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El Chaar M, Michaud A, Farabaugh SA, Manchester D, Harrison M, Alvarado L. Robotic-assisted hiatal hernia repairs with and without magnetic sphincter augmentation (MSA): short- and long-term patient-centered outcomes in a single academic center. Surg Endosc 2025; 39:2211-2220. [PMID: 39930121 DOI: 10.1007/s00464-025-11583-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: 10/09/2024] [Accepted: 01/20/2025] [Indexed: 03/26/2025]
Abstract
INTRODUCTION Hiatal Hernia (HH) repairs are commonly performed using a laparoscopic (L) approach. Recently, the robotic-assisted (RA) approach was introduced. The objective of the study is to describe our experience and analyze patient-centered clinical outcomes of RA-HH repairs with and without MSA (Magnetic Sphincter Augmentation). METHODS Patients who underwent RA-HH repair with or without MSA between April 2018 and February 2023 were included. The data were summarized using mean and standard deviation for all continuous variables. Frequency and percent were used for categorical data. Postoperative endoscopy and/or barium swallow were done on all patients. Postoperative clinical follow-up occurred at 2 weeks, 3,6,12, and 24 months. At 6 months, the Gastroesophageal Reflux Disease Health-Related Quality-of-Life (GERD-HRQL) scale was used to assess quality of life and symptom severity. The data were analyzed for both MSA and non-MSA patients and reported at 2 years. All data management and analysis were conducted using Stata V.18. RESULTS Overall, the study included 295 patients. 30-day readmission and ED visit rates were 7.51% and 14.92%, respectively. In-hospital postoperative complication rate was 10.85%. We had no 30-day mortality. Conversion to open was 0.34%. Hospital length of stay was 0-1 day in 82.03% of cases. GERD-HRQL score decreased from 8.78 preoperatively to 1.34 at 6 months with 86.1% of patients reporting a score of 0. Our follow-up rate at year 2 from the index procedure was 74% ( 217 patients out of 295). Hernia recurrence rate at 24 months was 3.93%. PPI use at 2 years was 38.71%. MSA group had more post-op globus at 24 months (5.13% vs 1.12%) but similar rates of post-op heartburn and PPI use. CONCLUSION RA-HH at our center appears to be safe and feasible with low recurrence rates at 24 months. MSA had similar rates of PPI use but more post-op globus compared to the non-MSA group at 2 years.
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Affiliation(s)
- Maher El Chaar
- St Luke's University Hospital and Health Network, 1736 Hamilton St, Allentown, PA, 18103, USA.
| | - Allincia Michaud
- St Luke's University Hospital and Health Network, 1736 Hamilton St, Allentown, PA, 18103, USA
| | - Scott Allen Farabaugh
- Lewis Katz School of Medicine at Temple University, 3500 N Broad St, Philadelphia, PA, 19140, USA
| | - Dustin Manchester
- St Luke's University Hospital and Health Network, 801 Ostrum St, Bethlehem, PA, 18015, USA
| | - Meredith Harrison
- St Luke's University Hospital and Health Network, 801 Ostrum St, Bethlehem, PA, 18015, USA
| | - Luis Alvarado
- St Luke's University Hospital and Health Network, 1736 Hamilton St, Allentown, PA, 18103, USA
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Karikis I, Pachos N, Mela E, Saliaris K, Kitsou E, Linardoutsos D, Triantafyllou S, Theodorou D. Comparative analysis of robotic and laparoscopic techniques in hiatal hernia and crural repair: a review of current evidence and outcomes. Hernia 2024; 28:1559-1569. [PMID: 39123086 DOI: 10.1007/s10029-024-03126-5] [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: 04/02/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE The purpose of this narrative review is to evaluate the implementation of robotic surgery in hiatal hernia and crural repair, based on the existing literature and to compare this approach to other established techniques. METHODS We performed a non- systematic literature search of PubMed and MEDLINE on February 25, 2024 for papers published to date focusing on the surgical repair of hiatal hernias using the robotic platform. After eliminating publications based on eligibility criteria, 13 studies were selected for analysis. RESULTS Robotic surgery is increasingly utilized in hiatal hernia repair due to its enhanced ergonomics and superior visualization capabilities. Operative times vary, with some studies indicating longer durations for robotic surgery (e.g., Giovannetti et al. demonstrated median operative time of 196 min for robotic compared to 145 min for laparoscopic) while others report shorter times (e.g., Lang F et al. demonstrated 88 min for robotic versus 102 min for laparoscopic). Recurrence rates between robotic and laparoscopic repairs are comparable, with reported recurrence rates of 1.8% for robotic and 1.2% for laparoscopic approaches by Benedix et al. Robotic surgery offers potential advantages, including reduced intraoperative blood loss (e.g., Giovannetti et al. mentioned median blood loss of 20 ml for robotic versus 50 ml for laparoscopic). The length of hospital stay and postoperative complication rates also vary, with some studies suggesting shorter stays and fewer complications for robotic surgery as surgeons become more proficient. Soliman et al. reported a statistically significant reduction in complication rates with robotic surgery (6.3% versus 19.2%). CONCLUSIONS Robotic surgery presents promising results regarding the length of hospital stay, conversion rate to open surgery and postoperative complication rates when compared to laparoscopy based on the existing literature. Despite the lack of striking differences, robotic hiatal hernia repair is a valid and evolving approach.
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Affiliation(s)
- I Karikis
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece.
| | - N Pachos
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - E Mela
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - K Saliaris
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - E Kitsou
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - D Linardoutsos
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - S Triantafyllou
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - D Theodorou
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
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Liu L, Lewis N, Mhaskar R, Sujka J, DuCoin C. Robotic-assisted foregut surgery is associated with lower rates of complication and shorter post-operative length of stay. Surg Endosc 2022; 37:2800-2805. [PMID: 36477641 DOI: 10.1007/s00464-022-09814-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Two of the most common foregut operations are laparoscopic Heller myotomy and laparoscopic Nissen fundoplication. Robotic assistance, compared to standard laparoscopic approach, may potentially grant surgeons advantages such as enhanced visualization and dexterity. This study compares patient outcomes for Heller myotomy (HM) and Nissen fundoplication (NF) when performed laparoscopically versus robotically. METHODS A retrospective review of patients at a single institution who underwent laparoscopic or robotic-assisted HM or NF from January 2019 to July 2022 was conducted. 123 HM (72 laparoscopic, 51 robotic-assisted) and 92 NF (62 laparoscopic, 30 robotic-assisted) were performed by three surgeons. Outcomes investigated were operative time, hospital length of stay, pre- and post-operative imaging, resolution of symptoms at 30 days, resolution of symptoms at 90 days, and complications. RESULTS In the HM cohorts, the average operative time was longer in the robotic cohort (127 min robotic versus 108 min laparoscopic, p < 0.01). However, overall complication rates (p < 0.05) were lower, and hospital length of stay was shorter in the robotic group (1.5 days compared to 2.7 days, p < 0.001). In the NF cohorts, there was no significant difference in operative time. However, hospital length of stay was shorter in the robotic group (1.54 days compared to 2.7 days, p < 0.001) with otherwise similar outcomes. There was no difference in the rate of post-operative resolution of symptoms or need for additional interventions in either HM or NF. CONCLUSION Robotic-assisted HM and NF are associated with shorter hospital stays compared to their respective laparoscopic approaches. Robotic-assisted HM also has a lower rate of complications. Our findings suggest that robotic assistance may be beneficial for shortening hospital length of stay and decreasing complications for certain surgeries specific to Foregut surgery.
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Mohr C, Ciomperlik H, Dhanani N, Olavarria OA, Hannon C, Hope W, Roth S, Liang MK, Holihan JL. Review of SAGES GERD guidelines and recommendations. Surg Endosc 2022; 36:9345-9354. [PMID: 35414134 DOI: 10.1007/s00464-022-09209-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 02/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) developed evidence-based guidelines for the management of patients with gastroesophageal reflux disease (GERD). The aim of this study is to evaluate guidelines lacking agreement among experts (grades B-D) or lacking support from randomized controlled trials (levels II-III). METHODS Six guidelines were chosen for evaluation. A retrospective review of a multicenter database of patients undergoing fundoplication surgery for treatment of GERD between 2015 and 2020 was performed. Patients that underwent a concurrent gastrectomy or were diagnosed with pre-operative achalasia were excluded. Demographics, pre-operative, intra-operative, and post-operative variables were collected. Post-operative outcomes were evaluated based on selected SAGES guidelines. Outcomes were assessed using multivariable regression or stratified analysis for each guideline. RESULTS A total of 444 patients from four institutions underwent surgery for the management of GERD with a median (interquartile range) follow-up of 16 (13) months. Guidelines supported by our data were (1) robotic repair has similar short-term outcomes to laparoscopic repair, (2) outcomes in older patients are similar to outcomes of younger patients undergoing antireflux surgery, and (3) following laparoscopic antireflux surgery, dysphagia has been reported to significantly improve from pre-operative values. Guidelines that were not supported were (1) mesh reinforcement may be beneficial in decreasing the incidence of wrap herniation, (2) a bougie has been found to be effective, and (3) the long-term effectiveness of fundoplication in obese individuals (BMI > 30) has been questioned due to higher failure rates. CONCLUSION Many SAGES GERD guidelines not receiving Grade A or Level I recommendation are supported by large, multicenter database findings. However, further studies at low risk for bias are needed to further refine these guidelines.
