. As a result of using different assessment methods, previous HTAs have reached different conclusions when evaluating RAS. While the number of available systems and surgical procedures is rapidly growing, existing frameworks for assessing MedTech provide a starting point, but specific considerations are needed for HTAs of RAS to ensure consistent results. This work aimed to discuss different approaches and produce guidance on evaluating RAS. METHODS A consensus conference research methodology was adopted. A panel of 14 experts was assembled with international experience and representing relevant stakeholders: clinicians, health economists, HTA practitioners, policy makers, and industry. A review of previous HTAs was performed and seven key themes were extracted from the literature for consideration. Over five meetings, the panel discussed the key themes and formulated consensus statements. RESULTS A total of ninety-eight previous HTAs were identified from twenty-five total countries. The seven key themes were evidence inclusion and exclusion, patient- and clinician-reported outcomes, the learning curve, allocation of costs, appropriate time horizons, economic analysis methods, and robotic ecosystem/wider benefits. CONCLUSIONS Robotic surgical platforms are tools, not therapies. Their value varies according to context and should be considered across therapeutic areas and stakeholders. The principles set out in this paper should help HTA bodies at all levels to evaluate RAS. This work may serve as a case study for rapidly developing areas in MedTech that require particular consideration for HTAs.
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Affiliation(s)
| | - Payam Abrishami
- Erasmus School of Health Policy and Management, National Health Care Institute, Rotterdam, The Netherlands
| | - Richard Charter
- Alira Health, London, UK
- HTAi – Health Technology Assessment International, Edmonton, AB, Canada
| | - Americo Cicchetti
- Department of Economics and Business Management, Università Cattolica del Sacro Cuore, Milano, Italy
| | | | - Eliney Faria
- Department of Urology, Hospital Felicio Rocho, Belo Horizonte, Brazil
| | - Jo Carol Hiatt
- Medical Device Innovation Consortium, Arlington, VA, USA
| | - Jim Khan
- Portsmouth Hospitals NHS Trust, University of Portsmouth, Portsmouth, UK
| | - Guy Maddern
- Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Anita Patel
- Ipsos, London, UK
- University of East Anglia, Norwich, UK
| | - Koon Ho Rha
- Yonsei University Medical School, Seoul, South Korea
| | | | - Prasanna Sooriakumaran
- Lerner College of Medicine, Cleveland Clinic, London, UK
- Department of Urology, University College London Hospital, London, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Giuseppe Turchetti
- Management Institute, Scuola Superiore di Studi Universitari e di Perfezionamento Sant’Anna, Pisa, Italy
| | - Anastasia Chalkidou
- HTAi – Health Technology Assessment International, Edmonton, AB, Canada
- National Institute of Health and Care Excellence, London, UK
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Xu J, Wang JG, Lei K, Liu ZJ. A single-center initial experience on laparoscopic pancreatic operation combined with hepatic arterial resection and reconstruction. Front Surg 2023; 10:1153531. [PMID: 37266002 PMCID: PMC10229900 DOI: 10.3389/fsurg.2023.1153531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023] Open
Abstract
Objective This study aims to summarize our single-center initial experience in laparoscopic pancreatic operation (LPO) combined with hepatic arterial resection and reconstruction, as well as to demonstrate the feasibility, safety, and key surgical procedure for LPO. Methods We retrospectively analyzed 7 patients who had undergone LPO combined with hepatic arterial resection and reconstruction in our center from January 2021 to December 2022. The clinical data of these 7 patients were collected and analyzed. Results In our case series, two patients underwent passive arterial resection and reconstruction due to iatrogenic arterial injury, and five patients underwent forward arterial resection and reconstruction due to arterial invasion. The arterial anastomosis was successful in 5 cases, including 2 cases of end-to-end in situ and 3 cases of arterial transposition, and the vascular reconstruction time was 38.28 ± 15.32 min. There were two conversions to laparotomy. The postoperative recovery of all patients was uneventful, with one liver abscess (Segment 4) and no Clavien III-IV complications. We also share valuable technical feedback and experience gained from the initial practice. Conclusions Based on the surgeon's proficiency in open arterial resection and reconstruction and laparoscopic technique. This study demonstrated the feasibility of total laparoscopic hepatic arterial resection and reconstruction in properly selected cases of arterial involvement or iatrogenic arterial injury. Our initial experience provides valuable information for laparoscopic pancreas surgery with arterial resection and reconstruction.
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Lim C, Barragan JA, Farrow JM, Wachs JP, Sundaram CP, Yu D. Physiological Metrics of Surgical Difficulty and Multi-Task Requirement during Robotic Surgery Skills. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094354. [PMID: 37177557 PMCID: PMC10181544 DOI: 10.3390/s23094354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
Previous studies in robotic-assisted surgery (RAS) have studied cognitive workload by modulating surgical task difficulty, and many of these studies have relied on self-reported workload measurements. However, contributors to and their effects on cognitive workload are complex and may not be sufficiently summarized by changes in task difficulty alone. This study aims to understand how multi-task requirement contributes to the prediction of cognitive load in RAS under different task difficulties. Multimodal physiological signals (EEG, eye-tracking, HRV) were collected as university students performed simulated RAS tasks consisting of two types of surgical task difficulty under three different multi-task requirement levels. EEG spectral analysis was sensitive enough to distinguish the degree of cognitive workload under both surgical conditions (surgical task difficulty/multi-task requirement). In addition, eye-tracking measurements showed differences under both conditions, but significant differences of HRV were observed in only multi-task requirement conditions. Multimodal-based neural network models have achieved up to 79% accuracy for both surgical conditions.
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Affiliation(s)
- Chiho Lim
- School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA
| | | | | | - Juan P Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA
| | | | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA
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26
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Goble M, Caddick V, Patel R, Modi H, Darzi A, Orihuela-Espina F, Leff DR. Optical neuroimaging and neurostimulation in surgical training and assessment: A state-of-the-art review. FRONTIERS IN NEUROERGONOMICS 2023; 4:1142182. [PMID: 38234498 PMCID: PMC10790870 DOI: 10.3389/fnrgo.2023.1142182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/03/2023] [Indexed: 01/19/2024]
Abstract
Introduction Functional near-infrared spectroscopy (fNIRS) is a non-invasive optical neuroimaging technique used to assess surgeons' brain function. The aim of this narrative review is to outline the effect of expertise, stress, surgical technology, and neurostimulation on surgeons' neural activation patterns, and highlight key progress areas required in surgical neuroergonomics to modulate training and performance. Methods A literature search of PubMed and Embase was conducted to identify neuroimaging studies using fNIRS and neurostimulation in surgeons performing simulated tasks. Results Novice surgeons exhibit greater haemodynamic responses across the pre-frontal cortex than experts during simple surgical tasks, whilst expert surgical performance is characterized by relative prefrontal attenuation and upregulation of activation foci across other regions such as the supplementary motor area. The association between PFC activation and mental workload follows an inverted-U shaped curve, activation increasing then attenuating past a critical inflection point at which demands outstrip cognitive capacity Neuroimages are sensitive to the impact of laparoscopic and robotic tools on cognitive workload, helping inform the development of training programs which target neural learning curves. FNIRS differs in comparison to current tools to assess proficiency by depicting a cognitive state during surgery, enabling the development of cognitive benchmarks of expertise. Finally, neurostimulation using transcranial direct-current-stimulation may accelerate skill acquisition and enhance technical performance. Conclusion FNIRS can inform the development of surgical training programs which modulate stress responses, cognitive learning curves, and motor skill performance. Improved data processing with machine learning offers the possibility of live feedback regarding surgeons' cognitive states during operative procedures.
