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Sample records for robot assisted laparoscopic

  1. Robotic assisted laparoscopic colectomy.

    LENUS (Irish Health Repository)

    Pandalai, S

    2010-06-01

    Robotic surgery has evolved over the last decade to compensate for limitations in human dexterity. It avoids the need for a trained assistant while decreasing error rates such as perforations. The nature of the robotic assistance varies from voice activated camera control to more elaborate telerobotic systems such as the Zeus and the Da Vinci where the surgeon controls the robotic arms using a console. Herein, we report the first series of robotic assisted colectomies in Ireland using a voice activated camera control system.

  2. Robot assisted transperitoneal laparoscopic pyeloplasty

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ Nowadays,with laparoscope techniques increasingly developed its indications are covering more complicated medical fields.Moreover,as a camera holder,the robotic system of an automated endoscopic system for optimal positioning (AESOP) can be controlled directly by the surgeon's voice.

  3. Completely Intracorporeal Robotic-Assisted Laparoscopic Ileovesicostomy

    Directory of Open Access Journals (Sweden)

    MaryEllen T. Dolat

    2014-01-01

    Full Text Available We present a report of a completely intracorporeal robotic-assisted laparoscopic ileovesicostomy with long term follow-up. The patient was a 55-year-old man with paraplegia secondary to tropical spastic paresis resulting neurogenic bladder dysfunction. The procedure was performed using a da Vinci Surgical system (Intuitive Surgical, Sunnyvale, CA and took 330 minutes with an estimated blood loss of 100 mL. The patient recovered without perioperative complications. He continues to have low pressure drainage without urethral incontinence over two years postoperatively.

  4. Care of the patient undergoing robotic-assisted laparoscopic pyeloplasty.

    Science.gov (United States)

    Francis, Paula; Winfield, Howard N

    2006-04-01

    Laparoscopic pyeloplasty as a treatment for ureteropelvic junction obstruction has shown comparable success rates with open pyeloplasty techniques. The use of robotic technology to assist during laparoscopic pyeloplasty procedures has been encouraged by the steep learning curve for laparoscopic surgical skills, and the complexity of laparoscopic suturing. Robotic technology provides the surgeon with the ability to filter out any physiologic hand tremor, more degrees of freedom of movement than traditional laparoscopic instruments, the ability to scale movement to provide better control for microsurgery, better ergonomics during surgery, and three-dimensional vision. Details of the procedure and specific nursing care of the patient undergoing robotic-assisted laparoscopic pyeloplasty at the University of Iowa Hospital and Clinics are described.

  5. ROBOT-ASSISTED LAPAROSCOPIC PROSTATECTOMY: OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    S. N. Nesterov

    2014-08-01

    Full Text Available Background. Retropubic radical prostatectomy (RPE is now the gold standard of treatment for locally advanced prostate cancer (PC. However, robot-assisted RPE procedures using the da Vinci system are finding increasing acceptance.Materials and methods. The authors conducted a prospective study of 60 robot-assisted prostatectomies made at the Clinic of Urology, N.I. Pirogov National Medical Surgical Center, in the period January 2009 to December 2010.Results. The duration of an operation averaged 230 min; the average amount of blood loss was 200 ml. The mean duration of postoperative analgesia was 2,7 days. That of urinary catheterization was 8.5 days. A normal postoperative course was noted in most cases (88,4 %. Seven patients were found to have 8 (13,3 % mild and moderate complications. A pathohistological study revealed a positive surgical margin of resection in 21,7 % of the patients, extracapsular tumor growth in 21,7 %, and seminal vesicle invasion in 23,3 %. Tumor-affected regional lymph nodes were detected in 1 (1,7 % patient. In our observed series, 82 and 93 % of the subjects completely retained urine after 6 and 12 moths, respectively. Throughout the follow-up, erectile function recovered in 7 of the 15 patients undergoing a nerve-sparing surgical procedure.Conclusion. Postoperative results in our series of interventions are comparable to those obtained in the studies by Russian and foreign colleagues at the early stage of mastering this procedure. By considering a few observations, it is today difficult to say that our study is valid in the context of evidence-based medicine. Estimation of the benefits of robot-assisted laparoscopic prostatectomy calls for long-term multicenter randomized trials.

  6. ROBOT-ASSISTED LAPAROSCOPIC PROSTATECTOMY: OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    S. N. Nesterov

    2011-01-01

    Full Text Available Background. Retropubic radical prostatectomy (RPE is now the gold standard of treatment for locally advanced prostate cancer (PC. However, robot-assisted RPE procedures using the da Vinci system are finding increasing acceptance.Materials and methods. The authors conducted a prospective study of 60 robot-assisted prostatectomies made at the Clinic of Urology, N.I. Pirogov National Medical Surgical Center, in the period January 2009 to December 2010.Results. The duration of an operation averaged 230 min; the average amount of blood loss was 200 ml. The mean duration of postoperative analgesia was 2,7 days. That of urinary catheterization was 8.5 days. A normal postoperative course was noted in most cases (88,4 %. Seven patients were found to have 8 (13,3 % mild and moderate complications. A pathohistological study revealed a positive surgical margin of resection in 21,7 % of the patients, extracapsular tumor growth in 21,7 %, and seminal vesicle invasion in 23,3 %. Tumor-affected regional lymph nodes were detected in 1 (1,7 % patient. In our observed series, 82 and 93 % of the subjects completely retained urine after 6 and 12 moths, respectively. Throughout the follow-up, erectile function recovered in 7 of the 15 patients undergoing a nerve-sparing surgical procedure.Conclusion. Postoperative results in our series of interventions are comparable to those obtained in the studies by Russian and foreign colleagues at the early stage of mastering this procedure. By considering a few observations, it is today difficult to say that our study is valid in the context of evidence-based medicine. Estimation of the benefits of robot-assisted laparoscopic prostatectomy calls for long-term multicenter randomized trials.

  7. Robot-assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy.

    Science.gov (United States)

    Shiroki, Ryoichi; Fukami, Naohiko; Fukaya, Kosuke; Kusaka, Mamoru; Natsume, Takahiro; Ichihara, Takashi; Toyama, Hiroshi

    2016-02-01

    Nephron-sparing surgery has been proven to positively impact the postoperative quality of life for the treatment of small renal tumors, possibly leading to functional improvements. Laparoscopic partial nephrectomy is still one of the most demanding procedures in urological surgery. Laparoscopic partial nephrectomy sometimes results in extended warm ischemic time and severe complications, such as open conversion, postoperative hemorrhage and urine leakage. Robot-assisted partial nephrectomy exploits the advantages offered by the da Vinci Surgical System to laparoscopic partial nephrectomy, equipped with 3-D vision and a better degree in the freedom of surgical instruments. The introduction of the da Vinci Surgical System made nephron-sparing surgery, specifically robot-assisted partial nephrectomy, safe with promising results, leading to the shortening of warm ischemic time and a reduction in perioperative complications. Even for complex and challenging tumors, robotic assistance is expected to provide the benefit of minimally-invasive surgery with safe and satisfactory renal function. Warm ischemic time is the modifiable factor during robot-assisted partial nephrectomy to affect postoperative kidney function. We analyzed the predictive factors for extended warm ischemic time from our robot-assisted partial nephrectomy series. The surface area of the tumor attached to the kidney parenchyma was shown to significantly affect the extended warm ischemic time during robot-assisted partial nephrectomy. In cases with tumor-attached surface area more than 15 cm(2) , we should consider switching robot-assisted partial nephrectomy to open partial nephrectomy under cold ischemia if it is imperative. In Japan, a nationwide prospective study has been carried out to show the superiority of robot-assisted partial nephrectomy to laparoscopic partial nephrectomy in improving warm ischemic time and complications. By facilitating robotic technology, robot-assisted partial nephrectomy

  8. Robot-assisted laparoscopic gastrectomy for gastric cancer

    Science.gov (United States)

    Caruso, Stefano; Franceschini, Franco; Patriti, Alberto; Roviello, Franco; Annecchiarico, Mario; Ceccarelli, Graziano; Coratti, Andrea

    2017-01-01

    Phase III evidence in the shape of a series of randomized controlled trials and meta-analyses has shown that laparoscopic gastrectomy is safe and gives better short-term results with respect to the traditional open technique for early-stage gastric cancer. In fact, in the East laparoscopic gastrectomy has become routine for early-stage gastric cancer. In contrast, the treatment of advanced gastric cancer through a minimally invasive way is still a debated issue, mostly due to worries about its oncological efficacy and the difficulty of carrying out an extended lymphadenectomy and intestinal reconstruction after total gastrectomy laparoscopically. Over the last ten years the introduction of robotic surgery has implied overcoming some intrinsic drawbacks found to be present in the conventional laparoscopic procedure. Robot-assisted gastrectomy with D2 lymphadenectomy has been shown to be safe and feasible for the treatment of gastric cancer patients. But unfortunately, most available studies investigating the robotic gastrectomy for gastric cancer compared to laparoscopic and open technique are so far retrospective and there have not been phase III trials. In the present review we looked at scientific evidence available today regarding the new high-tech surgical robotic approach, and we attempted to bring to light the real advantages of robot-assisted gastrectomy compared to the traditional laparoscopic and open technique for the treatment of gastric cancer. PMID:28101302

  9. Robot-assisted laparoscopic liver resection: A review.

    Science.gov (United States)

    Salloum, C; Lim, C; Malek, A; Compagnon, P; Azoulay, D

    2016-12-01

    Surgery using a robotic platform is expanding rapidly today, with a notable surge since its authorization on the international medical market by the US Food and Drug Administration in 2000. The first hepatectomy by a robotic approach was reported in 2002, 10 years after the first laparoscopic hepatectomy. Yet, in hepatic surgery, series are scarce and the lack of relevant data in the literature is an obstacle to the development of robot-assisted laparoscopic hepatectomy (RALH). Based on a review of the literature, this update focuses on current indications, short-term and oncologic outcomes following RALH.

  10. Pure laparoscopic and robot-assisted laparoscopic reconstructive surgery in congenital megaureter: a single institution experience.

    Directory of Open Access Journals (Sweden)

    Weijun Fu

    Full Text Available To report our experience of pure laparoscopic and robot-assisted laparoscopic reconstructive surgery in congenital megaureter, seven patients (one bilateral with symptomatic congenital megaureter underwent pure laparoscopic or robot-assisted laparoscopic surgery. The megaureter was exposed at the level of the blood vessel and was isolated to the bladder narrow area. Extreme ureter trim and submucosal tunnel encapsulation or papillary implantations and anti-reflux ureter bladder anastomosis were performed intraperitoneally by pure laparoscopic or robot-assisted laparoscopic surgery. The clinical data of seven patients after operation were analyzed, including the operation time, intraoperative complications, intraoperative bleeding volumes, postoperative complications, postoperative hospitalization time and pathological results. All of the patients were followed. The operation was successfully performed in seven patients. The mean operation times for pure laparoscopic surgery and robotic-assistant laparoscopic surgery were 175 (range: 150-220 and 187 (range: 170-205 min, respectively, and the mean operative blood loss volumes were 20 (range: 10-30 and 28.75 (range: 15-20 ml, respectively. There were no intraoperative complications. The postoperative drainage time was 5 (range: 4-6 and 5.75 (range: 5-6 d, respectively, and the indwelling catheter time was 6.33 (range: 4-8 d and 7 (range: 7-7 d, respectively. The postoperative hospitalization time was 7.67 (range: 7-8 d and 8 (range: 7-10 d, respectively. There was no obvious pain, no secondary bleeding and no urine leakage after the operation. Postoperative pathology reports revealed chronic urothelial mucosa inflammation. The follow-up results confirmed that all patients were relieved of their symptoms. Both pure laparoscopic and robot-assisted laparoscopic surgery using different anti-reflux ureter bladder anastomoses are safe and effective approaches in the minimally invasive treatment of

  11. Robot-assisted laparoscopic urological surgery in children.

    Science.gov (United States)

    Sávio, Luís F; Nguyen, Hiep T

    2013-11-01

    Robot-assisted laparoscopic surgery (RALS) has been proven to be safe and effective for various urological procedures in children, including pyeloplasty, orchiopexy, nephrectomy, and bladder augmentation. The robot system enables delicate and precise movements, which are ideal for the types of reconstructive surgeries that children with urological issues often require, overcoming many of the impediments associated with the conventional laparoscopic approach. RALS helps the relative novice to perform fine surgical techniques and is thought to reduce the learning curve associated with some surgical techniques, such as intracorporeal suturing, owing to the improved freedom of movement of the surgical instruments, the ergonomic positioning of the surgeon, and the 3D vision provided by the robotic system. Given the favourable safety profile and associated benefits of the robot system, including reductions in mean postoperative hospital stay compared with conventional procedures, RALS is becoming more widely adopted by paediatric urologists.

  12. Robotic-assisted laparoscopic management of a caliceal diverticular calculus

    Science.gov (United States)

    Torricelli, Fabio Cesar Miranda; Batista, Lucas T; Colombo, Jose Roberto; Coelho, Rafael Ferreira

    2014-01-01

    Purpose To report the first case of robotic-assisted laparoscopic management of a symptomatic caliceal diverticular calculus and review the literature on laparoscopic treatment for this condition. Case report A 33-year-old obese woman with a 2×1 cm calculus within an anterior caliceal diverticulum located in the middle pole of the left kidney was referred to our service. She had already undergone two flexible ureterorenoscopies without success. We considered that a percutaneous approach would be very challenging due to stone location, thus we elected to perform a robotic-assisted laparoscopic procedure for stone removal and diverticulum fulguration. The procedure was uneventfully performed with no intraoperative or postoperative complications. The patient was discharged from the hospital on the second postoperative day and after 1.5 years of follow-up she is asymptomatic with no recurrence. Conclusions The robotic-assisted laparoscopic approach to caliceal diverticular calculi is feasible and safe, providing one more option for treatment of stones in challenging locations. PMID:25188925

  13. Robotic Assisted Laparoscopic Prostatectomy Performed after Previous Suprapubic Prostatectomy

    Science.gov (United States)

    Tsui, Johnson F.; Feuerstein, Michael; Jazayeri, Seyed Behzad

    2016-01-01

    Operative management of prostate cancer in a patient who has undergone previous open suprapubic simple prostatectomy poses a unique surgical challenge. Herein, we describe a case of intermediate risk prostate cancer in a man who had undergone simple prostatectomy ten years prior to presentation. The patient was found to have Gleason 7 prostate cancer on MRI fusion biopsy of the prostate for elevated PSA and underwent an uncomplicated robot assisted laparoscopic radical prostatectomy. PMID:27882057

  14. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions

    Science.gov (United States)

    Rodríguez-Sanjuán, Juan C; Gómez-Ruiz, Marcos; Trugeda-Carrera, Soledad; Manuel-Palazuelos, Carlos; López-Useros, Antonio; Gómez-Fleitas, Manuel

    2016-01-01

    Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen’s fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated. PMID:26877605

  15. Robot-assisted laparoscopic augmentation ileocystoplasty in a tubercular bladder

    Directory of Open Access Journals (Sweden)

    Prem Nath Dogra

    2014-01-01

    Full Text Available Some of the patients with genitourinary tuberculosis (GUTB present to the urologist with small contracted bladders or with significant renal damage. [1] Additional reconstructive procedures are often required along with anti-tubercular treatment in these patients. These procedures commonly performed via the open approach, now have the advantage of minimally invasive approach provided by laparoscopic and robotic surgery. The technique of robot-assisted laparoscopic augmentation ileocystoplasty in a patient with a small contracted bladder due to GUTB will be described. The procedure was performed via a completely intra-corporeal technique using an ileal "cap" created from a 15 cm segment of distal ileum which was anastomosed to the urinary bladder bi-valved in the mid-sagittal plane. The procedure lasted for 420 minutes and the patient was discharged on postoperative day 5. At 6 month follow-up, the patient has no irritative urinary symptoms and voiding with insignificant post-void residual urine.

  16. Robot - assisted laparoscopic retroperitoneal lymph node dissection in testicular tumor

    Science.gov (United States)

    Torricelli, Fabio C. M.; Jardim, Denis; Guglielmetti, Giuliano B.; Patel, Vipul; Coelho, Rafael F.

    2017-01-01

    ABSTRACT Introduction and objective Retroperitoneal lymph node dissection (RPLND) is indicated for patients with non-seminomatous germ cell tumor (NSGCT) with residual disease after chemotherapy. Although the gold standard approach is still the open surgery, few cases of robot-assisted laparoscopic RPLND have been described. Herein, we aim to present the surgical technique for robot-assisted laparoscopic RPLND. Patient and method A 30 year-old asymptomatic man presented with left testicular swelling for 2 months. Physical examination revealed an enlarged and hard left testis. Alpha-fetoprotein (>1000ng/mL) and beta-HCG (>24.000U/L) were increased. Beta-HCG increased to >112.000U/L in less than one month. The patient underwent a left orchiectomy. Pathological examination showed a mixed NSGCT (50% embryonal carcinoma; 30% teratoma; 10% yolk sac; 10% choriocarcinoma). Computed tomography scan revealed a large tumor mass close to the left renal hilum (10x4x4cm) and others enlarged paracaval and paraortic lymph nodes (T2N3M1S3-stage III). Patient was submitted to 4 cycles of BEP with satisfactory response. Residual mass was suggestive of teratoma. Based on these findings, he was submitted to a robot-assisted RPLND. Results RPLND was uneventfully performed. Operative time was 3.5 hours. Blood loss was minimal, and there were no intra- or postoperative complications. The patient was discharged from hospital in the 1st postoperative day. Pathological examination showed a pure teratoma. After 6 months of follow-up, patient is asymptomatic with an alpha-fetoprotein of 2.9ng/mL and an undetectable beta-HCG. Conclusion Robot-assisted laparoscopic RPLND is a feasible procedure with acceptable morbidity even for post chemotherapy patients when performed by an experienced surgeon.

  17. Robot-assisted laparoscopic rectovaginopexy for rectal prolapse: a prospective cohort study on feasibility and safety

    NARCIS (Netherlands)

    Draaisma, W.A.; Nieuwenhuis, D.H.; Janssen, L.W.M.; Broeders, I.A.M.J.

    Robotic systems may be particularly supportive for procedures requiring careful pelvic dissection and suturing in the Douglas pouch, as in surgery for rectal prolapse. Studies reporting robot-assisted laparoscopic rectovaginopexy for rectal prolapse, however, are scarce. This prospective cohort

  18. Robotic-assisted laparoscopic surgery: recent advances in urology.

    Science.gov (United States)

    Autorino, Riccardo; Zargar, Homayoun; Kaouk, Jihad H

    2014-10-01

    The aim of the present review is to summarize recent developments in the field of urologic robotic surgery. A nonsystematic literature review was performed to retrieve publications related to robotic surgery in urology and evidence-based critical analysis was conducted by focusing on the literature of the past 5 years. The use of the da Vinci Surgical System, a robotic surgical system, has been implemented for the entire spectrum of extirpative and reconstructive laparoscopic kidney procedures. The robotic approach can be applied for a range of adrenal indications as well as for ureteral diseases, including benign and malignant conditions affecting the proximal, mid, and distal ureter. Current evidence suggests that robotic prostatectomy is associated with less blood loss compared with the open surgery. Besides prostate cancer, robotics has been used for simple prostatectomy in patients with symptomatic benign prostatic hyperplasia. Recent studies suggest that minimally invasive radical cystectomy provides encouraging oncologic outcomes mirroring those reported for open surgery. In recent years, the evolution of robotic surgery has enabled urologic surgeons to perform urinary diversions intracorporeally. Robotic vasectomy reversal and several other robotic andrological applications are being explored. In summary, robotic-assisted surgery is an emerging and safe technology for most urologic operations. The acceptance of robotic prostatectomy during the past decade has paved the way for urologists to explore the entire spectrum of extirpative and reconstructive urologic procedures. Cost remains a significant issue that could be solved by wider dissemination of the technology. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  19. Robotic-assisted laparoscopic radical cystectomy: history, techniques and outcomes.

    Science.gov (United States)

    Liss, Michael A; Kader, A Karim

    2013-06-01

    Robotic-assisted radical cystectomy (RARC) is a less invasive means of performing the radical cystectomy operation, which holds promise for improved patient morbidity. We review the history, technique and current literature pertaining to RARC and place the current results in context with the open procedure. All articles regarding RARC found in PubMed after January 2000 were examined. We selected articles that appeared in high-impact journals, had large patient population size (>80 patients), or were novel in technique or findings. We chose key laparoscopic articles to give reference to the history in transition to robotic radical cystectomy. In addition, we chose classic articles from open radical cystectomy to give reference regarding the newer robotic perioperative outcomes. Studies suggest that a 20-patient learning curve is needed to reach an operative time of 6.5 h, with 30 surgeries performed to reach lymph node counts in excess of 20 (International Robotic Cystectomy Consortium). The only randomized surgical trial comparing open and robotic techniques showed equivalent lymph node yield, which may be surgeon and volume dependent. Literature demonstrates lower estimated blood loss, transfusion rates, early return of bowel function and decreased complications in early small series. RARC and urinary diversion are still early in development and limited to centers with extensive robotic experience and volume, although adoption of the robotic approach is becoming more common. Early studies have shown promise to reduce complications with equivalent oncologic results.

  20. Outcomes after robot-assisted laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Declan G.Murphy; Benjamin J.Challacombe; Anthony J.Costello

    2009-01-01

    Robot-assisted laparoscopic radical prostatectomy (RALRP) using the da Vinci surgical system is now in widespread use in many countries where economic conditions allow the installation of this expensive technology.Controversy has surrounded the procedure since it was first performed in 2000,with many critics highlighting the lack of evidence to support its use.However,despite the lack of level I evidence,many large studies of patients have confirmed that the procedure is feasible and safe,with low morbidity.Available longer-term oncological data seem to show that outcomes from the robotic approach at least match those of traditional open radical prostatectomy.Functional outcomes also seem satisfactory,although randomized controlled trials are lacking.This paper reviews the current status of RALRP with respect to perioperative data and complications and oncologic and functional outcomes.

  1. Outcomes of robot-assisted versus laparoscopic repair of small-sized ventral hernias.

    Science.gov (United States)

    Chen, Y Julia; Huynh, Desmond; Nguyen, Scott; Chin, Edward; Divino, Celia; Zhang, Linda

    2017-03-01

    The aim of the study is to investigate the outcomes of the da Vinci robot-assisted laparoscopic hernia repair of small-sized ventral hernias with circumferential suturing of the mesh compared to the traditional laparoscopic repair with trans-fascial suturing. A retrospective review was conducted of all robot-assisted umbilical, epigastric and incisional hernia repairs performed at our institution between 2013 and 2015 compared to laparoscopic umbilical or epigastric hernia repairs. Patient characteristics, operative details and postoperative complications were collected and analyzed using univariate analysis. Three primary minimally invasive fellowship trained surgeons performed all of the procedures included in the analysis. 72 patients were identified during the study period. 39 patients underwent robot- assisted repair (21 umbilical, 14 epigastric, 4 incisional), and 33 patients laparoscopic repair (27 umbilical, 6 epigastric). Seven had recurrent hernias (robot: 4, laparoscopic: 3). There were no significant differences in preoperative characteristics between the two groups. Average operative time was 156 min for robot-assisted repair and 65 min for laparoscopic repair (p robot group [3.07 cm (1-9 cm)] than that for the laparoscopic group [2.02 cm (0.5-5 cm)] (p robot-assisted technique versus the standard laparoscopic repair.

  2. Robotic-Assisted Laparoscopic Ovarian Cystectomy during Pregnancy.

    Science.gov (United States)

    Carter, Susanna; Depasquale, Steven; Stallings, Shawn

    2011-09-01

    The use of robotic-assisted laparoscopic surgery (RALS) in gynecologic oncology is rising rapidly; however, the role of this modality in obstetrics has not been widely investigated. During pregnancy, the surgical management of adnexal masses is traditionally approached via laparotomy or laparoscopy. RALS offers a minimally invasive approach secondary to improved instrument dexterity and precision, 14-fold magnification, and 3-D imaging. For the pregnant patient, this translates into minimal manipulation of the gravid uterus, quicker recovery times, and potentially decreased maternal and fetal morbidity. Here we report six cases in which the da Vinci robotic surgical system (Intuitive Surgical Incorporated, Sunnyvale, CA) was used to perform an ovarian cystectomy during pregnancy. Pathology in all cases returned benign and each patient continued pregnancy without complications of surgery. In centers with the resources and adequately trained physicians, RALS offers the obstetric patient a safe and less invasive alternative to laparotomy or conventional laparoscopy. Although the advantages of robotic surgery are many, the limitations of this modality remain elevated equipment costs as well as the time investment necessary to train physicians.

  3. Robotic-Assisted Laparoscopic Ovarian Cystectomy during Pregnancy

    Directory of Open Access Journals (Sweden)

    Susanna Carter

    2011-09-01

    Full Text Available The use of robotic-assisted laparoscopic surgery (RALS in gynecologic oncology is rising rapidly; however, the role of this modality in obstetrics has not been widely investigated. During pregnancy, the surgical management of adnexal masses is traditionally approached via laparotomy or laparoscopy. RALS offers a minimally invasive approach secondary to improved instrument dexterity and precision, 14-fold magnification, and 3-D imaging. For the pregnant patient, this translates into minimal manipulation of the gravid uterus, quicker recovery times, and potentially decreased maternal and fetal morbidity. Here we report six cases in which the da Vinci robotic surgical system (Intuitive Surgical Incorporated, Sunnyvale, CA was used to perform an ovarian cystectomy during pregnancy. Pathology in all cases returned benign and each patient continued pregnancy without complications of surgery. In centers with the resources and adequately trained physicians, RALS offers the obstetric patient a safe and less invasive alternative to laparotomy or conventional laparoscopy. Although the advantages of robotic surgery are many, the limitations of this modality remain elevated equipment costs as well as the time investment necessary to train physicians.

  4. Laparoscopic Radical Prostatectomy in the ERA of Robot-Assisted Technology

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    Iason Kyriazis

    2014-05-01

    Full Text Available In this work the outcomes of laparoscopic radical prostatectomy (LRP with regard to perioperative morbidity, oncological effectiveness, as well as postoperative continence and potency preservation are being reviewed and compared with the gold standard open radical prostatectomy. In addition, the limitations of LRP are being presented in contrast to the advancement offered by the emerging robotic assisted radical prostatectomy in an attempt to reveal whether laparoscopic approach still has a role in the era of robot-assisted technology.

  5. Robot-assisted laparoscopic hysterectomy vs traditional laparoscopic hysterectomy: five metaanalyses.

    Science.gov (United States)

    Scandola, Michele; Grespan, Lorenzo; Vicentini, Marco; Fiorini, Paolo

    2011-01-01

    To assess differences between laparoscopic hysterectomy performed with or without robot-assistance, we performed metaanalyses of 5 key indices strongly associated with societal and hospital costs, patient safety, and intervention quality. The 5 indexes included estimated blood loss (EBL), operative time, number of conversions to laparotomy, hospital length of stay (LOS), and number of postoperative complications. A search of PubMed, Medline, Embase, and Science citation index online databases yielded a total of 605 studies. After a systematic review, we proceeded with meta-analysis of 14 articles for EBL, with a summary effect of -0.61 (95% confidence interval [CI], -42.42 to 46.20); 20 for operative time, with a summary effect of 0.66 (95% CI, -15.72 to 17.04); 17 for LOS, with a summary effect of -0.43 (95% CI, -0.68 to -0.17); 15 for conversion to laparotomy (odds ratio, 0.50; 95% CI, 0.31 to 0.79 with a random model); and 14 for postoperative complications (odds ratio, 0.69; 95% CI, 0.43 to 1.09 with a random model). In conclusion, compared with traditional laparoscopic hysterectomy, robot-assisted laparoscopic hysterectomy was associated with shorter LOS and fewer postoperative complications and conversions to laparotomy; there were no differences in EBL and operative time. These results confirm that robot-assisted laparoscopy has less deletorious effect on hospital, society, and patient stress and leads to better intervention quality. Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.