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Affiliation(s)
- Cassandra Mohr
- Department of Surgery, McGovern Medical School, Houston, TX, USA.
- Department of Surgery, Lyndon B. Johnson Hospital, 5656 Kelley St, Houston, TX, 77026, USA.
| | | | - Naila Dhanani
- Department of Surgery, McGovern Medical School, Houston, TX, USA
| | | | - Craig Hannon
- Department of Surgery, McGovern Medical School, Houston, TX, USA
| | - William Hope
- Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Scott Roth
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Mike K Liang
- Department of Surgery, HCA Healthcare Kingwood, University of Houston, Kingwood, TX, USA
| | - Julie L Holihan
- Department of Surgery, McGovern Medical School, Houston, TX, USA
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Huttman MM, Robertson HF, Smith AN, Biggs SE, Dewi F, Dixon LK, Kirkham EN, Jones CS, Ramirez J, Scroggie DL, Zucker BE, Pathak S, Blencowe NS. A systematic review of robot-assisted anti-reflux surgery to examine reporting standards. J Robot Surg 2022; 17:313-324. [PMID: 36074220 PMCID: PMC10076351 DOI: 10.1007/s11701-022-01453-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/11/2022] [Indexed: 12/01/2022]
Abstract
Robot-assisted anti-reflux surgery (RA-ARS) is increasingly being used to treat refractory gastro-oesophageal reflux disease. The IDEAL (Idea, Development, Exploration, Assessment, Long-term follow up) Collaboration's framework aims to improve the evaluation of surgical innovation, but the extent to which the evolution of RA-ARS has followed this model is unclear. This study aims to evaluate the standard to which RA-ARS has been reported during its evolution, in relation to the IDEAL framework. A systematic review from inception to June 2020 was undertaken to identify all primary English language studies pertaining to RA-ARS. Studies of paraoesophageal or giant hernias were excluded. Data extraction was informed by IDEAL guidelines and summarised by narrative synthesis. Twenty-three studies were included: two case reports, five case series, ten cohort studies and six randomised controlled trials. The majority were single-centre studies comparing RA-ARS and laparoscopic Nissen fundoplication. Eleven (48%) studies reported patient selection criteria, with high variability between studies. Few studies reported conflicts of interest (30%), funding arrangements (26%), or surgeons' prior robotic experience (13%). Outcome reporting was heterogeneous; 157 distinct outcomes were identified. No single outcome was reported in all studies.The under-reporting of important aspects of study design and high degree of outcome heterogeneity impedes the ability to draw meaningful conclusions from the body of evidence. There is a need for further well-designed prospective studies and randomised trials, alongside agreement about outcome selection, measurement and reporting for future RA-ARS studies.
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Affiliation(s)
- Marc M Huttman
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Harry F Robertson
- St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Sarah E Biggs
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ffion Dewi
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Lauren K Dixon
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Emily N Kirkham
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK
| | - Conor S Jones
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,Torbay Hospital, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Jozel Ramirez
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Darren L Scroggie
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Benjamin E Zucker
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Samir Pathak
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Natalie S Blencowe
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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Robotic Foregut Surgery in the Veterans Health Administration: Increasing Prevalence, Decreasing Operative Time, and Improving Outcomes. J Am Coll Surg 2022; 235:149-156. [PMID: 35839388 DOI: 10.1097/xcs.0000000000000218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Historically, robotic surgery incurs longer operative times, higher costs, and nonsuperior outcomes compared with laparoscopic surgery. However, in areas of limited visibility and decreased accessibility such as the gastroesophageal junction, robotic platforms may improve visualization and facilitate dissection. This study compares 30-day outcomes between robotic-assisted foregut surgery (RAF) and laparoscopic-assisted foregut surgery in the Veterans Health Administration. STUDY DESIGN This is a retrospective review of the Veterans Affairs Quality Improvement Program database. Patients undergoing laparoscopic-assisted foregut surgery and RAF were identified using CPT codes 43280, 43281, 43282, and robotic modifier S2900. Multivariable logistic regression and multivariable generalized linear models were used to analyze the independent association between surgical approach and outcomes of interest. RESULTS A total of 9,355 veterans underwent minimally invasive fundoplication from 2008 to 2019. RAF was used in 5,392 cases (57.6%): 1.63% of cases in 2008 to 83.41% of cases in 2019. After adjusting for confounding covariates, relative to laparoscopic-assisted foregut surgery, RAF was significantly associated with decreased adjusted odds of pulmonary complications (adjusted odds ratio [aOR] 0.44, p < 0.001), acute renal failure (aOR 0.14, p = 0.046), venous thromboembolism (aOR 0.44, p = 0.009) and increased odds of infectious complications (aOR 1.60, p = 0.017). RAF was associated with an adjusted mean ± SD of 29 ± 2-minute shorter operative time (332 minutes vs 361 minutes; p < 0.001). CONCLUSIONS Veterans undergoing RAF ascertained shorter operative times and reduced complications vs laparoscopy. As surgeons use the robotic platform, clinical outcomes and operative times continue to improve, particularly in operations where extra articulation in confined spaces is required.
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Dhanani NH, Olavarria OA, Bernardi K, Lyons NB, Holihan JL, Loor M, Haynes AB, Liang MK. The Evidence Behind Robot-Assisted Abdominopelvic Surgery : A Systematic Review. Ann Intern Med 2021; 174:1110-1117. [PMID: 34181448 DOI: 10.7326/m20-7006] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Use of robot-assisted surgery has increased dramatically since its advent in the 1980s, and nearly all surgical subspecialties have adopted it. However, whether it has advantages compared with laparoscopy or open surgery is unknown. PURPOSE To assess the quality of evidence and outcomes of robot-assisted surgery compared with laparoscopy and open surgery in adults. DATA SOURCES PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials were searched from inception to April 2021. STUDY SELECTION Randomized controlled trials that compared robot-assisted abdominopelvic surgery with laparoscopy, open surgery, or both. DATA EXTRACTION Two reviewers independently extracted study data and risk of bias. DATA SYNTHESIS A total of 50 studies with 4898 patients were included. Of the 39 studies that reported incidence of Clavien-Dindo complications, 4 (10%) showed fewer complications with robot-assisted surgery. The majority of studies showed no difference in intraoperative complications, conversion rates, and long-term outcomes. Overall, robot-assisted surgery had longer operative duration than laparoscopy, but no obvious difference was seen versus open surgery. LIMITATIONS Heterogeneity was present among and within the included surgical subspecialties, which precluded meta-analysis. Several trials may not have been powered to assess relevant differences in outcomes. CONCLUSION There is currently no clear advantage with existing robotic platforms, which are costly and increase operative duration. With refinement, competition, and cost reduction, future versions have the potential to improve clinical outcomes without the existing disadvantages. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42020182027).
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Affiliation(s)
- Naila H Dhanani
- McGovern Medical School at UTHealth, Houston, Texas (N.H.D., O.A.O., K.B., N.B.L., J.L.H.)
| | - Oscar A Olavarria
- McGovern Medical School at UTHealth, Houston, Texas (N.H.D., O.A.O., K.B., N.B.L., J.L.H.)
| | - Karla Bernardi
- McGovern Medical School at UTHealth, Houston, Texas (N.H.D., O.A.O., K.B., N.B.L., J.L.H.)
| | - Nicole B Lyons
- McGovern Medical School at UTHealth, Houston, Texas (N.H.D., O.A.O., K.B., N.B.L., J.L.H.)
| | - Julie L Holihan
- McGovern Medical School at UTHealth, Houston, Texas (N.H.D., O.A.O., K.B., N.B.L., J.L.H.)
| | - Michele Loor
- Baylor College of Medicine, Houston, Texas (M.L.)
| | - Alex B Haynes
- Dell Medical School at the University of Texas, Austin, Texas (A.B.H.)
| | - Mike K Liang
- University of Houston, HCA Kingwood, Kingwood, Texas (M.K.L.)
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Luberice K, Ross S, Crespo K, De La Cruz C, Dolce JK, Sucandy I, Rosemurgy AS. Robotic Complex Fundoplication in Patients at High-Risk to Fail. JSLS 2021; 25:JSLS.2020.00111. [PMID: 34248333 PMCID: PMC8241286 DOI: 10.4293/jsls.2020.00111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: This study was undertaken to analyze our outcomes after robotic fundoplication for GERD in patients with failed antireflux procedures, with type IV (i.e., giant) hiatal hernias, or after extensive intra-abdominal surgery with mesh, and to compare our results to outcomes predicted by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator and to national outcomes reported by NSQIP. Methods: 100 patients undergoing robotic fundoplication for the aforementioned factors were prospectively followed. Results: 100 patients, aged 67 (67 ± 10.3) years with body mass index (BMI) of 26 (25 ± 2.9) kg/m2 underwent robotic fundoplication for failed antireflux fundoplications (43%), type IV hiatal hernias (31%), or after extensive intra-abdominal surgery with mesh (26%). Operative duration was 184 (196 ± 74.3) min with an estimated blood loss of 24 (51 ± 82.9) mL. Length of stay was 1 (2 ± 3.6) day. Two patients developed postoperative ileus. Two patients were readmitted within 30 days for nausea. Nationally reported outcomes and those predicted by NSQIP were similar. When comparing our actual outcomes to predicted and national NSQIP outcomes, actual outcomes were superior for serious complications, any complications, pneumonia, surgical site infection, deep vein thrombosis, readmission, return to OR, and sepsis (P < 0.05); our actual outcomes were not worse for renal failure, deaths, cardiac complications, and discharge to a nursing facility. Conclusions: Our patients were not a selective group; rather they were more complex than reported in NSQIP. Most of our results after robotic fundoplication were superior to predicted and national outcomes. The utilization of the robotic platform for complex operations and fundoplications to treat patients with GERD is safe and efficacious.