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Affiliation(s)
- Mary Goble
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Li S, Liu Y, Li K, Cao G, Li S, Mao Y, Wang Y, Feng J, Tang ST. Validation and effect of the NASA-TLX score on the assessment of the workload of pediatric robotic operations. Surg Endosc 2023:10.1007/s00464-023-09959-y. [PMID: 36917343 DOI: 10.1007/s00464-023-09959-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/12/2023] [Indexed: 03/15/2023]
Abstract
OBJECTIVE The objective of the study was to assess the validity of the NASA-TLX score in rating the workload of pediatric robotic operations. METHODS The workload of 230 pediatric gastrointestinal and thoracic robotic operations was rated using the NASA-TLX score. The difference between the high workload group and the low workload group in each subscale of the NASA-TLX score was analyzed. The correlation of each subscale with the total workload score in the high workload group and low workload group was also analyzed. A logistic regression analysis was subsequently conducted to assess the effects of different factors (sex, age, weight, procedure duration, procedure specialties, combined malformation and blood loss) on the workload. RESULTS The average NASA-TLX score was 56.5 ± 5.1 for the total group, 56.9 ± 5.0 for the gastrointestinal group and 54.6 ± 4.8 for the thoracic group, p = 0.007. The score of the high workload group was 62.7 ± 3.2, while it was 50.6 ± 2.7 for the low workload group (p < 0.001). The score on each subscale was also significantly different between the high and low workload groups. In the high workload group, a stronger correlation was observed between the total score and TD and Fr and a lower correlation with MD and Pe. In the low workload group, all six subscales showed a moderate correlation with the total score. A multivariate logistic regression analysis revealed that the procedure duration was an independent influencing factor for a higher workload score. CONCLUSIONS NASA-TLX is a valid tool to rate the surgeon's workload in pediatric robotic surgery. A longer operative time contributes to a higher workload.
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Affiliation(s)
- Shuai Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Yuan Liu
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Kang Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Guoqing Cao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Shiwang Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Yongzhong Mao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Yong Wang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Jianjun Feng
- Department of Pediatric Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, China.
| | - Shao-Tao Tang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
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Amirthanayagam A, Zecca M, Barber S, Singh B, Moss EL. Impact of minimally invasive surgery on surgeon health (ISSUE) study: protocol of a single-arm observational study conducted in the live surgery setting. BMJ Open 2023; 13:e066765. [PMID: 36882245 PMCID: PMC10008445 DOI: 10.1136/bmjopen-2022-066765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION The rapid evolution of minimally invasive surgery has had a positive impact on patient outcomes; however, it is reported to be associated with work-related musculoskeletal symptoms (WMS) in surgeons. Currently there is no objective measure to monitor the physical and psychological impact of performing a live surgical procedure on the surgeon. METHODS AND ANALYSIS A single-arm observational study with the aim of developing a validated assessment tool to quantify the impact of surgery (open/laparoscopic/robotic-assisted) on the surgeon. Development and validation cohorts of major surgical cases of varying levels of complexity performed by consultant gynaecological and colorectal surgeons will be recruited. Recruited surgeons wear three Xsens DOT monitors (muscle activity) and an Actiheart monitor (heart rate). Salivary cortisol levels will be taken and questionnaires (WMS and State-Trait Anxiety Inventory) completed by the participants preoperatively and postoperatively. All the measures will be incorporated to produce a single score that will be called the 'S-IMPACT' score. ETHICS AND DISSEMINATION Ethical approval for this study has been granted by the East Midlands Leicester Central Research Ethics Committee REC ref 21/EM/0174. Results will be disseminated to the academic community through conference presentations and peer-reviewed journal publications. The S-IMPACT score developed within this study will be taken forward for use in definitive multicentre prospective randomised control trials.
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Affiliation(s)
| | - Massimiliano Zecca
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, UK
| | - Shaun Barber
- Leicester Clinical Trials Unit, University of Leicester, Leicester, Leicestershire, UK
- NIHR Research Design Service East Midlands, Leicester, UK
| | - Baljit Singh
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Esther L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
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Hotton J, Bogart E, Le Deley MC, Lambaudie E, Narducci F, Marchal F. Ergonomic Assessment of the Surgeon's Physical Workload During Robot-Assisted Versus Standard Laparoscopy in a French Multicenter Randomized Trial (ROBOGYN-1004 Trial). Ann Surg Oncol 2023; 30:916-923. [PMID: 36175710 DOI: 10.1245/s10434-022-12548-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Standard laparoscopy (SL) is responsible for musculoskeletal disorders in surgeons because of poor ergonomic positions, which could be reduced by robot-assisted laparoscopy (RAL) owing to the surgeons' seated position. One of the aims of the ROBOGYN-1004 study (NCT01247779) was to evaluate surgeons' workloads during real-time procedures of gynecological oncological surgery. METHODS Patients with gynecological cancer eligible for minimally invasive surgery were recruited from 13 French centers between December 2010 and December 2015. Physical workload was evaluated using the Borg scale every hour over the surgery duration and the perception of workload evaluated using NASA-TLX at the end of surgery. RESULTS A total of 369 patients were recruited, of whom 176 underwent RAL and 193 underwent SL (per-protocol analysis). Posture during SL was significantly more challenging for all body parts except the back. There was an increase in discomfort over time (up to 4 h) for the hands and arms, neck, and legs in SL compared with RAL. Perceived physical activity and abilities were rated higher in SL than in RAL (p < 0.01), whereas perceived personal performance was higher in SL (p < 0.01). Perceived physical effort during surgery was lower in RAL than in SL. CONCLUSIONS RAL improves the perception of physical workload. Compared with SL, the perceived effort is lower in RAL regardless of the complexity of the surgery.
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Affiliation(s)
| | - Emilie Bogart
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Marie-Cécile Le Deley
- DRCI - Unité de Méthodologie et de Biostatistiques, Centre Oscar Lambret, Lille, France
| | - Eric Lambaudie
- Surgical Department, Institut Paoli-Calmette, Marseille, France
| | | | - Frédéric Marchal
- Surgical Department, CRAN, UMR 7039, CNRS Institut de Cancérologie de Lorraine, Université de Lorraine, Vandoeuvre-les-Nancy, France
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30
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Khajeh E, Aminizadeh E, Dooghaie Moghadam A, Nikbakhsh R, Goncalves G, Carvalho C, Parvaiz A, Kulu Y, Mehrabi A. Outcomes of Robot-Assisted Surgery in Rectal Cancer Compared with Open and Laparoscopic Surgery. Cancers (Basel) 2023; 15:cancers15030839. [PMID: 36765797 PMCID: PMC9913667 DOI: 10.3390/cancers15030839] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
With increasing trends for the adoption of robotic surgery, many centers are considering changing their practices from open or laparoscopic to robot-assisted surgery for rectal cancer. We compared the outcomes of robot-assisted rectal resection with those of open and laparoscopic surgery. We searched Medline, Web of Science, and CENTRAL databases until October 2022. All randomized controlled trials (RCTs) and prospective studies comparing robotic surgery with open or laparoscopic rectal resection were included. Fifteen RCTs and 11 prospective studies involving 6922 patients were included. The meta-analysis revealed that robotic surgery has lower blood loss, less surgical site infection, shorter hospital stays, and higher negative resection margins than open resection. Robotic surgery also has lower conversion rates, lower blood loss, lower rates of reoperation, and higher negative circumferential margins than laparoscopic surgery. Robotic surgery had longer operation times and higher costs than open and laparoscopic surgery. There were no differences in other complications, mortality, and survival between robotic surgery and the open or laparoscopic approach. However, heterogeneity between studies was moderate to high in some analyses. The robotic approach can be the method of choice for centers planning to change from open to minimally invasive rectal surgery. The higher costs of robotic surgery should be considered as a substitute for laparoscopic surgery (PROSPERO: CRD42022381468).