  6. Comparison of Perioperative Outcomes of Total Laparoscopic and Robotically Assisted Hysterectomy for Benign Pathology during Introduction of a Robotic Program

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    Gokhan Sami Kilic

    2011-01-01

    Full Text Available Study Objective. Prospectively compare outcomes of robotically assisted and laparoscopic hysterectomy in the process of implementing a new robotic program. Design. Prospectively comparative observational nonrandomized study. Design Classification. II-1. Setting. Tertiary caregiver university hospital. Patients. Data collected consecutively 24 months, 34 patients underwent laparoscopic hysterectomy, 25 patients underwent robotic hysterectomy, and 11 patients underwent vaginal hysterectomy at our institution. Interventions. Outcomes of robotically assisted, laparoscopic, and vaginal complex hysterectomies performed by a single surgeon for noncancerous indications. Measurements and Main Results. Operative times were 208.3±59.01 minutes for laparoscopic, 286.2±82.87 minutes for robotic, and 163.5±61.89 minutes for vaginal (<.0001. Estimated blood loss for patients undergoing laparoscopic surgery was 242.7±211.37 cc, 137.4±107.50 cc for robotic surgery, and 243.2±127.52 cc for vaginal surgery (=0.05. The mean length of stay ranged from 1.8 to 2.3 days for the 3 methods. Association was significant for uterine weight (=0.0043 among surgery methods. Conclusion. Robotically assisted hysterectomy is feasible with low morbidity, a shorter hospital stay, and less blood loss. This suggests that robotic assistance facilitates a minimally invasive approach for patients with larger uterine size even during implementing a new robotic program.

  7. CLINICAL EFFICACY OF THE ROBOT-ASSISTED LAPAROSCOPIC MYOMECTOMY (A REVIEW OF THE LITERATURE

    Directory of Open Access Journals (Sweden)

    V. A. Gudebskaya

    2016-01-01

    Full Text Available Rationale: One of the most complicated and unresolved problems in clinical medicine is the choice of an optimal method for organ-preservation treatment of uterine fibroids in women of childbearing age. Aim: To assess clinical efficacy of robot-assisted laparoscopic myomectomy. Materials and methods: The search was performed in PubMed, Embase, Trip, Cochrane, DocMe databases by keywords: “fibroids”, “robot”, “da Vinci”, “robotic myomectomy”, “robot-assisted myomectomy”. Results: We found 25 publications on robot-assisted laparoscopic myomectomy, including 6  papers on its reproductive outcomes (levels of evidence II–IV. Duration of robot-assisted surgery ranged from 132 to 261 minutes, intraoperative blood loss was in the range from 50 to 387 mL, postoperative hospital stay ranged from 1 to  3.9  days. There was a  lower percentage of intra- and postoperative complications after the robot-assisted interventions, compared to abdominal or classic laparoscopic access, as well as a lower percentage of conversion laparotomies compared to laparoscopy. Pregnancy rates after robotic myomectomy ranged from 16.7 to 69%. Only one case of uterine rupture after robot-assisted laparoscopic myomectomy has been described in the literature. Conclusion: Due to high cost of the method, the number of conducted studies is insufficient to evaluate the role of robotic technologies in the organ-preservation approach to uterine fibroids. Nevertheless, they suggest that robot-assisted laparoscopic myomectomy is justified in women of childbearing age who are planning pregnancy, with big centripetally growing intramural nodes and deformation of the uterine cavity. This technique on its own is an independent method for fertility restoration and could be the first step before the use of assisted reproductive technology.

  8. Robotic-Assisted Laparoscopic Management of Vesicoureteral Reflux

    OpenAIRE

    Thomas Lendvay

    2008-01-01

    Robotic-assisted laparoscopy (RAL) has become a promising means for performing correction of vesicoureteral reflux disease in children through both intravesical and extravesical techniques. We describe the importance of patient selection, intraoperative patient positioning, employing certain helpful techniques for exposure, and recognizing the limitations and potential complications of robotic reimplant surgery. As more clinicians embrace robotic surgery and more urology residents are traine...

  9. Robotic-Assisted Laparoscopic Management of Vesicoureteral Reflux

    Directory of Open Access Journals (Sweden)

    Thomas Lendvay

    2008-01-01

    Full Text Available Robotic-assisted laparoscopy (RAL has become a promising means for performing correction of vesicoureteral reflux disease in children through both intravesical and extravesical techniques. We describe the importance of patient selection, intraoperative patient positioning, employing certain helpful techniques for exposure, and recognizing the limitations and potential complications of robotic reimplant surgery. As more clinicians embrace robotic surgery and more urology residents are trained in robotics, we anticipate an expansion of the applications of robotics in children. We believe that it is necessary to develop robotic surgery curricula for novice roboticists and residents so that patients may experience improved surgical outcomes.

  10. Fertility and Symptom Relief following Robot-Assisted Laparoscopic Myomectomy

    Directory of Open Access Journals (Sweden)

    Michael C. Pitter

    2015-01-01

    Full Text Available Objective. To examine success of robot-assisted laparoscopic myomectomy (RALM measured by sustained symptom relief and fertility. Methods. This is a retrospective survey of 426 women who underwent RALM for fibroids, symptom relief, or infertility at three practice sites across the US. We examined rates of symptom recurrence and pregnancy and factors associated with these outcomes. Results. Overall, 70% of women reported being symptom-free, with 62.9% free of symptoms after three years. At >3 years, 66.7% of women who underwent surgery to treat infertility and 80% who were also symptom-free reported achieving pregnancy. Factors independently associated with symptom recurrence included greater time after surgery, preoperative dyspareunia, multiple fibroid surgeries, smoking after surgery, and preexisting diabetes. Factors positively correlated with achieving pregnancy included desiring pregnancy, prior pregnancy, greater time since surgery, and Caucasian race. Factors negatively correlated with pregnancy were advanced age and symptom recurrence. Conclusions. This paper, the first to examine symptom recurrence after RALM, demonstrates both short- and long-term effectiveness in providing symptom relief. Furthermore, RALM may have the potential to improve the chance of conception, even in a population at high risk of subfertility, with greater benefits among those who remain symptom-free. These findings require prospective validation.

  11. Robotic Assisted Laparoscopic Prostatectomy after High Intensity Focused Ultrasound Failure

    Directory of Open Access Journals (Sweden)

    Leon Telis

    2017-01-01

    Full Text Available Background. Prostate cancer is the most common cancer diagnosed in men. As new focal therapies become more popular in treatment of prostate cancer, failure cases requiring salvage therapy with either surgical or other techniques are being reported. Objective. To report the options in treatment of prostate cancer after recurrence or failure of the primary treatment modality. Methods. We report a salvage robotic assisted laparoscopic radical prostatectomy (RALP for prostate cancer recurrence following high intensity focused ultrasound treatment (HIFU in the United States. Results. A 67-year-old man who underwent HIFU treatment for prostate adenocarcinoma 2 years prior was presented with a rising prostate specific antigen of 6.1 ng/mL to our clinic. A biopsy proven recurrent disease in the area of previous treatment documented the failure of treatment. The patient elected to undergo a salvage RALP. The operation time was 159 minutes. The patient was discharged from the hospital on postoperative day 1 with no complications. The catheter was removed on post-op day 10. The patient reserved sexual function and urinary continence. The PSA levels on 6 months’ follow-up are undetectable. Conclusions. Salvage RALP is an effective and safe treatment choice for recurrent prostate adenocarcinoma following failed HIFU treatment if operated by an experienced surgeon.

  12. Robot-assisted laparoscopic rectovaginopexy for rectal prolapse: a prospective cohort study on feasibility and safety

    NARCIS (Netherlands)

    Draaisma, W.A.; Nieuwenhuis, D.H.; Janssen, L.W.M.; Broeders, I.A.M.J.

    2008-01-01

    Robotic systems may be particularly supportive for procedures requiring careful pelvic dissection and suturing in the Douglas pouch, as in surgery for rectal prolapse. Studies reporting robot-assisted laparoscopic rectovaginopexy for rectal prolapse, however, are scarce. This prospective cohort stud

  13. Robot-assisted laparoscopic rectovaginopexy for rectal prolapse: a prospective cohort study on feasibility and safety

    NARCIS (Netherlands)

    Draaisma, W.A.; Nieuwenhuis, D.H.; Janssen, L.W.M.; Broeders, I.A.M.J.

    2008-01-01

    Robotic systems may be particularly supportive for procedures requiring careful pelvic dissection and suturing in the Douglas pouch, as in surgery for rectal prolapse. Studies reporting robot-assisted laparoscopic rectovaginopexy for rectal prolapse, however, are scarce. This prospective cohort stud

  14. Transversus abdominis plane (TAP) block after robot-assisted laparoscopic hysterectomy

    DEFF Research Database (Denmark)

    Torup, H; Bøgeskov, M; Hansen, E G

    2015-01-01

    BACKGROUND: Transversus abdominis plane (TAP) block is widely used as a part of pain management after various abdominal surgeries. We evaluated the effect of TAP block as an add-on to the routine analgesic regimen in patients undergoing robot-assisted laparoscopic hysterectomy. METHODS......: In a prospective blinded study, 70 patients scheduled for elective robot-assisted laparoscopic hysterectomy were randomised to receive either TAP block (ropivacaine 0.5%, 20 ml on each side) or sham block (isotonic saline 0.9%, 20 ml on each side). All patients had patient-controlled analgesia (PCA) with morphine...... and Nonsteroidal anti-inflammatory drugs (NSAID) treatment, had no effect on morphine consumption, VAS pain scores, or frequency of nausea and vomiting after robot-assisted laparoscopic hysterectomy compared with paracetamol and NSAID alone....

  15. A Comparative Study of Single-Port Laparoscopic Surgery Versus Robotic-Assisted Laparoscopic Surgery for Rectal Cancer

    DEFF Research Database (Denmark)

    Levic, Katarina; Donatsky, Anders Meller; Bulut, Orhan

    2015-01-01

    INTRODUCTION: Conventional laparoscopic surgery is the treatment of choice for many abdominal procedures. To further reduce surgical trauma, new minimal invasive procedures such as single-port laparoscopic surgery (SPLS) and robotic assisted laparoscopic surgery (RALS) have emerged. The aim...... in either of the groups. There was no difference in median follow-up time between groups (P = .58). CONCLUSION: Both SPLS and RALS may have a role in rectal surgery. The short-term oncological outcomes were similar, although RALS harvested more lymph nodes than the SPLS procedure. However, SPLS seems...

  16. Lessons learned from a case of calf compartment syndrome after robot-assisted laparoscopic prostatectomy.

    Science.gov (United States)

    Rosevear, Henry M; Lightfoot, Andrew J; Zahs, Marta; Waxman, Steve W; Winfield, Howard N

    2010-10-01

    Robot-assisted laparoscopic prostatectomy is rapidly gaining favor as a minimally invasive method to surgically address prostate cancer. The sophisticated equipment and unique positioning requirements of this technology require exceptional preparation and attention to detail to minimize the chance of surgical complications. We present the case of a 57-year-old man who developed left calf compartment syndrome after (robot-assisted laparoscopic prostatectomy) requiring fasciotomies. We use this example to highlight specific areas of risk unique to the da Vinci Surgical System® using intraoperative photos to show danger areas as well as review basic positioning requirements common to all prolonged pelvic surgeries performed in Trendelenburg position.

  17. Robot-Assisted Laparoscopic Partial Colpectomy and Intracorporeal Ileal Conduit Urinary Diversion (Bricker for Cervical Adenocarcinoma Recurrence

    Directory of Open Access Journals (Sweden)

    Jennifer Uzan

    2015-01-01

    Full Text Available Ileal conduit urinary diversion (Bricker is a standard surgical open procedure. The Da Vinci robot allowed precision for this surgical procedure, especially for intracorporeal suturing. Meanwhile, few reports of robot-assisted laparoscopic ileal conduit diversion (Bricker are described in the literature. We report the case of a 69-year-old patient with a vaginal recurrence of cervical adenocarcinoma associated with vesicovaginal fistula treated by robot-assisted laparoscopic partial colpectomy and ileal conduit urinary diversion (Bricker. The robot-assisted laparoscopic procedure followed all surgical steps of the open procedure. Postoperative period was free of complications.

  18. Total intravenous anaesthesia versus inhalational anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic surgery

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Dreijer, Bjørn; Wrist Lam, Gitte

    2017-01-01

    BACKGROUND: Rapid implementation of robotic transabdominal surgery has resulted in the need for re-evaluation of the most suitable form of anaesthesia. The overall objective of anaesthesia is to minimize perioperative risk and discomfort for patients both during and after surgery. Anaesthesia...... for patients undergoing robotic assisted surgery is different from anaesthesia for patients undergoing open or laparoscopic surgery; new anaesthetic concerns accompany robotic assisted surgery. OBJECTIVES: To assess outcomes related to the choice of total intravenous anaesthesia (TIVA) or inhalational...... anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic gynaecological, urological or gastroenterological surgery. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016 Issue 5), Ovid MEDLINE (1946 to May 2016), Embase via OvidSP (1982 to May 2016...

  19. Perioperative surgical outcome of conventional and robot-assisted total laparoscopic hysterectomy.

    Science.gov (United States)

    van Weelden, W J; Gordon, B B M; Roovers, E A; Kraayenbrink, A A; Aalders, C I M; Hartog, F; Dijkhuizen, F P H L J

    2017-01-01

    To evaluate surgical outcome in a consecutive series of patients with conventional and robot assisted total laparoscopic hysterectomy. A retrospective cohort study was performed among patients with benign and malignant indications for a laparoscopic hysterectomy. Main surgical outcomes were operation room time and skin to skin operating time, complications, conversions, rehospitalisation and reoperation, estimated blood loss and length of hospital stay. A total of 294 patients were evaluated: 123 in the conventional total laparoscopic hysterectomy (TLH) group and 171 in the robot TLH group. After correction for differences in basic demographics with a multivariate linear regression analysis, the skin to skin operating time was a significant 18 minutes shorter in robot assisted TLH compared to conventional TLH (robot assisted TLH 92m, conventional TLH 110m, p0.001). The presence or absence of previous abdominal surgery had a significant influence on the skin to skin operating time as did the body mass index and the weight of the uterus. Complications were not significantly different. The robot TLH group had significantly less blood loss and lower rehospitalisation and reoperation rates. This study compares conventional TLH with robot assisted TLH and shows shorter operating times, less blood loss and lower rehospitalisation and reoperation rates in the robot TLH group.

  20. Clinical characteristics of remote Zeus robot-assisted laparoscopic cholecystectomy: A report of 40 cases

    Institute of Scientific and Technical Information of China (English)

    Han-Xin Zhou; Yue-Hua Guo; Xiao-Fang Yu; Shi-Yun Bao; Jia-Lin Liu; Yue Zhang; Yong-Gong Ren; Qun Zheng

    2006-01-01

    AIM: To summarize the performing essentials and analyze the characteristics of remote Zeus robot-assisted laparoscopic cholecystectomy.METHODS: Robot-assisted laparoscopic cholecystectomy was performed in 40 patients between May 2004 and July 2005. The operating procedures and a variety of clinical parameters were recorded and analyzed.RESULTS: Forty laparoscopic cholecystectomy procedures were successfully completed with Zeus robotic system. And there were no post-operative complications. Total operating time, system setup time and performing time were 100.3±18.5 min, 27.7±8.8 min and 65.6±18.3 min, respectively. The blood loss and postoperative hospital stay were 30.6±10.2 mL and 2.8±0.8d, respectively. Camera clearing times and time used for operative field adjustment were 1.1 ± 1.0 min and 2.0± 0.8min, respectively. The operative error was 7.5%.CONCLUSION: Robot-assisted laparoscopic cholecystectomy following the principles of laparoscopic operation has specific performing essentials. It preserves the benefits of minimally invasive surgery and offers enhanced ability of controlling operation field, precise and stable operative manipulations.

  1. Clinical characteristics of remote Zeus robot-assisted laparoscopic cholecystectomy: a report of 40 cases.

    Science.gov (United States)

    Zhou, Han-Xin; Guo, Yue-Hua; Yu, Xiao-Fang; Bao, Shi-Yun; Liu, Jia-Lin; Zhang, Yue; Ren, Yong-Gong; Zheng, Qun

    2006-04-28

    To summarize the performing essentials and analyze the characteristics of remote Zeus robot-assisted laparoscopic cholecystectomy. Robot-assisted laparoscopic cholecystectomy was performed in 40 patients between May 2004 and July 2005. The operating procedures and a variety of clinical parameters were recorded and analyzed. Forty laparoscopic cholecystectomy procedures were successfully completed with Zeus robotic system. And there were no post-operative complications. Total operating time, system setup time and performing time were 100.3 +/- 18.5 min, 27.7 +/- 8.8 min and 65.6 +/- 18.3 min, respectively. The blood loss and post-operative hospital stay were 30.6 +/- 10.2 mL and 2.8 +/- 0.8 d, respectively. Camera clearing times and time used for operative field adjustment were 1.1+/- 1.0 min and 2.0 +/- 0.8 min, respectively. The operative error was 7.5%. Robot-assisted laparoscopic cholecystectomy following the principles of laparoscopic operation has specific performing essentials. It preserves the benefits of minimally invasive surgery and offers enhanced ability of controlling operation field, precise and stable operative manipulations.

  2. Effect of body mass index on robotic-assisted total laparoscopic hysterectomy.

    Science.gov (United States)

    Nawfal, A Karim; Orady, Mona; Eisenstein, David; Wegienka, Ganesa

    2011-01-01

    To estimate the impact of body mass index (BMI) on the surgical outcomes of patients undergoing robotic-assisted total laparoscopic hysterectomy. Retrospective cohort study. Henry Ford Health System academic medical center (Henry Ford and Henry Ford West Bloomfield Hospitals) A total of 135 patients who underwent scheduled robotic-assisted total laparoscopic hysterectomy for benign indications, without concomitant urogynecologic procedures between January 2008 and June 2010. Patients underwent robotic-assisted total laparoscopic hysterectomy as the intention to treat. Two cases were converted to laparotomy. MEASUREMENTS & MAIN RESULTS: Electronic medical records of all patients that underwent robotic-assisted total laparoscopic hysterectomy at Henry Ford Health System were reviewed. Data on demographics, BMI (kg/m(2)), estimated blood loss, perioperative hemoglobin change, procedure duration, hospital length of stay, specimen weight, pathology, and postoperative complications were obtained. The women's median age was 45 years (range 30-68), 61.5% were black, and BMI ranged from 14.8-56.2 kg/m2; 23.4% of women were normal weight or less (BMI obese (BMI >30, n = 70) and 36 of these patients (27.1%) were morbidly obese (BMI ≥35). BMI did not correlate with procedure duration (Spearman r = .12, p = .16), length of stay (Spearman r = .10, p = .24), or estimated blood loss (Spearman r = .12, p =.18). Our analysis did not identify any meaningful associations between BMI and absolute change in hemoglobin. In addition BMI was not associated with an increase in major or minor complications. BMI is not associated with blood loss, duration of surgery, length of stay, or complication rates in patients undergoing robotic-assisted total laparoscopic hysterectomy. Robotic assistance may help surgeons overcome adverse outcomes sometimes found in obese patients. Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.

  3. A comparison of surgeon's postural muscle activity during robotic-assisted and laparoscopic rectal surgery.

    Science.gov (United States)

    Szeto, Grace P Y; Poon, Jensen T C; Law, Wai-Lun

    2013-09-01

    This study compared the muscular activity in the surgeon's neck and upper limbs during robotic-assisted laparoscopic (R-Lap) surgery and conventional laparoscopic (C-Lap) surgery. Two surgeons performed the same procedure of R-Lap and C-Lap low anterior resection, and real-time surface electromyography was recorded in bilateral cervical erector spinae, upper trapezius (UT) and anterior deltoid muscles for over 60 min in each procedure. In one surgeon, forearm muscle activities were also recorded during robotic surgery. Similar levels of cervical muscle activity were demonstrated in both types of surgery. One surgeon showed much higher activity in the left UT muscle during robotic surgery. In the second surgeon, C-Lap was associated with much higher levels of muscle activity in both UT muscles. This may be related to the bilateral abducted arm posture required in maneuvering the laparoscopic instruments. In the forearm region, the "ulnaris" muscles for wrist flexion and extension bilaterally showed high amplitudes during robotic-assisted surgery. Robotic-assisted surgery seemed to demand a higher level of muscle work in the forearm region while greater efforts of shoulder muscles were involved during laparoscopic surgery. There are also individual variations in postural habits and motor control that can affect the muscle activation patterns. This study demonstrated a method of objectively examining the surgeon's physical workload during real-time surgery in the operating theatre, and further research should explore the surgeon's workload in a larger group of surgeons performing different surgical procedures.

  4. Robot-Assisted Laparoscopic Hiatal Hernia Repair : Promising Anatomical and Functional Results

    NARCIS (Netherlands)

    Brenkman, Hylke J F; Parry, Kevin; Van Hillegersberg, Richard; Ruurda, Jelle P.

    2016-01-01

    Background: There is no consensus on the optimal technique for hiatal hernia (HH) repair, and considerable recurrence rates are reported. The aim of this study was to evaluate the perioperative outcomes, quality of life (QoL), and recurrence rate in patients undergoing robot-assisted laparoscopic HH

  5. Optic Nerve Sheath Diameter Remains Constant during Robot Assisted Laparoscopic Radical Prostatectomy

    NARCIS (Netherlands)

    Verdonck, Philip; Kalmar, Alain F.; Suy, Koen; Geeraerts, Thomas; Vercauteren, Marcel; Mottrie, Alex; De Wolf, Andre M.; Hendrickx, Jan F. A.

    2014-01-01

    Background: During robot assisted laparoscopic radical prostatectomy (RALRP), a CO2 pneumoperitoneum (CO2PP) is applied and the patient is placed in a head-down position. Intracranial pressure (ICP) is expected to acutely increase under these conditions. A non-invasive method, the optic nerve sheath

  6. Perioperative Outcomes of Robotic Assisted Laparoscopic Surgery Versus Conventional Laparoscopy Surgery for Advanced-Stage Endometriosis

    Science.gov (United States)

    Sirota, Ido

    2014-01-01

    Background and Objectives: To determine perioperative outcome differences in patients undergoing robotic-assisted laparoscopic surgery (RALS) versus conventional laparoscopic surgery (CLS) for advanced-stage endometriosis. Methods: This retrospective cohort study at a minimally invasive gynecologic surgery center at 2 academically affiliated, urban, nonprofit hospitals included all patients treated by either robotic-assisted or conventional laparoscopic surgery for stage III or IV endometriosis (American Society for Reproductive Medicine criteria) between July 2009 and October 2012 by 1 surgeon experienced in both techniques. The main outcome measures were extent of surgery, estimated blood loss, operating room time, intraoperative and postoperative complications, and length of stay, with medians for continuous measures and distributions for categorical measures, stratified by body mass index values. Robotically assisted laparoscopy and conventional laparoscopy were then compared by use of the Wilcoxon rank sum, χ2, or Fisher exact test, as appropriate. Results: Among 86 conventional laparoscopic and 32 robotically assisted cases, the latter had a higher body mass index (27.36 kg/m2 [range, 23.90–34.09 kg/m2] versus 24.53 kg/m2 [range, 22.27–26.96 kg/m2]; P laparoscopy patients. After body mass index stratification, obese patients varied in operating room time (282.5 minutes [range, 224–342 minutes] for robotic-assisted laparoscopy versus 174 minutes [range, 130–270 minutes] for conventional laparoscopy; P laparoscopy groups. Conclusion: Despite a higher operating room time, robotic-assisted laparoscopy appears to be a safe minimally invasive approach for patients, with all other perioperative outcomes, including intraoperative and postoperative complications, comparable with those in patients undergoing conventional laparoscopy. PMID:25489208

  7. Concurrent management of bilateral ureteropelvic junction obstruction in children using robotic-assisted laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Drew A. Freilich

    2008-03-01

    Full Text Available INTRODUCTION: Bilateral ureteropelvic junction (UPJ obstruction occurs infrequently. When surgical management is deemed necessary, staged pyeloplasties traditionally have been recommended to minimize the morbidity associated with performing procedures concurrently. With the advent of robotic-assistance, concurrent surgical management can more readily be performed laparoscopically. In this report, we evaluated the safety and outcome of managing patients with bilateral UPJ obstruction with concurrent robotic-assisted laparoscopic pyeloplasty. MATERIALS AND METHODS: We performed a retrospective review of five patients with bilateral ureteropelvic junction obstruction who underwent concurrent bilateral robotic-assisted pyeloplasties at our institution between October 2003 and April 2007. Technical consideration for patient positioning, robotic set-up, port placement, and the use of a hitch stitches was assessed. The operative time, complications, analgesic needs, length of hospitalization, and overall success of the procedure were evaluated. RESULTS: Operative time ranged from 235 to 541 minutes (mean = 384. Estimated blood loss was 5-100 cc (mean = 48.0. Length of hospitalization ranged from 1.3 to 3.6 days (mean = 2.4. Ureteral stents were removed 3-8 weeks postoperatively. There were no complications. All kidneys demonstrated decreased hydronephrosis on postoperative ultrasound or improved drainage parameters on diuretic renography or IVP. CONCLUSIONS: Simultaneous bilateral robotic-assisted laparoscopic pyeloplasties utilizing 4-port access is feasible and safe. It provides an effective method of managing patients with bilateral UPJ obstruction, avoiding the burden and morbidity of performing staged surgeries.

  8. Initial consecutive 125 cases of robotic assisted laparoscopic radical prostatectomy performed in Ireland's first robotic radical prostatectomy centre.

    LENUS (Irish Health Repository)

    Bouchier-Hayes, D M

    2012-03-01

    We examined the patient characteristics, operative proceedings and the outcomes of the initial series of 125 cases of robot-assisted laparoscopic radical prostatectomy (RALRP) in an independent hospital in Ireland, performed by two surgeons using the da Vinci(®) surgical system.

  9. Laparoscopic and robotic nephroureterectomy

    DEFF Research Database (Denmark)

    Azawi, Nessn H; Berg, Kasper Drimer; Thamsborg, Andreas Key Milan

    2017-01-01

    nephroureterectomy between January 2008 and December 2014 was conducted. Outcome measures were OS and CSM. RESULTS: In total, 298 patients underwent robot-assisted or laparoscopic radical nephroureterectomy with a final histological diagnosis of UTUC. LND was performed in 46 (15.4%). One hundred and seventy...

  10. Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery.

    Science.gov (United States)

    van der Schatte Olivier, R H; Van't Hullenaar, C D P; Ruurda, J P; Broeders, I A M J

    2009-06-01

    Robot-assisted surgical systems have been introduced to improve the outcome of minimally invasive surgery. These systems also have the potential to improve ergonomics for the surgeon during endoscopic surgery. This study aimed to compare the user's mental and physical comfort in performing standard laparoscopic and robot-assisted techniques. Surgical performance also was analyzed. In this study, 16 surgically inexperienced participants performed three tasks using both a robotic system and standard laparoscopic instrumentation. Distress was measured using questionnaires and an ambulatory monitoring system. Surgical performance was analyzed with time-action analysis. The physiologic parameters (p = 0.000), the questionnaires (p = 0.000), and the time-action analysis (p = 0.001) favored the robot-assisted group in terms of lower stress load and an increase in work efficiency. In this experimental setup, the use of a robot-assisted surgical system was of value in both cognitive and physical stress reduction. Robotic assistance also demonstrated improvement in performance.

  11. No differences in short-term morbidity and mortality after robot-assisted laparoscopic versus laparoscopic resection for colonic cancer

    DEFF Research Database (Denmark)

    Helvind, Neel Maria; Eriksen, Jens Ravn; Mogensen, Anders Skibsted

    2013-01-01

    BACKGROUND: Robot-assisted laparoscopy has been reported to be a safe and feasible alternative to traditional laparoscopy. The aim of this study was to compare short-term results in patients with colonic cancer who underwent robot-assisted laparoscopic colonic resection (RC) or laparoscopic colonic...... journals. Biochemical markers [C-reactive protein (CRP), hemoglobin, white blood cell count, and thrombocyte count] were recorded before surgery and for the first 3 days after surgery. RESULTS: A total of 101 patients underwent RC and 162 patients underwent LC. There were no significant differences...... in the rate of conversion to open surgery, number of permanent enterostomies, number of intraoperative complications, level of postoperative cellular stress response, number of postoperative complications, length of postoperative hospital stay, or 30-day mortality between the two groups...