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Affiliation(s)
- Kenneth Luberice
- Digestive Disorders Institute, AdventHealth Tampa, 3000 Medical Park Dr. Ste 500, Tampa, Florida 33613
| | - Sharona Ross
- Digestive Disorders Institute, AdventHealth Tampa, 3000 Medical Park Dr. Ste 500, Tampa, Florida 33613
| | - Kaitlyn Crespo
- Digestive Disorders Institute, AdventHealth Tampa, 3000 Medical Park Dr. Ste 500, Tampa, Florida 33613
| | - Christina De La Cruz
- Digestive Disorders Institute, AdventHealth Tampa, 3000 Medical Park Dr. Ste 500, Tampa, Florida 33613
| | - John-Kevin Dolce
- Digestive Disorders Institute, AdventHealth Tampa, 3000 Medical Park Dr. Ste 500, Tampa, Florida 33613
| | - Iswanto Sucandy
- Digestive Disorders Institute, AdventHealth Tampa, 3000 Medical Park Dr. Ste 500, Tampa, Florida 33613
| | - Alexander S Rosemurgy
- Digestive Disorders Institute, AdventHealth Tampa, 3000 Medical Park Dr. Ste 500, Tampa, Florida 33613
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Shemmeri E, Wee JO. Robotics and minimally invasive esophageal surgery. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:898. [PMID: 34164532 PMCID: PMC8184479 DOI: 10.21037/atm-20-4138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The robotic platform has permeated esophageal surgery both in the abdominal and thoracic approaches. The most widely studied entities include achalasia, gastroesophageal reflux disease, hiatal hernia and esophageal cancer. A literature review of robotic surgeries for the management of the above mentioned disorders is presented. Data is limited to meta-analyses, case series, or small prospective trials in the different indications. One exception is a randomized controlled trial looking at outcomes in esophageal cancer being managed with a hybrid robotic versus open approach. Overall differences when comparing laparoscopic or thoracoscopic surgery to robotic are few. These differences are best highlighted in the achalasia and esophageal cancer literature. There are less intraoperative mucosal injuries in robotic Heller myotomy. A large meta analysis found a rate of 1% versus 24.5% mucosal injury rate favoring the robotic versus laparoscopic Heller myotomy methods. With respect to esophagectomy data, there is slightly less vocal cord paralysis in the robotic versus MIE data, with a P value of 0.044. However, length of stay, intraoperative bleeding and major morbidity are similar across the various indications. Robotic esophageal surgery is a safe alternative to laparoscopic/thoracoscopic techniques. Further large-scale randomized trials are needed to fully ascertain if it yields superior outcomes.
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Affiliation(s)
- Ealaf Shemmeri
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Jon O Wee
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
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10
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Abstract
The global numbers of robotic gastrointestinal surgeries are increasing. However, the evidence base for robotic gastrointestinal surgery does not yet support its widespread adoption or justify its cost. The reasons for its continued popularity are complex, but a notable driver is the push for innovation - robotic surgery is seen as a compelling solution for delivering on the promise of minimally invasive precision surgery - and a changing commercial landscape delivers the promise of increased affordability. Novel systems will leverage the robot as a data-driven platform, integrating advances in imaging, artificial intelligence and machine learning for decision support. However, if this vision is to be realized, lessons must be heeded from current clinical trials and translational strategies, which have failed to demonstrate patient benefit. In this Perspective, we critically appraise current research to define the principles on which the next generation of gastrointestinal robotics trials should be based. We also discuss the emerging commercial landscape and define existing and new technologies.
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12
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Sowards KJ, Holton NF, Elliott EG, Hall J, Bajwa KS, Snyder BE, Wilson TD, Mehta SS, Walker PA, Chandwani KD, Klein CL, Rivera AR, Wilson EB, Shah SK, Felinski MM. Safety of robotic assisted laparoscopic recurrent paraesophageal hernia repair: insights from a large single institution experience. Surg Endosc 2019; 34:2560-2566. [PMID: 31811451 DOI: 10.1007/s00464-019-07291-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 11/28/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Laparoscopic repair of recurrent as opposed to primary paraesophageal hernias (PEHs) are historically associated with increased peri-operative complication rates, worsened outcomes, and increased conversion rates. The robotic platform may aid surgeons in these complex revision procedures. The aim of this study was to compare the outcomes of patients undergoing robotic assisted laparoscopic (RAL) repair of recurrent as opposed to primary PEHs. METHODS Patients undergoing RAL primary and recurrent PEH repairs from 2009 to 2017 at a single institution were reviewed. Demographics, use of mesh, estimated blood loss, intra-operative complications, conversion rates, operative time, rates of esophageal/gastric injury, hospital length of stay, re-admission/re-operation rates, recurrence, dysphagia, gas bloat, and pre- and post-operative proton pump inhibitor (PPI) use were analyzed. Analysis was accomplished using Chi-square test/Fischer's exact test for categorical variables and the Mann-Whitney U test for continuous variables. RESULTS There were 298 patients who underwent RAL PEH repairs (247 primary, 51 recurrent). They were followed for a median (interquartile range) of 120 (44, 470) days. There were no significant differences in baseline demographics between groups. Patients in the recurrent PEH group had longer operative times, increased use of mesh, and increased length of hospital stay. They were also less likely to undergo fundoplication. There were no significant differences in estimated blood loss, incidence of intra-operative complications, re-admission rates, incidence of post-operative dysphagia and gas bloat, and incidence of post-operative PPI use. There were no conversions to open operative intervention or gastric/esophageal injury/leaks. CONCLUSIONS Although repair of recurrent PEHs are historically associated with worse outcomes, in this series, RAL recurrent PEH repairs have similar peri-operative and post-operative outcomes as compared to primary PEH repairs. Whether this is secondary to the potential advantages afforded by the robotic platform deserves further study.
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Affiliation(s)
- Kendell J Sowards
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Nicholas F Holton
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Ekatarina G Elliott
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - John Hall
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Kulvinder S Bajwa
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Brad E Snyder
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Todd D Wilson
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | | | | | - Kavita D Chandwani
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Connie L Klein
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Angielyn R Rivera
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Erik B Wilson
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Shinil K Shah
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. .,Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA.
| | - Melissa M Felinski
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
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13
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Cui R, Yu MH, Chen JJ, Qin J, Yue B, Luo Y, Huang YZ, Zhou H, Zhong M. Monopolar Electrosurgical Scissors Versus Harmonic Scalpel in Robotic Anterior Resection of Rectal Cancer: A Retrospective Cohort Study. J Laparoendosc Adv Surg Tech A 2019; 29:880-885. [PMID: 30758251 DOI: 10.1089/lap.2018.0740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Robot-assisted surgical techniques have been introduced in recent years as an alternative minimally invasive approach for colorectal surgery. In practice, we found that the monopolar electrosurgical scissors had its unique advantages in preservation of the pelvic autonomic nerves. We performed a retrospective review of short-term results between using monopolar electrosurgical scissors and harmonic scalpel in robotic anterior resection (using the da Vinci® Surgical System) in rectal cancer patients. Method: Forty-six patients who underwent robotic anterior resection of rectal cancer from June 2016 to January 2018 were retrospectively analyzed and compared. Twenty-two cases underwent resection using monopolar electrosurgical scissors and 24 cases underwent resection using the harmonic scalpel. Patient characteristics, perioperative clinical results, complications, and pathological results were compared between two groups. Results: There were not significantly different patient characteristics between the two groups. The mean operative time was lesser in the monopolar electrosurgical scissors group than in the inharmonic scalpel group [95.59 ± 21.44 minutes versus 81.45 ± 13.89 minutes, P < .01]. The mean estimated blood loss was lesser in the monopolar electrosurgical scissors group than in the inharmonic scalpel group [48.64 ± 19.35 mL versus 61.82 ± 24.23 mL, P = .03]. The complication rate was 18.2% in the monopolar electrosurgical scissors group and 16.7% in the harmonic scalpel group (P = .89). The mean time of postoperational urinary catheter was lesser in the monopolar electrosurgical scissors group [3.73 ± 1.16 days versus 4.59 ± 1.71 days, P = .02]. The day to first passing flatus [3.45 ± 0.80 days versus 3.59 ± 1.14 days, P = .67], feeding time [4.50 ± 1.00 days versus 4.05 ± 1.87 days, P = .35], hospital stay [8.18 ± 3.74 days versus 8.68 ± 3.44 days, P = .52], and the mean number of harvested lymph nodes of detection [13.59 ± 1.71 versus 13.77 ± 1.41, P = .67] were comparable between procedures. Conclusion: Monopolar electrosurgical scissors were used safely and effectively in robotic anterior resection of rectal cancer (using the da Vinci Surgical System). The use of monopolar electrosurgical scissors has benefits in performing blunt and sharp separation in narrow pelvic and cheaper hospitalization expenses.