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Affiliation(s)
- Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69121 Heidelberg, Germany
- Digestive Unit, Department of Surgery, Champalimaud Foundation, 1400-038 Lisbon, Portugal
| | - Ehsan Aminizadeh
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69121 Heidelberg, Germany
| | - Arash Dooghaie Moghadam
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69121 Heidelberg, Germany
| | - Rajan Nikbakhsh
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69121 Heidelberg, Germany
| | - Gil Goncalves
- Digestive Unit, Department of Surgery, Champalimaud Foundation, 1400-038 Lisbon, Portugal
| | - Carlos Carvalho
- Digestive Unit, Department of Oncology, Champalimaud Foundation, 1400-038 Lisbon, Portugal
| | - Amjad Parvaiz
- Digestive Unit, Department of Surgery, Champalimaud Foundation, 1400-038 Lisbon, Portugal
| | - Yakup Kulu
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69121 Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, 69121 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-5636223
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Kumar K, Kumar P, Deb D, Unguresan ML, Muresan V. Artificial Intelligence and Machine Learning Based Intervention in Medical Infrastructure: A Review and Future Trends. Healthcare (Basel) 2023; 11:healthcare11020207. [PMID: 36673575 PMCID: PMC9859198 DOI: 10.3390/healthcare11020207] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/01/2023] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
People in the life sciences who work with Artificial Intelligence (AI) and Machine Learning (ML) are under increased pressure to develop algorithms faster than ever. The possibility of revealing innovative insights and speeding breakthroughs lies in using large datasets integrated on several levels. However, even if there is more data at our disposal than ever, only a meager portion is being filtered, interpreted, integrated, and analyzed. The subject of this technology is the study of how computers may learn from data and imitate human mental processes. Both an increase in the learning capacity and the provision of a decision support system at a size that is redefining the future of healthcare are enabled by AI and ML. This article offers a survey of the uses of AI and ML in the healthcare industry, with a particular emphasis on clinical, developmental, administrative, and global health implementations to support the healthcare infrastructure as a whole, along with the impact and expectations of each component of healthcare. Additionally, possible future trends and scopes of the utilization of this technology in medical infrastructure have also been discussed.
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Affiliation(s)
- Kamlesh Kumar
- Department of Electrical and Computer Science Engineering, Institute of Infrastructure Technology Research And Management, Ahmedabad 380026, India
| | - Prince Kumar
- Department of Electrical and Computer Science Engineering, Institute of Infrastructure Technology Research And Management, Ahmedabad 380026, India
| | - Dipankar Deb
- Department of Electrical and Computer Science Engineering, Institute of Infrastructure Technology Research And Management, Ahmedabad 380026, India
- Correspondence:
| | | | - Vlad Muresan
- Department of Automation, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
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Kauffmann EF, Napoli N, Ginesini M, Gianfaldoni C, Asta F, Salamone A, Ripolli A, Di Dato A, Vistoli F, Amorese G, Boggi U. Tips and tricks for robotic pancreatoduodenectomy with superior mesenteric/portal vein resection and reconstruction. Surg Endosc 2023; 37:3233-3245. [PMID: 36624216 PMCID: PMC10082118 DOI: 10.1007/s00464-022-09860-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/27/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Open pancreatoduodenectomy with vein resection (OPD-VR) is now standard of care in patients who responded to neoadjuvant therapies. Feasibility of robotic pancreatoduodenectomy (RPD) with vein resection (RPD-VR) was shown, but no study provided a detailed description of the technical challenges associated with this formidable operation. Herein, we describe the trips and tricks for technically successful RPD-VR. METHODS The vascular techniques used in RPD-VR were borrowed from OPD-VR, as well as from our experience with robotic transplantation of both kidney and pancreas. Vein resection was classified into 4 types according to the international study group of pancreatic surgery. Each type of vein resection was described in detail and shown in a video. RESULTS Between October 2008 and November 2021, a total of 783 pancreatoduodenectomies were performed, including 233 OPDs-VR (29.7%). RPD was performed in 256 patients (32.6%), and RPDs-VR in 36 patients (4.5% of all pancreatoduodenectomies; 15.4% of all pancreatoduodenectomies with vein resection; 14.0% of all RPDs). In RPD-VR vein resections were: 4 type 1 (11.1%), 10 type 2 (27.8%), 12 type 3 (33.3%) and 10 type 4 (27.8%). Vascular patches used in type 2 resections were made of peritoneum (n = 8), greater saphenous vein (n = 1), and deceased donor aorta (n = 1). Interposition grafts used in type 4 resections were internal left jugular vein (n = 8), venous graft from deceased donor (n = 1) and spiral saphenous vein graft (n = 1). There was one conversion to open surgery (2.8%). Ninety-day mortality was 8.3%. There was one (2.8%) partial vein thrombosis, treated with heparin infusion. CONCLUSIONS We have reported 36 technically successful RPDs-VR. We hope that the tips and tricks provided herein can contribute to safer implementation of RPD-VR. Based on our experience, and according to data from the literature, we strongly advise that RPD-VR is performed by expert surgeons at high volume centers.
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Affiliation(s)
- Emanuele F Kauffmann
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Michael Ginesini
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Cesare Gianfaldoni
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Fabio Asta
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Alice Salamone
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Allegra Ripolli
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Armando Di Dato
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Fabio Vistoli
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Gabriella Amorese
- Division of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
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McDonald-Bowyer A, Dietsch S, Dimitrakakis E, Coote JM, Lindenroth L, Stoyanov D, Stilli A. Organ curvature sensing using pneumatically attachable flexible rails in robotic-assisted laparoscopic surgery. Front Robot AI 2023; 9:1099275. [PMID: 36686214 PMCID: PMC9849801 DOI: 10.3389/frobt.2022.1099275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
In robotic-assisted partial nephrectomy, surgeons remove a part of a kidney often due to the presence of a mass. A drop-in ultrasound probe paired to a surgical robot is deployed to execute multiple swipes over the kidney surface to localise the mass and define the margins of resection. This sub-task is challenging and must be performed by a highly-skilled surgeon. Automating this sub-task may reduce cognitive load for the surgeon and improve patient outcomes. The eventual goal of this work is to autonomously move the ultrasound probe on the surface of the kidney taking advantage of the use of the Pneumatically Attachable Flexible (PAF) rail system, a soft robotic device used for organ scanning and repositioning. First, we integrate a shape-sensing optical fibre into the PAF rail system to evaluate the curvature of target organs in robotic-assisted laparoscopic surgery. Then, we investigate the impact of the PAF rail's material stiffness on the curvature sensing accuracy, considering that soft targets are present in the surgical field. We found overall curvature sensing accuracy to be between 1.44% and 7.27% over the range of curvatures present in adult kidneys. Finally, we use shape sensing to plan the trajectory of the da Vinci surgical robot paired with a drop-in ultrasound probe and autonomously generate an Ultrasound scan of a kidney phantom.