  12. Robot-assisted laparoscopic partial nephrectomy: Current review of the technique and literature

    Directory of Open Access Journals (Sweden)

    Singh Iqbal

    2009-01-01

    Full Text Available Aim: To visit the operative technique and to review the current published English literature on the technique, and outcomes following robot-assisted laparoscopic partial nephrectomy (RPN. Materials and Methods: We searched the published English literature and the PubMed (TM for published series of ′robotic partial nephrectomy′ (RPN using the keywords; robot, robot-assisted laparoscopic partial nephrectomy, laparoscopic partial nephrectomy, partial nephrectomy and laparoscopic surgery. Results: The search yielded 15 major selected series of ′robotic partial nephrectomy′; these were reviewed, tracked and analysed in order to determine the current status and role of RPN in the management of early renal neoplasm(s, as a minimally invasive surgical alternative to open partial nephrectomy. A review of the initial peri-operative outcome of the 350 cases of select series of RPN reported in published English literature revealed a mean operating time, warm ischemia time, estimated blood loss and hospital stay, of 191 minutes, 25 minutes, 162 ml and 2.95 days, respectively. The overall computed mean complication rate of RPN in the present select series was about 7.4%. Conclusions: RPN is a safe, feasible and effective minimally invasive surgical alternative to laparoscopic partial nephrectomy for early stage (T 1 renal neoplasm(s. It has acceptable initial renal functional outcomes without the increased risk of major complications in experienced hands. Prospective randomised, controlled, comparative clinical trials with laparoscopic partial nephrectomy (LPN are the need of the day. While the initial oncological outcomes of RPN appear to be favourable, long-term data is awaited.

  13. Use of near infrared fluorescence during robot-assisted laparoscopic partial nephrectomy.

    Science.gov (United States)

    Cornejo-Dávila, V; Nazmy, M; Kella, N; Palmeros-Rodríguez, M A; Morales-Montor, J G; Pacheco-Gahbler, C

    2016-04-01

    Partial nephrectomy is the treatment of choice for T1a tumours. The open approach is still the standard method. Robot-assisted laparoscopic surgery offers advantages that are applicable to partial nephrectomy, such as the use of the Firefly® system with near-infrared fluorescence. To demonstrate the implementation of fluorescence in nephron-sparing surgery. This case concerned a 37-year-old female smoker, with obesity. The patient had a right kidney tumour measuring 31 mm, which was found using tomography. She therefore underwent robot-assisted laparoscopic partial nephrectomy, with a warm ischaemia time of 22 minutes and the use of fluorescence with the Firefly® system to guide the resection. There were no complications. The tumour was a pT1aN0M0 renal cell carcinoma, with negative margins. Robot-assisted renal laparoscopic surgery is employed for nephron-sparing surgery, with good oncological and functional results. The combination of the Firefly® technology and intraoperative ultrasound can more accurately delimit the extent of the lesion, increase the negative margins and decrease the ischaemia time. Near-infrared fluorescence in robot-assisted partial nephrectomy is useful for guiding the tumour resection and can potentially improve the oncological and functional results. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Human capital gains associated with robotic assisted laparoscopic pyeloplasty in children compared to open pyeloplasty.

    Science.gov (United States)

    Behan, James W; Kim, Steve S; Dorey, Frederick; De Filippo, Roger E; Chang, Andy Y; Hardy, Brian E; Koh, Chester J

    2011-10-01

    Robotic assisted laparoscopic pyeloplasty is an emerging, minimally invasive alternative to open pyeloplasty in children for ureteropelvic junction obstruction. The procedure is associated with smaller incisions and shorter hospital stays. To our knowledge previous outcome analyses have not included human capital calculations, especially regarding loss of parental workdays. We compared perioperative factors in patients who underwent robotic assisted laparoscopic and open pyeloplasty at a single institution, especially in regard to human capital changes, in an institutional cost analysis. A total of 44 patients 2 years old or older from a single institution underwent robotic assisted (37) or open (7) pyeloplasty from 2008 to 2010. We retrospectively reviewed the charts to collect demographic and perioperative data. The human capital approach was used to calculate parental productivity losses. Patients who underwent robotic assisted laparoscopic pyeloplasty had a significantly shorter average hospital length of stay (1.6 vs 2.8 days, p human capital gains, eg decreased lost parental wages, and lower hospitalization expenses. Future comparative outcome analyses in children should include financial factors such as human capital loss, which can be especially important for families with young children. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  15. Robot-assisted total laparoscopic hysterectomy in obese and morbidly obese women.

    Science.gov (United States)

    Rebeles, Sonia A; Muntz, Howard G; Wieneke-Broghammer, Carrie; Vason, Emily S; McGonigle, Kathryn F

    2009-10-01

    Total laparoscopic hysterectomy (TLH) in obese patients is challenging. We sought to evaluate whether total laparoscopic hysterectomies using the da Vinci robotic system in obese patients, in comparison with non-obese patients, is a reasonable surgical approach. One-hundred consecutive robot-assisted TLHs were performed over a 17-month period. Obesity was not a contraindication to robotic surgery, assuming adequate respiratory function to tolerate Trendelenburg position and, for cancer cases, a small enough uterus to allow vaginal extraction without morcellation. Data were prospectively collected on patient characteristics, total operative time, hysterectomy time, estimated blood loss, length of stay, and complications. Outcomes with non-obese and obese women were compared. The median age, weight, and BMI of the 100 patients who underwent robot-assisted TLH was 57.6 years (30.0-90.6), 82.1 kg (51.9-159.6), and 30.2 kg/m(2) (19.3-60.2), respectively. Fifty (50%) patients were obese (BMI ≥ 30); 22 patients were morbidly obese (BMI ≥ 40). There was no increase in complications (p = 0.56) or blood loss (p = 0.44) with increasing BMI. While increased BMI was associated with longer operative times (p = 0.05), median time increased by only 36 min when comparing non-obese and morbidly obese patients. Median length of stay was one day for all weight categories (p = 0.42). Robot-assisted TLH is feasible and can be safely performed in obese patients. More data are needed to compare robot-assisted TLH with other hysterectomy techniques in obese patients. Nonetheless, our results are encouraging. Robot-assisted total laparoscopic hysterectomy may be the preferred technique for appropriately selected obese patients.

  16. Robotic-assisted laparoscopic partial nephrectomy: initial experience in Brazil and a review of the literature

    Directory of Open Access Journals (Sweden)

    Carlo Camargo Passerotti

    2012-02-01

    Full Text Available CONTEXT AND PURPOSE: Partial nephrectomy has become the standard of care for renal tumors less than 4 cm in diameter. Controversy still exists, however, regarding the best surgical approach, especially when minimally invasive techniques are taken into account. Robotic-assisted laparoscopic partial nephrectomy (RALPN has emerged as a promising technique that helps surgeons achieve the standards of open partial nephrectomy care while offering a minimally invasive approach. The objective of the present study was to describe our initial experience with robotic-assisted laparoscopic partial nephrectomy and extensively review the pertinent literature. MATERIALS AND METHODS: Between August 2009 and February 2010, eight consecutive selected patients with contrast enhancing renal masses observed by CT were submitted to RALPN in a private institution. In addition, we collected information on the patients' demographics, preoperative tumor characteristics and detailed operative, postoperative and pathological data. In addition, a PubMed search was performed to provide an extensive review of the robotic-assisted laparoscopic partial nephrectomy literature. RESULTS: Seven patients had RALPN on the left or right sides with no intraoperative complications. One patient was electively converted to a robotic-assisted radical nephrectomy. The operative time ranged from 120 to 300 min, estimated blood loss (EBL ranged from 75 to 400 mL and, in five cases, the warm ischemia time (WIT ranged from 18 to 32 min. Two patients did not require any clamping. Overall, no transfusions were necessary, and there were no intraoperative complications or adverse postoperative clinical events. All margins were negative, and all patients were disease-free at the 6-month follow-up. CONCLUSIONS: Robotic-assisted laparoscopic partial nephrectomy is a feasible and safe approach to small renal cortical masses.Further prospective studies are needed to compare open partial nephrectomy with

  17. Robot-assisted gastrectomy for early gastric cancer: is it beneficial in viscerally obese patients compared to laparoscopic gastrectomy?

    Science.gov (United States)

    Park, Ji Yeon; Ryu, Keun Won; Reim, Daniel; Eom, Bang Wool; Yoon, Hong Man; Rho, Ji Yoon; Choi, Il Ju; Kim, Young-Woo

    2015-07-01

    The adoption of robotic systems for gastric cancer surgery has been proven feasible and safe; however, a benefit over the laparoscopic approach has not yet been well-documented. We aimed to investigate the surgical outcomes of robotic versus laparoscopic gastrectomy for gastric cancer, according to the extent of surgery and patients' obesity status. Between January 2009 and July 2011, 770 patients were enrolled in this retrospective analysis. All had stage IA/IB gastric cancer preoperatively and underwent either laparoscopic (n = 622) or robotic (n = 148) gastrectomy. Patients were classified into obese and non-obese groups on the basis of visceral fat area (VFA). The extent of surgery was defined by whether patients underwent distal or total gastrectomy. The surgical outcomes following distal gastrectomy were similar between the robotic and laparoscopic groups regardless of the obesity status. After total gastrectomy, the number of total and N2-area lymph nodes were significantly higher in the robotic group than in the laparoscopic group in non-obese patients with VFA obese population. Robotic group developed less severe complications after total gastrectomy compared to laparoscopic group in non-obese patients (p = 0.036). Robotic assistance did not improve surgical outcomes over the laparoscopic approach in obese patients undergoing distal gastrectomy. However, non-obese patients with low VFA may benefit from robotic assistance during total gastrectomy in terms of radical D2 lymphadenectomy with fewer serious complications.

  18. Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes

    Directory of Open Access Journals (Sweden)

    Adrian Treiyer

    2012-06-01

    Full Text Available PURPOSE:Our first 91 consecutive cases undergoing a robotic assisted cystectomy were analyzed regarding perioperative outcomes, pathological stages and surgical complications. MATERIALS AND METHODS: Between 2007 and 2010 a total of 91 patients (76 male and 15 female, 86 with clinically localized bladder cancer and 5 with non-urothelial tumors underwent a radical robotic assisted cystectomy. We analyzed the perioperative factors, length of hospital stay, pathological outcomes and complication rates. RESULTS: Mean age was 65.6 years (range 28 to 82. Among the 91 patients, 68 were submitted to an ileal conduit and 23 to a neobladder procedure for urinary diversion. Mean operating time was 412 min (range: 243-618 min. and mean blood loss was 294 mL (range: 50-2000 mL. In 29% of the cases with urothelial carcinoma the T-stage was pT1 or less, 38% were pT2; 26% and 7% were classified as pT3 and pT4, respectively. 14% of cases had lymph node positive disease. Mean number of lymph nodes removed was 15 (range 4 to 33. Positive surgical margins occurred in 2 cases (2.1%. Mean days to flatus were 2.13, bowel movement 2.88 and inpatient stay 18.8 (range: 10-33. There were 45 postoperative complications with 11% major (Clavien grade 3 or higher. At a mean follow-up of 15 months 10 patients had disease recurrence and 6 died of the disease. CONCLUSIONS: Our experience demonstrates that robotic assisted radical cystectomies for the treatment of bladder cancers seems to be very promising regarding surgical and oncological outcomes.

  19. Management of pelvic lymphoceles following robot-assisted laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Omer A Raheem

    2012-01-01

    Full Text Available Pelvic lymphocele is a potential complication of radical prostatectomy. Although lymphoceles often regress spontaneously, many may progress, precipitate clinical symptoms, and ultimately require intervention. To date, the best treatment of pelvic lymphoceles has not yet been fully defined. However, laparoscopic marsupialization is a definitive and efficacious surgical alternative to percutaneous drainage. It is effective, results in minimal patient morbidity, and allows for rapid recovery. We report our experience with management of clinically symptomatic pelvic lymphoceles following robotic-assisted prostatectomy using laparoscopic marsupialization.

  20. Complex cystine kidney stones treated with combined robot-assisted laparoscopic pyelolithotomy and intraoperative renoscopy.

    Science.gov (United States)

    Meggiato, Luca; Cattaneo, Francesco; Zattoni, Fabio; Dal Moro, Fabrizio; Beltrami, Paolo; Zattoni, Filiberto

    2017-02-18

    Cystinuria, a rare autosomal recessive disease characterized by a defect in cystine renal reabsorption, can often determine complex cystine renal calculi, leading to important complications such as urinary obstruction, urinary infections, and impaired kidney function. Complex kidney stones can have a difficult management and can be very arduous to treat. We present the case of a 20-year-old Jeowah's witness woman with complex cystine renal stones treated with combined robot-assisted laparoscopic pyelolithotomy and intraoperative renoscopy. The combination of robot-assisted laparoscopic pyelolithotomy and intraoperative renoscopy can be useful to achieve an immediate high stone clearance rate also in complex renal stones. This combined technique could be indicated to minimize intraoperative bleeding. Moreover, it can also be used in pediatric cases or when there is no ureteral compliance. However, this strategy can be performed only in hospital referral centers by expert surgeons.

  1. Robot assisted laparoscopic radical prostatectomy: assistant's seniority has no influence on perioperative course.

    Science.gov (United States)

    Abu-Ghanem, Yasmin; Erlich, Tomer; Ramon, Jacob; Dotan, Zohar; Zilberman, Dorit E

    2016-11-09

    An experienced surgical team, in general, and the surgeon assistant in particular are believed to play a critical role in the operation's safety and success. We sought to explore whether the assistant's seniority influences perioperative course following robot assisted laparoscopic radical prostatectomy (RALP). We reviewed our prospective registry database of RALP cases performed by a single surgeon who during the study period was beyond his learning curve. The following parameters were documented and analyzed: patient's age, body mass index (BMI), associated comorbidities, previous abdominal surgeries, assistant's identity, total and skin-to-skin operative time (tOT, ssOT, respectively), estimated blood loss (EBL), immediate post-operative complications, length of stay (LOS), and prostate weight per final pathology report. Univariate analysis and Spearman's correlation test were used to evaluate whether the assistant's seniority influenced perioperative course. Between the years 2011-2015, 106 consecutive cases were retrieved and analyzed. Prostate weight was found to be associated with longer tOT (Spearman's ρ = 0.34, p < 0.001), ssOT (0.3, p < 0.01) and increased EBL (0.28, p < 0.01). Patient's age, BMI, associated comorbidities, and previous abdominal surgeries were found to have no influence on neither tOT, ssOT nor EBL. Three assistants' subgroups were identified (seniors, PGY 1-3, PGY 4-6). The assistant's seniority was found to have no influence on tOT, ssOT, EBL, immediate post-operative complications and LOS. Same results were obtained following prostate size adjustments. The assistant's seniority has no influence on perioperative course following RALP. Consequently, given a highly experienced primary surgeon, a less experienced assistant can be safely incorporated into this procedure.

  2. Robot-assisted Versus Laparoscopic Surgery for Rectal Cancer: A Phase II Open Label Prospective Randomized Controlled Trial.

    Science.gov (United States)

    Kim, Min Jung; Park, Sung Chan; Park, Ji Won; Chang, Hee Jin; Kim, Dae Yong; Nam, Byung-Ho; Sohn, Dae Kyung; Oh, Jae Hwan

    2017-05-25

    The phase II randomized controlled trial aimed to compare the outcomes of robot-assisted surgery with those of laparoscopic surgery in the patients with rectal cancer. The feasibility of robot-assisted surgery over laparoscopic surgery for rectal cancer has not been established yet. Between February 21, 2012 and March 11, 2015, patients with rectal cancer (cT1-3NxM0) were enrolled. Patients were randomized 1:1 to either robot-assisted or laparoscopic surgery, and stratified per sex and administration of preoperative chemoradiotherapy. The primary outcome was the quality of total mesorectal excision (TME) specimen. Secondary outcomes were the circumferential and distal resection margins, the number of harvested lymph nodes, morbidity, bowel function recovery, and quality of life. A total of 163 patients were randomly assigned to the robot-assisted (n = 81) and laparoscopic (n = 82) surgery groups, and 139 patients were eligible for the analyses (73 vs 66, respectively). One patient (1.2%) in the robot-assisted group was converted to open surgery. The TME quality did not differ between the robot-assisted and laparoscopic groups (80.3% vs 78.1% complete TME, respectively; 18.2% vs 21.9% nearly complete TME, respectively; P = 0.599). The resection margins, number of harvested lymph nodes, morbidity, and bowel function recovery also were not significantly different. On analyzing quality of life, scores of the European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ C30) and EORTC QLQ CR38 were similar in the 2 groups, but in the EORTC QLQ CR 38 questionnaire, sexual function 12 months postoperatively was better in the robot-assisted group than in the laparoscopic group (P = 0.03). Robot-assisted surgery in rectal cancer showed TME quality comparable with that of laparoscopic surgery, and it demonstrated similar postoperative morbidity, bowel function recovery, and quality of life.

  3. Robot-assisted laparoscopic pyeloplasty: minimum 1-year follow-up

    Science.gov (United States)

    Patel, Vipul; Thaly, Rahul; Shah, Ketul

    2007-02-01

    Objectives: To evaluate the feasibility and efficacy of robotic-assisted laparoscopic pyeloplasty. Laparoscopic pyeloplasty has been shown to have a success rate comparable to that of the open surgical approach. However, the steep learning curve has hindered its acceptance into mainstream urologic practice. The introduction of robotic assistance provides advantages that have the potential to facilitate precise dissection and intracorporeal suturing. Methods: A total of 50 patients underwent robotic-assisted laparoscopic dismembered pyeloplasty. A four-trocar technique was used. Most patients were discharged home on day 1, with stent removal at 3 weeks. Patency of the ureteropelvic junction was assessed in all patients with mercaptotriglycylglycine Lasix renograms at 1, 3, 6, 9, and 12 months, then every 6 months for 1 year, and then yearly. Results: Each patient underwent a successful procedure without open conversion or transfusion. The average estimated blood loss was 40 ml. The operative time averaged 122 minutes (range 60 to 330) overall. Crossing vessels were present in 30% of the patients and were preserved in all cases. The time for the anastomosis averaged 20 minutes (range 10 to 100). Intraoperatively, no complications occurred. Postoperatively, the average hospital stay was 1.1 days. The stents were removed at an average of 20 days (range 14 to 28) postoperatively. The average follow-up was 11.7 months; at the last follow-up visit, each patient was doing well. Of the 50 patients, 48 underwent one or more renograms, demonstrating stable renal function, improved drainage, and no evidence of recurrent obstruction. Conclusions: Robotic-assisted laparoscopic pyeloplasty is a feasible technique for ureteropelvic junction reconstruction. The procedure provides a minimally invasive alternative with good short-term results.

  4. Learning Curve Analysis of Different Stages of Robotic-Assisted Laparoscopic Hysterectomy

    Science.gov (United States)

    Tang, Feng-Hsiang

    2017-01-01

    Objective. To analyze the learning curves of the different stages of robotic-assisted laparoscopic hysterectomy. Design. Retrospective analysis. Design Classification. Canadian Task Force classification II-2. Setting. Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Patient Intervention. Women receiving robotic-assisted total and subtotal laparoscopic hysterectomies for benign conditions from May 1, 2013, to August 31, 2015. Measurements and Main Results. The mean age, body mass index (BMI), and uterine weight were 46.44 ± 5.31 years, 23.97 ± 4.75 kg/m2, and 435.48 ± 250.62 g, respectively. The most rapid learning curve was obtained for the main surgery console stage; eight experiences were required to achieve duration stability, and the time spent in this stage did not violate the control rules. The docking stage required 14 experiences to achieve duration stability, and the suture stage was the most difficult to master, requiring 26 experiences. BMI did not considerably affect the duration of the three stages. The uterine weight and the presence of adhesion did not substantially affect the main surgery console time. Conclusion. Different stages of robotic-assisted laparoscopic hysterectomy have different learning curves. The main surgery console stage has the most rapid learning curve, whereas the suture stage has the slowest learning curve. PMID:28373977

  5. The Experience of Robotic-Assisted Laparoscopic Hysterectomy for Women Treated for Early-Stage Endometrial Cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Palle, Connie; Moeller, Ann M

    2016-01-01

    BACKGROUND: An increasing number of women are offered robotic-assisted laparoscopic hysterectomy as treatment for early-stage endometrial cancer in the developed world. OBJECTIVE: The aim of this study was to explore how women diagnosed with early-stage endometrial cancer experienced robotic......-assisted laparoscopic hysterectomy. METHODS: Semistructured interviews were carried out with 12 women, and interview data were analyzed by qualitative content analysis. RESULTS: Four overarching themes emerged: "surgery was a piece of cake," "recovering physically after surgery," "going from being off guard to being...... on guard," and "preparing oneself by seeking information." The women had confidence in the robotic technique and experienced fast recovery after robotic-assisted laparoscopic hysterectomy; however, they had uncertainties and unanswered questions concerning the postoperative course. Shortly after discharge...

  6. Technological advances in robotic-assisted laparoscopic surgery.

    Science.gov (United States)

    Tan, Gerald Y; Goel, Raj K; Kaouk, Jihad H; Tewari, Ashutosh K

    2009-05-01

    In this article, the authors describe the evolution of urologic robotic systems and the current state-of-the-art features and existing limitations of the da Vinci S HD System (Intuitive Surgical, Inc.). They then review promising innovations in scaling down the footprint of robotic platforms, the early experience with mobile miniaturized in vivo robots, advances in endoscopic navigation systems using augmented reality technologies and tracking devices, the emergence of technologies for robotic natural orifice transluminal endoscopic surgery and single-port surgery, advances in flexible robotics and haptics, the development of new virtual reality simulator training platforms compatible with the existing da Vinci system, and recent experiences with remote robotic surgery and telestration.

  7. Robot-assisted laparoscopic hiatal hernia and antireflux surgery

    NARCIS (Netherlands)

    Tolboom, R. C.; Broeders, I. A M J; Draaisma, W. A.

    2015-01-01

    Gastroesophageal reflux disease is a common disorder of the GE-junction that allows gastric acid to enter the esophagus. Surgery is indicated when the presence of the disease is objectively documented. The laparoscopic Toupet fundoplication is the preferred treatment of GERD. There is no clear advan

  8. Robot-assisted laparoscopic hiatal hernia and antireflux surgery

    NARCIS (Netherlands)

    Tolboom, R. C.; Broeders, I. A M J; Draaisma, W. A.

    2015-01-01

    Gastroesophageal reflux disease is a common disorder of the GE-junction that allows gastric acid to enter the esophagus. Surgery is indicated when the presence of the disease is objectively documented. The laparoscopic Toupet fundoplication is the preferred treatment of GERD. There is no clear

  9. Early Experience with Robot-assisted Laparoscopic Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Hong Gee Sim

    2004-10-01

    Conclusions: rLRP is feasible in a practice with a low volume of radical prostatectomies. Significant improvement in perioperative parameters occurs after the first eight cases. This technique confers the benefits of enhanced precision and dexterity for complex laparoscopic work in the pelvic cavity.

  10. Robot-assisted Laparoscopic Augmentation Ileocystoplasty and Mitrofanoff Appendicovesicostomy in Children: Updated Interim Results.

    Science.gov (United States)

    Murthy, Prithvi; Cohn, Joshua A; Selig, Ryan B; Gundeti, Mohan S

    2015-12-01

    Robot-assisted laparoscopic augmentation ileocystoplasty with Mitrofanoff appendicovesicostomy (RALIMA) may protect the upper urinary tract and reestablish continence in patients with refractory neurogenic bladder. Robotic assistance can provide the benefits of minimally invasive surgery without the steep learning curve of pure laparoscopy. To highlight the interim outcomes of RALIMA with salient tips and technical modifications through comparison with patients undergoing open augmentation ileocystoplasty (OAI). A retrospective chart review of 17 patients undergoing robot-assisted laparoscopic augmentation ileocystoplasty (RALI) and 13 patients undergoing OAI by a single surgeon at an academic center from 2008 to 2012 (OAI) or 2014 (RALI). RALI and all concomitant procedures were performed completely intracorporeally using the da Vinci surgical system (Intuitive Surgical, Inc., Sunnyvale, CA, USA). Outcomes of interest included change in bladder capacity, operative time, pain medication use, hospitalization time, and perioperative complication rates. Of 17 patients selected, 15 successfully underwent RALI. Overall, 11, 6, and 4 patients had a concomitant Mitrofanoff appendicovesicostomy, antegrade colonic enema channel, and bladder neck closure, respectively. The median operative time was significantly longer in RALI (623 vs 287 min; p8 d; p=0.01). The postoperative percentage increase in bladder capacity, narcotic use, and complication rates did not differ between RALI and OAI. Limitations include the retrospective study design and the small cohort of patients. RALI appears to offer functional outcomes similar to OAI. Although it is a significantly longer procedure, it may decrease LOS and avoid epidural use. Further refinements may reduce operative time. In this report, we examined outcomes after robotic bladder augmentation surgery in children. We found that the robotic approach may eliminate epidural analgesia use and decrease hospitalization time after surgery

  11. Robotic-assisted laparoscopic excision of gossypiboma simulating bladder wall mass after 35 years of appendectomy

    Directory of Open Access Journals (Sweden)

    Emad Sabri Rajih

    2014-01-01

    Full Text Available Gossypiboma or textiloma are terms commonly used to describe a retained sponge in the body that is composed of sponge invested within a layer of foreign body reaction in the form of an abscess or an aseptic fibrotic reaction. These cases are rarely reported despite an incidence of 1:1,000-1,500 of abdominal or pelvic surgery. We report a patient who presented with an incidental supravesical mass discovered upon work up for frequency and suprapubic pain. He had appendectomy 35 years ago. The mass was excised by robotic-assisted laparoscopic technique. The pathologic evaluation came as gossypiboma.

  12. Perioperative Systemic Inflammatory Response following Robot-Assisted Laparoscopic Cystectomy vs. Open Mini-Laparotomy Cystectomy

    DEFF Research Database (Denmark)

    Skjold Kingo, Pernille; Palmfeldt, Johan; Nørregaard, Rikke

    2017-01-01

    INTRODUCTION: Surgeries, such as radical cystectomy (RC), induce a systemic inflammatory response (SIR). SIR plays an important role in controlling the human immune system. This study aims at comparing the SIR in robot-assisted laparoscopic cystectomy (RALC) to open mini-laparotomy cystectomy (OMC...... with intracorporeal UD (RALC-IUD; n = 9) was performed. Blood samples were obtained preoperatively (PREOP), immediately after surgery (POD0), 24 (POD1) and 48 h (POD2) postoperatively. Clinical parameters were collected from medical records. RESULTS: Estimated blood loss and blood transfusion volume was higher in OMC...

  13. Ability to Reach Orgasm in Patients with Prostate Cancer Treated with Robot-assisted Laparoscopic Prostatectomy

    DEFF Research Database (Denmark)

    Østby-Deglum, Marie; Axcrona, K; Brennhovd, B.

    2016-01-01

    Objectives To study the ability to reach orgasm after robot-assisted laparoscopic prostatectomy (RALP) in relation to demographic, cancer-related, and surgical variables, and the use of erectile aids. Methods In this cross-sectional study at a mean of 3 years after RALP at Oslo University Hospital...... used erectile aids had significantly better orgasmic ability than the nonusers. Conclusion In our sample, 27% had good ability to reach orgasm at a mean of 3 years after RALP. Poor orgasmic ability was associated with being older, poor erectile function, and a reduced physical quality of life. Using...

  14. Systematic review of open versus laparoscopic versus robot-assisted nephroureterectomy.

    Science.gov (United States)

    Mullen, Emma; Ahmed, Kamran; Challacombe, Ben

    2017-01-01

    Upper tract urothelial carcinoma is a relatively uncommon malignancy. The gold standard treatment for this type of neoplasm is an open radical nephroureterectomy with excision of the bladder cuff. This systematic review compares the perioperative and oncologic outcomes for the open surgical method with the alternative surgical management options of laparoscopic nephroureterectomy and robot-assisted nephroureterectomy (RANU). MEDLINE, EMBASE, PubMed, and Cochrane Library databases were searched using a sensitive search strategy. Article inclusion was then assessed by review of abstracts and full papers were read if more detail was required. In all, 50 eligible studies were identified that looked at perioperative and oncologic outcomes. The range for estimated blood loss when examining observational studies was 296 to 696 mL for open nephroureterectomy (ONU), 130 to 479 mL for laparoscopic nephroureterectomy (LNU), and 50 to 248 mL for RANU. The one randomized controlled trial identified reported estimated blood loss and length of stay results in which LNU was shown to be superior to ONU (P ONU with regard to oncologic outcomes. Results show that laparoscopic techniques are superior to ONU in perioperative results, and the longer-term oncologic outcomes look comparable. There is, however, a paucity of quality evidence regarding ONU, LNU, and RANU; data that address RANU outcomes are particularly scarce. As the robotic field within urology advances, it is hoped that this technique will be investigated further using gold standard research methods.