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Affiliation(s)
- Ran Cui
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Min-Hao Yu
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Jian-Jun Chen
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Jun Qin
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Ben Yue
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Yang Luo
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Yi-Zhou Huang
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Hong Zhou
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Ming Zhong
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
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14
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Roh HF, Nam SH, Kim JM. Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery in randomized controlled trials: A systematic review and meta-analysis. PLoS One 2018; 13:e0191628. [PMID: 29360840 PMCID: PMC5779699 DOI: 10.1371/journal.pone.0191628] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/14/2017] [Indexed: 12/22/2022] Open
Abstract
Importance This review provides a comprehensive comparison of treatment outcomes between robot-assisted laparoscopic surgery (RLS) and conventional laparoscopic surgery (CLS) based on randomly-controlled trials (RCTs). Objectives We employed RCTs to provide a systematic review that will enable the relevant community to weigh the effectiveness and efficacy of surgical robotics in controversial fields on surgical procedures both overall and on each individual surgical procedure. Evidence review A search was conducted for RCTs in PubMed, EMBASE, and Cochrane databases from 1981 to 2016. Among a total of 1,517 articles, 27 clinical reports with a mean sample size of 65 patients per report (32.7 patients who underwent RLS and 32.5 who underwent CLS), met the inclusion criteria. Findings CLS shows significant advantages in total operative time, net operative time, total complication rate, and operative cost (p < 0.05 in all cases), whereas the estimated blood loss was less in RLS (p < 0.05). As subgroup analyses, conversion rate on colectomy and length of hospital stay on hysterectomy statistically favors RLS (p < 0.05). Conclusions Despite higher operative cost, RLS does not result in statistically better treatment outcomes, with the exception of lower estimated blood loss. Operative time and total complication rate are significantly more favorable with CLS.
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Affiliation(s)
- Hyunsuk Frank Roh
- Department of Biomedical Science, Hanyang University College of Medicine and Graduate School of Biomedical Science and Engineering, Seoul, Korea
- Department of Microbiology and Biomedical Science, Hanyang University College of Medicine and Graduate School of Biomedical Science and Engineering, Seoul, Korea
| | - Seung Hyuk Nam
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Guri, Gyunggi, Korea
| | - Jung Mogg Kim
- Department of Microbiology and Biomedical Science, Hanyang University College of Medicine and Graduate School of Biomedical Science and Engineering, Seoul, Korea
- * E-mail:
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15
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Two years of experience with robot-assisted anti-reflux surgery: A retrospective cohort study. Int J Surg 2017; 39:260-266. [PMID: 28216290 DOI: 10.1016/j.ijsu.2017.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Robot-assisted anti-reflux surgery (RAAS) is an alternative to conventional laparoscopic anti-reflux surgery (CLAS). The purpose of this study was to evaluate initial Danish experiences with robot-assisted anti-reflux surgery compared to conventional laparoscopic anti-reflux surgery incorporating follow-up and evaluation of possible learning curve. MATERIAL AND METHODS Patients undergoing primary RAAS or CLAS at The Department of Surgery A, Odense University Hospital and The Department of General Surgery, Kolding Hospital from April 2013 to April 2015 was included. Demographic data, comorbidity, docking time, length of procedure, type of fundic wrap as well as perioperative complications and postoperative complications, need for reoperation or any upper gastrointestinal endoscopy from surgery to final follow-up was retrospectively extracted from patient records. RESULTS 103 patients were included in this study. 39 patients underwent RAAS and 64 patients underwent CLAS. There were no statistically significant differences in demographic data or comorbidities except distribution of heart disease (RAAS: 5.1% vs. CLAS: 18.8%, p = 0.05) and previous abdominal surgery (RAAS: 28.2% vs. CLAS: 48.4%, p = 0.04). Duration of surgery was significantly increased in patients undergoing RAAS (RAAS: 135 ± 27 min vs. CLAS: 86 ± 19 min, p < 0.01). There was no statistical significant difference in intraoperative complications (p = 0.20), 30-day postoperative complication rate (p = 0.20) or mortality (p = 1.00). At follow-up in April 2016, there were no statistically significant differences in patients having undergone upper endoscopy postoperatively (p = 0.92), the use of anti-secretory drugs (p = 0.46) or patients having undergone reoperation (p = 0.60). Reasons for reoperation were significantly dependent on type of fundic wrap with reoperation of Nissen fundoplication being dysphagia and reoperation of Toupet being recurrent reflux (p = 0.008). There was no clearly determined learning curve. CONCLUSIONS RAAS was safe, feasible and with equal efficacy to CLAS. There were however no particular advantages to performing antireflux surgery as robot-assisted procedures neither intra-operatively nor at follow-up.
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Rebecchi F, Allaix ME, Morino M. Robotic technological aids in esophageal surgery. J Vis Surg 2017; 3:7. [PMID: 29078570 DOI: 10.21037/jovs.2017.01.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/18/2016] [Indexed: 12/13/2022]
Abstract
Robotic technology is an emerging technology that has been developed in order to overcome some limitations of the standard laparoscopic approach, offering a stereoscopic three-dimensional visualization of the surgical field, increased maneuverability of the surgical tools with consequent increased movement accuracy and precision and improved ergonomics. It has been used for the surgical treatment of most benign esophageal disorders. More recently, it has been proposed also for patients with operable esophageal cancer. The current evidence shows that there are no real benefits of the robotic technology over conventional laparoscopy in patients undergoing a fundoplication for gastroesophageal reflux disease (GERD), hiatal closure for giant hiatal hernia, or Heller myotomy for achalasia. A few small studies suggest potential advantages in patients undergoing redo surgery for failed fundoplication or Heller myotomy, but large comparative studies are needed to better clarify the role of the robotic technology in these patients. Robot-assisted esophagectomy seems to be safe and effective in selected patients; however, there are no data showing superiority of this approach over both conventional laparoscopic and open surgery. The short-term and long-term oncologic results of ongoing randomized controlled trials (RCTs) are awaited to validate this approach for the treatment of esophageal cancer.
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Affiliation(s)
- Fabrizio Rebecchi
- Department of Surgical Sciences, University of Torino, Corso A. M. Dogliotti, Torino, Italy
| | - Marco E Allaix
- Department of Surgical Sciences, University of Torino, Corso A. M. Dogliotti, Torino, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Torino, Corso A. M. Dogliotti, Torino, Italy
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Leon P, Rivellini R, Giudici F, Sciuto A, Pirozzi F, Corcione F. 3D Vision Provides Shorter Operative Time and More Accurate Intraoperative Surgical Performance in Laparoscopic Hiatal Hernia Repair Compared With 2D Vision. Surg Innov 2017; 24:155-161. [DOI: 10.1177/1553350616687434] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background. The aim of this study is to evaluate if 3-dimensional high-definition (3D) vision in laparoscopy can prompt advantages over conventional 2D high-definition vision in hiatal hernia (HH) repair. Study design. Between September 2012 and September 2015, we randomized 36 patients affected by symptomatic HH to undergo surgery; 17 patients underwent 2D laparoscopic HH repair, whereas 19 patients underwent the same operation in 3D vision. Results. No conversion to open surgery occurred. Overall operative time was significantly reduced in the 3D laparoscopic group compared with the 2D one (69.9 vs 90.1 minutes, P = .006). Operative time to perform laparoscopic crura closure did not differ significantly between the 2 groups. We observed a tendency to a faster crura closure in the 3D group in the subgroup of patients with mesh positioning (7.5 vs 8.9 minutes, P = .09). Nissen fundoplication was faster in the 3D group without mesh positioning ( P = .07). Conclusions. 3D vision in laparoscopic HH repair helps surgeon’s visualization and seems to lead to operative time reduction. Advantages can result from the enhanced spatial perception of narrow spaces. Less operative time and more accurate surgery translate to benefit for patients and cost savings, compensating the high costs of the 3D technology. However, more data from larger series are needed to firmly assess the advantages of 3D over 2D vision in laparoscopic HH repair.
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18
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Limited Evidence for Robot-assisted Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Surg Laparosc Endosc Percutan Tech 2017; 26:117-23. [PMID: 26766316 DOI: 10.1097/sle.0000000000000248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate available evidence on robot-assisted surgery compared with open and laparoscopic surgery. METHOD The databases Medline, Embase, and Cochrane Library were systematically searched for randomized controlled trials comparing robot-assisted surgery with open and laparoscopic surgery regardless of surgical procedure. Meta-analyses were performed on each outcome with appropriate data material available. Cochrane Collaboration's tool for assessing risk of bias was used to evaluate risk of bias on a study level. The GRADE approach was used to evaluate the quality of evidence of the meta-analyses. RESULTS This review included 20 studies comprising 981 patients. The meta-analyses found no significant differences between robot-assisted and laparoscopic surgery regarding blood loss, complication rates, and hospital stay. A significantly longer operative time was found for robot-assisted surgery. Open versus robot-assisted surgery was investigated in 3 studies. A lower blood loss and a longer operative time were found after robot-assisted surgery. No other difference was detected. CONCLUSIONS At this point there is not enough evidence to support the significantly higher costs with the implementation of robot-assisted surgery.