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Affiliation(s)
- A. McDonald-Bowyer
- Welcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - S. Dietsch
- Welcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - E. Dimitrakakis
- Welcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - J. M. Coote
- Welcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - L. Lindenroth
- Department of Surgical & Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - D. Stoyanov
- Welcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - A. Stilli
- Welcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
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Monfared S, Athanasiadis DI, Umana L, Hernandez E, Asadi H, Colgate CL, Yu D, Stefanidis D. A comparison of laparoscopic and robotic ergonomic risk. Surg Endosc 2022; 36:8397-8402. [PMID: 35182219 DOI: 10.1007/s00464-022-09105-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/07/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Work related injuries in minimally invasive surgery (MIS) are common because of the strains placed on the surgeon's or assistant's body. The objective of this study was to compare specific ergonomic risks among surgeons and surgical trainees performing robotic and laparoscopic procedures. MATERIALS AND METHODS Ergonomic data and discomfort questionnaires were recorded from surgeons and trainees (fellows/residents) for both robotic and laparoscopic procedures. Perceived discomfort questionnaires were recorded pre/postoperatively. Intraoperatively, biomechanical loads were captured using motion tracking sensors and electromyography (EMG) sensors. Perceived discomfort, body position and muscle activity were compared between robotic and laparoscopic procedures using a linear regression model. RESULTS Twenty surgeons and surgical trainees performed 29 robotic and 48 laparoscopic procedures. Postoperatively, increases in right finger numbness and right shoulder stiffness and surgeon irritability were noted after laparoscopy and increased back stiffness after robotic surgery. Further, the laparoscopic group saw increases in right hand/shoulder pain (OR 0.8; p = 0.032) and left hand/shoulder pain (0.22; p < 0.001) compared to robotic. Right deltoid and trapezius excessive muscle activity were significantly higher in laparoscopic operations compared to robotic. Demanding and static positioning was similar between the two groups except there was significantly more static neck position required for robotic operations. CONCLUSION Robotic assisted surgeries led to lower postoperative discomfort and muscle strain in both upper extremities, particularly dominant side of the surgeon, but increased static neck positioning with subjective back stiffness compared with laparoscopy. These recognized ergonomic differences between the two platforms can be used to raise surgeon awareness of their intraoperative posture and to develop targeted physical and occupational therapy interventions to decrease surgeon WMSDs and increase surgeon longevity.
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Affiliation(s)
- Sara Monfared
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dimitrios I Athanasiadis
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Luke Umana
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Edward Hernandez
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Cameron L Colgate
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Denny Yu
- Purdue University, West Lafayette, IN, USA
| | - Dimitrios Stefanidis
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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Spampatti S, La Regina D, Pini R, Mongelli F, Gaffuri P, Porcellini I, Romanzi A, Marcantonio M. Three-point mesh fixation in robot-assisted transabdominal preperitoneal (R-TAPP) repair of 208 inguinal hernias: preliminary results of a single-center consecutive series. Langenbecks Arch Surg 2022; 407:2555-2561. [PMID: 35581394 DOI: 10.1007/s00423-022-02542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to assess the efficacy of our mesh fixation technique in robot-assisted transabdominal preperitoneal inguinal hernia repair (R-TAPP). The primary outcome was the recurrence rate. Secondary outcomes were postoperative pain, chronic pain, and return to normal activities. METHODS Between January 2018 and December 2019, we performed 208 consecutive R-TAPP in 161 patients and the mesh was fixed by three intracorporeal stiches using a Polyglactin 910 (Vicryl®) 3-0 suture. Patients were followed up at 10 and 30 days after surgery with a clinical evaluation for detection of early complications, postoperative pain, need for analgesics, return to normal activities, and satisfaction rate. Patients were further followed up at study conclusion in February 2021 for recurrence and chronic pain detection. RESULTS Painkillers were stopped by 57% of the patients after the first postoperative day and by 96% after 1 week. Chronic pain (> 3 months after surgery) was observed in three patients (1.8%) and only one of them was treated with percutaneous ilioinguinal-iliohypogastric nerve infiltration. After a mean follow-up of 24.0 ± 6.7 months, only 1 recurrence (0.48%) was clinically detected and confirmed by a CT-scan. CONCLUSIONS The 3-point mesh fixation technique is feasible during robot-assisted TAPP repair for inguinal hernia and seems to be a viable alternative to other fixation methods. Further long-term controlled investigations are needed to understand if this technique is effective in influencing recurrence and chronic pain rates.
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Affiliation(s)
- Sebastiano Spampatti
- Ente Ospedaliero Cantonale Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, via Ospedale 12, 6500, Bellinzona, Switzerland.
| | - Davide La Regina
- Ente Ospedaliero Cantonale Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Ramon Pini
- Ente Ospedaliero Cantonale Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Francesco Mongelli
- Ente Ospedaliero Cantonale Department of Surgery, Ospedale Regionale Di Lugano, via Tesserete 46, 6900, Lugano, Switzerland
| | - Paolo Gaffuri
- Ente Ospedaliero Cantonale Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Iride Porcellini
- Ente Ospedaliero Cantonale Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Andrea Romanzi
- Department of Surgery, Ospedale Valduce, Via Dante Alighieri 11, 22100, Como, Italy
| | - Maria Marcantonio
- Ente Ospedaliero Cantonale Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, via Ospedale 12, 6500, Bellinzona, Switzerland
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Liu K, Yu Y, Zeng LL, Liang X, Liu Y, Chu X, Lu G, Zhou Z. Effects of Low Mental Energy from Long Periods of Work on Brain-Computer Interfaces. Brain Sci 2022; 12:brainsci12091152. [PMID: 36138888 PMCID: PMC9497083 DOI: 10.3390/brainsci12091152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
Brain-computer interfaces (BCIs) provide novel hands-free interaction strategies. However, the performance of BCIs is affected by the user’s mental energy to some extent. In this study, we aimed to analyze the combined effects of decreased mental energy and lack of sleep on BCI performance and how to reduce these effects. We defined the low-mental-energy (LME) condition as a combined condition of decreased mental energy and lack of sleep. We used a long period of work (>=18 h) to induce the LME condition, and then P300- and SSVEP-based BCI tasks were conducted in LME or normal conditions. Ten subjects were recruited in this study. Each subject participated in the LME- and normal-condition experiments within one week. For the P300-based BCI, we used two decoding algorithms: stepwise linear discriminant (SWLDA) and least square regression (LSR). For the SSVEP-based BCI, we used two decoding algorithms: canonical correlation analysis (CCA) and filter bank canonical correlation analysis (FBCCA). Accuracy and information transfer rate (ITR) were used as performance metrics. The experimental results showed that for the P300-based BCI, the average accuracy was reduced by approximately 35% (with a SWLDA classifier) and approximately 40% (with a LSR classifier); the average ITR was reduced by approximately 6 bits/min (with a SWLDA classifier) and approximately 7 bits/min (with an LSR classifier). For the SSVEP-based BCI, the average accuracy was reduced by approximately 40% (with a CCA classifier) and approximately 40% (with a FBCCA classifier); the average ITR was reduced by approximately 20 bits/min (with a CCA classifier) and approximately 19 bits/min (with a FBCCA classifier). Additionally, the amplitude and signal-to-noise ratio of the evoked electroencephalogram signals were lower in the LME condition, while the degree of fatigue and the task load of each subject were higher. Further experiments suggested that increasing stimulus size, flash duration, and flash number could improve BCI performance in LME conditions to some extent. Our experiments showed that the LME condition reduced BCI performance, the effects of LME on BCI did not rely on specific BCI types and specific decoding algorithms, and optimizing BCI parameters (e.g., stimulus size) can reduce these effects.
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Voskens FJ, van der Schans EM, Ruurda JP, Broeders IAMJ. Endoscopic surgery suturing techniques: a randomized study on learning. BMC Surg 2022; 22:59. [PMID: 35172810 PMCID: PMC8851769 DOI: 10.1186/s12893-022-01513-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgeons have widely adopted endoscopic suturing techniques using conventional laparoscopic instruments and the more advanced robotic systems. The FlexDex is a novel articulating laparoscopic needle driver providing enhanced dexterity in laparoscopic surgery. This study evaluates and compares the learning curve of endoscopic suturing with conventional laparoscopy, the FlexDex and robotic suturing in novices. METHODS Participants performed a minimal invasive suturing task in three different ways in a randomized order: with a conventional laparoscopic needle driver, using the FlexDex needle driver and third, using the Da Vinci Si surgical system. Primary outcome was suturing task time. Secondary outcome parameters were assessment of suturing quality and workload perception. RESULTS A total of 10 novice participants were included and completed a total of 300 sessions. Median (IQR) suturing time of the first 5 sessions was 231 s (188-291) in the laparoscopic group versus 378 s (282-471) in the FlexDex group versus 189 s (160-247) in the DaVinci Si group. The last 5 sessions showed significant reduction of median suturing time of 143 s (120-190), 232 s (180-265) and 172 s (134-199) respectively. Analysis identified that the learning curve for the laparoscopic needle driver and Da Vinci Si was reached in 5 sessions, compared to 8 sessions for the Flexdex. The laparoscopic needle driver and Da Vinci Si showed a significant shorter median suturing time compared to the FlexDex (p = 0.00). The FlexDex quality assessment scores were significantly lower compared to the laparoscopic (p = 0.00) and robotic (p = 0.00) scores and perceived workload remains high for the FlexDex users. CONCLUSIONS Ex vivo endoscopic suturing with the FlexDex demonstrated a prolonged learning curve compared to laparoscopic and robotic suturing. The learning curve of the FlexDex is fundamentally different from conventional laparoscopic and robotic instruments. This study provides further insights in the implementation and training of endoscopic suturing techniques.
