Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience (original) (raw)
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Current status of robotics in general surgery
Hellenic Journal of Surgery, 2010
Telesurgical systems have met with a great degree of acceptance in urology but indications are not yet that clear in the field of general surgery. The surgical robot overcomes certain limitations of conventional laparoscopy by offering three-dimensional, high definition vision, and seven degrees of freedom to the articulating instruments. Newer robots provide image integration, telestration and the dual-console capability for training purposes. According to our experiencs indications for robotic surgery are: the need for intracorporeal suturing, the expectant narrow surgical field, the expectant difficult dissection and/or adhesiolysis, especially in the upper abdomen, near the hiatus or very low in the pelvis. Although the use of robotic systems for simple laparoscopic cases is generally opposed on the basis of its increased operative time and cost, most teams accept that the beginning of the learning curve in robotic surgery must rely upon simple procedures such as cholecystectomies and Nissen fundoplications. Recent studies show more indications for robotic approach of cholecystectomies, such as in the setting of a reoperative, hostile abdomen following gangrenous cholecystitis, or in completion cholecystectomy. Robotic surgery constitutes a revolutionary stage in the evolution of surgery. Current systems aim to overcome certain limitations of laparoscopy. More advanced forms of robotic assistance are expected in the future, incorporating special software for intraoperational navigation and augmented reality guidance, help with the decision-making process, and smart "robotic-assistants" with artificial intelligence and autonomy. Integration of this technology will determine the definite role of robotics in the operating theater.
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.
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 general surgery experience: a gradual progress from simple to more complex procedures
The International Journal of Medical Robotics and Computer Assisted Surgery, 2013
Background Robotic surgery was introduced at our institution in 2003, and we used a progressive approach advancing from simple to more complex procedures. Methods A retrospective chart review. Results Cases included totalled 129. Setup and operative times have improved over time and with experience. Conversion rates to standard laparoscopic or open techniques were 4.7% and 1.6%, respectively. Intraoperative complications (6.2%), blood loss and hospital stay were directly proportional to complexity. There were no mortalities and the postoperative complication rate (13.2%) was within accepted norms. Conclusion Our findings suggest that robot technology is presently most useful in cases tailored toward its advantages, i.e. those confined to a single space, those that require performance of complex tasks, and redo procedures.
European Journal of Vascular and Endovascular Surgery, 2004
Background. Robot-assisted surgery is thought to facilitate complex laparoscopic movements, enhancing advanced laparoscopic procedures. Objective. To evaluate the benefit of robotic assistance for laparoscopic vascular surgery. Design. Experimental study using prosthetic conduits in a laparoscopic training box. Methods. Two surgeons each performed 40 laparoscopic vascular anastomoses alternating with and without robotic assistance. A Zeus-Aesop surgical Robotic systeme with 3-D visualisation was used. Each surgeon made 40 anastomoses in total, using different prostheses (5 mm PTFE and 16 mm Dacron) and suture material (Prolene and PTFE). A time-action analysis was performed to evaluate surgical performance. Primary efficacy parameters were quality and leakage of the anastomosis, total time and total number of actions.
Robot-assisted laparoscopic (RAL) procedures in general surgery
The International Journal of Medical Robotics and Computer Assisted Surgery, 2015
Background Robotics was introduced in clinical practice more than two decades ago, and it has gained remarkable popularity for a wide variety of laparoscopic procedures. We report our results of robot-assisted laparoscopic surgery (RALS) in the most commonly applied general surgical procedures. Method Ninety seven patients underwent RALS from 2009 to 2012. Indications for RALS were cholelithiasis, gastric carcinoma, splenic tumors, colorectal carcinoma, benign colorectal diseases, non-toxic nodular goiter and incisional hernia. Records of patients were analyzed for demographic features, intraoperative and postoperative complications and conversion to open surgery. Results Forty six female and 51 male patients were operated and mean age was 58,4 (range: 25-88). Ninety three out of 97 procedures (96%) were completed robotically, 4 were converted to open surgery and there were 15 postoperative complications. There was no mortality. Conclusion Wide variety of procedures of general surgery can be managed safely and effectively by RALS.
Robot-assisted surgical systems: a new era in laparoscopic surgery
Annals of the Royal College of Surgeons, 2002
The introduction of laparoscopic surgery offers clear advantages to patients; to surgeons, it presents the challenge of learning new remote operating techniques quite different from traditional operating. Telemanipulation, introduced in the late 1990s, was a major advance in overcoming the reduced dexterity introduced by laparoscopic techniques. This paper reviews the development of robotic systems in surgery and their role in the operating room of the future.
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, 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).