  15. Comparison of functional outcomes with purely laparoscopic sacrocolpopexy and robot-assisted sacrocolpopexy in obese women.

    Science.gov (United States)

    Joubert, M; Thubert, T; Lefranc, J-P; Vaessen, C; Chartier-Kastler, É; Deffieux, X; Rouprêt, M

    2014-12-01

    To compare the functional outcomes and complication rates following laparoscopic sacrocolpopexy (LS) with those occurring in robot-assisted laparoscopic sacrocolpopexy (RALSCP) in obese women. A comparative retrospective multicentre study was made, involving 39 obese women (BMI≥30 kg/m2) who underwent LS, and 17 obese women who underwent RASCLP. The operative parameters (length of operation, associated procedures, complication rate and length of hospitalization) and the objective and subjective results were evaluated at 12 months follow-up. The median (IQR) BMI was 30.5 kg/m2 (30-32) in the LS group vs 31.6 kg/m2 (30-34) in the RALSCP group (P=0.402). The anatomical results were comparable in both groups (LS vs RALSCP): post-operative stage of prolapse (POP-Q-ICS): stage 0-1: 34/39 (88%) vs 16/17 (94.1%), P=0.7; stage 2: 4/39 (10%) vs 0/17 (0%), P=0.7; stage 3-4: 1/39 (2%) vs 1/17 (5.9%), P=0.7. The complication rate was similar in both groups (LS vs RALSCP): bladder injury 2.5% (1/39) vs 0% (0/17), P=0.6, laparoconversion 5.1% (2/39) vs 5.9% (1/17), P=0.5. The overall reoperation rate was (LS vs RALSCP): 18% (7/39) vs 5.9% (1/17), P=0.4. Laparoscopic sacrocolpopexy and robot-assisted laparoscopic sacrocolpopexy have equal results in obese women. The complication rates and outcomes appear to be similar in both groups of obese women. 3. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  16. Total intravenous anaesthesia versus inhalational anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic surgery.

    Science.gov (United States)

    Herling, Suzanne Forsyth; Dreijer, Bjørn; Wrist Lam, Gitte; Thomsen, Thordis; Møller, Ann Merete

    2017-04-04

    Rapid implementation of robotic transabdominal surgery has resulted in the need for re-evaluation of the most suitable form of anaesthesia. The overall objective of anaesthesia is to minimize perioperative risk and discomfort for patients both during and after surgery. Anaesthesia for patients undergoing robotic assisted surgery is different from anaesthesia for patients undergoing open or laparoscopic surgery; new anaesthetic concerns accompany robotic assisted surgery. To assess outcomes related to the choice of total intravenous anaesthesia (TIVA) or inhalational anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic gynaecological, urological or gastroenterological surgery. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016 Issue 5), Ovid MEDLINE (1946 to May 2016), Embase via OvidSP (1982 to May 2016), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCOhost (1982 to May 2016) and the Institute for Scientific Information (ISI) Web of Science (1956 to May 2016). We also searched the International Standard Randomized Controlled Trial Number (ISRCTN) Registry and Clinical trials gov for ongoing trials (May 2016). We searched for randomized controlled trials (RCTs) including adults, aged 18 years and older, of both genders, treated with transabdominal robotic assisted laparoscopic gynaecological, urological or gastroenterological surgery and focusing on outcomes of TIVA or inhalational anaesthesia. We used standard methodological procedures of Cochrane. Study findings were not suitable for meta-analysis. We included three single-centre, two-arm RCTs involving 170 participants. We found one ongoing trial. All included participants were male and were undergoing radical robotic assisted laparoscopic radical prostatectomy (RALRP). The men were between 50 and 75 years of age and met criteria for American Society of Anesthesiologists physical classification scores (ASA) I, ll and III.We found

  17. Robot assisted laparoscopic excision of a paraganglioma: new therapeutic approach

    Directory of Open Access Journals (Sweden)

    G. Cochetti

    2014-04-01

    Full Text Available The Paraganglioma is the most common extra-adrenal pheochromocytoma arising from neural crest (1 (It will better to write: The paraganglioma is an extra-adrenal pheocromocytoma arising from the neural crest. 10% of pheocromocytomas are extra-adrenal and can arise form chromaffin tissue derived from primitive neuroectoderm. Minimally invasive techniques allow surgeons to perform the procedure without wide exposure and mobilization of intra abdominal organs. To our knowledge we present the third case of robotic excision of a retroperitoneal paraganglioma (2,3.

  18. Robotic-assisted laparoscopic hysterectomy seems safe in women with early-stage endometrial cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Havemann, Maria Cecilie; Palle, Connie

    2015-01-01

    INTRODUCTION: Robotic surgery is increasingly used in the management of endometrial cancer; and although it is known that minimally invasive surgery reduces post-operative morbidity, the outcomes of this novel treatment should be monitored carefully. The aim of this study was to examine...... the incidence of complications according to the Clavien-Dindo scale after robotic-assisted laparoscopic hysterectomy (RALH) for early-stage endometrial cancer and atypical complex hyperplasia. The Clavien-Dindo scale grades the severity of complications. METHODS: This was a retrospective, descriptive cohort...... study of 235 women with endometrial cancer or atypical complex hyperplasia who had RALH. Surgeries were stratified into two groups: with or without pelvic lymphadenectomy. RESULTS: A total of 6% developed a grade 3 or higher complication with no significant difference (p = 0.24) between the groups...

  19. Robot assisted laparoscopic pyeloplasty in obese and non-obese patients.

    Science.gov (United States)

    Lindgren, Bruce W; Frainey, Brendan T; Cheng, Earl Y; Yerkes, Elizabeth B; Gong, Edward M

    2014-12-01

    We assessed whether increased BMI has a negative impact in children undergoing robot assisted laparoscopic pyeloplasty (RALP). Records of patients who underwent RALP were retrospectively reviewed and separated into healthy weight, overweight, and obese cohorts based on age-adjusted BMI percentile, and surgical and postsurgical outcomes were evaluated. Of the 103 patients, there were 79 healthy weight and 24 overweight, with 10 of the 24 considered obese (BMIobese cohorts, respectively. Complication rates were similar in regard to minor and major complications. There was no difference in decreased hydronephrosis (92.2%, 89.6%, p=0.440; 88.9%, p=0.730). Four patients (3.4%) required a reoperative procedure (three healthy weight, one overweight; p=NS). Despite the potential difficulties with surgery in overweight patients, our data indicate that robot-assisted laparoscopic pyeloplasty can be performed as safely and effectively in overweight or obese children as in healthy weight children. Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  20. Robotic-assisted laparoscopic radical prostatectomy: initial 15 cases in Japan.

    Science.gov (United States)

    Yoshioka, K; Hatano, T; Nakagami, Y; Ozu, C; Horiguchi, Y; Yonou, H; Tachibana, M; Coughlin, G; Patel, V R

    2008-07-01

    Recently, we have introduced robotic-assisted laparoscopic radical prostatectomy (RALP) in Japan. This article describes the details of a training program to shorten the learning curve in the absence of an urologist with expertise in robotic surgery. Five months after a 2-day training course of robotic surgery, RALP was first performed in Japan, and a total of 15 cases were performed in the subsequent 4 months. Our training program consisted of: (1) image training using surgical operation videos, (2) dry lab training using a sham pelvic cavity model, and (3) intraoperative mentoring. The operative procedure was divided into five consecutive stages, and time required to complete each stage was recorded. Robotic radical prostatectomy was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-h operation had been imposed by the ethics committee. The mean console time and the mean intraoperative blood loss (including urine) reduced from 264.2 min and 459.4 ml, respectively, in the first 11 cases, to 151 min and 133.3 ml, respectively, in the last three cases. With direct intraoperative guidance by the mentor during cases 13 and 14, the operation time was reduced at all five stages of the operative procedure. Our training program proved remarkably effective in reducing the learning curve of RALP in Japan, where there is no person with expertise in robotic surgery.

  1. [Robotic assisted laparoscopic colposacropexy in the treatment of pelvic organ prolapse].

    Science.gov (United States)

    Moreno Sierra, Jesús; Galante Romo, Isabel; Ortiz Oshiro, Elena; Núñez Mora, Carlos; Silmi Moyano, Angel

    2007-05-01

    Laparoscopic colposacropexy has become a substitute for open surgery in the treatment of pelvic organ prolapse. In the same way, robotic assisted surgery is a new step in the evolution of the procedure. In this paper we intend to show our surgical technique and preliminary results. From November 2006 to date, 10 patients have undergone this procedure at the Hospital Clinico San Carlos. The main indication for the operation was existence of symptomatic pelvic prolapse. Both patients with or without hysterectomy have been operated, without making significant differences between them. Preoperative evaluation workout included: cystogram, urinary tract ultrasound and urodynamics in all cases; urinary tract MRI was performed only in selected cases. All patients underwent surgery under general anesthesia, with at least three robotic trocars (8 mm) and one conventional trocar for the assistant; 2 accessory trocars were necessary in some cases, mainly at the beginning of the series. Most procedures in our series were associated with a transobturator suburethral sling for the treatment of stress urinary incontinence or prevention of its appearance after prolapse repair. Our results are comparable to those reported in other larger series in terms of operative time, hospital stay and early or late complications. Pending an evaluation on the long term with larger series, we can include robot assisted colposacropexy among the therapeutic options for symptomatic pelvic floor prolapse repair.

  2. Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist?

    Science.gov (United States)

    Tobias-Machado, Marcos; Mitre, Anuar Ibrahim; Rubinstein, Mauricio; da Costa, Eduardo Fernandes; Hidaka, Alexandre Kyoshi

    2016-01-01

    ABSTRACT Background Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience. Materials and Methods Between January 2010 and September 2013, a total of 60 consecutive patients who have undergone RALP were prospectively evaluated and compared to the last 60 cases of LRP. Data included demographic data, operative duration, blood loss, transfusion rate, positive surgical margins, hospital stay, complications and potency and continence rates. Results The mean operative time and blood loss were higher in RALP (236 versus 153 minutes, p<0.001 and 245.6 versus 202ml p<0.001). Potency rates at 6 months were higher in RALP (70% versus 50% p=0.02). Positive surgical margins were also higher in RALP (31.6% versus 12.5%, p=0.01). Continence rates at 6 months were similar (93.3% versus 89.3% p=0.43). Patient’s age, complication rates and length of hospital stay were similar for both groups. Conclusions Experienced laparoscopic surgeons (ELS) present a learning curve for RALP only demonstrated by longer operative time and clinically insignificant blood loss. Our initial results demonstrated similar perioperative and functional outcomes for both approaches. ELS were able to achieve satisfactory oncological and functional results during the learning curve period for RALP. PMID:27136471

  3. Combined laparoscopic abdominoperineal resection and robotic-assisted prostatectomy for synchronous double cancer of the rectum and the prostate.

    Science.gov (United States)

    Kamiyama, Hirohiko; Sakamoto, Kazuhiro; China, Toshiyuki; Aoki, Jun; Niwa, Koichiro; Ishiyama, Shun; Takahashi, Makoto; Kojima, Yutaka; Goto, Michitoshi; Tomiki, Yuichi; Horie, Shigeo

    2016-05-01

    Here we report a combined laparoscopic abdominoperineal resection and robotic-assisted prostatectomy. A 74-year-old man was diagnosed with T4b low rectal and prostate cancer. The operation was performed after neoadjuvant chemotherapy for the rectal cancer. The procedure used eight ports in total, five for laparoscopic abdominoperineal resection and six for robotic-assisted prostatectomy. First, laparoscopic total mesorectal excision including division of the inferior mesenteric artery was performed, and then, robotic dissection of the prostate was performed. The en bloc specimen was removed through the perineal wound. Then, robotic urethrovesical anastomosis was performed. An extraperitoneal end colostomy was created to finish the operation. The operating time was 545 min, and blood loss was 170 mL. The postoperative course was uneventful, and the patient discharged on postoperative day 17. The combined laparoscopic abdominoperineal resection and robotic-assisted prostatectomy were performed safely without any additional technical difficulty, as both procedures shared port settings and patient positions.

  4. Robotically assisted total laparoscopic radical trachelectomy for fertility sparing in stage IB1 adenosarcoma of the cervix.

    Science.gov (United States)

    Geisler, John P; Orr, Curtis J; Manahan, Kelly J

    2008-10-01

    Adenosarcomas are rare cervical tumors with unknown optimal treatment, which often affects young women. A 23-year-old woman was found to have a stage IB1 adenosarcoma of the cervix. She underwent a robotically assisted total laparoscopic radical trachelectomy with the placement of abdominal cerclage for the sparing of fertility.

  5. Intra-operative prostate motion tracking using surface markers for robot-assisted laparoscopic radical prostatectomy

    Science.gov (United States)

    Esteghamatian, Mehdi; Sarkar, Kripasindhu; Pautler, Stephen E.; Chen, Elvis C. S.; Peters, Terry M.

    2012-02-01

    Radical prostatectomy surgery (RP) is the gold standard for treatment of localized prostate cancer (PCa). Recently, emergence of minimally invasive techniques such as Laparoscopic Radical Prostatectomy (LRP) and Robot-Assisted Laparoscopic Radical Prostatectomy (RARP) has improved the outcomes for prostatectomy. However, it remains difficult for the surgeons to make informed decisions regarding resection margins and nerve sparing since the location of the tumor within the organ is not usually visible in a laparoscopic view. While MRI enables visualization of the salient structures and cancer foci, its efficacy in LRP is reduced unless it is fused into a stereoscopic view such that homologous structures overlap. Registration of the MRI image and peri-operative ultrasound image using a tracked probe can potentially be exploited to bring the pre-operative information into alignment with the patient coordinate system during the procedure. While doing so, prostate motion needs to be compensated in real-time to synchronize the stereoscopic view with the pre-operative MRI during the prostatectomy procedure. In this study, a point-based stereoscopic tracking technique is investigated to compensate for rigid prostate motion so that the same motion can be applied to the pre-operative images. This method benefits from stereoscopic tracking of the surface markers implanted over the surface of the prostate phantom. The average target registration error using this approach was 3.25+/-1.43mm.

  6. Robot-assisted laparoscopic versus open partial nephrectomy in patients with chronic kidney disease: A propensity score-matched comparative analysis of surgical outcomes.

    Science.gov (United States)

    Takagi, Toshio; Kondo, Tsunenori; Tachibana, Hidekazu; Iizuka, Junpei; Omae, Kenji; Kobayashi, Hirohito; Yoshida, Kazuhiko; Tanabe, Kazunari

    2017-07-01

    To compare surgical outcomes between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy in patients with chronic kidney disease. Of 550 patients who underwent partial nephrectomy between 2012 and 2015, 163 patients with T1-2 renal tumors who had an estimated glomerular filtration rate between 30 and 60 mL/min/1.73 m(2) , and underwent robot-assisted laparoscopic partial nephrectomy or open partial nephrectomy were retrospectively analyzed. To minimize selection bias between the two surgical methods, patient variables were adjusted by 1:1 propensity score matching. The present study included 75 patients undergoing robot-assisted laparoscopic partial nephrectomy and 88 undergoing open partial nephrectomy. After propensity score matching, 40 patients were included in each operative group. The mean preoperative estimated glomerular filtration rate was 49 mL/min/1.73 m(2) . The mean ischemia time was 21 min in robot-assisted laparoscopic partial nephrectomy (warm ischemia) and 35 min in open partial nephrectomy (cold ischemia). Preservation of the estimated glomerular filtration rate 3-6 months postoperatively was not significantly different between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy (92% vs 91%, P = 0.9348). Estimated blood loss was significantly lower in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (104 vs 185 mL, P = 0.0025). The postoperative length of hospital stay was shorter in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (P robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy provide similar outcomes in terms of functional preservation and perioperative complications among patients with chronic kidney disease. However, a lower estimated blood loss and shorter postoperative length of hospital stay can be obtained with robot-assisted laparoscopic partial

  7. Robotic-assisted laparoscopic hysterectomy: outcomes in obese and morbidly obese patients.

    Science.gov (United States)

    Gallo, Taryn; Kashani, Shabnam; Patel, Divya A; Elsahwi, Karim; Silasi, Dan-Arin; Azodi, Masoud

    2012-01-01

    To describe patient characteristics and perioperative outcomes among women undergoing roboticassisted laparoscopic hysterectomy and to evaluate the characteristics of nonobese, obese, and morbidly obese patients. A retrospective review was conducted of 442 cases of women who underwent robotic-assisted laparoscopic hysterectomy for benign and malignant conditions over a 4-y period at an academic and community teaching hospital. Patient demographics, surgical indications, operative outcomes, and complications were evaluated for patients with a body mass index (BMI) obese or morbidly obese, with a BMI of ≥30 kg/m(2). Overall, the median estimated blood loss was 100 mL (range, 10 to 800), the operative time was 135 min (range, 40 to 436), and the length of stay was 1 d (range, 0 to 22). These did not differ significantly by BMI group. Overall, 11.9% of patients experienced complications (7.9% minor, 4.1% major), and this did not differ significantly across BMI groups. Robotic hysterectomy can be performed safely in obese and morbidly obese patients, with surgical outcomes and complications similar to those in nonobese patients.

  8. Robotic assisted laparoscopic adrenalectomy: Initial experience from a tertiary care centre in India

    Directory of Open Access Journals (Sweden)

    Mrinal Pahwa

    2015-01-01

    Full Text Available Introduction: Laparoscopic adrenalectomy (LA is now considered the standard for treatment of surgically correctable adrenal disorders. Robotic adrenalectomy has been performed worldwide and has established itself as safe, feasible and effective approach. We hereby present the first study in robotic transperitoneal LA from Indian subcontinent. Materials and Methods: We conducted a retrospective evaluation of 25 patients who had undergone robotic assisted LA at a tertiary health centre by a single surgeon. Demographic, clinical, histopathological and perioperative outcome data were collected and analysed. Results: Mean age of the patients was 45 years (range: 27-65 years. Eleven male and 14 female patients were operated. Mean operative time was 139 min ± 30 min (range: 110-232 min and mean blood loss was 85 ml ± 12 ml (range: 34-313 ml. Mean hospital stay was 2.5 ± 1.05 days (range: 2-6 days. Mean visual analogue scale score was 3.2 (range: 1-6 mean analgesic requirement was 50 mg diclofenac daily (range: 0-150 mg. Histopathological evaluation revealed 11 adenomas, eight phaeochromocytomas, two adrenocortical carcinomas, and four myelolipomas. According to Clavien-Dindo classification, three patients developed Grade I post-operative complications namely hypotension and pleural effusion. Conclusion: Robotic adrenalectomy is safe, technically feasible and comfortable to the surgeon. It is easier to perform with a short learning curve.

  9. Perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted gastric sleeve resection

    Directory of Open Access Journals (Sweden)

    Anita Joselyn

    2015-01-01

    Full Text Available Purpose: One of the major advantages for patients undergoing minimally invasive surgery as compared to an open surgical procedure is the improved recovery profile and decreased opioid requirements in the perioperative period. There are no definitive studies comparing the analgesic requirements in patients undergoing two different types of minimally invasive procedure. This study retrospectively compares the perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted, laparoscopic gastric sleeve resection. Materials and Methods: With Institutional Review Board approval, the medication administration records of all severely obese patients who underwent gastric sleeve resection were retrospectively reviewed. Intra-operative analgesic and adjuvant medications administered, postoperative analgesic requirements, and visual analog pain scores were compared between those undergoing a laparoscopic procedure versus a robotic-assisted procedure. Results: This study cohort included a total of 28 patients who underwent gastric sleeve resection surgery with 14 patients in the laparoscopic group and 14 patients in the robotic-assisted group. Intra-operative adjuvant administration of both intravenous acetaminophen and ketorolac was similar in both groups. Patients in the robotic-assisted group required significantly less opioid during the intra-operative period as compared to patients in the laparoscopic group (0.15 ± 0.08 mg/kg vs. 0.19 ± 0.06 mg/kg morphine, P = 0.024. Cumulative opioid requirements for the first 72 postoperative h were similar in both the groups (0.64 ± 0.25 vs. 0.68 ± 0.27 mg/kg morphine, P = NS. No difference was noted in the postoperative pain scores. Conclusion: Although intraoperative opioid administration was lower in the robotic-assisted group, the postoperative opioid requirements, and the postoperative pain scores were similar in both groups.

  10. Robotic-Assisted Laparoscopic “Salvage” Rectopexy for Recurrent Ileoanal J-Pouch Prolapse

    Directory of Open Access Journals (Sweden)

    Madhu Ragupathi

    2010-01-01

    Full Text Available Total restorative proctocolectomy with ileal pouch-anal anastomosis (RP/IPAA has become the standard of care for the surgical treatment of ulcerative colitis. Despite its correlation with an excellent quality of life and favorable long-term outcomes, RP/IPAA has been associated with several complications. Prolapse of the ileoanal pouch is a rare and debilitating complication that should be considered in the differential diagnosis of pouch failure. Limited data exist regarding the prevalence and treatment of pouch prolapse. We present the case of a recurrent J-pouch prolapse treated with a novel minimally invasive “salvage” approach involving a robotic-assisted laparoscopic rectopexy with mesh.

  11. Nerve sparing can preserve orgasmic function in most men after robotic-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Tewari, Ashutosh; Grover, Sonal; Sooriakumaran, Prasanna; Srivastava, Abhishek; Rao, Sandhya; Gupta, Amit; Gray, Robert; Leung, Robert; Paduch, Darius A

    2012-02-01

    •  To investigate orgasmic outcomes in patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) and the effects of age and nerve sparing on these outcomes. •  Between January 2005 and June 2007, 708 patients underwent RALP at our institution. •  We analysed postoperative potency and orgasmic outcomes in the 408 men, of the 708, who were potent, able to achieve orgasm preoperatively and available for follow-up. •  Of men aged ≤60 years, 88.4% (198/224) were able to achieve orgasm postoperatively in comparison to 82.6% (152/184) of older men (P function after RALP. •  Men ≤60 years old and those who undergo BNS are most likely to maintain normal sexual function. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  12. Robotic-assisted laparoscopic hysterectomy seems safe in women with early-stage endometrial cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Havemann, Maria Cecilie; Palle, Connie;

    2015-01-01

    INTRODUCTION: Robotic surgery is increasingly used in the management of endometrial cancer; and although it is known that minimally invasive surgery reduces post-operative morbidity, the outcomes of this novel treatment should be monitored carefully. The aim of this study was to examine the incid......INTRODUCTION: Robotic surgery is increasingly used in the management of endometrial cancer; and although it is known that minimally invasive surgery reduces post-operative morbidity, the outcomes of this novel treatment should be monitored carefully. The aim of this study was to examine...... the incidence of complications according to the Clavien-Dindo scale after robotic-assisted laparoscopic hysterectomy (RALH) for early-stage endometrial cancer and atypical complex hyperplasia. The Clavien-Dindo scale grades the severity of complications. METHODS: This was a retrospective, descriptive cohort....... CONCLUSION: The types and frequency of complications observed in this study resemble those reported in similar studies of RALH for malignant gynaecologic conditions. Health-care professionals treating and caring for women with early-stage endometrial cancer should know of the types and frequency of post...

  13. The natural history of voiding function after robot-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Wang, Lushun; Chung, Stephanie Fook-Chong Man; Yip, Sidney Kam Hung; Lau, Weber Kam On; Cheng, Christopher Wai Sam; Sim, Hong Gee

    2011-01-01

    We report the natural history of voiding function in men with clinically localized prostate cancer after robot-assisted laparoscopic radical prostatectomy (RLRP), describing the trend of functional recovery, which is currently not well described using the robot-assisted laparoscopic approach. We determined the impact on voiding function by prospectively evaluating 100 consecutive men who underwent RLRP between May 2005 and December 2006 and compared their reported International Prostate Symptom Score (IPSS) and Quality of Life (QOL) scores at 3, 6, and 12 months with preoperative scores after surgery. Patients with preoperative IPSS of 0-7 and 8-35 were defined as having mild lower urinary tract symptoms (LUTS) and moderate to severe LUTS, respectively. Continence was achieved in 82%, 87%, and 91% of men at 3, 6, and 12 months after RLRP, respectively. There were statistically and clinically significant improvements in both IPSS and QOL preoperative scores at all studied time points for patients with moderate to severe preexisting LUTS. The mean IPSS scores for these patients preoperatively and at 3, 6, and 12 months after surgery were 14.1, 5.2, 3.0, and 2.9, respectively and the corresponding mean QOL scores were 3.4, 2.1, 1.6, and 1.6, respectively. Patients with mild preexisting LUTS showed no statistically significant improvement in IPSS at 3 and 6 months after surgery but significant improvement was found at 1 year (P = 0.04). Good continence recovery is expected in most patients undergoing RLRP. Patients with moderate to severe preexisting LUTS can expect early and clinically significant symptom and QOL improvements after RLRP. Patients with mild preexisting LUTS show significant symptom improvement at 1 year. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Robotic-assisted Laparoscopic Repair of a Cesarean Section Scar Defect.

    Science.gov (United States)

    Mahmoud, Mohamad S; Nezhat, Farr R

    2015-01-01

    To describe our technique for the repair of a cesarean section uterine scar defect after removal of an ectopic pregnancy from the scar in a patient desiring future pregnancies. Step-by-step explanation of the procedure using video (Canadian Task Force classification III). Uterine scar dehiscence/defect is a known complications of multiple cesarean deliveries that can result in abnormal bleeding, infertility, and cesarean scar ectopic pregnancy. With the increasing number of cesarean sections performed in the United States, the prevalence of this complication is rising. Nonetheless, there currently are no standardized surgical treatment guidelines available to manage this pathology through a minimally invasive approach. In this video, we describe our technique for the surgical management of a symptomatic cesarean section scar defect. We performed a robotic-assisted laparoscopic repair of this defect in a 40-year-old G4P3013 with a recent cesarean section scar ectopic pregnancy managed by endometrial curettage, with subsequent persistent abnormal vaginal bleeding. A repeat ultrasound revealed a low uterine segment defect consistent with dehiscence. She was referred to us because she desired a conservative treatment given her desire for future pregnancies. The defect was localized by hysteroscopy and laparoscopy after developing the bladder flap. The scar tissue around the defect was resected, and the freshened edges of the defect were closed using delayed absorbable suture. Chromopertubation confirmed the watertightness of the repair. Postoperatively, the patient had regular normal periods, and her hysterosalpingogram didn't show any uterine defect. Robotic-assisted laparoscopic repair of cesarean section scar defect is a feasible and safe procedure when done with respect to anatomy and following sound surgical technique. With the increasing number of cesarean sections, gynecologists will be dealing with this pathology more frequently, and need to become more

  15. Uterine sparing robotic-assisted laparoscopic sacrohysteropexy for pelvic organ prolapse: safety and feasibility.

    Science.gov (United States)

    Lee, Ted; Rosenblum, Nirit; Nitti, Victor; Brucker, Benjamin M

    2013-09-01

    The aim of this study was to describe the surgical technique and report the safety and feasibility of robotic-assisted laparoscopic sacrohysteropexy, a uterine sparing procedure to correct pelvic organ prolapse (POP). Hysterectomy at the time of POP surgery has yet to be proven to improve the durability of repair. Nevertheless, the leading indication for hysterectomy in postmenopausal women is POP. We reviewed the medical records of a consecutive case series of uterine sparing prolapse repair procedures from 2005 to 2011. Fifteen women were identified. Procedures utilized a type I polypropylene mesh securing the posterior uterocervical junction to the sacral promontory. This was later modified to utilize a Y-shaped strip that was inserted through the broad ligaments to include the anterior uterocervical junction. Objective success was defined as Baden Walker grade 0 uterine prolapse and subjective success was defined as no complaint of vaginal bulge or pressure. The mean age of women was 51.8 years (28-64 years). No intraoperative complications were noted. The mean operating time was 159.4 minutes (130-201 minutes) and mean estimated blood loss was 35 mL (0-100 mL). The mean length of stay was 1.6 days (1-4 days) and mean length of follow-up was 10.8 months. Uterine prolapse improved in all 15 patients. Objective success was 93% (14/15) and subjective success was 80% (12/15). Robotic-assisted laparoscopic sacrohysteropexy was found to be a safe and feasible surgical treatment option for POP patients who desire uterine preservation.