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Affiliation(s)
- F J Voskens
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands. .,University of Twente, Robotics and Mechatronics, Enschede, The Netherlands.
| | - E M van der Schans
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands.,University of Twente, Robotics and Mechatronics, Enschede, The Netherlands
| | - J P Ruurda
- Department of Gastro-Intestinal and Oncologic Surgery, University Medical Center, Utrecht, The Netherlands
| | - I A M J Broeders
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands.,University of Twente, Robotics and Mechatronics, Enschede, The Netherlands
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Hannah TC, Turner D, Kellner R, Bederson J, Putrino D, Kellner CP. Neuromonitoring Correlates of Expertise Level in Surgical Performers: A Systematic Review. Front Hum Neurosci 2022; 16:705238. [PMID: 35250509 PMCID: PMC8888846 DOI: 10.3389/fnhum.2022.705238] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 01/25/2022] [Indexed: 12/02/2022] Open
Abstract
Surgical expertise does not have a clear definition and is often culturally associated with power, authority, prestige, and case number rather than more objective proxies of excellence. Multiple models of expertise progression have been proposed including the Dreyfus model, however, they all currently require subjective evaluation of skill. Recently, efforts have been made to improve the ways in which surgical excellence is measured and expertise is defined using artificial intelligence, video recordings, and accelerometers. However, these aforementioned methods of assessment are still subjective or indirect proxies of expertise, thus uncovering the neural mechanisms that differentiate expert surgeons from trainees may enhance the objectivity of surgical expertise validation. In fact, some researchers have already suggested that their neural imaging-based expertise classification methods outperform currently used methods of surgical skill certification such as the Fundamentals of Laparoscopic Surgery (FLS) scores. Such imaging biomarkers would not only help better identify the highest performing surgeons, but could also improve residency programs by providing more objective, evidence-based feedback and developmental milestones for those in training and perhaps act as a marker of surgical potential in medical students. Despite the potential advantages of using neural imaging in the assessment of surgical expertise, this field of research remains in its infancy. This systematic review identifies studies that have applied neuromonitoring in assessing surgical skill across levels of expertise. The goals of this review are to identify (1) the strongest neural indicators of surgical expertise, (2) the limitations of the current literature on this subject, (3) the most sensible future directions for further study. We found substantial evidence that surgical expertise can be delineated by differential activation and connectivity in the prefrontal cortex (PFC) across multiple task and neuroimaging modalities. Specifically, novices tend to have greater PFC activation than experts under standard conditions in bimanual and decision-making tasks. However, under high temporal demand tasks, experts had increased PFC activation whereas novices had decreased PFC activation. Common limitations uncovered in this review were that task difficulty was often insufficient to delineate between residents and attending. Moreover, attending level involvement was also low in multiple studies which may also have contributed to this issue. Most studies did not analyze the ability of their neuromonitoring findings to accurately classify subjects by level of expertise. Finally, the predominance of fNIRS as the neuromonitoring modality limits our ability to uncover the neural correlates of surgical expertise in non-cortical brain regions. Future studies should first strive to address these limitations. In the longer term, longitudinal within-subjects design over the course of a residency or even a career will also advance the field. Although logistically arduous, such studies would likely be most beneficial in demonstrating effects of increasing surgical expertise on regional brain activation and inter-region connectivity.
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Affiliation(s)
- Theodore C. Hannah
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- *Correspondence: Theodore C. Hannah,
| | | | - Rebecca Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - David Putrino
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Christopher P. Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Giannini A, Russo E, Misasi G, Falcone M, Caretto M, Morganti R, Mannella P, Simoncini T. Technical features, perioperative and anatomical outcomes of a standardized suturing pattern for robotic sacrocolpopexy. Int Urogynecol J 2022; 33:3085-3092. [PMID: 35037972 DOI: 10.1007/s00192-021-05049-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 11/13/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Several technical alternatives to repair mesh using laparoscopic sacrocolpopexy exist. We aim to describe the outcomes and surgical technique of robotic-assisted colpo-/cervicosacropexy using a standardized suturing scheme to repair the mesh. METHODS We retrospectively reported data of 60 consecutive cases of robotic-assisted colpo-/cervicosacropexy for advanced multicompartmental prolapse using a standardized suturing design. We placed three non-absorbable stitches on the cervix or three absorbable stitches on the apex of the vaginal vault, six long-term absorbable stitches on the anterior vaginal wall deep to the basis of the vesical trigone, six similar posterior stitches with the deeper row of sutures down to the levator ani plane and three non-absorbable stitches on the sacral promontory as the cranial support for Y-shaped polypropylene mesh. RESULTS Median operative time was 188 ± 43 min. All the procedures were successfully performed using a Da Vinci Si platform in a three-arm configuration, and no conversion to open or traditional laparoscopic surgery was needed. The length of hospital stay was 1.2 ± 1.7 days, and no readmission within 30 postoperative days was reported. At a follow-up of 12 and 24 months, no case of extrusion or exposure of the mesh occurred, and the retreatment rate was 6.7%. CONCLUSIONS Our suturing technique is safe and effective, with negligible risk of complications and good medium-term results. It is plausible that robotic systems may facilitate precise, accurate and reproducible placement of the stitches, thereby favoring wider diffusion of minimally invasive treatment of advanced prolapse.
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Affiliation(s)
- Andrea Giannini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
| | - Eleonora Russo
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Giulia Misasi
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Maria Falcone
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Marta Caretto
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Paolo Mannella
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
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Varban OA, Cain-Nielsen AH, Wood MH, Carlin AM, Ghaferi AA, Telem DA. Adopt or Abandon? Surgeon-Specific Trends in Robotic Bariatric Surgery Utilization Between 2010 and 2019. J Laparoendosc Adv Surg Tech A 2022; 32:768-774. [PMID: 35041519 DOI: 10.1089/lap.2021.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: It is unknown if surgeons are more likely to adopt or abandon robotic techniques given that bariatric procedures are already performed by surgeons with advanced laparoscopic skills. Methods: We used a statewide bariatric-specific data registry to evaluate surgeon-specific volumes of robotic bariatric cases between 2010 and 2019. Operative volume, procedure type, and patient characteristics were compared between the highest utilizers of robotic bariatric procedures (adopters) and surgeons who stopped performing robotic cases, despite demonstrating prior use (abandoners). Results: A total of 44 surgeons performed 3149 robotic bariatric procedures in Michigan between 2010 and 2019. Robotic utilization peaked in 2019, representing 7.24% of all bariatric cases. We identified 7 surgeons (16%) who performed 95% of the total number of robotic cases (adopters) and 12 surgeons (27%) who stopped performing bariatric cases during the study period (abandoners). Adopters performed a higher proportion of gastric bypass both robotically (22.9% versus 3.1%, P < .001) and laparoscopically (27.5% versus 15.1%, P < .001), when compared with abandoners. Surgeon experience (no. of years in practice), type of practice (teaching versus nonteaching hospital), and patient populations were similar between groups. Conclusions: Robotic bariatric utilization increased during the study period. The majority of robotic cases were performed by a small number of surgeons who were more likely to perform more complex cases such as gastric bypass in their own practice. Robotic adoption may be influenced by surgeon-specific preferences based upon procedure-specific volumes and may play a greater role in performing more complex surgical procedures in the future.
