The Efficacy of Robot-assisted Versus Conventional Laparoscopic Vascular Anastomoses in an Experimental Model (original) (raw)
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Surgical Endoscopy, 2005
Background: Considerable training is necessary to master laparoscopic suturing and knot-tying. Robotic systems are assumed to facilitate these skills and shorten the learning curve. The effect of laparoscopic experience and robotic assistance on the learning curve of vascular anastomoses was studied. Methods: A laparoscopically experienced surgeon and a laparoscopically inexperienced surgeon made alternating laparoscopic vascular anastomoses and robot-assisted laparoscopic vascular anastomoses using a Zeus-Aesop surgical robotic system with various prosthetic conduits and suture materials in a laparoscopic training box. Results: Neither laparoscopic method influenced the quality score or leakage rate, but with laparoscopic experience, significantly fewer failures were made. Suturing and knot-tying were faster with laparoscopic experience both with and without the robotic system, and fewer stitch actions and knot actions were performed. The learning curves of both surgeons were not improved by the robotic system. Conclusions: Experience is the most important factor in the performance of laparoscopic vascular anastomoses. The robotic system was not helpful in shortening the learning curve.
Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience
Surgical Endoscopy, 2005
Background: In the last few years, robotics has been applied in clinical practice for a variety of laparoscopic procedures. This study reports our preliminary experience using robotics in the field of general surgery to evaluate the advantages and limitations of robotassisted laparoscopy. Methods: Thirty-two consecutive patients were scheduled to undergo robot-assisted laparoscopic surgery in our units from March 2002 to July 2003. The indications were cholecystectomy, 20 patients; right adrenalectomy, two points; bilateral varicocelectomy, two points; Heller's cardiomyotomy, two points; Nissen's fundoplication, two points; total splenectomy, one point; right colectomy, one point; left colectomy, 1 point; and bilateral inguinal hernia repair, one point. In all cases, we used the da Vinci surgical system, with the surgeon at the robotic work station and an assistant by the operating table.
Archives of Surgery, 1998
Objective: To compare the surgical performance of manual and robotically assisted laparoscopic instruments on basic maneuvers and intracorporeal suturing in inanimate models. Design: A set of laparoscopic tasks was used to evaluate basic endoscopic movements and intracorporeal suturing: positioning a cylinder on a Peg-Board, dropping beads into receptacles, running a 25-cm rope, and capping a hypodermic needle. Intracorporeal knot tying and running a suture through predetermined points were evaluated separately. The sutures used for these tasks were 2-0 and 4-0 silk and 6-0 and 7-0 polypropylene. Participants: Twenty surgeons completed the set of laparoscopic tasks manually and then with a robotically assisted system. None had used the robotic system before. Main Outcome Measures: Time required to complete the tasks and the precision in performing them. Results: The robotic system accurately reproduced the movements of the surgeons and filtered their hand tremors efficiently. In the basic tasks, operative times were significantly longer for the robotic system (PϽ.001). In the suturing tasks, operative times were longer with the use of the robotic system for sutures sizes 2-0 and 4-0 (PϽ.001). However, time differences were not significant for suture sizes 6-0 and 7-0 (PՆ.07). Precision measurements were similar for all tasks using the manual instruments and the robotically assisted system. No significant differences were found between the performance of advanced laparoscopic surgeons and laparoscopic fellows. Conclusions: Laparoscopic maneuvering and suturing is faster and just as precise when performed manually as when performed with the prototype robotic system. These differences in speed are inversely proportional to the size of the suture. Future generations of the robotic system may eliminate these differences.
The Future of Robotic-Assisted Laparoscopic Surgery
2020
Introduction: Since the first revolution of robotic-assisted surgery officially happened in 2000, the healthcare service worldwide has transformed into a new era due to its superior technological advancements, particularly in laparoscopic surgery. Da Vinci which is seen as a master-slave system and Kymerax which is categorized as a hand-held device are commonly used in roboticassisted laparoscopic surgery. Whilst a conventional or open method requires a large incision to perform a surgery, laparoscopy a minimally invasive surgery (MIS) is an advantageous surgical method which reduces an abdominal incision to a minimum, and effectively exploited with robots. Methods: Based on available articles with the object of robotic surgical surgery, two SWOT analysis for Da Vinci and Kymerax were formulated to understand strengths, weaknesses, opportunities and threats of each system in comparison with the traditional laparoscopic surgery. From that, the future outlook is anticipated based on t...
Robotic surgery versus laparoscopy; a comparison between two robotic systems and laparoscopy
Journal of Robotic Surgery, 2008
Laparoscopy has found a role in standard urologic practice, and with training programs continuing to increase emphasis on its use, the division between skill sets of established non-laparoscopic urologic practitioners and urology trainees continues to widen. At the other end of the spectrum, as technology progresses apace, advanced laparoscopists continue to question the role of surgical robotics in urologic practice, citing a lack of signiWcant advantage to this modality over conventional laparoscopy. We seek to compare two robotic systems (Zeus and DaVinci) versus conventional laparoscopy in surgical training modules in the drylab environment in the context of varying levels of surgical expertise. A total of 12 volunteers were recruited to the study: four staV, four postgraduate trainees, and four medical student interns. Each volunteer performed repeated time trials of standardized tasks consisting of suturing and knot tying using each of the three platforms: DaVinci, Zeus and conventional laparoscopy. Task times and numbers of errors were recorded for each task. Following each platform trial, a standardized subjective ten-point Likert score questionnaire was distributed to the volunteer regarding various operating parameters experienced including: visualization, Xuidity, eYcacy, precision, dexterity, tremor, tactile feedback, and coordination. Task translation from laparoscopy to Zeus robotics appeared to be diYcult as both suture times and knot-tying times increased in pairwise comparisons across skill levels.