  16. Laparoscopic and robot-assisted hysterectomy for uterine cancer: a comparison of costs and complications.

    Science.gov (United States)

    Zakhari, Andrew; Czuzoj-Shulman, Nicholas; Spence, Andrea R; Gotlieb, Walter H; Abenhaim, Haim A

    2015-11-01

    Increasingly, robotic surgery is being used for total hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection for uterine cancer. The purpose of this study was to compare the costs and complications among women undergoing robotic and laparoscopic hysterectomy for uterine cancer. We carried out a cohort study using the Nationwide Inpatient Sample (NIS) database between 2008 and 2012 on all women diagnosed with uterine cancer, classifying women as either laparoscopically or robotically treated, excluding laparotomies or vaginal approaches. Logistic regression analyses were used to evaluate the adjusted effect of surgical approach on complication rates. There were 10,347 women who underwent hysterectomies for uterine cancer either laparoscopically (39%) or robotically (61%). The rate of robotic surgery consistently increased over the 5 year period. Women undergoing robotic surgery had more comorbid conditions (diabetes, hypertension, cardiovascular disease, renal disease, obesity or morbid obesity, and pulmonary disease). In adjusted analyses, women undergoing robotic surgery were more likely to have a lymph node dissection (73.01% vs 66.04%; P laparoscopic surgery. The composite endpoint of any complication was similar between both cohorts (20.56% robotic vs 21.00% laparoscopy). In overall and subset analyses, robotic surgery was more costly, with median charges of $38,161.00 compared with $31,476.00 in those undergoing laparoscopic surgery (P < .0001). Despite the considerably greater burden of comorbidities in those undergoing robotic surgery compared with laparoscopy, the former have shorter hospital admissions, a greater rate of lymph node dissection, and similar postoperative morbidity and mortality, albeit at greater total cost. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. The "halo effect" in Korea: change in practice patterns since the introduction of robot-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Sung, Ee-Rah; Jeong, Wooju; Park, Sung Yul; Ham, Won Sik; Choi, Young Deuk; Hong, Sung Joon; Rha, Koon Ho

    2009-03-01

    Acquisition of the da Vinci surgical system (Intuitive Surgical, Mountain View, USA) has enabled robot-assisted surgery to become an acceptable alternative to open radical prostatectomy (ORP). Implementation of robotics at a single institution in Korea induced a gradual increase in the number of performances of robot-assisted laparoscopic radical prostatectomy (RALP) to surgically treat localized prostate cancer. We analyzed the impact of robotic instrumentation on practice patterns among urologists and explain the change in value in ORP and RALP-the standard treatment and the new approach or innovation of robotic technology. The overall number of prostatectomies has increased over time because the number of RALPs has grown drastically whereas the number of OPRs did not decrease during the period of evaluation. Our experience emphasizes the potential of RALP to become the gold standard in the treatment of localized prostate cancer in various parts of the world.

  18. Initial Clinical Experience With Surgical Technique of Robot-assisted Transperitoneal Laparoscopic Partial Nephrectomy

    Directory of Open Access Journals (Sweden)

    Cheng-Kuang Yang

    2009-12-01

    Conclusion: Robot-assisted LPN is feasible and may be a viable alternative to open or LPN in selected patients with small exophytic renal tumors. Compared with standard LPN, the robotic assisted LPN approach with precise renal reconstruction under a safe warm ischemia time is feasible and can be easily adopted by those with experience in robot-assisted surgery.

  19. Robot-assisted laparoscopic radical cystectomy with complete intracorporeal urinary diversion

    Directory of Open Access Journals (Sweden)

    Jason M. Sandberg

    2016-07-01

    Full Text Available Robot-assisted radical cystectomy with intracorporeal urinary diversion (RARC-ICUD has only recently been explored as a viable surgical option for patients with muscle-invasive bladder cancer seeking satisfactory oncologic control while benefiting from minimally invasive surgical techniques. Inspired by earlier open and laparoscopic work, initial descriptions of RARC-ICUD were published in 2003, and have since been followed by multiple larger case series which have suggested promising outcomes for our patients. However, the rate of adoption has remained relatively slow when compared to other robot-assisted procedures such as the radical prostatectomy, likely owing to longer operative times, operative complexity, costs, and uncertainty regarding oncologic efficacy. The operative technique for RARC-ICUD has evolved over the past decade and several high-volume centers have shared tips to improve efficiency and make the operation possible for a growing number of urologists. Though there are still questions regarding economic costs, effectiveness, and generalizability of outcomes reported in published data, a growing dataset has brought us ever closer to the answers. Here, we present our current operative technique for RARC-ICUD and discuss the state of the literature so that the urologist may hold an informed discussion with his or her patients.

  20. Robotic Camera Assistance and Its Benefit in 1033 Traditional Laparoscopic Procedures: Prospective Clinical Trial Using a Joystick-guided Camera Holder.

    Science.gov (United States)

    Holländer, Sebastian W; Klingen, Hans Joachim; Fritz, Marliese; Djalali, Peter; Birk, Dieter

    2014-11-01

    Despite advances in instruments and techniques in laparoscopic surgery, one thing remains uncomfortable: the camera assistance. The aim of this study was to investigate the benefit of a joystick-guided camera holder (SoloAssist®, Aktormed, Barbing, Germany) for laparoscopic surgery and to compare the robotic assistance to human assistance. 1033 consecutive laparoscopic procedures were performed assisted by the SoloAssist®. Failures and aborts were documented and nine surgeons were interviewed by questionnaire regarding their experiences. In 71 of 1033 procedures, robotic assistance was aborted and the procedure was continued manually, mostly because of frequent changes of position, narrow spaces, and adverse angular degrees. One case of short circuit was reported. Emergency stop was necessary in three cases due to uncontrolled movement into the abdominal cavity. Eight of nine surgeons prefer robotic to human assistance, mostly because of a steady image and self-control. The SoloAssist® robot is a reliable system for laparoscopic procedures. Emergency shutdown was necessary in only three cases. Some minor weak spots could have been identified. Most surgeons prefer robotic assistance to human assistance. We feel that the SoloAssist® makes standard laparoscopic surgery more comfortable and further development is desirable, but it cannot fully replace a human assistant.

  1. Robot-assisted laparoscopic retroperitoneal lymph node dissection for stage IIIb mixed germ cell testicular cancer after chemotherapy.

    Science.gov (United States)

    Lee, Sang Hyub; Kim, Dong Soo; Chang, Sung-Goo; Jeon, Seung Hyun

    2015-07-01

    Laparoscopic retroperitoneal lymph node dissection, especially when performed with the da Vinci Surgical System (Intuitive Surgical), has shown excellent cosmetic results with similar oncologic outcomes to those of open surgery. In this study, we present a case of robot-assisted retroperitoneal lymph node dissection performed in an 18-year-old man who was diagnosed with a stage IIIb mixed germ cell tumor and who was initially treated with radical orchiectomy, followed by chemotherapy. This case shows that robot-assisted retroperitoneal lymph node dissection is technically feasible, safe, and cosmetically favorable, even when performed on patients with high-stage disease or after chemotherapy.

  2. Use of a novel multi-purpose sponge for laparoscopic surgery: Does it have special relevance to robotically-assisted laparoscopic surgery?

    Science.gov (United States)

    Morelli, Luca; Guadagni, Simone; Troia, Elena; Di Franco, Gregorio; Palmeri, Matteo; Caprili, Giovanni; D’Isidoro, Cristiano; Moglia, Andrea; Pisano, Roberta; Pietrabissa, Andrea; Cuschieri, Alfred; Mosca, Franco

    2016-01-01

    BACKGROUND: The STAR System (Ekymed SpA) is a novel multipurpose sponge developed for conventional manual laparoscopic surgery. MATERIALS AND METHODS: Between December 2012 and December 2014, we successfully used the sponge in ten robot-assisted and ten direct manual laparoscopic operations to achieve haemostasis, for blunt dissections, for atraumatic lifting of solid organs, to check for bile leaks, for cleaning the surgical field thus avoiding frequent use of suction or the application of haemostatic agents. The reason of the insertion (RI), the main use (MU) and any further use (FU), once inserted, were registered for each operation and compared between the two groups. RESULTS: The principal RI was haemostasis for minor bleeding, without differences between the two groups (P = not significant). Regard to MU, in the robotic group cleaning the surgical field was utilised more than laparoscopic group (100% vs. 60%; P = 0.03). About FU, atraumatic solid organs lifting was more frequent during robotically assisted surgery than with laparoscopy (50% vs. 0%; P = 0.01). A statistically more frequent use of the sponge was registered during standard laparoscopy for the blunt dissection (30% vs. 80%; P = 0.03). CONCLUSIONS: The STAR System was beneficial in both approaches, but it imparts added benefit during robotically-assisted laparoscopic surgery organs because of the lack of tactile feedback and because the operating surgeon is remote from the patient, and has to rely on the assisting surgeon in the sterile field for dealing with bleeding episodes, cleansing/mopping the operative field when necessary, who may not be experienced or completely proficient. PMID:27251845

  3. Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study

    OpenAIRE

    Turchetti, Giuseppe; Pierotti, Francesca; Palla, Ilaria; Manetti, Stefania; Freschi, Cinzia; Ferrari, Vincenzo; Cuschieri, Alfred

    2016-01-01

    Background Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA). Methods The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italia...

  4. Update on Robotic Laparoscopic Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Garrett S. Matsunaga

    2006-01-01

    Full Text Available The da Vinci surgical robot has been shown to help shorten the learning curve for laparoscopic radical prostatectomy (LRP for both laparoscopically skilled and na surgeons[1,2]. This approach has shown equal or superior outcomes to conventional laparoscopic prostatectomy with regard to ease of learning, initial complication rates, conversion to open, blood loss, complications, continence, potency, and margin rates. Although the data are immature to compare oncologic and functional outcomes to open prostatectomy, preliminary data are promising.Herein, we review the technique and outcomes of robotic-assisted laparoscopic radical prostatectomy (RALP.

  5. Ocular parameters before and after steep Trendelenburg positioning for robotic-assisted laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Mizumoto K

    2017-09-01

    Full Text Available Kyoichi Mizumoto,1 Masahiko Gosho,2 Masayoshi Iwaki,1 Masahiro Zako3 1Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; 2Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; 3Department of Ophthalmology, Asai Hospital, Seto, Aichi, Japan Purpose: Intraocular pressure (IOP increases in patients in a steep Trendelenburg position during robotic-assisted laparoscopic radical prostatectomy (RALP. We hypothesized that a steep Trendelenburg position during RALP, an unusual systemic condition involving a transiently increased IOP, may induce ocular pathology that can be detected by detailed evaluations long after the surgery. This study aims to explore ocular structural and functional parameters in patients before and in the long term after the surgery. Patients and methods: A comparative observational study was performed. A total of 44 eyes of 22 male patients scheduled for RALP at Aichi Medical University from August 2012 to July 2013 were included. Clinical parameters before and after RALP were compared. Peri­operative IOP was measured immediately post-induction of anesthesia in the flat supine position (T1, immediately post-steep Trendelenburg position (T2, and prior to returning to a flat supine position while in a steep Trendelenburg position (T3. The thicknesses of the peripapillary retinal nerve fiber layer, ganglion cell complex (GCC, and central fovea were measured with spectral domain optical coherence tomography. Humphrey perimetry was performed before and at 3 and 6 months after surgery. Results: The average IOPs (mmHg at each stage were T1=10.4, T2=21.7, and T3=29.6, and differed significantly. The mean visual acuity (logarithm of the minimal angle of resolution, IOP, mean deviation, and pattern standard deviation measured by the Humphrey field analyzer showed no statistically significant difference before and after surgery. The ganglion

  6. Prophylactic belladonna suppositories on anesthetic recovery after robotic assisted laparoscopic prostatectomy.

    Science.gov (United States)

    Scavonetto, Federica; Lamborn, David R; McCaffrey, Joan M; Schroeder, Darrell R; Gettman, Mattew T; Sprung, Juraj; Weingarten, Toby N

    2013-06-01

    Two prospective trials have demonstrated prophylactic antimuscarinics following prostatectomy reduce pain from bladder spasms. Our practice adopted the routine administration of prophylactic belladonna and opium (B&O) suppositories to patients undergoing robotic assisted laparoscopic radical prostatectomy (RALP). The aim of this study is to determine if this change in clinical practice was associated with improvement of postoperative outcomes. The medical records of 202 patients that underwent RALP surgery who were or were not administered prophylactic B&O suppositories in the immediate postoperative period were abstracted for duration of anesthesia recovery, pain and analgesic use. Patient and surgical characteristics between groups were similar except B&O group were slightly older (p = 0.04) and administered less opioid analgesics (p = 0.05). There was no difference between groups in the duration of phase I recovery from anesthesia (p = 0.96). Multivariable adjustments for age, body mass index, American Society of Anesthesiologists physical status, and surgical duration were made, and again it was found that suppository administration had no association with phase I recovery times (p = 0.94). The use of antimuscarinic medication for bladder spams in the B&O group was less during phase I recovery (p suppositories at the immediate conclusion of RALP surgery was not associated with improvements of the postoperative course.

  7. Changes in pathologic outcomes and operative trends with robot-assisted laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Aaron Bernie

    2014-01-01

    Full Text Available Introduction: We hypothesized that there is a reverse stage migration, or a shift toward operating on higher-risk prostate cancer, in patients undergoing robot-assisted laparoscopic prostatectomy (RALP. We therefore evaluated the stage of disease at the time of surgery for patients with prostate cancer at a large tertiary academic medical center. Materials and Methods: After institutional review board approval, we reviewed all patients that had undergone robotic prostatectomy. These patients were separated into three categories: An early era of 2005-2008, intermediate era of 2009-2010, and a current era of 2011-2012. Results: A total of 3451 patients underwent robotic prostatectomy from 2005 to 2012. The proportion men with clinical T1 tumors declined from 88.3% in the early era to 72.2% in the current era (P < 0.0001. Men with preoperative biopsy Gleason 6 disease decreased from the early to the current era (P < 0.0001, while men with preoperative biopsy Gleason ≥ 8 showed the opposite trend, increasing from the early to the current era (P = 0.0002. From the early to the current era, the proportion of patients with National Comprehensive Cancer Network (NCCN low risk prostate cancer decreased, while those with NCCN intermediate and high-risk disease increased. The proportion of pathologic T3 disease increased from 15.5% in the early to 30.6% in the current era (P < 0.0001. On the other hand, the proportion of pathologic T2/+ SMS (surgical margin status decreased from 6.6% in the early era to 3.1% in the current era (P = 0.0002. Conclusions: We have demonstrated a reverse stage migration in men undergoing robotic prostatectomy. Despite the increasing proportion of men with extra-capsular disease undergoing RALP, the surgical margin status has remained similar. This could reflect both the changing dynamics of the population opting for surgery as well as the learning curve of the surgeons.

  8. Pathologic outcomes during the learning curve for robotic-assisted laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Amul Shah

    2008-03-01

    Full Text Available OBJECTIVE: We report our initial experience with 62 patients undergoing robotic-assisted laparoscopic prostatectomy (RALP, focusing on the primary parameter of positive surgical margins. The authors demonstrate that excellent oncologic outcomes can be attained with a less steep learning curve than previously hypothesized. MATERIALS AND METHODS: The first 62 patients undergoing RALP by a single physician (DPD at our institution between November 2005 and August 2007 were retrospectively assessed. Surgical pathology records were reviewed for Gleason score, pathologic tumor stage, nodal status, location of prostate cancer within the specimen, extracapsular extension, surgical margin status, presence of perineural invasion, tumor volume, and weight of the surgical specimen. Margin status was determined using surgical specimens only, and not intraoperative frozen sections. All cases in this series were completed using the four-arm da Vinci Robotic System (Intuitive Surgical, Sunnyvale, California. RESULTS: Sixty-one patients had prostate cancer on their final surgical pathology specimens. Pathologic stage T2 and stage T3 patients were 88.7% and 9.7% of all cases, respectively. The pathologic Gleason score was 7 or greater in 62.3%. Our overall positive surgical margin rate was 3.3%. Patients with pathologic T2 and T3 disease had a positive surgical margin rate of 1.8% and 16.7%, respectively. CONCLUSIONS: Our study suggests that RALP can have equal if not better pathologic outcomes compared to open radical prostatectomy even during the initial series of cases. We argue that the learning curve for RALP is shorter than previously thought with respect to oncologic outcomes, and concerns asserting that lack of tactile feedback leads to poor oncologic outcomes are unfounded.

  9. Perioperative outcome of initial 190 cases of robot-assisted laparoscopic radical prostatectomy - A single-center experience

    Directory of Open Access Journals (Sweden)

    P N Dogra

    2012-01-01

    Full Text Available Objective: To analyze the perioperative outcome of the first 190 cases of robot-assisted laparoscopic radical prostatectomy performed at our center from July 2006 to December 2010. Materials and Methods: Operative and recovery data for men with localized prostate cancer undergoing robot-assisted radical prostatectomy at our center were reviewed. All surgeries were performed using the 4-arm da Vinci-S surgical robot. Preoperative data included age, body mass index (BMI, prostate specific antigen (PSA level, prostate weight, biopsy Gleason score and TNM staging, while operative and recovery data included total operative time, estimated blood loss, complications, hospital stay and catheter time. These parameters were evaluated for the safety and efficacy of this procedure in our center. Results: The mean age of our patients was 65 ± 1.2 years. The mean BMI was 25.20 ± 2.88 and the median PSA was 14.8 ng/ml. Majority of our patients belonged to clinical stage T2 (51.58%. The mean total operative time was 166.44 ± 11.5 min. Six patients required conversion to open procedure and there was one rectal injury. The median estimated blood loss was 302 ± 14.45 ml and the median duration of hospital stay was 4 days. The overall margin positivity rate was 12.63%. Conclusion: Despite our limited robotic surgery experience, our perioperative outcome and complication rate is comparable to most contemporary series. Robot-assisted laparoscopic prostatectomy (RALP is easy to learn and provides the patient with the benefits of minimally invasive surgery with minimal perioperative morbidity.

  10. Robot-assisted laparoscopic pyeloplasty in a pediatric patient with horseshoe kidney: surgical technique and review of the literature.

    Science.gov (United States)

    Oderda, Marco; Calleris, Giorgio; Allasia, Marco; Dalmasso, Ettore; Falcone, Marco; Catti, Massimo; Merlini, Emilio; Gontero, Paolo

    2017-02-03

    The aim of this study was to describe the technical aspects of a robotic pyeloplasty in pediatric patients with uretero-pelvic junction obstruction (UPJO) in horseshoe kidney (HSK) through the report of our recent case, and to outline the state of the art of minimally invasive pyeloplasty (MIP) with a systematic review of the literature. We describe all the steps of our surgery performed on an 11-year-old patient with left UPJO in HSK in detail. All the anatomic landmarks are clearly showed, with particular attention to trocar placement in a pediatric patient. A systematic review of the literature on the outcomes of MIP in HSK patients has been performed, including 16 articles. Our surgery was successful following a standardized approach. However, we recorded a rare complication, the herniation of a small portion of omentum through the 8 - mm defect used for the caudal robotic port. The evidence synthesis shows excellent postoperative outcomes for both laparoscopic and robot-assisted laparoscopic pyeloplasties in HSK patients. Probably, MIP should be preferred to the traditional open approach in these patients, when feasible. Transperitoneal robotic pyeloplasty is an excellent minimally invasive choice for the treatment of UPJO in HSK pediatric patients. The pediatric setting should prompt attention to every detail to avoid unfortunate complications.

  11. Prostate Cancer Biochemical Recurrence Rates After Robotic-Assisted Laparoscopic Radical Prostatectomy

    Science.gov (United States)

    Ginzburg, Serge; Nevers, Thomas; Staff, Ilene; Tortora, Joseph; Champagne, Alison; Kesler, Stuart S.; Laudone, Vincent P.

    2012-01-01

    Background and Objectives: To determine prostate cancer biochemical recurrence rates with respect to surgical margin (SM) status for patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP). Methods: IRB-approved radical prostatectomy database was queried. Patients were stratified as low, intermediate, and high risk according to D’Amico's risk classification. Postoperative prostate-specific antigen (PSA) values were obtained every 3 mo for the first year, then biannually and annually thereafter. Biochemical recurrence was defined as ≥0.2ng/mL. Patients receiving adjuvant or salvage treatment were included. Positive surgical margin was defined as presence of cancer cells at inked resection margin in the final specimen. Margin presence (negative/positive), margin multiplicity (single/multiple), and margin length (≤3mm focal and >3mm extensive) were noted. Kaplan-Meier curves of biochemical recurrence-free survival (BRFS) as a function of SM were generated. Forward stepwise multivariate Cox regression was performed, with preoperative PSA, Gleason score, pathologic stage, prostate gland weight, and SM as covariates. Results: At our institution, 1437 patients underwent RALP (2003-2009). Of these, 1159 had sufficient data and were included in our analysis. Mean follow-up was 16 mo. Kaplan-Meier curves demonstrated significant increase in BRFS in low-risk and intermediate-risk groups with negative SM. Overall BRFS at 5 y was 72%. Gleason score, pathologic stage, and SM status were significant prognostic factors in multivariate analysis. Conclusions: Negative surgical margins resulted in lower biochemical recurrence rates for low-risk and intermediate-risk groups. Multifocal and longer positive margins were associated with higher biochemical recurrence rates compared with unifocal and shorter positive margins. Documenting biochemical recurrence rates for RALP is important, because this treatment for localized prostate cancer is validated. PMID

  12. Uterine preservation in pelvic organ prolapse using robot assisted laparoscopic sacrohysteropexy: quality of life and technique.

    Science.gov (United States)

    Mourik, Sarah L; Martens, Jolise E; Aktas, Mustafa

    2012-11-01

    Measuring quality of life of women with disorders of the pelvic floor is crucial when evaluating a therapy. The aim of this study is to profile health related quality of life of women with pelvic organ prolapse who are treated with robot assisted laparoscopic sacrohysteropexy (RALS). We also compare the operative characteristics and learning curve in this study with the current literature and describe the surgical technique. A prospective cohort study in a teaching hospital in The Netherlands. Fifty women with uterovaginal prolapse were treated with RALS. This study presents the largest cohort in Europe treated by RALS to date. Quality of life was assessed pre- and post-operatively using the UDI/IIQ validated self-questionnaire designed for Dutch-speaking patients. Clinical and operative data were prospectively collected up to 29 months. RALS was performed with preservation of the uterus. Statistical analysis of categorical data was performed with the paired T-test. Descriptive statistics were computed with the use of standard methods for means, median and proportions. Before operation, overall wellbeing was scored at 67.7% and after surgery this improved to 82.1% (p=0.03). Feelings of nervousness, frustration and embarrassment reduced significantly. Sexual functioning improved, but not significantly. The mean operative time was 223 (103-340) min. Operative time decreased significantly with gained experience and became comparable to the operative time for abdominal sacrocolpopexy and classic laparoscopy. Average blood loss was less than 50 ml and patients had a mean hospital stay of 2 days. Of all women, 95.2% were very satisfied with the result after RALS. Health related quality of life improves significantly after RALS. There are high rates of patient satisfaction. RALS proves to be a safe and effective treatment of pelvic organ prolapse. Operative time is comparable to abdominal sacrocolpopexy and classic laparoscopy in the current literature. Copyright © 2012

  13. Haemodynamics and cardiac function during robotic-assisted laparoscopic prostatectomy in steep Trendelenburg position.

    Science.gov (United States)

    Haas, Sebastian; Haese, Alexander; Goetz, Alwin E; Kubitz, Jens C

    2011-12-01

    Robotic-assisted laparoscopic prostatectomy (RALP) is usually performed in steep Trendelenburg position, which can be associated with cardiac impairment due to positioning and capnoperitoneum. This study investigated haemodynamic consequences and cardiac function in this type of surgery and evaluated the hypothesis that steep Trendelenburg position and capnoperitoneum results in haemodynamic and ventricular impairment. 10 patients (ASA I-III) scheduled for RALP in steep Trendelenburg position with capnoperitoneum were prospectively studied. Heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) were recorded. Stroke volume variation (SVV) and cardiac output (CO) were measured using pulse-contour analysis. Further, cardiac function was assessed using trans-oesophageal echocardiography before positioning (T1) and 10 min (T2) and 60 min (T3) after implementation of steep Trendelenburg position and capnoperitoneum. HR did not change statistically. MAP (T1, 69.7 ± 1.55; T2, 82.9 ± 3.05; T3, 79.4 ± 2.18 mmHg), CVP (T1, 7.7 ± 1.3; T2, 17.3 ± 2.01; T3, 16.9 ± 1.66 mmHg) and CO (T1, 4.0 ± 0.15; T2, 4.9 ± 0.26; T3, 4.9 ± 0.36 l/min) increased significantly at T2 and T3. Echocardiography showed no deterioration of left or right ventricular function. In one patient with pre-existing mitral valve insufficiency (I°) an aggravation of the insufficiency (III°) was observed. No other valve dysfunctions were observed. The steep Trendelenburg position may improve haemodynamic function and does not deteriorate left or right ventricular function during RALP. However, mitral valve insufficiency may be aggravated by positioning and capnoperitoneum. Copyright © 2011 John Wiley & Sons, Ltd.

  14. Pediatric robot-assisted laparoscopic radical adrenalectomy and lymph-node dissection for neuroblastoma in a 15-month-old.

    Science.gov (United States)

    Uwaydah, Nabeel I; Jones, Alex; Elkaissi, Mahmoud; Yu, Zhongxin; Palmer, Blake W

    2014-09-01

    Neuroblastoma (NB) is the most common extra-cranial solid tumor in children and the most common malignancy in infants, with complete resection being curative in low-stage disease. The previous standard of treatment for many abdominal NBs involving the adrenal gland had been open surgery; however, there have been numerous descriptions of the safety and feasibility of a laparoscopic approach to resect adrenal masses in the pediatric population in benign and malignant disease, including improved cosmetic results, decreased length of stay, decreased surgical morbidity, and comparable oncological outcomes to open surgery. Despite these reported advantages over open surgery, the newer robot-assisted laparoscopy (RAL) offers benefits over the conventional laparoscopic approach that could further improve outcomes and expand the use of minimally invasive surgical approaches for pediatric adrenal masses. RAL offers many additional advantages over conventional laparoscopy, such as 3D visualization, increased range of motion of surgical instruments, tremor control, and a shorter learning curve compared with traditional laparoscopic surgery, while still maintaining the advantages of minimally invasive surgery. The body of literature concerning robot-assisted oncological surgery involving the adrenal gland in children is quite small, and to our knowledge no case reports have been published describing robot-assisted removal of an adrenal NB in a pediatric patient. We present our experience and technique of an RAL approach for lymph-node dissection and radical resection of a low-stage NB involving the adrenal gland with no image-defined risk factors in a 15-month-old infant.

  15. Health-related quality of life after robotic-assisted laparoscopic hysterectomy for women with endometrial cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Møller, Ann M; Palle, Connie

    2016-01-01

    OBJECTIVE: The aim of this prospective cohort study using patient-reported outcome measures (PROMs) was to detect short term changes in functioning, symptoms and health-related quality of life (HRQoL) after robotic-assisted laparoscopic hysterectomy (RALH) for endometrial cancer or atypical complex...... level in a diary during the first 5 weeks after surgery. RESULTS: We found a clinically relevant decrease in HRQoL after 1 week. At 5 weeks postoperatively, HRQoL was again at the preoperative level. Fatigue, pain, constipation, gastrointestinal symptoms, and appetite were all negatively affected 1 week...