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Affiliation(s)
- Oliver A Varban
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne H Cain-Nielsen
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael H Wood
- Department of Surgery, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Dana A Telem
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
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Pérez-Marchán M, Pérez-Brayfield M. Comparison of laparoscopic pyeloplasty vs. robot-assisted pyeloplasty for the management of ureteropelvic junction obstruction in children. Front Pediatr 2022; 10:1038454. [PMID: 36425398 PMCID: PMC9679786 DOI: 10.3389/fped.2022.1038454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ureteropelvic junction obstruction (UPJO) is a commonly observed abnormality in pediatric urology. Minimally invasive approaches have gained popularity in recent years. Studies have demonstrated excellent results with both laparoscopic pyeloplasty (LAP) and robot-assisted pyeloplasty (RAP). Few studies have compared the experience of both procedures performed in a single institution. Our objective is to compare laparoscopic pyeloplasty and robot-assisted pyeloplasty in the Puerto Rican pediatric population. METHODS We conducted a retrospective cohort study using our clinic's database on patients with UPJO that were operated by the same surgeon (MPB) from 2008 to 2019. Statistical analysis was conducted of demographics, preoperative studies, perioperative data and complications of both procedures. This study was approved by our local IRB committee. RESULTS A total of 86 patients that underwent pyeloplasty with at least 3 years of follow up were recorded for this study. Laparoscopic pyeloplasty and robot-assisted pyeloplasty were performed in 44 (51.1%) and 42 (48.8%) patients, respectively. Patient age ranged between 4 months and 17 years (LAP group - mean age of 6.19 years/RAP group - mean age of 7.07 years). Success rates was high in this series (LAP - 100% and RAP -95%). Using Wilcoxon signed rank test and Mann whitney sum test, significant differences between preoperative and postoperative hydronephrosis grading were observed in both LAP and RAP groups. However, no significant difference was seen regarding reduction of hydronephrosis grading when comparing both groups. No intraoperative complications were seen on either group. CONCLUSION Both LAP and RAP are safe and effective procedures that can properly manage UPJO. Our study shows that, under experienced hands, pure laparoscopic pyeloplasty achieves comparable results to robotic assisted laparoscopic pyeloplasty. Pediatric urologists should be comfortable offering either of these approaches as they demonstrate high success rates in our pediatric population. Selection of LAP vs. RAP approach depends on the Surgeon's preference or experience, and on institutional availability. Minimally invasive therapies will continue to gain popularity with future advances in laparoscopic and robotic technology.
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Affiliation(s)
- Marcos Pérez-Marchán
- Department of Surgery at the University of Puerto Rico School of Medicine, Urology Section, San Juan, Puerto Rico
| | - Marcos Pérez-Brayfield
- Urology Section, Department of Surgery, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico.,Section of Pediatric Urology, HIMA San Pablo Caguas Hospital, Caguas, Puerto Rico
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Lee J, Park HS, Lee DW, Song SY, Yu J, Ryu JM, Bae SJ, Lew DH, Kim SI, Toesca A. From cadaveric and animal studies to the clinical reality of robotic mastectomy: a feasibility report of training program. Sci Rep 2021; 11:21032. [PMID: 34702866 PMCID: PMC8548531 DOI: 10.1038/s41598-021-00278-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/28/2021] [Indexed: 11/27/2022] Open
Abstract
Robotic nipple-sparing mastectomy (RNSM) provides better cosmetic outcomes and improves the quality of life of women with breast cancer. However, this has not been widely adapted due to the lack of well-structured training programs. The present study aimed to report the establishment of cadaveric and animal skill laboratory training programs for RNSM and the participants’ perception on the training programs. We performed 24 RNSMs using 11 cadavers and one porcine model. Then, the skill laboratory characteristics were reviewed. Five trainers and 10 trainees participated in the programs. The first four cadaveric RNSMs with latissimus dorsi flaps and implants were performed using the da Vinci Si® system. We performed 14 and six RNSMs using the Xi® and SP® systems, respectively. The scores for questionnaires on the satisfaction with the training consisted of the trainees’ perceived goals in attending the course, teaching/learning environment, and teaching staff performance. The scores were excellent. Cadaveric or porcine RNSM skill laboratory training may be essential programs that can provide safe and efficient training.
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Affiliation(s)
- Jeea Lee
- Department of Surgery, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Department of Surgery, Uijeongbu Eulji Medical Center, Eulji University, Gyeonggi-do, Korea
| | - Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Dong Won Lee
- Department of Plastic and Reconstruction Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Yong Song
- Department of Plastic and Reconstruction Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jonghan Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dea Hyun Lew
- Department of Plastic and Reconstruction Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Antonio Toesca
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
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Abstract
The use of robotic-assisted laparoscopic surgery has continued to grow since the Food and Drug Administration approval for robotic-assisted gynecologic surgery in 2005. However, despite this growth in utilization, the data supporting its use in benign gynecologic surgery has not strongly supported its advantages over conventional laparoscopy. Controversy exists between supporters of robotic-assisted laparoscopic surgery and conventional laparoscopy. This article discusses the current literature regarding the use of robotic-assisted surgery in benign gynecologic surgery.
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Nagyné Elek R, Haidegger T. Non-Technical Skill Assessment and Mental Load Evaluation in Robot-Assisted Minimally Invasive Surgery. SENSORS (BASEL, SWITZERLAND) 2021; 21:2666. [PMID: 33920087 PMCID: PMC8068868 DOI: 10.3390/s21082666] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND: Sensor technologies and data collection practices are changing and improving quality metrics across various domains. Surgical skill assessment in Robot-Assisted Minimally Invasive Surgery (RAMIS) is essential for training and quality assurance. The mental workload on the surgeon (such as time criticality, task complexity, distractions) and non-technical surgical skills (including situational awareness, decision making, stress resilience, communication, leadership) may directly influence the clinical outcome of the surgery. METHODS: A literature search in PubMed, Scopus and PsycNet databases was conducted for relevant scientific publications. The standard PRISMA method was followed to filter the search results, including non-technical skill assessment and mental/cognitive load and workload estimation in RAMIS. Publications related to traditional manual Minimally Invasive Surgery were excluded, and also the usability studies on the surgical tools were not assessed. RESULTS: 50 relevant publications were identified for non-technical skill assessment and mental load and workload estimation in the domain of RAMIS. The identified assessment techniques ranged from self-rating questionnaires and expert ratings to autonomous techniques, citing their most important benefits and disadvantages. CONCLUSIONS: Despite the systematic research, only a limited number of articles was found, indicating that non-technical skill and mental load assessment in RAMIS is not a well-studied area. Workload assessment and soft skill measurement do not constitute part of the regular clinical training and practice yet. Meanwhile, the importance of the research domain is clear based on the publicly available surgical error statistics. Questionnaires and expert-rating techniques are widely employed in traditional surgical skill assessment; nevertheless, recent technological development in sensors and Internet of Things-type devices show that skill assessment approaches in RAMIS can be much more profound employing automated solutions. Measurements and especially big data type analysis may introduce more objectivity and transparency to this critical domain as well. SIGNIFICANCE: Non-technical skill assessment and mental load evaluation in Robot-Assisted Minimally Invasive Surgery is not a well-studied area yet; while the importance of this domain from the clinical outcome's point of view is clearly indicated by the available surgical error statistics.