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20
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Bhatia P, Bindal V, Singh R, Gonzalez-Heredia R, Kalhan S, Khetan M, John S. Robot-assisted sleeve gastrectomy in morbidly obese versus super obese patients. JSLS 2016; 18:JSLS-D-14-00099. [PMID: 25392663 PMCID: PMC4208899 DOI: 10.4293/jsls.2014.00099] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background and Objectives: This study evaluates our technique for robot-assisted sleeve gastrectomy for morbidly obese and super obese patients and our outcomes. Methods: A retrospective analysis of patients who underwent robot-assisted sleeve gastrectomy at a single center was performed. The procedure was performed with the da Vinci Si HD Surgical System (Intuitive Surgical, Sunnyvale, California). The staple line was imbricated with No. 2-0 polydioxanone in all cases. The super obese (body mass index ≥50 kg/m2) subset of patients was compared with the morbidly obese group in terms of demographic characteristics, comorbidities, operative times, perioperative complications, and excess body weight loss. Results: A total of 35 patients (15 female and 20 male patients) with a mean body mass index of 48.17 ± 11.7 kg/m2 underwent robot-assisted sleeve gastrectomy. Of these patients, 11 were super obese and 24 were morbidly obese. The mean operative time was 116.3 ± 24.7 minutes, and the mean docking time was 8.9 ± 5.4 minutes. Mean blood loss was 19.36 ± 4.62 mL, and there were no complications, conversions, or perioperative deaths. When compared with the morbidly obese patients, the super obese patients showed no significant difference in operative time, blood loss, and length of hospital stay. There was a steep decline in operating room times after 10 cases of robot-assisted sleeve gastrectomy. Conclusion: This study shows the feasibility and safety of robot-assisted sleeve gastrectomy. Robotic assistance might help overcome the operative difficulties encountered in super obese patients. It shows a rapid reduction in operative times with the growing experience of the entire operative team. Robot-assisted sleeve gastrectomy can be a good procedure by which to introduce robotics in a bariatric surgery center before going on to perform Roux-en-Y gastric bypass and revision procedures.
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Affiliation(s)
- Parveen Bhatia
- Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Vivek Bindal
- Division of General, Minimally Invasive & Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Rahul Singh
- Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Raquel Gonzalez-Heredia
- Division of General, Minimally Invasive & Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Sudhir Kalhan
- Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Mukund Khetan
- Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Suviraj John
- Institute of Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
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21
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Tan A, Ashrafian H, Scott AJ, Mason SE, Harling L, Athanasiou T, Darzi A. Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years. Surg Endosc 2016; 30:4330-52. [PMID: 26895896 PMCID: PMC5009165 DOI: 10.1007/s00464-016-4752-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/11/2016] [Indexed: 12/14/2022]
Abstract
Background Robotic surgery has been in existence for 30 years. This study aimed to evaluate the overall perioperative outcomes of robotic surgery compared with open surgery (OS) and conventional minimally invasive surgery (MIS) across various surgical procedures. Methods MEDLINE, EMBASE, PsycINFO, and ClinicalTrials.gov were searched from 1990 up to October 2013 with no language restriction. Relevant review articles were hand-searched for remaining studies. Randomised controlled trials (RCTs) and prospective comparative studies (PROs) on perioperative outcomes, regardless of patient age and sex, were included. Primary outcomes were blood loss, blood transfusion rate, operative time, length of hospital stay, and 30-day overall complication rate. Results We identified 99 relevant articles (108 studies, 14,448 patients). For robotic versus OS, 50 studies (11 RCTs, 39 PROs) demonstrated reduction in blood loss [ratio of means (RoM) 0.505, 95 % confidence interval (CI) 0.408–0.602], transfusion rate [risk ratio (RR) 0.272, 95 % CI 0.165–0.449], length of hospital stay (RoM 0.695, 0.615–0.774), and 30-day overall complication rate (RR 0.637, 0.483–0.838) in favour of robotic surgery. For robotic versus MIS, 58 studies (21 RCTs, 37 PROs) demonstrated reduced blood loss (RoM 0.853, 0.736–0.969) and transfusion rate (RR 0.621, 0.390–0.988) in favour of robotic surgery but similar length of hospital stay (RoM 0.982, 0.936–1.027) and 30-day overall complication rate (RR 0.988, 0.822–1.188). In both comparisons, robotic surgery prolonged operative time (OS: RoM 1.073, 1.022–1.124; MIS: RoM 1.135, 1.096–1.173). The benefits of robotic surgery lacked robustness on RCT-sensitivity analyses. However, many studies, including the relatively few available RCTs, suffered from high risk of bias and inadequate statistical power. Conclusions Our results showed that robotic surgery contributed positively to some perioperative outcomes but longer operative times remained a shortcoming. Better quality evidence is needed to guide surgical decision making regarding the precise clinical targets of this innovation in the next generation of its use.
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Affiliation(s)
- Alan Tan
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK.
| | - Alasdair J Scott
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Sam E Mason
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Leanne Harling
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London, W2 1NY, UK
- Institute of Global Health Innovation, Imperial College London, London, SW7 2NA, UK
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Straughan DM, Azoury SC, Bennett RD, Pimiento JM, Fontaine JP, Toloza EM. Robotic-Assisted Esophageal Surgery. Cancer Control 2015; 22:335-9. [DOI: 10.1177/107327481502200312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- David M. Straughan
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Saïd C. Azoury
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Robert D. Bennett
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Jose M. Pimiento
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
- Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
- Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Jacques P. Fontaine
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
- Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
- Departments of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Eric M. Toloza
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
- Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
- Departments of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Tolboom R, Broeders I, Draaisma W. Robot-assisted laparoscopic hiatal hernia and antireflux surgery. J Surg Oncol 2015; 112:266-70. [DOI: 10.1002/jso.23912] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 03/08/2015] [Indexed: 12/22/2022]
Affiliation(s)
- R.C. Tolboom
- Meander Medical Centre; Department of Surgery; Amersfoort The Netherlands
- University of Twente; Robotics and Minimal Invasive Surgery; Enschede The Netherlands
| | - I.A.M.J. Broeders
- Meander Medical Centre; Department of Surgery; Amersfoort The Netherlands
- University of Twente; Robotics and Minimal Invasive Surgery; Enschede The Netherlands
| | - W.A. Draaisma
- Meander Medical Centre; Department of Surgery; Amersfoort The Netherlands
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Szold A, Bergamaschi R, Broeders I, Dankelman J, Forgione A, Langø T, Melzer A, Mintz Y, Morales-Conde S, Rhodes M, Satava R, Tang CN, Vilallonga R. European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery. Surg Endosc 2015; 29:253-88. [PMID: 25380708 DOI: 10.1007/s00464-014-3916-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/19/2014] [Indexed: 12/14/2022]
Abstract
Following an extensive literature search and a consensus conference with subject matter experts the following conclusions can be drawn: 1. Robotic surgery is still at its infancy, and there is a great potential in sophisticated electromechanical systems to perform complex surgical tasks when these systems evolve. 2. To date, in the vast majority of clinical settings, there is little or no advantage in using robotic systems in general surgery in terms of clinical outcome. Dedicated parameters should be addressed, and high quality research should focus on quality of care instead of routine parameters, where a clear advantage is not to be expected. 3. Preliminary data demonstrates that robotic system have a clinical benefit in performing complex procedures in confined spaces, especially in those that are located in unfavorable anatomical locations. 4. There is a severe lack of high quality data on robotic surgery, and there is a great need for rigorously controlled, unbiased clinical trials. These trials should be urged to address the cost-effectiveness issues as well. 5. Specific areas of research should include complex hepatobiliary surgery, surgery for gastric and esophageal cancer, revisional surgery in bariatric and upper GI surgery, surgery for large adrenal masses, and rectal surgery. All these fields show some potential for a true benefit of using current robotic systems. 6. Robotic surgery requires a specific set of skills, and needs to be trained using a dedicated, structured training program that addresses the specific knowledge, safety issues and skills essential to perform this type of surgery safely and with good outcomes. It is the responsibility of the corresponding professional organizations, not the industry, to define the training and credentialing of robotic basic skills and specific procedures. 7. Due to the special economic environment in which robotic surgery is currently employed special care should be taken in the decision making process when deciding on the purchase, use and training of robotic systems in general surgery. 8. Professional organizations in the sub-specialties of general surgery should review these statements and issue detailed, specialty-specific guidelines on the use of specific robotic surgery procedures in addition to outlining the advanced robotic surgery training required to safely perform such procedures.
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Affiliation(s)
- Amir Szold
- Technology Committee, EAES, Assia Medical Group, P.O. Box 58048, Tel Aviv, 61580, Israel,
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Bindal V, Bhatia P, Dudeja U, Kalhan S, Khetan M, John S, Wadhera S. Review of contemporary role of robotics in bariatric surgery. J Minim Access Surg 2015; 11:16-21. [PMID: 25598594 PMCID: PMC4290112 DOI: 10.4103/0972-9941.147673] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 01/07/2023] Open
Abstract
With the rise in a number of bariatric procedures, surgeons are facing more complex and technically demanding surgical situations. Robotic digital platforms potentially provide a solution to better address these challenges. This review examines the published literature on the outcomes and complications of bariatric surgery using a robotic platform. Use of robotics to perform adjustable gastric banding, sleeve gastrectomy, roux-en-y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch and revisional bariatric procedures (RBP) is assessed. A search on PubMed was performed for the most relevant articles in robotic bariatric surgery. A total of 23 articles was selected and reviewed in this article. The review showed that the use of robotics led to similar or lower complication rate in bariatric surgery when compared with laparoscopy. Two studies found a significantly lower leak rate for robotic gastric bypass when compared to laparoscopic method. The learning curve for RYGB seems to be shorter for robotic technique. Three studies revealed a significantly shorter operative time, while four studies found a longer operative time for robotic technique of gastric bypass. As for the outcomes of RBP, one study found a lower complication rate in robotic arm versus laparoscopic and open arms. Most authors stated that the use of robotics provides superior visualisation, more degrees of freedom and better ergonomics. The application of robotics in bariatric surgery seems to be a safe and feasible option. Use of robotics may provide specific advantages in some situations, and overcome limitations of laparoscopic surgery. Large and well-designed randomised clinical trials with long follow-up are needed to further define the role of digital platforms in bariatric surgery.