  16. The new era of minimally invasive interventions for prostate cancer: robot-assisted laparoscopic radical prostatectomy and focal therapy

    Directory of Open Access Journals (Sweden)

    Schatloff O

    2011-10-01

    Full Text Available Oscar Schatloff1, Alyssa S Louis2, Uri Lindner21Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA; 2Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, ON, CanadaAbstract: Prostate cancer remains a common but highly treatable disease. Innovations in prostate cancer treatment have allowed a transition toward minimally invasive approaches in an attempt to avoid treatment-related morbidities. In the middle of the treatment spectrum between radical open surgeries and active surveillance lies robot-assisted laparoscopic radical prostatectomy (RALP and focal therapy (FT. This review sets out the most current information on RALP and FT (including laser ablation, cryotherapy, high-intensity focused ultrasound, photodynamic therapy, and irreversible electroporation.Keywords: PCa, RALP, FT, laser ablation, cryotherapy, high-intensity focused ultrasound, photodynamic therapy, irreversible electroporation

  17. Erectile Function and Oncologic Outcomes Following Open Retropubic and Robot-assisted Radical Prostatectomy: Results from the LAParoscopic Prostatectomy Robot Open Trial.

    Science.gov (United States)

    Sooriakumaran, Prasanna; Pini, Giovannalberto; Nyberg, Tommy; Derogar, Maryam; Carlsson, Stefan; Stranne, Johan; Bjartell, Anders; Hugosson, Jonas; Steineck, Gunnar; Wiklund, Peter N

    2017-09-04

    Whether surgeons perform better utilising a robot-assisted laparoscopic technique compared with an open approach during prostate cancer surgery is debatable. To report erectile function and early oncologic outcomes for both surgical modalities, stratified by prostate cancer risk grouping. In a prospective nonrandomised trial, we recruited 2545 men with prostate cancer from seven open (n=753) and seven robot-assisted (n=1792) Swedish centres (2008-2011). Clinometrically-validated questionnaire-based patient-reported erectile function was collected before, 3 mo, 12 mo, and 24 mo after surgery. Surgeon-reported degree of neurovascular-bundle preservation, pathologist-reported positive surgical margin (PSM) rates, and 2-yr prostate-specific antigen-relapse rates were measured. Among 1702 preoperatively potent men, we found enhanced erectile function recovery for low/intermediate-risk patients in the robot-assisted group at 3 mo. For patients with high-risk tumours, point estimates for erectile function recovery at 24 mo favoured the open surgery group. The degree of neurovascular bundle preservation and erectile function recovery were greater correlated for robot-assisted surgery. In pT2 tumours, 10% versus 17% PSM rates were observed for open and robot-assisted surgery, respectively; corresponding rates for pT3 tumours were 48% and 33%. These differences were associated with biochemical recurrence in pT3 but not pT2 disease. The study is limited by its nonrandomised design and relatively short follow-up. Earlier recovery of erectile function in the robot-assisted surgery group in lower-risk patients is counterbalanced by lower PSM rates for open surgeons in organ-confined disease; thus, both open and robotic surgeons need to consider this trade-off when determining the plane of surgical dissection. Robot-assisted surgery also facilitates easier identification of nerve preservation planes during radical prostatectomy as well as wider dissection for pT3 cases. For

  18. Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Marc Manganiello

    2012-02-01

    Full Text Available PURPOSE: V-LocTM180 (Covidien Healthcare, Mansfield, MA is a new unidirectional barbed suture that may reduce loss of tension during a running closure. We evaluated the use of the barbed suture for urethrovesical anastomosis (UVA during robotic assisted laparoscopic prostatectomy (RALP. Time to completion of UVA, post-operative anastomotic leak rate, and urinary incontinence were compared in patients undergoing UVA with 3-0 unidirectional-barbed suture vs. 3-0 MonocrylTM (Ethicon, Somerville, NJ. MATERIALS AND METHODS: Data were prospectively collected for 70 consecutive patients undergoing RALP for prostate cancer between November 2009 and October 2010. In the first 35 patients, the UVA was performed using a modified running van Velthoven anastomosis technique using two separate 3-0 monofilament sutures. In the subsequent 35 patients, the UVA was performed using two running novel unidirectional barbed sutures. At 7-12 days postoperatively, all patients were evaluated with a cystogram to determine anastomotic integrity. Urinary incontinence was assessed at two months and five months by total daily pad usage. Clinical symptoms suggestive of bladder neck contracture were elicited. RESULTS: Age, PSA, Gleason score, prostate size, estimated blood loss, body mass index, and clinical and pathologic stage between the 2 groups were similar. Comparing the monofilament group and V-LocTM180 cohorts, average time to complete the anastomosis was similar (27.4 vs. 26.4 minutes, p = 0.73 as was the rate of urinary extravasation on cystogram (5.7 % vs. 8.6%, p = 0.65. There were no symptomatic bladder neck contractures noted at 5 months of follow-up. At 2 months, the percentage of patients using 2 or more pads per day was lower in the V-LocTM180 cohort (24% vs. 44%, p < 0.02. At 5 months, this difference was no longer evident. CONCLUSIONS: Time to complete the UVA was similar in the intervention and control groups. Rates of urine leak were also comparable

  19. Robotic-assisted laparoscopic hysterectomy for women with endometrial cancer - complications, women´s experiences, quality of life and a health economic evaluation

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth

    2016-01-01

    . These changes should be addressed in the preoperative information and at the post-operative follow-up. It is difficult imagining a RCT of robotic-assisted laparoscopic hysterectomy being conducted in the future due to reluctance towards randomisation to open surgery. However, it would be advisable continuously...... to monitor relevant surgical and patient-reported outcomes as indications for robotic surgery may alter, experiences may develop and further technical advances may change robotic surgery for women with endometrial cancer in the future.......This thesis contains four studies all focusing on women with endometrial cancer undergoing robotic-assisted laparoscopic hysterectomy (RALH). Women with endometrial cancer are typically elderly with co-morbidities. RALH is a relatively new treatment option which has been introduced and adopted over...

  20. An assessment of the physical impact of complex surgical tasks on surgeon errors and discomfort: a comparison between robot-assisted, laparoscopic and open approaches.

    Science.gov (United States)

    Elhage, Oussama; Challacombe, Ben; Shortland, Adam; Dasgupta, Prokar

    2015-02-01

    To evaluate, in a simulated suturing task, individual surgeons’ performance using three surgical approaches: open, laparoscopic and robot-assisted. subjects and methods: Six urological surgeons made an in vitro simulated vesico-urethral anastomosis. All surgeons performed the simulated suturing task using all three surgical approaches (open, laparoscopic and robot-assisted). The time taken to perform each task was recorded. Participants were evaluated for perceived discomfort using the self-reporting Borg scale. Errors made by surgeons were quantified by studying the video recording of the tasks. Anastomosis quality was quantified using scores for knot security, symmetry of suture, position of suture and apposition of anastomosis. The time taken to complete the task by the laparoscopic approach was on average 221 s, compared with 55 s for the open approach and 116 s for the robot-assisted approach (anova, P errors and the level of self-reported discomfort were highest for the laparoscopic approach (anova, P robot-assisted surgery combines the accuracy of open surgery while causing lesser surgeon discomfort than laparoscopy and maintaining minimal access.

  1. A comparative study of erectile function and use of erectile aids in high-risk prostate cancer patients after robot-assisted laparoscopic prostatectomy

    DEFF Research Database (Denmark)

    Østby-Deglum, Marie; Brennhovd, B.; Axcrona, K.

    2015-01-01

    Objective. Erectile function with and without use of erectile aids was compared in high-, intermediate- and low-risk prostate cancer patients at a mean of 3 years after robot-assisted laparoscopic prostatectomy (RALP). Materials and methods. A sample of 982 men who underwent RALP at Oslo University...

  2. Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery

    NARCIS (Netherlands)

    Olivier, R. H. van der Schatte; van't Hullenaar, C. D. P.; Ruurda, J. P.; Broeders, I. A. M. J.

    2009-01-01

    Robot-assisted surgical systems have been introduced to improve the outcome of minimally invasive surgery. These systems also have the potential to improve ergonomics for the surgeon during endoscopic surgery. This study aimed to compare the user's mental and physical comfort in performing standard

  3. Robotic-assisted laparoscopic resection of ectopic pancreas in the posterior wall of gastric high body: Case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Sheng-Der Hsu; Hurng-Sheng Wu; Chien-Long Kuo; Yueh-Tsung Lee

    2005-01-01

    Minimally invasive surgery has revolutionized the treatment of gastrointestinal tumors. Submucosal tumors of the stomach can be resected using laparoscopic techniques. We report here a case of ectopic pancreas tissue in the gastric wall that was removed using robotic-assisted laparoscopic resection. The patient was a 15-year-old female who presented with abdominal discomfort and tarry stools. Laboratory analysis showed iron deficiency anemia. Preoperative endoscopy revealed a submucosal lesion in the posterior wall of the gastric high body. Intraoperative upper endoscopy clearly located the lesion. A robotic-assisted laparoscopic wedge resection of the putative gastric submucosal tumor was performed. The pathology results showed an ectopic pancreas. The patient had an uneventful recovery and we believe that this is a valid treatment option for this benign condition.

  4. A three-arm (laparoscopic, hand-assisted, and robotic) matched-case analysis of intraoperative and postoperative outcomes in minimally invasive colorectal surgery.

    Science.gov (United States)

    Patel, Chirag B; Ragupathi, Madhu; Ramos-Valadez, Diego I; Haas, Eric M

    2011-02-01

    Robotic-assisted laparoscopic surgery is an emerging modality in the field of minimally invasive colorectal surgery. However, there is a dearth of data comparing outcomes with other minimally invasive techniques. We present a 3-arm (conventional, hand-assisted, and robotic) matched-case analysis of intraoperative and short-term outcomes in patients undergoing minimally invasive colorectal procedures. Between August 2008 and October 2009, 70 robotic cases of the rectum and rectosigmoid were performed. Thirty of these were organized into triplets with conventional and hand-assisted cases based on the following 6 matching criteria: 1) surgeon; 2) sex; 3) body mass index; 4) operative procedure; 5) pathology; and 6) history of neoadjuvant therapy in malignant cases. Demographics, intraoperative parameters, and postoperative outcomes were assessed. Pathological outcomes were analyzed in malignant cases. Data were stratified by postoperative diagnosis and operative procedure. There was no significant difference in intraoperative complications, estimated blood loss (126.1 ± 98.5 mL overall), or postoperative morbidity and mortality among the groups. Robotic technique required longer operative time compared with conventional laparoscopic (P arm case-matched series, the robotic approach results in short-term outcomes comparable to conventional and hand-assisted laparoscopic approaches for benign and malignant diseases of the rectum and rectosigmoid. With 3-dimensional visualization, additional freedom of motion, and improved ergonomics, this enabling technology may play an important role when performing colorectal procedures involving the pelvic anatomy.

  5. Pedagogic approach in the surgical learning: The first period of “assistant surgeon” may improve the learning curve for laparoscopic robotic-assisted hysterectomy.

    Directory of Open Access Journals (Sweden)

    Angeline Favre

    2016-11-01

    Full Text Available Background: Hysterectomy is the most frequently surgery done with robotic assistance in the world and has been widely studied since its emergence. The surgical outcomes of the robotic hysterectomy are similar to those obtained with other minimally invasive hysterectomy techniques (laparoscopic and vaginal and appear as a promising surgical technique in gynaecology surgery. The aim of this study was to observe the learning curve of robot-assisted hysterectomy in a French surgical center, and was to evaluate the impact of the surgical mentoring.Methods: We retrospectively collected the data from the files of the robot-assisted hysterectomies with the Da Vinci® Surgical System performed between March 2010 and June 2014 at the Foch hospital in Suresnes (France. We first studied the operative time according to the number of cases, independently of the surgeon to determine two periods: the initial learning phase (Phase 1 and the control of surgical skills phase (Phase 2. The phase was defined by mastering the basic surgical tasks. Secondarily we compared these two periods for operative time, blood losses, Body Mass Index (BMI, days of hospitalisations and uterine weight. We finally studied the difference of the learning curve between an experimented surgeon (S1 who practised the first the robot-assisted hysterectomies and a less experimented surgeon (S2 who first assisted S1 and then operated on his own patients.Results: 154 robot-assisted hysterectomies were analysed. 20 procedures were necessary to access to the control of surgical skills phase. There was a significant decrease of the operative time between the learning phase (156.8 minutes compared to the control of surgical skills phase (125.8 minutes, p=0.003. No difference between these two periods for blood losses, BMI, days of hospitalisations and uterine weight were demonstrated. The learning curve of S1 showed 20 procedures to master the robot-assisted hysterectomies with a significant

  6. Robot-assisted laparoscopic resection of a huge pelvic tumor: A case report.

    Science.gov (United States)

    Jia, Zhuomin; Lyu, Xiangjun; Xu, Yong; Leonardi, Rosario; Zhang, Xu

    2016-07-04

    The traditional open surgery, for the treatment of huge tumor in the narrow space of pelvic cavity and in close proximity to pelvic organs and neurovascular structures, is very difficult and challenging. We report a case of huge neurilemmoma operated using the robot-assisted laparoscopy. We used interventional pre-operation embolization to control blood supply of tumor because MRI showed the tumor had a sufficient blood supply.

  7. Minimally invasive approaches to adrenal tumors: an up-to-date summary including patient position and port placement of laparoscopic, retroperitoneoscopic, robot-assisted, and single-site adrenalectomy.

    Science.gov (United States)

    Hupe, Marie C; Imkamp, Florian; Merseburger, Axel S

    2017-01-01

    There are multiple minimal invasive approaches to remove the adrenal gland. The purpose of this review is to summarize the most up-to-date findings about laparoscopic, retroperitoneoscopic, robot-assisted, and single-site adrenalectomy, and to define the most common approaches to the adrenal gland. Laparoscopic adrenalectomy is the gold standard to remove adrenal tumors. New approaches are being explored to outperform the advantages of laparoscopic adrenalectomy. Retroperitoneoscopic adrenalectomy, when performed by skilled surgeons, offers an alternative to the conventional laparoscopic approach, with better outcome. The robot-assisted and single-site approaches still need further studies to fully identify their roles in adrenalectomy.

  8. A comparison of radical perineal, radical retropubic, and robot-assisted laparoscopic prostatectomies in a single surgeon series.

    Science.gov (United States)

    Mirza, Moben; Art, Kevin; Wineland, Logan; Tawfik, Ossama; Thrasher, J Brantley

    2011-01-01

    Objective. We sought to compare positive surgical margin rates (PSM), estimated blood loss (EBL), and quality of life outcomes (QOL) among perineal (RPP), retropubic (RRP), and robot-assisted laparoscopic (RALP) prostatectomies. Methods. Records from 463 consecutive men undergoing RPP (92), RRP (180), or RALP (191) for clinically localized prostate cancer were retrospectively reviewed. Age, percent tumor volume, Gleason score, stage, EBL, PSM, and QOL using the expanded prostate cancer index composite (EPIC) were compared. Results. PSM were similar when adjusted for stage, grade, and volume. EBL was significantly less in the RALP (189 ml) group compared to both RPP (475 ml) and RRP (999 ml) groups. When corrected for nerve sparing, there were no differences in erectile function and sexual function amongst the three groups. Urinary summary and pad usage scores showed no significant differences. Conclusion. RPP, RRP, and RALP offer similar surgical and QOL outcomes. RALP and RPP demonstrate less EBL compared to RRP.

  9. [First 24 Japanese cases of robotic-assisted laparoscopic radical prostatectomy using the daVinci Surgical System].

    Science.gov (United States)

    Yoshioka, Kunihiko; Hatano, Tadashi; Nakagami, Yoshihiro; Ozu, Choichiro; Horiguchi, Yutaka; Sakamoto, Noboru; Yonov, Hiroyuki; Ohno, Yoshio; Ohori, Makoto; Tachibana, Masaaki; Patel, Vipul R

    2008-05-01

    In Japan, as of September 2007, prostatectomy is conducted with open surgical procedures in more than 90% of the cases. Following the first reported robotic prostatectomy by Binder, et al. in 2000, a robotic-assisted laparoscopic radical prostatectomy (RALP) using the daVinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA) has been extensively used as a standard procedure with gratifying results in the United States. In the Asian region, in contrast, RALP is still in an introductory phase. Recently, we introduced RALP in Japan. A total of 24 patients received robotic surgery within a year since August 2006. RALP was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-hour operation had been imposed by the Ethical Committee. The mean operative time using the daVinci device and the mean estimated blood loss were 232.0 (range; 136-405) minutes and 313.0 (range; 10-1,000) ml, respectively. The training program we recently developed proved remarkably effective in reducing the learning curve of robotic surgery in Japan, where there is no person with expertise in this operating procedure. In particular, the intraoperative guidance given by the expert was useful after relevant problematic points were delineated by operators who received comprehensive video-based image training and actually performed robot surgery in several cases. With direct intraoperative guidance by the mentor during cases 13 and 14, both the operation time and estimated blood loss was markedly reduced.

  10. Robot-assisted laparoscopic radical prostatectomy with early retrograde release of the neurovascular bundle and endopelvic fascia sparing

    Science.gov (United States)

    de Albuquerque, George Augusto Monteiro Lins; Guglielmetti, Giuliano Betoni; Cordeiro, Maurício Dener; Nahas, William Carlos; Coelho, Rafael Ferreira

    2017-01-01

    ABSTRACT Introduction Robotic-assisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. The introduction of robotic assistance has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. The purpose of this video is to demonstrate the early retrograde release of the neurovascular bundle without open the endopelvic fascia during RAP. Materials and Methods A 51-year old male, presenting histological diagnosis of prostate adenocarcinoma, Gleason 6 (3+3), in 4 cores of 12, with an initial PSA=3.41ng/dl and the digital rectal examination demonstrating a prostate with hardened nodule in the right lobe of the prostate base (clinical stage T2a). Surgical treatment with the robot-assisted technique was offered as initial therapeutic option and the critical technical point was the early retrograde release of the neurovascular bundle with endopelvic fascia preservation, during radical prostatectomy. Results The operative time was of 89 minutes, blood loss was 100ml. No drain was left in the peritoneal cavity. The patient was discharged within 24 hours. There were no intraoperative or immediate postoperative complications. The pathological evaluation revealed prostate adenocarcinoma, Gleason 6, with free surgical margins and seminal vesicles free of neoplastic involvement (pathologic stage T2a). At 3-month-follow-up, the patient lies with undetectable PSA, continent and potent. Conclusion This is a feasible technique combining the benefits of retrograde release of the neurovascular bundle, the preservation of the pubo-prostatic collar and the preservation of the antero-lateral cavernous nerves. PMID:27802002

  11. Anastomotic complications after robot-assisted laparoscopic and open radical prostatectomy

    DEFF Research Database (Denmark)

    Jacobsen, André; Berg, Kasper Drimer; Iversen, Peter

    2016-01-01

    Objective Anastomotic complications are well known after radical prostatectomy (RP). The vesicourethral anastomotic technique is handled differently between open and robotic RP. The aim of the study was to investigate whether the frequency of anastomotic leakages and strictures differed between...... patients undergoing retropubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP) and to identify risk factors associated with these complications. Materials and methods The study included 735 consecutive patients who underwent RRP (n = 499) or RARP (236) at the Department...... of Urology, Rigshospitalet, Denmark, in a complete 3 year period from 2010 to 2012. Univariate and multivariate logistic regression analysis was used to analyse associations between surgical procedure (RRP vs RARP) and anastomotic complications. Analyses included age, smoking status, diabetes, hypertension...

  12. Cost-analysis of robotic-assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Palle, Connie; Møller, Ann M

    2016-01-01

    INTRODUCTION: The aim of this study was to analyse the hospital cost of treatment with robotic-assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost. MATERIAL...... AND METHODS: This cost analysis was based on two cohorts: women treated with robotic-assisted laparoscopic hysterectomy (n = 202) or with total abdominal hysterectomy (n = 158) at Copenhagen University Hospital, Herlev, Denmark. We conducted an activity-based cost analysis including consumables and healthcare...... professionals' salaries. As cost-drivers we included severe complications, duration of surgery, anesthesia and stay at the post-anesthetic care unit, as well as number of hospital bed-days. Ordinary least-squares regression was used to explore the cost variation. The primary outcome was cost difference...

  13. Contribution of laparoscopic training to robotic proficiency.

    Science.gov (United States)

    Angell, Jordan; Gomez, Michael S; Baig, Mirza M; Abaza, Ronney

    2013-08-01

    Robotic surgical technology has been adopted by surgeons with and without previous standard laparoscopic experience. The necessity or benefit of prior training and experience in laparoscopic surgery is unknown. We hypothesized that laparoscopic training enhances performance in robotic surgery. Fourteen medical students with no surgical experience were instructed to incise a spiral using the da Vinci(®) surgical robot with time to completion and errors recorded. Each student was then trained for 1 month in standard laparoscopy, but with no further robotic exposure. Training included a validated laparoscopic training program, including timed and scored parameters. After completion of the month-long training, the students repeated the cutting exercise using the da Vinci robot as well as with standard laparoscopic instruments and were scored within the same parameters. The mean time to completely incise the spiral robotically before training was 16.72 min with a mean of 6.21 errors. After 1 month of validated laparoscopic training, the mean robotic time fell to 9:03 min (p=0.0002) with 3.57 errors (p=0.02). Laparoscopic performance after 1 month of validated laparoscopic training was 13.95 min with 6.14 errors, which was no better than pretraining robotic performance (p=0.20) and worse than post-training robotic performance (p=0.01). Formal laparoscopic training improved the performance of a complex robotic task. The initial robotic performance without any robotic or laparoscopic training was equivalent to standard laparoscopic performance after extensive training. Additionally, after laparoscopic training, the robot allowed significantly superior speed and precision of the task. Laparoscopic training may improve the proficiency in operation of the robot. This may explain the perceived ease with which robotics is adopted by laparoscopically trained surgeons and may be important in training future robotic surgeons.

  14. Robotic-assisted laparoscopic hysterectomy: outcomes in obese and morbidly obese patients

    National Research Council Canada - National Science Library

    Gallo, Taryn; Kashani, Shabnam; Patel, Divya A; Elsahwi, Karim; Silasi, Dan-Arin; Azodi, Masoud

    2012-01-01

    To describe patient characteristics and perioperative outcomes among women undergoing roboticassisted laparoscopic hysterectomy and to evaluate the characteristics of nonobese, obese, and morbidly obese patients...

  15. Robotic-assisted laparoscopic partial nephrectomy: A single centre Indian experience

    Directory of Open Access Journals (Sweden)

    Arvind P Ganpule

    2015-01-01

    Full Text Available Background: We summarise our experience with RPN emphasising on learning curve, techniques and outcomes. Patients and Methods: A retrospective chart review of 57 patients was done. The preoperative workup included a triple phase CT angiography. The parameters analyzed were demographics, tumor characteristics, operative details, postoperative outcome, histopathology and follow-up. The data were compared with historical cohort of the laparoscopic partial nephrectomy (LPN. Results: 58 renal units in 57 patients (45 males and 12 females underwent RPN. The mean age was 53.08 ± 13.6 (30-71 years. The mean tumor size was 4.96 ± 2.33 (2-15.5 cm. Average operative time was 129.4 ± 29.9 (70-200 min.; mean warm ischemia time was 20.9 ± 7.34 (9-39 min. 8 renal units in 7 patients were operated with the zero ischemia technique. The average follow-up was 5.15 months (1-18. There was no recurrence. 15 patients underwent LPN. The mean tumor size was 4.3 ± 1.6 (1.6-8 cm. operative time was 230.7 ± 114.8 (150-300 min.; mean warm ischemia time was 31.8 ± 9 min. The nephromerty score in the LPN group was 7.1 ± 0.89, in the RPN group was 8.75 ± 1.21. Conclusion: Our results suggest that prior experience of LPN shortens the learning curve for RPN as seen by shorter warm ischemia time and operative time in our series. The nephrometry score in RPN were higher suggesting that complex tumour can be managed with robotic approach.

  16. An unexpected resident in the ileum detected during robot-assisted laparoscopic radical cystoprostatectomy and intracorporeal Studer pouch formation: Taenia saginata parasite.

    Science.gov (United States)

    Canda, Abdullah Erdem; Asil, Erem; Balbay, Mevlana Derya

    2011-02-01

    A case of moving ileal Taenia saginata parasites is presented with demonstrative images. We came across the parasites surprisingly while performing robot-assisted laparoscopic radical cystoprostatectomy with intracorporeal Studer pouch urinary diversion. We recommend stool sample evaluation in the preoperative period for possible presence of intestinal parasitic diseases, particularly in patients with bladder cancer who are admitted from areas with an increased incidence of intestinal parasitic diseases, before opening the bowel segments during surgery to perform radical cystectomy and urinary diversion.

  17. Robot-assisted laparoscopic right hemicolectomy for colonic cancer%达芬奇机器人系统辅助右半结肠切除术

    Institute of Scientific and Technical Information of China (English)

    鲍扬; 江志伟; 谢立飞; 刘凤涛; 黎介寿

    2011-01-01

    Objective To investigate the safety and feasibility of robot-assisted laparoscopic right hemicolectomy for colonic cancer. Methods These 5 patients with ascending colonic cancer received robot-assisted laparoscopic right hemicolectomy. Results All operations were performed successfully. There was no postoperative complications. Da Vinci surgical system was found to be associated with fewer hemorrhage, rapid postoperative intestinal recovery, and therefore a shorter hospital stay. Conclusions Robot-assisted laparoscopic right hemicolectomy can be applied safely and with feasibility for colonic cancer.%目的 探讨达芬奇机器人系统辅助右半结肠切除术的安全性与可行性.方法 总结2010年5-11月完成的5例达芬奇辅助右半结肠切除术的方法 及术后恢复情况.结果 5例患者行右半结肠切除,其中1例同时行胆囊切除.手术均顺利完成,无中转开腹.手术时间140~200 min,术中失血量30~80 ml.术后无并发症发生.结论 达芬奇机器人系统应用于右半结肠癌手术是安全可行的.

  18. Characteristics of positive surgical margins in robotic-assisted radical prostatectomy, open retropubic radical prostatectomy, and laparoscopic radical prostatectomy: a comparative histopathologic study from a single academic center.

    Science.gov (United States)

    Albadine, Roula; Hyndman, Matthew E; Chaux, Alcides; Jeong, J Y; Saab, Shahrazad; Tavora, Fabio; Epstein, Jonathan I; Gonzalgo, Mark L; Pavlovich, Christian P; Netto, George J

    2012-02-01

    Studies detailing differences in positive surgical margin among open retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted laparoscopic radical prostatectomy are lacking. A retrospective review of all prostatectomies with positive surgical margin performed at our center in 2007 disclosed 99 cases, 6 (5%) of which were reinterpreted cases as having negative margins. Ninety-three cases were, therefore, included, corresponding to 37 retropubic radical prostatectomies, 19 laparoscopic radical prostatectomies, and 37 robotic-assisted laparoscopic radical prostatectomies. The relationship of positive surgical margin characteristics to clinicopathologic parameters and biochemical recurrence was assessed. The most commonly found positive surgical margin site was the apex/distal third in all groups (62% retropubic prostatectomies, 79% laparoscopic prostatectomies, 60% robotic-assisted prostatectomies). Total linear length of positive surgical margin sites was significantly correlated with preoperative prostate-specific antigen, preoperative prostate-specific antigen density, pT stage, and tumor volume (P ≤ .001). We found no significant differences among the 3 groups with respect to total linear length, number of foci, laterality, or location of positive surgical margin. The rate of biochemical recurrence was also comparable in the 3 groups. On univariate analyses, biochemical recurrence was significantly associated with preoperative prostate-specific antigen values, preoperative prostate-specific antigen density, Gleason score, number of positive surgical margins, and total linear length of positive surgical margin (P ≤ .02). Only preoperative prostate-specific antigen density and number of positive surgical margin foci were statistically significant (P ≤ .03) independent predictors of biochemical recurrence. We found no significant difference in positive surgical margin characteristics or biochemical recurrence among the 3

  19. Robotic-assisted laparoscopic radical prostatectomy: The Ohio State University technique.

    Science.gov (United States)

    Patel, Vipul R; Shah, Ketul K; Thaly, Rahul K; Lavery, Hugh

    2007-03-01

    Robotic radical prostatectomy is a new innovation in the surgical treatment of prostate cancer. The technique is continuously evolving. In this article we demonstrate The Ohio State University technique for robotic radical prostatectomy. Robotic radical prostatectomy is performed using the da Vinci surgical system. The video demonstrates each step of the surgical procedure. Preliminary results with robotic prostatectomy demonstrate the benefits of minimally invasive surgery while also showing encouraging short-term outcomes in terms of continence, potency and cancer control. Robotic radical prostatectomy is an evolving technique that provides a minimally invasive alternative for the treatment of prostate cancer. Our experience with the procedure now stands at over 1,300 cases.