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Affiliation(s)
- Renáta Nagyné Elek
- Antal Bejczy Center for Intelligent Robotics, University Research and Innovation Center, Óbuda University, 1034 Budapest, Hungary;
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, 1034 Budapest, Hungary
| | - Tamás Haidegger
- Antal Bejczy Center for Intelligent Robotics, University Research and Innovation Center, Óbuda University, 1034 Budapest, Hungary;
- John von Neumann Faculty of Informatics, Óbuda University, 1034 Budapest, Hungary
- Austrian Center for Medical Innovation and Technology, 2700 Wiener Neustadt, Austria
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Are Surgeons Working Smarter or Harder? A Systematic Review Comparing the Physical and Mental Demands of Robotic and Laparoscopic or Open Surgery. World J Surg 2021; 45:2066-2080. [PMID: 33772324 DOI: 10.1007/s00268-021-06055-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Minimally invasive surgical techniques such as robotic surgical platforms have provided favourable outcomes for patients, but the impact on surgeons is not well described. This systematic review aims to synthesize and evaluate the physical and mental impact of robotic surgery on surgeons compared to standard laparoscopic or open surgery. METHODS A search strategy was developed to identify peer-reviewed English articles published from inception to end of December 2019 on the following databases: MEDLINE, PubMed, PsycINFO and Embase. The articles were assessed using a modified Newcastle-Ottawa tool. RESULTS Of the 6563 papers identified, 30 studies were included in the qualitative synthesis of this review. Most of the included studies presented a high risk of bias. A total of 13 and 21 different physical and mental tools, respectively, were used to examine the impact on surgeons. The most common tool used to measure physical and mental demand were surface electromyography (N = 9) and the NASA Task Load Index (NASA-TLX; N = 8), respectively. Majority of studies showed mixed results for physical (N = 10) and mental impact (N = 7). This was followed by eight and six studies favouring RS over other surgical modalities for physical and mental impact, respectively. CONCLUSION Most studies showed mixed physical and mental outcomes between the three surgical modalities. There was a high risk of bias and methodological heterogeneity. Future studies need to correlate mental and physical stress with long-term impact on the surgeons.
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Willuth E, Hardon SF, Lang F, Haney CM, Felinska EA, Kowalewski KF, Müller-Stich BP, Horeman T, Nickel F. Robotic-assisted cholecystectomy is superior to laparoscopic cholecystectomy in the initial training for surgical novices in an ex vivo porcine model: a randomized crossover study. Surg Endosc 2021; 36:1064-1079. [PMID: 33638104 PMCID: PMC8758618 DOI: 10.1007/s00464-021-08373-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/09/2021] [Indexed: 12/11/2022]
Abstract
Background Robotic-assisted surgery (RAS) potentially reduces workload and shortens the surgical learning curve compared to conventional laparoscopy (CL). The present study aimed to compare robotic-assisted cholecystectomy (RAC) to laparoscopic cholecystectomy (LC) in the initial learning phase for novices. Methods In a randomized crossover study, medical students (n = 40) in their clinical years performed both LC and RAC on a cadaveric porcine model. After standardized instructions and basic skill training, group 1 started with RAC and then performed LC, while group 2 started with LC and then performed RAC. The primary endpoint was surgical performance measured with Objective Structured Assessment of Technical Skills (OSATS) score, secondary endpoints included operating time, complications (liver damage, gallbladder perforations, vessel damage), force applied to tissue, and subjective workload assessment. Results Surgical performance was better for RAC than for LC for total OSATS (RAC = 77.4 ± 7.9 vs. LC = 73.8 ± 9.4; p = 0.025, global OSATS (RAC = 27.2 ± 1.0 vs. LC = 26.5 ± 1.6; p = 0.012, and task specific OSATS score (RAC = 50.5 ± 7.5 vs. LC = 47.1 ± 8.5; p = 0.037). There were less complications with RAC than with LC (10 (25.6%) vs. 26 (65.0%), p = 0.006) but no difference in operating times (RAC = 77.0 ± 15.3 vs. LC = 75.5 ± 15.3 min; p = 0.517). Force applied to tissue was similar. Students found RAC less physical demanding and less frustrating than LC. Conclusions Novices performed their first cholecystectomies with better performance and less complications with RAS than with CL, while operating time showed no differences. Students perceived less subjective workload for RAS than for CL. Unlike our expectations, the lack of haptic feedback on the robotic system did not lead to higher force application during RAC than LC and did not increase tissue damage. These results show potential advantages for RAS over CL for surgical novices while performing their first RAC and LC using an ex vivo cadaveric porcine model. Registration number researchregistry6029 Graphic abstract ![]()
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Affiliation(s)
- E Willuth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - S F Hardon
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Amsterdam, The Netherlands
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - F Lang
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - C M Haney
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - E A Felinska
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - K F Kowalewski
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - B P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Horeman
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
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Gall TMH, Alrawashdeh W, Soomro N, White S, Jiao LR. Shortening surgical training through robotics: randomized clinical trial of laparoscopic versus robotic surgical learning curves. BJS Open 2020; 4:1100-1108. [PMID: 33052038 PMCID: PMC7709379 DOI: 10.1002/bjs5.50353] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/13/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Minimally invasive surgery is the standard technique for many operations. Laparoscopic training has a long learning curve. Robotic solutions may shorten the training pathway. The aim of this study was to compare laparoscopic with robotic training in surgical trainees and medical students. METHODS Surgical trainees (ST group) were randomized to receive 6 h of robotic or laparoscopic simulation training. They then performed three surgical tasks in cadaveric specimens. Medical students (MS group) had 2 h of robotic or laparoscopic simulation training followed by one surgical task. The Global Rating Scale (GRS) score (maximum 30), number of suture errors, and time to complete each procedure were recorded. RESULTS The median GRS score for the ST group was better for each procedure after robotic training compared with laparoscopic training (total GRS score: 27·00 (i.q.r. 22·25-28·33) versus 18·00 (16·50-19·04) respectively, P < 0·001; 10 participants in each arm). The ST group made fewer errors in robotic than in laparoscopic tasks, for both continuous (7·00 (4·75-9·63) versus 22·25 (20·75-25·25); P < 0·001) and interrupted (8·25 (6·38-10·13) versus 29·50 (23·75-31·50); P < 0·001) sutures. For the MS group, the robotic group completed 8·67 interrupted sutures with 15·50 errors in 40 min, compared with only 3·50 sutures with 40·00 errors in the laparoscopic group (P < 0·001) (10 participants in each arm). Fatigue and physical comfort levels were better after robotic compared with laparoscopic operating for both groups (P < 0·001). CONCLUSION The acquisition of surgical skills in surgical trainees and the surgically naive takes less time with a robotic compared with a laparoscopic platform.
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Affiliation(s)
- T. M. H. Gall
- The Academic Surgical UnitThe Royal Marsden Hospital, Imperial CollegeLondonUK
| | - W. Alrawashdeh
- Hepatopancreatobiliary Surgical UnitNewcastle upon TyneUK
| | - N. Soomro
- Department of UrologyThe Freeman HospitalNewcastle upon TyneUK
| | - S. White
- Hepatopancreatobiliary Surgical UnitNewcastle upon TyneUK
| | - L. R. Jiao
- The Academic Surgical UnitThe Royal Marsden Hospital, Imperial CollegeLondonUK
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Jang JH, Kim CN. Robotic Total Mesorectal Excision for Rectal Cancer: Current Evidences and Future Perspectives. Ann Coloproctol 2020; 36:293-303. [PMID: 33207112 PMCID: PMC7714377 DOI: 10.3393/ac.2020.06.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023] Open
Abstract
Despite the technical limitations of minimally invasive surgery, laparoscopic total mesorectal excision (LTME) for rectal cancer has short-term advantages over open surgery, but the pathological outcomes reported in randomized clinical trials are still in controversy. Minimally invasive robotic total mesorectal excision (RTME) has recently been gaining popularity as robotic surgical systems potentially provide greater benefits than LTME. Compared to LTME, RTME is associated with lower conversion rates and similar or better genitourinary functions, but its long-term oncological outcomes have not been established. Although the operating time of RTME is longer than that of LTME, RTME has a shorter learning curve, is more convenient for surgeons, and is better for sphincter-preserving operations than LTME. The robotic surgical system is a good technical tool for minimally invasive surgery for rectal cancer, especially in male patients with narrow deep pelvises. Robotic systems and robotic surgical techniques are still improving, and the contribution of RTME to the treatment of rectal cancer will continue to increase in the future.