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Affiliation(s)
- Vivek Bindal
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Parveen Bhatia
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Usha Dudeja
- Department of Biochemistry, University College of Medical Sciences, New Delhi, India
| | - Sudhir Kalhan
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Mukund Khetan
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Suviraj John
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sushant Wadhera
- Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Technique Evolution, Learning Curve, and Outcomes of 200 Robot-Assisted Gastric Bypass Procedures: a 5-Year Experience. Obes Surg 2014; 25:997-1002. [DOI: 10.1007/s11695-014-1502-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Falkenback D, Lehane CW, Lord RVN. Robot-assisted oesophageal and gastric surgery for benign disease: antireflux operations and Heller's myotomy. ANZ J Surg 2014; 85:113-20. [PMID: 25039924 DOI: 10.1111/ans.12731] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Robot-assisted general surgery operations are being performed more frequently. This review investigates whether robotic assistance results in significant advantages or disadvantages for the operative treatment of gastro-oesophageal reflux disease and achalasia. METHODS The electronic databases (Medline, Embase, PubMed) were searched for original English language publications for antireflux surgery and Heller's myotomy between January 1990 and December 2013. RESULTS Thirty-three publications included antireflux operations and 20 included Heller's myotomy. The publications indicate that the safety and effectiveness of robotic surgery is similar to that of conventional minimally invasive surgery for both operations. The six randomized trials of robot-assisted versus laparoscopic antireflux surgery showed no significant advantages but significantly higher costs for the robotic method. Gastric perforation during non-redo robotic fundoplication occurred in four trials. CONCLUSIONS No consistent advantage for robot-assisted antireflux surgery has been demonstrated, and there is an increased cost with current robotic technology. A reported advantage for robotic in reducing the perforation rate during Heller's myotomy for achalasia remains unproven. Gastric perforation during robotic fundoplication may be due to the lack of haptic feedback combined with the superhuman strength of the robot.
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Affiliation(s)
- Dan Falkenback
- Department of Surgery, St Vincent's Hospital, University of Notre Dame Medical School, Sydney, New South Wales, Australia; Department of Surgery, Lund University and Lund University Hospital (Skane University Hospital), Lund, Sweden
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Abstract
The overall advantages of thoracoscopy over thoracotomy in terms of patient recovery have been fairly well established. The use of robotics, however, is a newer and less proven modality in the realm of thoracic surgery. Robotics offers distinct advantages and disadvantages in comparison with video-assisted thoracoscopic surgery. Robotic technology is now used for a variety of complex cardiac, urologic, and gynecologic procedures including mitral valve repair and microsurgical treatment of male infertility. This article addresses the potential benefits and limitations of using the robotic platform for the performance of a variety of thoracic operations.
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Abstract
Robotic master-slave devices can assist surgeons to perform minimally invasive esophageal operations with approaches that have already been demonstrated using laparoscopy and thoracoscopy. Robotic-assisted surgery for benign esophageal disease is described for the treatment of achalasia, epiphrenic diverticula, refractory reflux, paraesophageal hernias, duplication cysts, and benign esophageal masses, such as leiomyomas. Indications and contraindications for robotic surgery in benign esophageal disease should closely approximate the indications for laparoscopic and thoracoscopic procedures. Given the early application of the technology and paucity of clinical evidence, there are currently no procedures for which robotic esophageal surgery is the clinically proven preferred approach.
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Affiliation(s)
- Jennifer M Hanna
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Box 3305, Erwin Road, Durham, NC 21170, USA
| | - Mark W Onaitis
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Box 3305, Erwin Road, Durham, NC 21170, USA.
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Mak TWC, Lee JFY, Futaba K, Hon SSF, Ngo DKY, Ng SSM. Robotic surgery for rectal cancer: A systematic review of current practice. World J Gastrointest Oncol 2014; 6:184-193. [PMID: 24936229 PMCID: PMC4058726 DOI: 10.4251/wjgo.v6.i6.184] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 02/23/2014] [Accepted: 04/17/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To give a comprehensive review of current literature on robotic rectal cancer surgery.
METHODS: A systematic review of current literature via PubMed and Embase search engines was performed to identify relevant articles from january 2007 to november 2013. The keywords used were: “robotic surgery”, “surgical robotics”, “laparoscopic computer-assisted surgery”, “colectomy” and “rectal resection”.
RESULTS: After the initial screen of 380 articles, 20 papers were selected for review. A total of 1062 patients (male 64.0%) with a mean age of 61.1 years and body mass index of 24.9 kg/m2 were included in the review. Out of 1062 robotic-assisted operations, 831 (78.2%) anterior and low anterior resections, 132 (12.4%) intersphincteric resection with coloanal anastomosis, 98 (9.3%) abdominoperineal resections and 1 (0.1%) Hartmann’s operation were included in the review. Robotic rectal surgery was associated with longer operative time but with comparable oncological results and anastomotic leak rate when compared with laparoscopic rectal surgery.
CONCLUSION: Robotic colorectal surgery has continued to evolve to its current state with promising results; feasible surgical option with low conversion rate and comparable short-term oncological results. The challenges faced with robotic surgery are for more high quality studies to justify its cost.
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Robotic Nissen fundoplication for gastroesophageal reflux disease: a meta-analysis of prospective randomized controlled trials. Surg Today 2014; 44:1415-23. [PMID: 24909497 DOI: 10.1007/s00595-014-0948-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/13/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE Since its introduction, the Da Vinci surgical system for the treatment of gastroesophageal reflux disease (GERD) has been the subject of much controversy. Several prospective randomized controlled trials, conducted to assess its effectiveness and safety, have revealed differences. We performed this meta-analysis to evaluate the efficiency and safety of robotic Nissen fundoplication for GERD. METHODS We performed a comprehensive search of PubMed, Embase, and OVID-MEDLINE, from 1950 to the present, with daily updates generated by a computer, to identify all published papers on robotic Nissen fundoplication for the treatment of GERD. The meta-analysis was performed by Review Manager Version 5.0. Differences of the overall effect were considered significant at P < 0.05 with a 95 % confidence interval (95 % CI). RESULTS Five studies with a collective total of 160 patients were included. Apart from intra-operative and post-operative complications, which were excluded because of incomplete primary data, there were no significant differences in outcomes, including of total operation interval (P = 0.16), effective operation interval (P = 0.95), post-operative dysphagia (P = 0.94), intra-operative conversion (P = 0.94), re-operation (P = 0.43), hospital stay (P = 0.97) and in-hospital costs (P = 0.08). CONCLUSIONS As current data do not clarify the advantages of the Da Vinci surgical system in Nissen fundoplication for GERD, we believe that a large a multi-center controlled trial is warranted.
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Affiliation(s)
- Jay Shah
- College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Suite 655, Lansing, MI 48912
| | - Arpita Vyas
- Assistant Professor, Department of Pediatrics, Adjunct Professor, Institute of International Health, College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Suite 655, Lansing, MI 48912
| | - Dinesh Vyas
- Assistant Professor, Department of Surgery, Advanced Robotic and GI Surgeon, Adjunct Professor, Institute of International Health, Director, MS Surgery Clerkship, College of Human Medicine, Michigan State University, 1200 East Michigan Avenue, Suite 655, Lansing, MI 48912,
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Huerta-Iga F, Tamayo-de la Cuesta JL, Noble-Lugo A, Hernández-Guerrero A, Torres-Villalobos G, Ramos-de la Medina A, Pantoja-Millán JP. [The Mexican consensus on gastroesophageal reflux disease. Part II]. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2013; 78:231-9. [PMID: 24290724 DOI: 10.1016/j.rgmx.2013.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 05/14/2013] [Accepted: 05/27/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To update the themes of endoscopic and surgical treatment of Gastroesophageal Reflux Disease (GERD) from the Mexican Consensus published in 2002. METHODS Part I of the 2011 Consensus dealt with the general concepts, diagnosis, and medical treatment of this disease. Part II covers the topics of the endoscopic and surgical treatment of GERD. In this second part, an expert in endoscopy and an expert in GERD surgery, along with the three general coordinators of the consensus, carried out an extensive bibliographic review using the Embase, Cochrane, and Medline databases. Statements referring to the main aspects of endoscopic and surgical treatment of this disease were elaborated and submitted to specialists for their consideration and vote, utilizing the modified Delphi method. The statements were accepted into the consensus if the level of agreement was 67% or higher. RESULTS Twenty-five statements corresponding to the endoscopic and surgical treatment of GERD resulted from the voting process, and they are presented herein as Part II of the consensus. The majority of the statements had an average level of agreement approaching 90%. CONCLUSION Currently, endoscopic treatment of GERD should not be regarded as an option, given that the clinical results at 3 and 5 years have not demonstrated durability or sustained symptom remission. The surgical indications for GERD are well established; only those patients meeting the full criteria should be candidates and their surgery should be performed by experts.