  20. Comparison of oncological results and functional outcomes of radical prostatectomy techniques – retropubic, laparoscopic and robot-assisted

    Directory of Open Access Journals (Sweden)

    E. A. Prilepskaya

    2015-01-01

    Full Text Available Radical prostatectomy (RP continues to be the «gold standard» in the treatment of localized prostate cancer (PC for patients with a life expectancy of 10 years.The purpose of this article is to review pertinent literature to the several surgical approaches for PC and compare both functional outcomes and oncological results of radical retropubic prostatectomy (RRP, laparoscopic radical prostatectomy (LRP and robot-assisted radical prostatectomy (RARP. We chose and systematically reviewed 44 articles published between 1999 and 2013. Comparison analysis showed that the mean blood loss during RRP, LRP and RARP was 935, 442 and 191 ml respectively. Intraoperative transfusion required 19,9; 6,3 and 4,6 % patients respectively. We’d like to outline in our functional outcomes that within the 6-months and 12-months period of follow-up acute urinary retention experienced 89,1 and 92,7 % patients undergoing RARP.However, lack of certain data and absence of standard assessment methods made objective evaluation of erectile function quite complex. Oncologic results revealed that positive surgical margin rates were higher for RARP in comparison to patients after RRP and LRP (the difference was statistically significant.Nevertheless, the absence of randomized approach in an overwhelming majority of cases, as well as the short follow-up period are serious deterrents limiting the number of such trials. Therefore it’s still impossible today to draw certain conclusions about the superiority of any surgical approach for RP

  1. Perioperative Systemic Inflammatory Response following Robot-Assisted Laparoscopic Cystectomy vs. Open Mini-Laparotomy Cystectomy: A Prospective Study.

    Science.gov (United States)

    Skjold Kingo, Pernille; Palmfeldt, Johan; Nørregaard, Rikke; Borre, Michael; Jensen, Jørgen Bjerggaard

    2017-07-01

    Surgeries, such as radical cystectomy (RC), induce a systemic inflammatory response (SIR). SIR plays an important role in controlling the human immune system. This study aims at comparing the SIR in robot-assisted laparoscopic cystectomy (RALC) to open mini-laparotomy cystectomy (OMC) with a urinary diversion (UD). Comparison was based on immunologic markers of SIR, thus quantifying the degree of tissue trauma. Forty-two male patients underwent RC with an ileal conduit. Either OMC RC (OMC; n = 20), RALC with extracorporeal UD (RALC-EUD; n = 13), or RALC with intracorporeal UD (RALC-IUD; n = 9) was performed. Blood samples were obtained preoperatively (PREOP), immediately after surgery (POD0), 24 (POD1) and 48 h (POD2) postoperatively. Clinical parameters were collected from medical records. Estimated blood loss and blood transfusion volume was higher in OMC (p's OMC (p = 0.016). IL-10 level was higher at POD0 (p = 0.029) and POD1 (p = 0.038) in OMC vs. RALC-EUD. MCP-1 levels for RALC-IUD were significantly lower compared to RALC-EUD (p = 0.027). This study found that postoperative SIR was overall less pronounced in RALC, thus depicting reduced tissue trauma. No major clinical differences between RALC-IUD and -EUD were found. © 2017 S. Karger AG, Basel.

  2. A Comparison of Radical Perineal, Radical Retropubic, and Robot-Assisted Laparoscopic Prostatectomies in a Single Surgeon Series

    Directory of Open Access Journals (Sweden)

    Moben Mirza

    2011-01-01

    Full Text Available Objective. We sought to compare positive surgical margin rates (PSM, estimated blood loss (EBL, and quality of life outcomes (QOL among perineal (RPP, retropubic (RRP, and robot-assisted laparoscopic (RALP prostatectomies. Methods. Records from 463 consecutive men undergoing RPP (92, RRP (180, or RALP (191 for clinically localized prostate cancer were retrospectively reviewed. Age, percent tumor volume, Gleason score, stage, EBL, PSM, and QOL using the expanded prostate cancer index composite (EPIC were compared. Results. PSM were similar when adjusted for stage, grade, and volume. EBL was significantly less in the RALP (189 ml group compared to both RPP (475 ml and RRP (999 ml groups. When corrected for nerve sparing, there were no differences in erectile function and sexual function amongst the three groups. Urinary summary and pad usage scores showed no significant differences. Conclusion. RPP, RRP, and RALP offer similar surgical and QOL outcomes. RALP and RPP demonstrate less EBL compared to RRP.

  3. Effect of minimizing tension during robotic-assisted laparoscopic radical prostatectomy on urinary function recovery.

    Science.gov (United States)

    Kowalczyk, Keith J; Huang, Andy C; Hevelone, Nathanael D; Lipsitz, Stuart R; Yu, Hua-yin; Lynch, John H; Hu, Jim C

    2013-06-01

    Although most prostatectomy studies emphasize optimal nerve-sparing dissection planes, subtle technical variation also affects functional outcomes. The impact of minimizing assistant/surgeon tension on urinary function has not been quantified. We assess urinary function after attenuating neurovascular bundle (NVB) and rhabdosphincter tension during robotic-assisted radical prostatectomy (RARP). Retrospective study of prospectively collected data for 268 (RARP-T) versus 342 (RARP-0T) men with versus without tension on the NVB and rhabdosphincter during RARP. Outcomes compared include Expanded Prostate Cancer Index (EPIC) urinary function, estimated blood loss (EBL), operative time, and positive surgical margins (PSM). In unadjusted analysis, men undergoing RARP-T versus RARP-0T were older, had higher biopsy and pathologic Gleason grade, and higher preoperative prostate specific antigen (all p ≤ 0.023). Baseline urinary function was similar. Postoperatively, RARP-0T versus RARP-T was associated with higher 5-month urinary function scores (69.7 versus 64, p = 0.049). In adjusted analyses, RARP-0T versus RARP-T was associated with improved 5-month urinary function [Parameter Estimate (PE) 7.37, Standard Error (SE) 2.67, p = 0.006], while bilateral versus non-/unilateral nerve-sparing was associated with improved 12-month urinary function and continence (both p ≤ 0.035). RARP-0T versus RARP-T was associated with shorter operative times (PE 6.66, SE 1.90, p = 0.001) and higher EBL (PE 20.88, SE 6.49, p = 0.001). There were no significant differences in PSM. While the use of tension aids in dissection of anatomic planes, avoidance of NVB counter-traction and minimizing tension on the rhabdosphincter during apical dissection attenuates neuropraxia and leads to earlier urinary function recovery. Bilateral versus non-/unilateral nerve-sparing also improves urinary function recovery.

  4. Robot-assisted laparoscopic approach for artificial urinary sphincter implantation in 11 women with urinary stress incontinence: surgical technique and initial experience.

    Science.gov (United States)

    Biardeau, Xavier; Rizk, Jérôme; Marcelli, François; Flamand, Vincent

    2015-05-01

    Artificial urinary sphincter (AUS) implantation is recommended for women suffering urinary stress incontinence. Robot-assisted laparoscopy allows improved dexterity and visibility compared to traditional laparoscopy, potentially providing significant advantages for deep pelvic surgery. To report our surgical technique and initial experience in transperitoneal robot-assisted laparoscopic AUS implantation in women with urinary stress incontinence. Eleven eligible patients with AUS implantation or revision using robot-assisted laparoscopy for urinary stress incontinence were included between January 2012 and February 2014 at Department of Urology, Lille University Hospital. Procedures were performed with the assistance of a four-arm da Vinci robot. The urethrovaginal space was dissected after transperitoneal access to the Retzius space. An 11-mm port placed in the right iliac fossa allowed introduction of the AUS device. The cuff and balloon tubes were externalised via a 5-mm suprapubic incision. The peritoneum was finally sutured. Clinical data were prospectively collected before, during, and after the procedure. Results were classified as complete continence (no leakage and no pad usage), social continence (leakage and/or pad usage with no impact on social life), or failure (leakage and/or pad usage impacting social life). After mean follow-up of 17.6 mo (interquartile range 10.8-26 mo), eight patients (72.7%) had a successful AUS implantation, of whom seven (87.5%) reported complete continence and one had social continence. Two vaginal injuries and two bladder injuries occurred intraoperatively. Two patients experienced early minor postoperative complications and two had a major postoperative complication. Robot-assisted laparoscopic AUS implantation is a feasible procedure. Further studies will better assess the place of robot-assisted laparoscopy in AUS implantation. We investigated the treatment of 11 patients with stress urinary incontinence using robot-assisted

  5. Robotic-assisted laparoscopic cystectomy with ileal conduit for urinary diversion.

    Science.gov (United States)

    Overstreet, Dana L; Sims, Terran Warren

    2006-04-01

    This case demonstrates the need for flexibility when approaching major abdominal surgery through a robotic approach. While the case was initiated with robotic technology, it ultimately had to be converted to an open procedure for reasons of patient safety and to ensure a good surgical outcome.

  6. Laparoscopic assisted cholecystostomy.

    Science.gov (United States)

    Grecu, F

    1999-01-01

    Laparoscopic assisted cholecystostomy (LAC) is a safe method for external biliary drainage in jaundiced patients with distal common bile duct obstruction. It consists of the retrieval of the fundus of the gallbladder through the trocar, thus through abdominal wall followed by suture to the skin. This technique could be an option for surgeons who manage a patients with jaundice by distal common bile duct obstruction.

  7. Standardized procedure of robotic assisted laparoscopic radical prostatectomy from case 1 to case 1200

    Directory of Open Access Journals (Sweden)

    Sheng-Chun Hung

    2016-12-01

    Conclusions: Meticulous preoperative evaluation, MRI planning and a dedicated robotic team to do RALP is essential. The procedure was standardized during each step. Complications were minimized. High risk patients had an acceptable oncologic outcome.

  8. Robotic Assisted Laparoscopic Prostatectomy in Men with Proctocolectomy and Restorative Ileal Pouch-Anal Anastomosis

    Directory of Open Access Journals (Sweden)

    Michael Leapman

    2014-01-01

    Full Text Available We conducted a retrospective chart review of robotic prostatectomies done by a single surgeon between 2003 and 2012. During that time period, we identified two patients within the year 2012, with ileal pouch-anal anastomosis (IPPA who also underwent robotic prostatectomies. The demographics and postoperative characteristics of the two patients were assessed. In both patients, prostatectomy, bilateral nerve sparing, and pelvic lymphadenectomy were successfully performed and the integrity of ileal pouch was maintained. There was a mean surgical time of 144.5 minutes, and an average estimated blood loss was 125 mL. Both patients were discharged on the second day postoperatively. In both patients there was a Gleason upgrade to 3 + 4, with negative margins, and preservation of fecal and urinary continence by their six-month followup. Owing to surgical modifications, these two surgeries represent the first successful robotic prostatectomies in patients with a J-pouch.

  9. The effect of music on robot-assisted laparoscopic surgical performance.

    Science.gov (United States)

    Siu, Ka-Chun; Suh, Irene H; Mukherjee, Mukul; Oleynikov, Dmitry; Stergiou, Nick

    2010-12-01

    Music is often played in the operating room to increase the surgeon's concentration and to mask noise. It could have a beneficial effect on surgical performance. Ten participants with limited experience with the da Vinci robotic surgical system were recruited to perform two surgical tasks: suture tying and mesh alignment when classical, jazz, hip-hop, and Jamaican music were presented. Kinematics of the instrument tips of the surgical robot and surface electromyography of the subjects were recorded. Results revealed that a significant music effect was found for both tasks with decreased time to task completion (P = .005) and total travel distance (P = .021) as well as reduced muscle activations ( P = .016) and increased median muscle frequency (P = .034). Subjects improved their performance significantly when they listened to either hip-hop or Jamaican music. In conclusion, music with high rhythmicity has a beneficial effect on robotic surgical performance. Musical environment may benefit surgical training and make acquisition of surgical skills more efficient.

  10. Learning curve evaluation using cumulative summation analysis-a clinical example of pediatric robot-assisted laparoscopic pyeloplasty.

    Science.gov (United States)

    Cundy, Thomas P; Gattas, Nicholas E; White, Alan D; Najmaldin, Azad S

    2015-08-01

    The cumulative summation (CUSUM) method for learning curve analysis remains under-utilized in the surgical literature in general, and is described in only a small number of publications within the field of pediatric surgery. This study introduces the CUSUM analysis technique and applies it to evaluate the learning curve for pediatric robot-assisted laparoscopic pyeloplasty (RP). Clinical data were prospectively recorded for consecutive pediatric RP cases performed by a single-surgeon. CUSUM charts and tests were generated for set-up time, docking time, console time, operating time, total operating room time, and postoperative complications. Conversions and avoidable operating room delay were separately evaluated with respect to case experience. Comparisons between case experience and time-based outcomes were assessed using the Student's t-test and ANOVA for bi-phasic and multi-phasic learning curves respectively. Comparison between case experience and complication frequency was assessed using the Kruskal-Wallis test. A total of 90 RP cases were evaluated. The learning curve transitioned beyond the learning phase at cases 10, 15, 42, 57, and 58 for set-up time, docking time, console time, operating time, and total operating room time respectively. All comparisons of mean operating times between the learning phase and subsequent phases were statistically significant (P=learning curve evaluation and outcome quality monitoring. In applying this statistical technique to the largest reported single surgeon series of pediatric RP, we demonstrate numerous distinctly shaped learning curves and well-defined learning phase transition points. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Impact of prior abdominal surgery on the outcomes after robotic - assisted laparoscopic radical prostatectomy: single center experience

    Directory of Open Access Journals (Sweden)

    Nozomu Kishimoto

    Full Text Available ABSTRACT Purpose: To evaluate the influence of prior abdominal surgery on the outcomes after robotic-assisted laparoscopic radical prostatectomy (RALP. Materials and Methods: We retrospectively analyzed patients with prostate cancer who underwent RALP between June 2012 and February 2015 at our institution. Patients with prior abdominal surgery were compared with those without prior surgery while considering the mean total operating, console, and port-insertion times; mean estimated blood loss; positive surgical margin rate; mean duration of catheterization; and rate of complications. Results: A total of 203 patients who underwent RALP during the study period were included in this study. In all, 65 patients (32% had a prior history of abdominal surgery, whereas 138 patients (68% had no prior history. The total operating, console, and port-insertion times were 328 and 308 (P=0.06, 252 and 242 (P=0.28, and 22 and 17 minutes (P=0.01, respectively, for patients with prior and no prior surgery. The estimated blood losses, positive surgical margin rates, mean durations of catheterization, and complication rates were 197 and 170 mL (P=0.29, 26.2% and 20.2% (P=0.32, 7.1 and 6.8 days (P=0.74, and 12.3% and 8.7% (P=0.42, respectively. Furthermore, whether prior abdominal surgery was performed above or below the umbilicus or whether single or multiple surgeries were performed did not further affect the perioperative outcomes. Conclusions: Our results suggest that RALP can be performed safely in patients with prior abdominal surgery, without increasing the risk of complications.

  12. Are Preexisting Retinal and Central Nervous System-Related Comorbidities Risk Factors for Complications Following Robotic-Assisted Laparoscopic Prostatectomy?

    Directory of Open Access Journals (Sweden)

    David Chalmers

    2015-08-01

    Full Text Available ABSTRACTPurpose:To assess whether retinal and central nervous system (CNS comorbidities are risk factors for complications following robotic assisted laparoscopic prostatectomy (RALP.Materials and Methods:A retrospective review of our RALP database identified 1868 patients who underwent RALP by a single surgeon between December 10, 2003-March 14, 2014. We hypothesized that patients with preexisting retinal or CNS comorbidities were at a greater risk of suffering retinal and CNS complications following RALP. Perioperative complications and risk of recurrence were graded using the Clavien and D'Amico systems, respectively.Results:40 (2.1% patients had retinal or CNS-related comorbidities, of which 15 had a history of retinal surgery and 24 had a history of cerebrovascular accident, aneurysm and/or neurosurgery. One additional patient had a history of both retinal and CNS events.Patients with retinal or CNS comorbidities were significantly older, had elevated PSA levels and CCI (Charlson Comorbidity Index scores than the control group. Blood loss, length of stay, surgical duration, BMI, diagnostic Gleason score and T-stage were not statistically different between groups.No retinal or CNS complications occurred in either group. The distribution of patients between D'Amico risk categories was not statistically different between the groups. There was also no difference in the incidence of total complications between the groups.Conclusions:RALP-associated retinal and CNS complications are rare. While our RALP database is large, the cohort of patients with retinal or CNS-related comorbidities was relatively small. Our dataset suggests retinal and CNS pathology presents no greater risk of suffering from perioperative complications following RALP.

  13. Nursing Cooperation in Robot-assisted Laparoscopic Partial Nephrectomy%机器人辅助腹腔镜肾部分切除术的护理配合

    Institute of Scientific and Technical Information of China (English)

    吴小凤; 盛夏; 吴震杰; 吕晨; 杨波

    2016-01-01

    目的:探讨机器人辅助腹腔镜肾部分切除术护理配合的要点。方法回顾性分析2012年3月至2014年10月在第二军医大学长海医院泌尿外科中心行机器人辅助腹腔镜肾部分切除术的151例肾脏肿瘤患者的临床资料,总结其护理要点。结果150例患者顺利完成手术,1例患者中转开腹行肾部分切除术。结论机器人辅助腹腔镜肾部分切除术是一种安全有效的治疗局限性肾肿瘤的微创手术方法,器械设备管理以及手术前后护理配合是保证手术顺利实施的重要环节。%Objective To summarize the key point of nursing cooperation in robot-assisted laparoscopic partial nephrectomy.Methods Clinical data of 15 1 cases were analyzed retrospectively,and the key nursing points were concluded.Results There were 150 patients underwent successful robot-assisted laparoscopic partial nephrectomy,1 case was transferred to opening partial nephrectomy.Conclusion Robot-assisted laparoscopic partial nephrectomy is a safe and effective minimally invasive treatment for localized renal cell carcinoma.The equipment management and preoperative and postoperative nursing cooperation is the key link to gurantee the successful implementation of the surgery.

  14. Robotic-assisted laparoscopic hysterectomy seems safe in women with early-stage endometrial cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Havemann, Maria Cecilie; Palle, Connie

    2015-01-01

    INTRODUCTION: Robotic surgery is increasingly used in the management of endometrial cancer; and although it is known that minimally invasive surgery reduces post-operative morbidity, the outcomes of this novel treatment should be monitored carefully. The aim of this study was to examine...

  15. Spontaneous Retroperitoneal Hemorrhage (Wunderlich Syndrome due to Large Upper Pole Renal Angiomyolipoma: Does Robotic-Assisted Laparoscopic Partial Nephrectomy Have a Role in Primary Treatment?

    Directory of Open Access Journals (Sweden)

    Achilles Ploumidis

    2013-01-01

    Full Text Available Spontaneous rapture with consequent retroperitoneal hemorrhage (Wunderlich’s syndrome is the complication mostly feared from large renal angiomyolipomas (RAMLs. In hemodynamic stable patients, minimal invasive therapies have superseded open surgery as the mainstay of treatment, with contemporary cases mostly treated by selective arterial embolization. Robotic-assisted laparoscopic partial nephrectomy (RALPN is an established minimal access treatment that has been used in the past for benign and malignant lesions of the kidney in the elective setting, but rarely in urgent situations as primary treatment. We present a case of a ruptured RAML in a young female treated effectively by RALPN.

  16. Robotic-assisted laparoscopic radical nephrectomy using the Da Vinci Si system: how to improve surgeon autonomy. Our step-by-step technique.

    Science.gov (United States)

    Davila, Hugo H; Storey, Raul E; Rose, Marc C

    2016-09-01

    Herein, we describe several steps to improve surgeon autonomy during a Left Robotic-Assisted Laparoscopic Radical Nephrectomy (RALRN), using the Da Vinci Si system. Our kidney cancer program is based on 2 community hospitals. We use the Da Vinci Si system. Access is obtained with the following trocars: Two 8 mm robotic, one 8 mm robotic, bariatric length (arm 3), 15 mm for the assistant and 12 mm for the camera. We use curved monopolar scissors in robotic arm 1, Bipolar Maryland in arm 2, Prograsp Forceps in arm 3, and we alternate throughout the surgery with EndoWrist clip appliers and the vessel sealer. Here, we described three steps and the use of 3 robotic instruments to improve surgeon autonomy. Step 1: the lower pole of the kidney was dissected and this was retracted upwards and laterally. This maneuver was performed using the 3rd robotic arm with the Prograsp Forceps. Step 2: the monopolar scissors was replaced (robotic arm 1) with the robotic EndoWrist clip applier, 10 mm Hem-o-Lok. The renal artery and vein were controlled and transected by the main surgeon. Step 3: the superior, posterolateral dissection and all bleeders were carefully coagulated by the surgeon with the EndoWrist one vessel sealer. We have now performed 15 RALRN following these steps. Our results were: blood loss 300 cc, console time 140 min, operating room time 200 min, anesthesia time 180 min, hospital stay 2.5 days, 1 incisional hernia, pathology: (13) RCC clear cell, (1) chromophobe and (1) papillary type 1. Tumor Stage: (5) T1b, (8) T2a, (2) T2b. We provide a concise, step-by-step technique for radical nephrectomy (RN) using the Da Vinci Si robotic system that may provide more autonomy to the surgeon, while maintaining surgical outcome equivalent to standard laparoscopic RN.

  17. A comparative study of clinical effect on the Da Vinci surgical robot-assisted and laparoscopic-assisted distal subtotal gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Objective:To evaluate the feasibility, safety and the clinical outcomes of the robotic distal gastrectomy for gastric cancer.Methods: We retrospectively analyzed the clinical and follow-up data of 113 cases underwent robotic distal gastrectomy from March 2010 to July 2013.Results:Compared with laparoscopic group, the robotic group had less intraoperative blood loss, more lymph nodes dissection (P<0.05). hTere was no signiifcant difference in the incidence of postoperative complications and neutrophil-lymphocyte ratio between the two groups. hTe follow-up data showed that the 1-, 2- and 3-year survival rates were 91.7%, 77.4% and 72.9% in robotic group while they were 91.2%, 76.2% and 70.4% in laparoscopic group ,and the difference was not significant. Conclusion:Robotic distal gastrectomy for gastric cancer is safe and effective, and it has less harm to the patients, with less intraoperative blood loss, more lymph nodes dissection and quicker postoperative recover than laparoscopic surgery, so it is worthy of popularization and application.

  18. Robotic-assisted Laparoscopic Transperitoneal Adrenalectomy: Outcomes of Initial Five Patients

    Directory of Open Access Journals (Sweden)

    Abdullah Erdem Canda

    2015-06-01

    Full Text Available Objective: To report the outcomes of transperitoneal robotic adrenalectomy (RA procedures in five initial cases performed at two institutions. Methods: Between March 2012 and November 2014, five patients underwent RA. A transperitoneal approach was taken by using the da Vinci-S four-arm surgical robot. Outcomes were assessed retrospectively. Results: Mean patient age was 42.6±5.1 (range: 34-47 years. Mean body mass index was 30.5±4.5 (range: 23.2-35.2 kg/m². Median tumour size detected on radiological imaging was 3.1±1.7 (range: 1.2-6.0 cm. Mean operation time was 129.0±12.4 (range: 120-150 minutes and median estimated blood loss was 100.0±119.3 (range: 50-350 ml. No intraoperative or perioperative complications occurred according to the modified Clavien complication scale. Median duration of hospital stay was 2.0±1.7 (range: 2-6 days. The fourth robotic arm was used in two patients. Histopathology results demonstrated: metastasis of renal cell carcinoma occurred in 1 case, adrenal cortical adenoma in 2 cases, pheochromocytoma in 1 case, and hyperplasia in 1 case. After a median follow-up of 17.0±15.0 (range: 3-40 months, no local recurrence was detected. Conclusion: RA is a safe minimally invasive surgical approach that has excellent surgical and oncological outcomes in the treatment of adrenal masses <7 cm in size.

  19. Early results after robot-assisted colorectal surgery

    DEFF Research Database (Denmark)

    Eriksen, Jens Ravn; Helvind, Neel Maria; Jakobsen, Henrik Loft

    2013-01-01

    Implementation of robotic technology in surgery is challenging in many ways. The aim of this study was to present the implementation process and results of the first two years of consecutive robot-assisted laparoscopic (RAL) colorectal procedures.......Implementation of robotic technology in surgery is challenging in many ways. The aim of this study was to present the implementation process and results of the first two years of consecutive robot-assisted laparoscopic (RAL) colorectal procedures....

  20. Early results after robot-assisted colorectal surgery

    DEFF Research Database (Denmark)

    Eriksen, Jens Ravn; Helvind, Neel Maria; Jakobsen, Henrik Loft

    2013-01-01

    Implementation of robotic technology in surgery is challenging in many ways. The aim of this study was to present the implementation process and results of the first two years of consecutive robot-assisted laparoscopic (RAL) colorectal procedures.......Implementation of robotic technology in surgery is challenging in many ways. The aim of this study was to present the implementation process and results of the first two years of consecutive robot-assisted laparoscopic (RAL) colorectal procedures....

  1. Limited Evidence for Robot-assisted Surgery

    DEFF Research Database (Denmark)

    Broholm, Malene; Onsberg Hansen, Iben; Rosenberg, Jacob

    2016-01-01

    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...

  2. Robotic Assisted Colorectal Surgery

    OpenAIRE

    Baik, Seung Hyuk; M.D&#

    2010-01-01

    Improvements of the robotic surgical system are continuously being made to overcome the technical limitations and disadvantages found during the surgeries. So detailed operation methods are newly designed to adapt to the upgraded model of the robotic surgical system. The major core technologies of the robotic surgical system are a three dimensional image of the surgical field and a function of articulation of the instruments tips compared to conventional laparoscopic instruments. With the hel...

  3. Robotic-assisted laparoscopic hysteromyoma enucleation%机器人辅助腹腔镜子宫肌瘤剥除术临床分析

    Institute of Scientific and Technical Information of China (English)

    蔡圣芸; 吕昆明; 汪静文; 李励; 奚佳燕; 徐明娟

    2014-01-01

    目的:探讨达芬奇机器人手术系统辅助腹腔镜子宫肌瘤剥除手术的安全性与可行性。方法回顾性总结2012年12月至2013年10月实施的16例达芬奇机器人辅助子宫肌瘤剥除手术的治疗效果。结果16例患者手术均顺利完成,无中转开腹。手术时间(170.0±45.3)min,术中失血量(196.9±186.9)ml,术后肠蠕动恢复时间为(45.1±8.2)h,术后住院时间(4.2±1.5)d,除1例术后出现尿潴留,留置尿管3d后恢复排尿功能外,未出现出血、感染等并发症。结论达芬奇机器人手术系统应用于子宫肌瘤剥除手术安全可行。%Objective To investigate the safety and feasibility of robotic-assisted laparoscopic hysteromyoma enucleation. Methods The clinical outcomes of 16 patients with hysteromyoma undergoing robotic-assisted laparoscopic enucleation from December 2012 to October 2013 were retrospectively evaluated. Results All the operations were performed successfully.The operative time was(170.0 ± 45.3)min.The estimated blood loss was(196.9 ± 186.9)m1.Time to the return of bowel function was(45.1 ± 8.2)h and postoperative hospital stay was (4.2 ± 1.5)d. There was one patient had a retention of urine at the first afternoon after operation,and recovered after 3-days-long indwelling catheter.No bleeding,infections,or other complications were found. Conclusion Robotic-assisted laparoscopic hysteromyoma enucleation is safe and feasible.

  4. Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery.