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Affiliation(s)
- Je-Ho Jang
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Chang-Nam Kim
- Department of Surgery, Eulji University School of Medicine, Daejeon, Korea
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Learning curve of surgical novices using the single-port platform SymphonX: minimizing OR trauma to only one 15-mm incision. Surg Endosc 2020; 35:5338-5351. [PMID: 32968918 PMCID: PMC8346421 DOI: 10.1007/s00464-020-07998-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/14/2020] [Indexed: 12/28/2022]
Abstract
Background Minimally invasive single-port surgery is always associated with large incisions up to 2–3 cm, complicated handling due to the lack of triangulation, and instrument crossing. The aim of this prospective study was to report how medical students without any laparoscopic experience perform several laparoscopic tasks (rope pass, paper cut, peg transfer, recapping, and needle threading) with the new SymphonX single-port platform and to examine the learning curves in comparison to the laparoscopic multi-port technique. Methods A set of 5 laparoscopic skill tests (Rope Pass, Paper cut, Peg Transfer, Recapping, Needle Thread) were performed with 3 repetitions. Medical students performed all tests with both standard laparoscopic instruments and the new platform. Time and errors were recorded. Results A total of 114 medical students (61 females) with a median age of 23 years completed the study. All subjects were able to perform the skill tests with both standard laparoscopic multi-port and the single-port laparoscopic system and were able to significantly improve their performance over the three trials for all five tasks—rope pass (p < 0.001), paper cut (p < 0.001), peg transfer (p < 0.001), needle threading (p < 0.001), and recapping (p < 0.001). In 3 out of 5 tasks, medical students performed the tasks faster using the standard multi-port system—rope pass (p < 0.001), paper cut (p < 0.001), and peg transfer (p < 0.001). In the task recapping, medical students performed the task faster using the new single-port system (p = 0.003). In the task needle threading, there was no significant difference between the standard multi-port system and the new single-port system (p > 0.05). Conclusion This is the first study analyzing learning curves of the commercially available SymphonX platform for abdominal laparoscopic surgery when used by novices. The learning curve and the error rate are promising.
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Long-term Anatomical and Functional Results of Robot-Assisted Pelvic Floor Surgery for the Management of Multicompartment Prolapse: A Prospective Study. Dis Colon Rectum 2020; 63:1293-1301. [PMID: 32618619 DOI: 10.1097/dcr.0000000000001696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Long-term data on robot-assisted sacrocolporectopexy for the treatment of multicompartment pelvic organ prolapse are scarce. With the rising prevalence of prolapse and increasing surgical repair, it is essential to evaluate long-term results. OBJECTIVE This study aimed to evaluate long-term functional and anatomic outcomes after sacrocolporectopexy. DESIGN This is a prospective, observational cohort study. SETTINGS This study was conducted at a teaching hospital with tertiary referral function for patients with gynecological/rectal prolapse. PATIENTS All patients undergoing robot-assisted sacrocolporectopexy from 2011 to 2012 were included. INTERVENTION Robot-assisted sacrocolporectopexy was performed. MAIN OUTCOME MEASURES The primary outcome was the anatomic cure rate after 1 and 4 years, defined as simplified pelvic organ prolapse quantification stage 1 vaginal apical prolapse and no external rectal prolapse or internal rectal prolapse present. Kaplan-Meier curves were used for determination of recurrence-free intervals. Secondary outcomes were functional pelvic floor symptoms (symptoms of bulge, obstructed defecation, fecal incontinence, urogenital distress inventory) and quality of life (Pelvic Floor Impact Questionnaire). RESULTS Fifty-three patients were included. After 12 and 48 months, the recurrence-free intervals based on Kaplan-Meier estimates were 100% and 90%. In total, there were 10 recurrences: 2 apical and 8 internal rectal prolapses. Symptoms of bulge (94%-12%; p < 0.0005), fecal incontinence (62%-32%; p < 0.0005), obstructed defecation (59%-24%; p = 0.008), and median Pelvic Floor Impact Questionnaire scores (124-5; p = 0.022) improved significantly at final follow-up. Median urogenital distress inventory scores showed improvement after 1 year (30-13; p = 0.021). LIMITATIONS This was an observational, single-center study with selective postoperative imaging. CONCLUSIONS Ninety percent of patients were recurrence free 48 months after robot-assisted sacrocolporectopexy. Symptoms of vaginal bulge, quality of life, constipation, and fecal incontinence improved significantly. However, a subgroup of patients showed persistent bowel complaints that underlie the complexity of multicompartment prolapse. See Video Abstract at http://links.lww.com/DCR/B265. RESULTADOS ANATÓMICOS Y FUNCIONALES A LARGO PLAZO DE LA CIRUGÍA DE PISO PÉLVICO ASISTIDA POR ROBOT EN EL TRATAMIENTO DEL PROLAPSO MULTICOMPARTIMENTAL: UN ESTUDIO PROSPECTIVO: Los datos a largo plazo sobre la sacrocolporectopexia asistida por robot para el tratamiento del prolapso multicompartimental de órganos pélvicos son escasos. Con el aumento de la prevalencia del prolapso y el aumento de la reparación quirúrgica, es esencial evaluar los resultados a largo plazo.Evaluar los resultados funcionales y anatómicos a largo plazo después de la sacrocolporectopexia.Estudio prospectivo observacional de cohorte.Hospital de enseñanza con función de referencia terciaria para pacientes con prolapso ginecológico/rectal.Todos los pacientes sometidos a sacrocolporectopexia asistida por robot en 2011-2012.Sacrocolporectopexia asistida por robot.El resultado primario fue la tasa de curación anatómica a uno y cuatro años, definida como etapa 1 de prolapso apical vaginal en la cuantificación del prolapso de órganos pélvicos simplificado, y sin prolapso rectal externo o prolapso rectal interno presentes. Se utilizaron curvas de Kaplan Meier para determinar los intervalos libres de recurrencia. Los resultados secundarios fueron síntomas funcionales del piso pélvico (síntomas de abultamiento, obstrucción defecatoria, incontinencia fecal, inventario de molestias urogenitales) y calidad de vida (cuestionario de impacto del piso pélvico).Se incluyeron 53 pacientes. Después de 12 y 48 meses, el intervalo libre de recurrencia basado en las estimaciones con método Kaplan Meier fue del 100% y 90%, respectivamente. En total hubo diez recurrencias: dos apicales y ocho prolapsos rectales internos. Los síntomas de abultamiento (94% a 12%; p <0.0005), incontinencia fecal (62% a 32%; p <0.0005), obstrucción defecatoria (59% a 24%; p = 0.008) y puntajes promedio del cuestionario de impacto del piso pélvico (124 a 5; p = 0.022) mejoraron significativamente en el seguimiento final. Las puntuaciones medias del inventario de molestias urogenitales mostraron una mejoría después de un año (30 a 13; p = 0.021).Estudio observacional de centro único con imagenología postoperatoria selectiva.Noventa por ciento de los pacientes estaban libres de recurrencia 48 meses después de la sacrocolporectopexia asistida por robot. Los síntomas de abultamiento vaginal, la calidad de vida, el estreñimiento y la incontinencia fecal mejoraron significativamente. Sin embargo, un subgrupo de pacientes mostró molestias intestinales persistentes que subrayan a la complejidad del prolapso multicompartimental. Consulte Video Resumen en http://links.lww.com/DCR/B265.
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