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Affiliation(s)
- F Huerta-Iga
- Encargado del Servicio de Endoscopia, Hospital Ángeles Torreón, Coahuila, México.
| | | | - A Noble-Lugo
- Departamento de Enseñanza, Hospital Español de México, México D.F., México
| | - A Hernández-Guerrero
- Jefe del Servicio de Endoscopia, Instituto Nacional de Cancerología, México D.F., México
| | - G Torres-Villalobos
- Servicio de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México D.F., México
| | | | - J P Pantoja-Millán
- Cirugía del Aparato Digestivo, Hospital Ángeles del Pedregal, México D.F., México
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Huerta-Iga F, Tamayo-de la Cuesta J, Noble-Lugo A, Hernández-Guerrero A, Torres-Villalobos G, Ramos-de la Medina A, Pantoja-Millán J. The Mexican consensus on gastroesophageal reflux disease. Part II. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2013. [DOI: 10.1016/j.rgmxen.2014.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Kandil E, Noureldine SI, Saggi B, Buell JF. Robotic liver resection: initial experience with three-arm robotic and single-port robotic technique. JSLS 2013; 17:56-62. [PMID: 23743372 PMCID: PMC3662746 DOI: 10.4293/108680812x13517013317671] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Robotic liver surgery was found to offer advantages not inherent in conventional laparoscopic liver resection. Background and Objective: Robotic-assisted surgery offers a solution to fundamental limitations of conventional laparoscopic surgery, and its use is gaining wide popularity. However, the application of this technology has yet to be established in hepatic surgery. Methods: A retrospective analysis of our prospectively collected liver surgery database was performed. Over a 6-month period, all consecutive patients who underwent robotic-assisted hepatic resection for a liver neoplasm were included. Demographics, operative time, and morbidity encountered were evaluated. Results: A total of 7 robotic-assisted liver resections were performed, including 2 robotic-assisted single-port access liver resections with the da Vinci-Si Surgical System (Intuitive Surgical Sunnyvalle, Calif.) USA. The mean age was 44.6 years (range, 21–68 years); there were 5 male and 2 female patients. The mean operative time (± SD) was 61.4 ± 26.7 minutes; the mean operative console time (± SD) was 38.2 ± 23 minutes. No conversions were required. The mean blood loss was 100.7 mL (range, 10–200 mL). The mean hospital stay (± SD) was 2 ± 0.4 days. No postoperative morbidity related to the procedure or death was encountered. Conclusion: Our initial experience with robotic liver resection confirms that this technique is both feasible and safe. Robotic-assisted technology appears to improve the precision and ergonomics of single-access surgery while preserving the known benefits of laparoscopic surgery, including cosmesis, minimal morbidity, and faster recovery.
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Affiliation(s)
- Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Robotic Applications in the Treatment of Diseases of the Esophagus. Surg Laparosc Endosc Percutan Tech 2012; 22:304-9. [DOI: 10.1097/sle.0b013e318258340a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Kim HJ, Choi GS, Park JS, Park SY, Jun SH. Simultaneous laparoscopic multi-organ resection combined with colorectal cancer: Comparison with non-combined surgery. World J Gastroenterol 2012; 18:806-13. [PMID: 22371641 PMCID: PMC3286144 DOI: 10.3748/wjg.v18.i8.806] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 06/09/2011] [Accepted: 06/16/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To access the short-term outcomes of simultaneous laparoscopic surgery combined with resection for synchronous lesions in patients with colorectal cancer.
METHODS: Between March 1996 and April 2010 prospectively collected data were reviewed from 93 consecutive patients who had colorectal cancer and underwent simultaneous multiple organ resection (combined group) and 1090 patients who underwent conventional laparoscopic right hemicolectomy or laparoscopic low/anterior resection for colorectal cancer (non-combined group). In the combined group, there were nine gastric resections, three nephrectomies, nine adrenalectomies, 56 cholecystectomies, and 21 gynecologic resections. In addition, five patients underwent simultaneous laparoscopic resection for three organs. The patient demographics, intra-operative outcomes, surgical morbidity, and short-term outcomes were compared between the two groups (the combined and non-combined groups).
RESULTS: There were no significant differences in the clinicopathological variables between the two groups. The operating time was significantly longer in the combined group than in the non-combined group, regardless of tumor location (laparoscopic right hemicolectomy and laparoscopic low/anterior resection groups; P = 0.048 and P < 0.001, respectively). The other intra-operative outcomes, such as the complications and open conversion rate, were similar in both groups. The rate of post-operative morbidity in the combined group was similar to the non-combined group (combined vs non-combined, 15.1% vs 13.5%, P = 0.667). Oncological safety for the colon and synchronous lesions were obtained in the combined group.
CONCLUSION: Simultaneous laparoscopic multiple organ resection combined with colorectal cancer is a safe and feasible option in selected patients.
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Wang Z, Zheng Q, Jin Z. Meta-analysis of robot-assisted versus conventional laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. ANZ J Surg 2012; 82:112-7. [PMID: 22510118 DOI: 10.1111/j.1445-2197.2011.05964.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Conventional laparoscopic Nissen fundoplication (CLF) is generally considered the surgical approach of choice for gastro-oesophageal reflux disease. Robotic-assisted laparoscopic fundoplication (RALF) has recently been introduced into laparoscopic clinical practice with the aim of improving surgical performance by eliminating tremors and fatigue. A meta-analysis of randomized clinical trials (RCTs) was performed to compare RALF and CLF. METHODS Medline, Embase, ISI Web of Knowledge CPCI-S and The Cochrane Library were searched and the methodological quality of included trials was evaluated. Outcomes evaluated were intraoperative, dysphagia, flatulence, antisecretory medication, satisfaction with intervention, operation time, hospital stay and total cost. Results were pooled in meta-analyses as risk ratios and weighted mean differences (WMD). RESULTS Of 221 patients in six RCTs, 111 were allocated to CLF and 110 to RALF. RALF prolonged total time necessary to carry out fundoplication (WMD 3.17 (95% confidence interval. 2.33-4.00) min; P < 0.00001, χ(2) P = 0.25, I(2) = 24%). Operation complication, antisecretory medication, satisfaction with intervention, the time needed for hiatal dissection, the time from incision to completion of sutures, the total operation time and total cost were similar in both groups. CONCLUSION Clinical outcomes from RALF were comparable to CLF approach, but RALF prolonged the operation time. Currently, CLF should be routinely used as costs are lower.
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Affiliation(s)
- Zhanhui Wang
- Shanghai Jiaotong University Affiliated Sixth People's Hospital, China
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Huettner F, Alley RA, Doubet JL, Ryan MJ, Dynda DI, Crawford DL. Robotic Foregut Surgery: One Surgeon’s Experience with Nissen Fundoplication, Esophagomyotomy, and Hiatal Hernia Repair. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ss.2012.31001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The first laparoscopic Nissen fundoplication was performed 20 years ago. Surgical management of gastroesophageal reflux disease (GERD) should be offered only to appropriately studied and selected patients, with the ultimate aim of improving the well-being of the individual, the "quality of life." The choice of fundoplication should be dictated by the surgeon's preference and experience.
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Affiliation(s)
- Bernard Dallemagne
- Department of Digestive and Endocrine Surgery, and Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), University Hospital of Strasbourg, IRCAD-EITS, 1 Place de l'Hôpital, 67091, Strasbourg, France.
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Markar SR, Karthikesalingam AP, Venkat-Ramen V, Kinross J, Ziprin P. Robotic vs. laparoscopic Roux-en-Y gastric bypass in morbidly obese patients: systematic review and pooled analysis. Int J Med Robot 2011; 7:393-400. [PMID: 22113976 DOI: 10.1002/rcs.414] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 06/12/2011] [Accepted: 06/21/2011] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of this study was to provide pooled analysis of individually small trials comparing robotic Roux-en-Y gastric bypass (RRYGB) with standard laparoscopic RYGB (LRYGB). METHODS A systematic literature search of Medline, Embase and Cochrane Library databases was performed. Primary outcome measures were the incidence of anastomotic leak and stricture. Secondary outcome measures were post-operative complications, operative time and length of hospital stay. RESULTS Seven relevant studies of 1686 patients were included in this analysis. There was a significantly reduced incidence of anastomotic stricture in the robotic group (POR = 0.43; 95% CI = 0.19 to 0.98; p = 0.04). There was no significant difference between robotic and laparoscopic groups for anastomotic leak, post-operative complications, operative time and length of hospital stay. CONCLUSION The incidence of anastomotic stricture was reduced with RRYGB compared with LRYGB over a minimum follow-up period of 6 months, thus demonstrating the potential benefit of RRYGB.
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Affiliation(s)
- S R Markar
- Academic Surgical Unit, St Mary's Hospital, Imperial College, London, UK.