Surgical Endoscopy, 2003
Background: The objective of this study was to compare the efficacy of the da Vinci robotic system using both the three-dimensional view (3D) and two-dimensional (2D) view options with traditional manually assisted laparoscopic techniques in performing standardized exercises. Methods: To evaluate surgical efficiency in the use of robotically assisted and manual laparoscopic surgery for standardized exercises six, last-year medical students without any surgical experience were selected. The exercises consisted of placing rings over receptacles, grasping a free hanging suture and cutting three pieces of it, running a suture, and performing a surgical knot. Each student performed the exercise twice. The median times needed for completion of the exercises and the median number of errors in performing the tasks were noted. Results: The unexperienced students performed the standardized tasks significantly quicker and with fewer errors when assisted by the da Vinci robot in the 3D optical display mode, as compared with traditional manually assisted laparoscopic surgery. Even when the 2D mode was selected, a significant advantage favoring the da Vinci robotic system was seen both in time and efficacy for most exercises. When the 3D and 2D modes were compared, time differences in favor of the 3D mode remained, but a significant difference in efficacy favoring the 3D mode was seen only in one exercise (exercise 2: suture cutting). Conclusions: The da Vinci robotic system permits standardized minimal invasive surgical exercises to be performed quicker and more efficiently than traditional minimally invasive techniques. Therefore, with the aid of this robotic system, difficult laparoscopic interventions may become easier to perform, and indications for minimal invasive surgery may be expanded.
Role of Robotics in Laparoscopic Surgery: Review
2019
No matter what type of surgery you choose, you can rest assured that you are in the hands of the most experienced and skilled doctors because laparoscopic or robotics both are operated by a surgeon only. Most patients and physicians would agree that minimally invasive surgery is preferred over traditional open surgery techniques. However, sometimes patients have the choice between two minimally invasive surgery techniques: robotic surgery and laparoscopic surgery. Most surgeons and patients would agree: minimally-invasive surgery is preferable to open surgery. There’s often less postoperative pain, hospital stays are shorter and recovery is easier. Only you and your doctor can decide which is best in your case. But we need to be through on to learn the basics and what to expect with both methods. This review explains about connection in laparoscopic and robotic surgery.
Surgical Endoscopy, 2010
Objective We used a model of biliary-enteric anastomosis to test whether da Vinci robotics improves performance on a complex minimally invasive surgical (MIS) procedure. Methods An ex vivo model for choledochojejunostomy was created using porcine livers with extrahepatic bile ducts and contiguous intestines. MIS choledochojejunostomies were performed in two arms: group 1 (laparoscopic, n = 30) and group 2 (da Vinci assisted, n = 30). Procedures were performed by three surgeons with graduated MIS expertise: surgeon A (MIS ? robotics), surgeon B (experienced MIS), and surgeon C (basic MIS). Each surgeon performed ten procedures per group. The primary objective was time to complete anastomoses using each method. Secondary objectives included anastomosis quality, impact of experience on performance, and learning curve. Results da Vinci led to faster anastomoses than laparoscopy (28.0 vs. 35.9 min, p = 0.002). Surgeon A's mean operative times were equivalent with both techniques (24.5 vs. 22.3 min). Surgeons B and C experienced faster operative times with robotics over laparoscopy alone (39.4 vs. 28.6 min, p = 0.01; and 43.8 vs. 33.0 min, p = 0.008, respectively). Surgeon A did not demonstrate a learning curve with either laparoscopy (22.4 vs. 22.4 min, p = not significant, NS) or robotics (24.7 vs. 19.8 min, p = NS). Surgeon B demonstrated nonsignificant improvement with laparoscopy (46.6 vs. 39.5 min, p = NS). With robotic assistance, a learning curve was demonstrated (36.8 vs. 24.7 min, p = 0.02). Surgeon C demonstrated a learning curve with laparoscopy (58.3 vs. 33.2 min, p = 0.004), but no improvement was noted with robot assistance (32.2 vs. 34.7 min, p = NS).
Robotic Surgery: Research and Reviews, 2019
Introduction: Robotic surgery has been increasingly used in fashioning various surgical anastomoses. Our aim was to collect and analyze outcomes related to anastomoses performed using a robotic approach and compare them with those done using laparoscopic or open approaches through meta-analysis. Methods: A systematic review was conducted for articles comparing robotic with laparoscopic and/or open operations (colectomy, low anterior resection, gastrectomy, Roux-en-Y gastric bypass (RYGB), pancreaticoduodenectomy, radical cystectomy, pyeloplasty, radical prostatectomy, renal transplant) published up to June 2019 searching Medline, Scopus, Google Scholar, Clinical Trials and the Cochrane Central Register of Controlled Trials. Studies containing information about outcomes related to hand-sewn anastomoses were included for meta-analysis. Studies with stapled anastomoses or without relevant information about the anastomotic technique were excluded. We also excluded studies in which the anastomoses were performed extracorporeally in laparoscopic or robotic operations. Results: We included 83 studies referring to the aforementioned operations (4 randomized controlled and 79 non-randomized, 10 prospective and 69 retrospective) apart from colectomy and low anterior resection. Anastomoses done using robotic instruments provided similar results to those done using laparoscopic or open approach in regards to anastomotic leak or stricture. However, there were lower rates of stenosis in robotic than in laparoscopic RYGB (p=0.01) and in robotic than in open radical prostatectomy (p<0.00001). Moreover, all anastomoses needed more time to be performed using the robotic rather than the open approach in renal transplant (p≤0.001). Conclusion: Robotic anastomoses provide equal outcomes with laparoscopic and open ones in most operations, with a few notable exceptions.