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Pugin F, Bucher P, Morel P. History of robotic surgery : From AESOP® and ZEUS® to da Vinci®. J Visc Surg 2011; 148:e3-8. [DOI: 10.1016/j.jviscsurg.2011.04.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Robotic gastric banding in children and adolescents: a comparative study. Surg Endosc 2011; 25:3647-51. [DOI: 10.1007/s00464-011-1772-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 05/05/2011] [Indexed: 12/15/2022]
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Jin LX, Ibrahim AM, Newman NA, Makarov DV, Pronovost PJ, Makary MA. Robotic surgery claims on United States hospital websites. J Healthc Qual 2011; 33:48-52. [PMID: 22059902 DOI: 10.1111/j.1945-1474.2011.00148.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To examine the prevalence and content of robotic surgery information presented on websites of U.S. hospitals. We completed a systematic analysis of 400 randomly selected U.S. hospital websites in June of 2010. Data were collected on the presence and location of robotic surgery information on a hospital's website; use of images or text provided by the manufacturer; use of direct link to manufacturer website; statements of clinical superiority; statements of improved cancer outcome; mention of a comparison group for a statement; citation of supporting data and mention of specific risks. Forty-one percent of hospital websites described robotic surgery. Among these, 37% percent presented robotic surgery on their homepage, 73% used manufacturer-provided stock images or text, and 33% linked to a manufacturer website. Statements of clinical superiority were made on 86% of websites, with 32% describing improved cancer control, and 2% described a reference group. No hospital website mentioned risks. Materials provided by hospitals regarding the surgical robot overestimate benefits, largely ignore risks and are strongly influenced by the manufacturer.
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Najarian S, Fallahnezhad M, Afshari E. Advances in medical robotic systems with specific applications in surgery--a review. J Med Eng Technol 2011; 35:19-33. [PMID: 21142589 DOI: 10.3109/03091902.2010.535593] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Although robotics was started as a form of entertainment, it gradually became used in different branches of science. Medicine, particularly in the operating room, has been influenced significantly by this field. Robotic technologies have offered valuable enhancements to medical or surgical processes through improved precision, stability and dexterity. In this paper we review different robotics and computer-assisted systems developed with medical and surgical applications. We cover early and recently developed systems in different branches of surgery. In addition to the united operational systems, we provide a review of miniature robotic, diagnostic and sensory systems developed to assist or collaborate with a main operator system. At the end of the paper, a discussion is given with the aim of summarizing the proposed points and predicting the future of robotics in medicine.
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Affiliation(s)
- S Najarian
- Biomechanics Department, Laboratory of Artificial Tactile Sensing and Robotic Surgery, Faculty of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Hafez Avenue, Tehran, Iran.
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Huettner F, Dynda D, Ryan M, Doubet J, Crawford DL. Robotic-assisted minimally invasive surgery; a useful tool in resident training--the Peoria experience, 2002-2009. Int J Med Robot 2011; 6:386-93. [PMID: 20687050 DOI: 10.1002/rcs.342] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study was to review the use of robotic-assisted general surgery at our institution. We evaluated the 8 year experience of one minimally invasive surgery (MIS) fellowship-trained surgeon in Peoria, IL, performing 240 cases of foregut, colon, solid organ and biliary surgery using the da Vinci system, with resident assistance. Foregut and colon procedures are the fifth and sixth most commonly performed procedures of the senior author annually. METHODS An IRB-approved retrospective review of prospectively collected data representing 124 foregut and 102 colon operations was performed. Data analysed were procedure performed and indications for surgery, gender, age, body mass index (BMI), estimated blood loss (EBL), port set-up time (PST), robot operating time (ROT), total case time (TCT), length of stay (LOS), complications, conversions and resident involvement were recorded. Fourteen cases were excluded from the data review. Statistical analysis using the ANOVA test was applied. A specific review of resident participation was performed. RESULTS Times for 226 foregut and colon cases were: PST 31.2 ± 9.4 (range 10-64) min, ROT 119.3 ± 41.5 (range 12-306) min, and TCT 194.8 ± 50.3 (range 50-380) min. The EBL was 48.6 ± 55.0 (range 5-500) ml, BMI 28.5 ± 4.7 (range 15.4-46.8) kg/m(2) , and median LOS 2.0 (range 0-27) days. The overall complication rate was 13.3%. No deaths occurred. Over the 8 year study period the number of cases participated in by residents was 0, 16, 22, 15, 29, 26, 28 and 10 (as of June 2009), respectively. CONCLUSION This series demonstrates the technical feasibility and safety of robotic surgery for the foregut and colon in a clinical setting where the surgeon does far more of other types of MIS. This series compares favorably with the literature. Incorporation of robotic training in the curriculum has allowed residents to learn robotic techniques in an effective manner.
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Affiliation(s)
- Franziska Huettner
- Department of Surgery, University of Illinois College of Medicine at Peoria, IL 61606, USA
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48
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Schraibman V, de Vasconcellos Macedo AL, Okazaki S, Mauro FC, Epstein MG, Goldman SM, Lustosa S, Matos D. Surgical treatment of hiatus hernia and gastroesophageal reflux disease in complex cases using robotic-assisted laparoscopic surgery: a prospective study/consistent experience in a single institution. J Robot Surg 2011; 5:29-33. [PMID: 27637256 DOI: 10.1007/s11701-010-0235-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 11/30/2010] [Indexed: 02/07/2023]
Abstract
The aim of this study was to report our experience in robotic-assisted surgery of hiatus hernia and gastroesophageal reflux disease in a large series of complex cases. From March 2009 until July 2010, 21 patients were operated due to hiatus hernia or reflux disease using robotic-assisted surgery at Albert Einstein Hospital, São Paulo, Brazil. All patients were selected for the robotic approach because of the complexity of the cases (associated co-morbidity) such as: previous major upper abdominal surgery in 6 patients, hiatus hernia with paraesophageal involvement in 8 patients, obesity with a body mass index of over 29 kg/m(2) in 8 patients, and previous hiatus hernioplasty in 3 patients. Optimal trocar positioning, operating and setup times, conversion rate, intraoperative complications, and perioperative morbidity and mortality rate were analyzed. The mean operating time was reduced from 316 to 195 min after five procedures and the setup time from 20 to 10 min after five procedures. There were no conversions in this group of patients and also no complication or need of blood transfusion. Robotic-assisted fundoplication is feasible, safe and effective for treating hiatus hernias and gastroesophageal reflux disease, especially in complex cases because improved dissection in the esophageal hiatus region compensates for long operating times. Disadvantages are the high costs, the time to master the setup/system, and the necessity of exact trocar positioning.
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Affiliation(s)
- Vladimir Schraibman
- Department of General, Gastric and Minimally Invasive Surgery, Albert Einstein Hospital, Rua Monte Aprazível, 149/61A, 04513-030, SP, São Paulo, Brazil. .,Department of Gastric Surgery, Federal University of São Paulo, São Paulo, Brazil.
| | - Antonio Luiz de Vasconcellos Macedo
- Department of General, Gastric and Minimally Invasive Surgery, Albert Einstein Hospital, Rua Monte Aprazível, 149/61A, 04513-030, SP, São Paulo, Brazil
| | - Samuel Okazaki
- Department of General, Gastric and Minimally Invasive Surgery, Albert Einstein Hospital, Rua Monte Aprazível, 149/61A, 04513-030, SP, São Paulo, Brazil.,Department of Gastric Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Fernando Concilio Mauro
- Department of General, Gastric and Minimally Invasive Surgery, Albert Einstein Hospital, Rua Monte Aprazível, 149/61A, 04513-030, SP, São Paulo, Brazil.,Department of Gastric Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Marina Gabrielle Epstein
- Department of General, Gastric and Minimally Invasive Surgery, Albert Einstein Hospital, Rua Monte Aprazível, 149/61A, 04513-030, SP, São Paulo, Brazil
| | - Suzan Menasce Goldman
- Diagnosis Imaging Department, Federal University of Sao Paulo/Escola Paulista de Medicina, São Paulo, Brazil
| | - Suzana Lustosa
- Department of General, Gastric and Minimally Invasive Surgery, Albert Einstein Hospital, Rua Monte Aprazível, 149/61A, 04513-030, SP, São Paulo, Brazil.,Department of Gastric Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Delcio Matos
- Department of General, Gastric and Minimally Invasive Surgery, Albert Einstein Hospital, Rua Monte Aprazível, 149/61A, 04513-030, SP, São Paulo, Brazil.,Department of Gastric Surgery, Federal University of São Paulo, São Paulo, Brazil
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49
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Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 2010; 24:2647-2669. [PMID: 20725747 DOI: 10.1007/s00464-010-1267-8] [Citation(s) in RCA: 240] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 05/27/2010] [Indexed: 02/06/2023]
Affiliation(s)
- Dimitrios Stefanidis
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA.
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50
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Markar SR, Karthikesalingam AP, Hagen ME, Talamini M, Horgan S, Wagner OJ. Robotic vs. laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease: systematic review and meta-analysis. Int J Med Robot 2010; 6:125-31. [PMID: 20506440 DOI: 10.1002/rcs.309] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of this meta-analysis was to compare clinical outcome following laparoscopic and robotic Nissen fundoplication. A systematic literature search of Medline, Embase and Cochrane Library databases was performed. Primary outcome measures were the requirement for re-operation, postoperative mortality and postoperative dysphagia. Secondary outcome measures were operative time, length of hospital stay, operative complications and cost. Six randomized trials, of 226 patients, were included in this meta-analysis. There was no significant difference in requirement for re-operation or in postoperative dysphagia. There was a significantly reduced total operative time in the laparoscopic group (weighted mean difference = 4.154; 95% CI = 1.932-6.375; p = 0.0002). There was no significant difference between robotic and laparoscopic groups for hospital stay or operative complications. Clinical results from robotic Nissen fundoplication were comparable to the standard laparoscopic approach, but there was associated increased operative time and procedure cost.
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Affiliation(s)
- S R Markar
- Center for the Future of Surgery, University of California, San Diego, CA 92103, USA
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