    Science.gov (United States)

    Geppert, Barbara; Lönnerfors, Celine; Persson, Jan

    2011-11-01

    Comparison of surgical results on obese patients undergoing hysterectomy by robot-assisted laparoscopy or laparotomy. University hospital. All women (n=114) with a BMI ≥30 kg/m(2) who underwent a simple hysterectomy as the main surgical procedure between November 2005 and November 2009 were identified. Robot-assisted procedures (n=50) were separated into an early (learning phase) and a late (consolidated phase) group; open hysterectomy was considered an established method. Relevant data was retrieved from prospective protocols (robot) or from computerized patient charts (laparotomy) until 12 months after surgery. Complications leading to prolonged hospital stay, readmission/reoperation, intravenous antibiotic treatment or blood transfusion were considered significant. The surgical technique used for morbidly obese patients is described. Women in the late robot group (n=25) had shorter inpatient time (1.6 compared to 3.8 days, plaparoscopic hysterectomy in a consolidated phase in obese women is associated with shorter hospital stay, less bleeding and fewer complications compared to laparotomy but, apart from women with BMI ≥35, a longer operative time. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

  5. Hem-o-lok clip: a neglected cause of severe bladder neck contracture and consequent urinary incontinence after robot-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Cormio, Luigi; Massenio, Paolo; Lucarelli, Giuseppe; Di Fino, Giuseppe; Selvaggio, Oscar; Micali, Salvatore; Carrieri, Giuseppe

    2014-02-20

    Hem-o-lok clips are widely used during robot-assisted and laparoscopic radical prostatectomy to control the lateral pedicles. There are a few reports of hem-o-lok clip migration into the bladder or vesico-urethral anastomosis and only four cases of hem-o-lok clip migration resulting into bladder neck contracture. Herein, we describe the first case, to our knowledge, of hem-o-lok clip migration leading to severe bladder neck contracture and subsequent stress urinary incontinence. A 62-year-old Caucasian man underwent robot-assisted laparoscopic radical prostatectomy for a T1c Gleason 8 prostate cancer. One month after surgery the patient was fully continent; however, three months later, he presented with acute urinary retention requiring suprapubic drainage. Urethroscopy showed a hem-o-lok clip strongly attached to the area between the vesico-urethral anastomosis and the urethral sphincter and a severe bladder neck contracture behind it. Following cold-knife urethral incision and clip removal, the bladder neck contracture was widely resected. At 3-month follow-up, the patient voided spontaneously with a peak flow rate of 9.5 ml/sec and absence of post-void residual urine, but leaked 240 ml urine at the 24-hour pad test. To date, at 1-year follow-up, his voiding situation remains unchanged. The present report provides further evidence for the risk of hem-o-lok clip migration causing bladder neck contracture, and is the first to demonstrate the potential of such complication to result into stress urinary incontinence.

  6. Robot-assisted partial nephrectomy in contemporary practice

    Directory of Open Access Journals (Sweden)

    Youssef S. Tanagho

    2013-01-01

    Full Text Available Laparoscopic renal surgery is associated with reduced blood loss, shorter hospital stay, enhanced cosmesis, and more rapid convalescence relative to open renal surgery. Laparoscopic partial nephrectomy is a minimally invasive, nephron-sparing alternative to laparoscopic radical nephrectomy for the management of small renal masses. While offering similar oncological outcomes to laparoscopic radical nephrectomy, the technical challenges and prolonged learning curve associated with laparoscopic partial nephrectomy limit its wider dissemination. Robot-assisted partial nephrectomy, although still an evolving procedure with no long-term data, has emerged as a viable alternative to laparoscopic partial nephrectomy, with favorable preliminary outcomes. This article provides an overview of the role of robot-assisted partial nephrectomy in the management of renal cell carcinoma. The clinical indications and principles of surgical technique for this procedure are discussed. The oncological, renal functional, and perioperative outcomes of robot-assisted partial nephrectomy are also evaluated, as are complication rates.

  7. 机器人辅助腹腔镜肾上腺手术的应用现状%Current application status of robot-assisted laparoscopic adrenalectomy

    Institute of Scientific and Technical Information of China (English)

    沈周俊; 王先进; 许天源

    2015-01-01

    泌尿外科是达芬奇机器人手术系统(Da Vinci surgical system,DVSS)应用的最主要领域之一,其开展范围广,技术较为成熟.近年来,机器人辅助腹腔镜肾上腺切除术(robot-assisted laparoscopic adrenalectomy,RALA)开展日益增多,适用于巨大、压迫下腔静脉的肾上腺肿瘤,不适于采用传统腹腔镜手术的肾上腺小肿瘤等.结合本中心开展的RALA的临床经验及RALA国内外应用现状,可以得出RALA可行、安全、微创的结论,是传统腹腔镜肾上腺切除术(laparoscopic adrenalectomy,LA)强有力的替代手术方式,是未来肾上腺手术的主要方法之一.

  8. Regaining Candidacy for Heart Transplantation after Robotic Assisted Laparoscopic Radical Prostatectomy in Left Ventricular Assist Device Patient

    Directory of Open Access Journals (Sweden)

    Tariq A. Khemees

    2012-01-01

    Full Text Available Several factors may highlight the relevance of prostate cancer to the pre-heart-transplant population. First, the expansion in candidate selection criteria led to increased number of men over the age of fifty to be considered for heart transplantation. With the introduction of left ventricular assist device (LVAD therapy, waiting-list mortality has dramatically declined over the past decade. Additionally, transplant candidates are diligently screened for preexisting neoplasm while on the waiting list. Taken together, screening-detected prostate cancer may increasingly be diagnosed in patients on the waiting list. If discovered, it will pose unique challenge to clinicians as to date there has been no universally accepted management guideline. We report a case of LVAD-treated heart transplant candidate diagnosed with prostate cancer while on the waiting list. Patient screening demonstrated PSA elevation which prompted prostate biopsy. Low-risk clinically localized prostate cancer was confirmed and led to removal of patient from transplant list. When counseled regarding management of his cancer, the patient elected to undergo radical prostatectomy in a hope to regain candidacy for heart transplantation. Despite being of high surgical risk, multidisciplinary team approach led to successful management of prostate cancer and the patient eventually received heart transplant one year following prostatectomy.

  9. Robotic versus conventional laparoscopic pyeloplasty: A single surgeon concurrent cohort review

    Directory of Open Access Journals (Sweden)

    Rajeev Kumar

    2013-01-01

    Conclusions: Robotic assistance helps decrease the operative time for laparoscopic pyeloplasty. It seems ergonomically superior for the surgeon, allowing multiple procedures in the same list. These may be important benefits in busy centers.

  10. 机器人结直肠癌根治术的学习曲线%Learning curve of robot-assisted laparoscopic radical resection for colorectal carcinoma

    Institute of Scientific and Technical Information of China (English)

    刘东宁; 唐城; 江群广; 李太原

    2016-01-01

    目的:评估机器人结直肠癌根治术不同阶段的手术效果,探讨机器人结直肠癌根治术学习曲线问题。方法分析2014年12月至2015年8月由同一组医师完成的75例腹腔镜结直肠癌根治术,按手术先后次序分3组(A、B、C),每组25例,比较各组机器人安装时间、手术时间、出血量、肛门排气时间、术后住院天数、术后并发症和3站淋巴结清扫数目及其总数的差异。结果 A组机器人安装时间(38±5)min,显著长于B组(22±4)min和C组(21±2)min(P均<0.05);A组手术时间(201±39)min,显著长于B组(160±42)min和C组(156±43)min(P均<0.05);A 组出血量(142±35)ml,显著多于B组(105±28)ml和C组(102±28)ml(P均<0.05)。3组肛门排气时间、术后住院天数、术后并发症和3站淋巴结清扫数目及其总数无显著性差异(P>0.05)。A组手术25例在4个月内完成,平均每月6.3台手术,B组和C组均在2个月内完成,平均每月12.5台手术。结论有丰富腹腔镜结直肠癌手术经验的外科医师行机器人结直肠癌根治术的学习曲线大约为25例,手术频度为平均每月6.3例。%ObjectiveTo evaluate the outcomes of robot-assisted laparoscopic radical colorectal resection and to define the learning curve of robot-assisted laparoscopic radical colorectal resections. MethodsClinical data of 75 cases underwent robot-assisted laparoscopic radical resection for colorectal cancer were reviewed form December 2014 to August 2015.The patients were divided into 3 groups (groups A, B and C) by operative sequence.The robotic set-up time, operating time, bleeding volume, postoperative aerofluxus time, hospital stay, postoperative complications, number of removed lymphatic nodes were compared among the 3 groups.ResultsThe robotic set-up time in group A was significantly longer than that in group B and C [ (38± 5) min vs. (22± 4) min,P0.05). The

  11. Comparative cost-effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of men with localised prostate cancer: a health technology assessment from the perspective of the UK National Health Service.

    Science.gov (United States)

    Close, Andrew; Robertson, Clare; Rushton, Stephen; Shirley, Mark; Vale, Luke; Ramsay, Craig; Pickard, Robert

    2013-09-01

    Robot-assisted laparoscopic prostatectomy is increasingly used compared with a standard laparoscopic technique, but it remains uncertain whether potential benefits offset higher costs. To determine the cost-effectiveness of robotic prostatectomy. We conducted a care pathway description and model-based cost-utility analysis. We studied men with localised prostate cancer able to undergo either robotic or laparoscopic prostatectomy for cure. We used data from a meta-analysis, other published literature, and costs from the UK National Health Service and commercial sources. Care received by men for 10 yr following radical prostatectomy was modelled. Clinical events, their effect on quality of life, and associated costs were synthesised assuming 200 procedures were performed annually. Over 10 yr, robotic prostatectomy was on average (95% confidence interval [CI]) £1412 (€1595) (£1304 [€1473] to £1516 [€1713]) more costly than laparoscopic prostatectomy but more effective with mean (95% CI) gain in quality-adjusted life-years (QALYs) of 0.08 (0.01-0.15). The incremental cost-effectiveness ratio (ICER) was £18 329 (€20 708) with an 80% probability that robotic prostatectomy was cost effective at a threshold of £30 000 (€33 894)/QALY. The ICER was sensitive to the throughput of cases and the relative positive margin rate favouring robotic prostatectomy. Higher costs of robotic prostatectomy may be offset by modest health gain resulting from lower risk of early harms and positive margin, provided >150 cases are performed each year. Considerable uncertainty persists in the absence of directly comparative randomised data. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  12. Robotic-assisted laparoscopic hysterectomy for women with endometrial cancer - complications, women´s experiences, quality of life and a health economic evaluation.

    Science.gov (United States)

    Herling, Suzanne Forsyth

    2016-07-01

    This thesis contains four studies all focusing on women with endometrial cancer undergoing robotic-assisted laparoscopic hysterectomy (RALH). Women with endometrial cancer are typically elderly with co-morbidities. RALH is a relatively new treatment option which has been introduced and adopted over the last decade without randomised controlled trials (RCTs) to prove superiority over other surgical alternatives. The purpose of the thesis was to explore and describe patient and health economic outcomes of RALH for women with endometrial cancer using different research approaches. The first study was a retrospective descriptive cohort study with 235 women. The aim was to explore types and incidence of post-operative complications within 12 months after RALH reported with the Clavien-Dindo scale. We found that 6% had severe complications and that women with lymphadenectomy did not have an increased rate of complications. Urinary tract and port site infections were the most frequent complications. The second study was a qualitative interview study where we explored the experience of undergoing RALH. Using content analysis, we analysed semi-structured interviews with 12 women who had undergone RALH on average 12 weeks earlier. The women were positive towards the robotic approach and felt recovered shortly after. They expressed uncertainty with the normal course of bleeding and bowel movement post-operatively as well as with the new anatomy. The third study was an economic evaluation; an activity-based costing study including 360 women comparing total abdominal hysterectomy (TAH) to RALH. This study showed that for women with endometrial cancer, RALH was cheaper compared to TAH, mainly due to fewer complications and shorter length of stay (LOS) that counterbalanced the higher robotic expenses. When including all cost drivers the analysis showed that the RALH procedure was more than 9.000 Danish kroner (DKK) cheaper than the TAH. Increased age and Type 2 diabetes appeared

  13. Combined thoracoscopic and laparoscopic robotic-assisted minimally invasive esophagectomy using a four-arm platform: experience, technique and cautions during early procedure development.

    Science.gov (United States)

    Sarkaria, Inderpal S; Rizk, Nabil P; Finley, David J; Bains, Manjit S; Adusumilli, Prasad S; Huang, James; Rusch, Valerie W

    2013-05-01

    This study reports an early, single-institution experience of combined thoracoscopic and laparoscopic robotic-assisted minimally invasive esophagectomy (RAMIE) using a four-arm robotic platform, with special attention given to the pitfalls and complications during procedure development. We conducted a prospective, single-cohort, observational study of patients undergoing RAMIE at a single institution. A total of 21 patients (median age, 62 years [range, 37-83 years]) underwent RAMIE with a four-arm robotic platform (17 by Ivor Lewis and 4 by McKeown). Of the patients, 17 (81%) had a complete (R0) resection, and 16 (76%) received induction treatment, the majority (14/21 [67%]) with combined chemoradiation. The median operative time was 556 min (range, 395-807 min), which decreased to 414 min (range, 405-543 min) for the last 5 cases in the series. The median estimated blood loss was 307 cm(3) (range, 200-500 cm(3)), and the median length of hospital stay was 10 days (range, 7-70 days). The median number of lymph nodes resected was 20 (range, 10-49). Five (24%) patients were converted to open procedures. Five patients (24%) had major complications. One (5%) died of complications on postoperative Day 70, and 3 (14%) had clinically significant anastomotic leaks (Grade II or greater, by Common Terminology Criteria for Adverse Events version 3.0). Three patients (14%) in this early experience developed airway fistulas. While four-arm RAMIE may offer advantages over standard minimally invasive esophagectomy approaches, its adoption in a structured program, with critical evaluation of adverse events and subsequent adjustment of technique, is paramount to maximize patient safety, minimize complications and improve the conduct of operation early in the learning curve. Particular technical consideration should be given to prevention of airway complications.

  14. Early vascular unclamping reduces warm ischaemia time in robot-assisted laparoscopic partial nephrectomy [v1; ref status: indexed, http://f1000r.es/570

    Directory of Open Access Journals (Sweden)

    Kevin Lah

    2015-05-01

    Full Text Available Introduction: The aim of this study was to assess the outcomes of early vascular release in robot-assisted laparoscopic partial nephrectomy (RAPN to reduce warm ischaemia time (WIT and minimise renal dysfunction. RAPN is increasingly utilised in the management of small renal masses. To this end it is imperative that WIT is kept to a minimum to maintain renal function. Methods: RAPN was performed via a four-arm robotic transperitoneal approach. The renal artery and vein were individually clamped with robotic vascular bulldog clamps to allow cold scissor excision of the tumour. The cut surface was then sutured with one or two running 3-0 V-LocTM sutures, following which the vascular clamps were released. Specific bleeding vessels were then selectively oversewn and the collecting system repaired. Renorrhaphy was then completed using a running horizontal mattress 0-0 V-LocTM suture. Results: A total of 16 patients underwent RAPN with a median WIT of 15 minutes (range: 8-25, operative time 230 minutes (range: 180-280 and blood loss of 100 mL (range: 50-1000. There were no transfusions, secondary haemorrhages or urine leaks. There was one focal positive margin in a central 5.5 cm pT3a renal cell carcinomas (RCC. Long-term estimated glomerular filtration rate (eGFR was not significantly different to pre-operative values. Conclusion: In this patient series, early vascular release effectively minimised WIT and maintained renal function without compromising perioperative safety.

  15. Multispectral Fluorescence Imaging During Robot-assisted Laparoscopic Sentinel Node Biopsy: A First Step Towards a Fluorescence-based Anatomic Roadmap.

    Science.gov (United States)

    van den Berg, Nynke S; Buckle, Tessa; KleinJan, Gijs H; van der Poel, Henk G; van Leeuwen, Fijs W B

    2017-07-01

    During (robot-assisted) sentinel node (SN) biopsy procedures, intraoperative fluorescence imaging can be used to enhance radioguided SN excision. For this combined pre- and intraoperative SN identification was realized using the hybrid SN tracer, indocyanine green-(99m)Tc-nanocolloid. Combining this dedicated SN tracer with a lymphangiographic tracer such as fluorescein may further enhance the accuracy of SN biopsy. Clinical evaluation of a multispectral fluorescence guided surgery approach using the dedicated SN tracer ICG-(99m)Tc-nanocolloid, the lymphangiographic tracer fluorescein, and a commercially available fluorescence laparoscope. Pilot study in ten patients with prostate cancer. Following ICG-(99m)Tc-nanocolloid administration and preoperative lymphoscintigraphy and single-photon emission computed tomograpy imaging, the number and location of SNs were determined. Fluorescein was injected intraprostatically immediately after the patient was anesthetized. A multispectral fluorescence laparoscope was used intraoperatively to identify both fluorescent signatures. Multispectral fluorescence imaging during robot-assisted radical prostatectomy with extended pelvic lymph node dissection and SN biopsy. (1) Number and location of preoperatively identified SNs. (2) Number and location of SNs intraoperatively identified via ICG-(99m)Tc-nanocolloid imaging. (3) Rate of intraoperative lymphatic duct identification via fluorescein imaging. (4) Tumor status of excised (sentinel) lymph node(s). (5) Postoperative complications and follow-up. Near-infrared fluorescence imaging of ICG-(99m)Tc-nanocolloid visualized 85.3% of the SNs. In 8/10 patients, fluorescein imaging allowed bright and accurate identification of lymphatic ducts, although higher background staining and tracer washout were observed. The main limitation is the small patient population. Our findings indicate that a lymphangiographic tracer can provide additional information during SN biopsy based on ICG-(99m

  16. Robotic laparoscopic surgery: cost and training.

    Science.gov (United States)

    Amodeo, A; Linares Quevedo, A; Joseph, J V; Belgrano, E; Patel, H R H

    2009-06-01

    The advantages of minimally invasive surgery are well accepted. Shorter hospital stays, decreased postoperative pain, rapid return to preoperative activity, decreased postoperative ileus, and preserved immune function are among the benefits of the laparoscopic approach. However, the instruments of laparoscopy afford surgeons limited precision and poor ergonomics, and their use is associated with a significant learning curve and the amount of time and energy necessary to develop and maintain such advanced laparoscopic skills is not insignificant. The robotic surgery allows all laparoscopists to perform advanced laparoscopic procedures with greater ease. The potential advantages of surgical robotic systems include making advanced laparoscopic surgical procedures accessible to surgeons who do not have advanced video endoscopic training and broadening the scope of surgical procedures that can be performed using the laparoscopic method. The wristed instruments, x10 magnifications, tremor filtering, scaling of movements and three-dimensional view allow the urologist to perform the intricate dissection and anastomosis with high precision. The robot is not, however, without significant disadvantages as compared with traditional laparoscopy. These include greater expense and consumption of operating room resources such as space and the availability of skilled technical staff, complete elimination of tactile feedback, and more limited options for trocar placement. The current cost of the da Vinci system is $ 1.2 million and annual maintenance is $ 138000. Many studies suggest that depreciation and maintenance costs can be minimised if the number of robotic cases is increased. The high cost of purchasing and maintaining the instruments of the robotic system is one of its many disadvantages. The availability of the robotic systems to only a limited number of centres reduces surgical training opportunities. Hospital administrators and surgeons must define the reasons for

  17. Robot-assisted surgery in a broader healthcare perspective

    DEFF Research Database (Denmark)

    Hyldgård, Vibe Bolvig; Laursen, Karin Rosenkilde; Poulsen, Johan

    2017-01-01

    OBJECTIVE: To estimate costs attributable to robot-assisted laparoscopic prostatectomy (RALP) as compared with open prostatectomy (OP) and laparoscopic prostatectomies (LP) in a National Health Service perspective. PATIENTS AND METHODS: Register-based cohort study of 4309 consecutive patients who...

  18. Applications of robot assisted laparoscopic operation in urinary surgery%机器人辅助腹腔镜手术在泌尿外科的应用

    Institute of Scientific and Technical Information of China (English)

    袁建林; 孟平

    2015-01-01

    近年来机器人辅助腹腔镜手术系统开展范围较广,技术较为成熟,正逐步应用于泌尿外科手术领域,目前可施行肾切除术、肾肿瘤剜除术、肾上腺肿瘤切除术、肾盂成形术、全膀胱切除术、前列腺癌根治术等,具有出血少、恢复快、住院时间短、并发症少等优点。本文就其在泌尿外科的应用作一综述。%In recent years,application of robot assisted laparoscopic operation has been carried out many fields and gradually used in urinary surgery.Currently,it has been used in a number of urological operations such as nephrectomy,renal tumor enucleation, excision of adrenal tumor,nephropyeloplasty,total cystectomy and radical prostatectomy.The technique has advantages of less bleeding, quicker recovery,shorter hospitalization time and less complications.This article reviewed its application in urinary surgery.

  19. Vesico-urethral anastomosis (VUA) evaluation of short- and long-term outcome after robot-assisted laparoscopic radical prostatectomy (RARP): selective cystogram to improve outcome.

    Science.gov (United States)

    Tillier, C; van Muilekom, H A M; Bloos-van der Hulst, J; Grivas, N; van der Poel, H G

    2017-01-12

    The role of a cystogram to assess the vesico-urethral anastomosis (VUA) after robot-assisted laparoscopic radical prostatectomy (RARP) has been debated. Early catheter removal without cystogram was reported to be associated with a trend towards an increased risk of acute urinary retention (AUR). In two cohorts we studied the effects of VUA leakage on cystogram and functional outcome after RARP. Cohort A contained 1390 consecutive men that routinely underwent a cystogram after RARP. Transurethral catheter (TUC) was removed in the absence of VUA leakage or minimal leakage on subsequent repeat cystogram. Outcome was compared to a group of 120 men that underwent cystography 7-10 days after RARP but had the TUC removed independent of cystography findings (cohort B). Outcome was assessed by early clinical follow-up and quality of life (QOL) questionnaires at 6 months. Men in cohort B had an increased risk of AUR and 6 months voiding complaints when compared to cohort A. The incidence of AUR and voiding complaints was associated with grade 2-3 leakage on cystography in cohort B but not in cohort A. Grade 2-3 leakage on cystogram was more likely in men with larger prostates larger and preoperative voiding complaints. Selective cystogram in men with larger prostates and preoperative lower urinary tract symptoms (LUTS) may prevent early AUR and voiding complaints after RARP when prolonged TUC use is applied.

  20. Robot-assisted laparoscopic radical prostatectomy%机器人辅助腹腔镜前列腺癌根治术

    Institute of Scientific and Technical Information of China (English)

    沈周俊; 王先进

    2010-01-01

    @@ 前列腺癌是老年男性最常见的泌尿生殖系统恶性肿瘤之一,严重威胁着患者的生命健康和生活质量.前列腺癌的治疗方法包括随访观察、经尿道前列腺切除术(TURP)、根治性前列腺切除术、放射治疗、冷冻治疗、内分泌治疗、综合治疗等.根治性前列腺切除术目前仍然是治疗前列腺癌的最佳方法,主要包括开放性耻骨后前列腺癌根治术(retropubic radical pro-statectomy,RRP)、腹腔镜前列腺癌根治术(laparos-copic radical prostatectomy,LRP)、机器人辅助腹腔镜前列腺癌根治术(Robot-assisted laparoscopic radicalprostatectomy,RLRP)等.

  1. 机器人辅助腹腔镜肝切除术的经验初探%Preliminary experience of robotic-assisted laparoscopic liver resection

    Institute of Scientific and Technical Information of China (English)

    肖乐; 李建伟; 郭鹏; 王小军; 别平; 郑树国

    2016-01-01

    Objective To summarize the preminiary experience of robotic-assisted laparoscopic liver resection. Methods The clinical data of 60 consecutive patients who underwent robot-assisted laparosopic liver resections for liver diseases at our institute from Jan 2010 to Jan 2016 were retrospectively analyzed. Results There were 57 cases who received successful robotic-assisted laparoscopic hepatectomy and 3 cases (5.0%) converted to open surgery. Operative time was (353±121) min. Intraoperative blood loss was(390±287) mL with transfusion rate 11.7%. Postoperative complications occurred in 15 cases (25.0%) and complications with Clavien≥3b accounted for 3.3%. Hospital stay was (9.1±3.3) days. The stone remove rate was 100%(22 cases) including 21 cases with hepatolithiasis(95.5%) removed intraoperatively and 1 case with residual stone successfully removed using choledochoscopy via a T-tube sinus postoperatively. No death occurred during perioperative period. All cases were followed-up for (18.8±12.0)(2-50)months. During the follow-up period,7 in 24 cases with cancer were found recurrence and 17 cases without. Among the cases with recurrence,4 cases died and 3 survived with tumor. Two in 22 cases with hepatolithiasis recurred and received reoperation and the other 2 cases experienced chronic cholangitis and resolved after medical treatment. Conclusions Robotic-assisted laparoscopic hepatectomy is safe, feasible and efficacious for selected patients with advantages of minimally invasive surgery.%目的:总结机器人辅助腹腔镜肝切除的初步经验。方法:回顾性分析我院2010年1月至2016年1月连续60例达芬奇机器人辅助腹腔镜肝切除术病人的临床资料。结果:60例中57例完成机器人辅助腹腔镜肝切除术,3例中转开腹,中转率为5.0%。平均手术时间(353±121) min,术中失血量(390±287) mL,术中输血率11.7%,术后并发症发生率25.0%(15例),其中3b级以上发生率3.3%

  2. Intraoperative nursing cooperation for robotic-assisted laparoscopic precise liver resection%机器人辅助腹腔镜精准肝切除的手术配合

    Institute of Scientific and Technical Information of China (English)

    许晓晓; 武伟; 李凤云; 孙建荷

    2011-01-01

    Objective To investigate intraoperative nursing cooperation for robotic-assisted laparoscopic precise liver resection. Methods Between April and July 2009, 13 consecutive patients underwent roboticassisted laparoscopic anatomic hepatectomy for benign and malignant hepatic diseases. The clinical data of preoperative preparation, intraoperative cooperation and management of emergency were analyzed retrospectively and summarized gradually. Results All 13 robotic-assisted laparoscopic precise liver resections were performed successfully in the manner of pure laparoscopic resection. The nursing protocol was formulated to improve the preoperative preparation, intraoperative cooperation, management of emergency and postoperative summary. The nursing outcome was satisfactory due to effective nursing strategy. Conclusions Robotic surgery has been expanded into multi-disciplinary field, therefore preparation, communication, discreet placement and protection are important guarantees in its development.%目的 探讨机器人辅助腹腔镜精准肝切除手术的护理配合。方法 回顾性分析13例机器人辅助腹腔镜精准肝切除手术资料,对本组手术的术前准备、术中配合及紧急情况的处理进行总结。结果 13例患者均成功接受了机器人辅助腹腔镜精准肝切除术,术前准备、术中配合、特殊情况应对及术后整理均不断改进,取得满意的护理效果。结论 机器人手术方式扩展到多专科多种术式,准备与沟通、谨慎的安置与保护,是手术护理伴随手术技术发展呈现专科护士作用的重要保障。

  3. Another novel application of Hem-o-Lok clips for transient vascular occlusion in robot-assisted laparoscopic partial nephrectomy: an alternative to laparoscopic bulldog and Satinsky clamps.

    Science.gov (United States)

    Ho, Henry Sun Sien; Peschel, Reinhard; Neururer, Richard; Steiner, Hannes; Schwentner, Christian; Bartsch, Georg

    2008-08-01

    We describe our technique of achieving transient vascular occlusion utilizing Hem-o-Lok clips during robotassisted laparoscopic partial nephrectomy (RLPN) A once-folded vascular loop is threaded through a 2-cm feeding tube. After passing around the renal vessel, its tail goes through the U-loop, creating a tourniquet. Vascular occlusion begins when the tube slides towards the vessel and a Hem-o-Lok clip is applied on the vascular loop next to the exposed end of the tube. When no longer needed, it is released. Since July 2006, 25 patients underwent RLPN utilizing this technique, which required bulldog or Satinsky clamps.

  4. Real-time 3D visual tracking of laparoscopic instruments for robotized endoscope holder.

    Science.gov (United States)

    Zhao, Zijian

    2014-01-01

    Robotized endoscope holder in laparoscopic surgeries allows surgeons to control the endoscope without the assistants' intervention. In this paper, a new method is proposed for the automatic 3D-tracking of laparoscopic instruments in real-time to provide more convenient interactions between surgeons and the robotized endoscope holder. The method is based on the 3D position measurements of the insertion points of the instruments and the strip markers, combined with the depth estimation of the instruments. The results of our experiments show that our method is fast and robust in the simulated laparoscopic surgeries.

  5. Robotic assisted andrological surgery

    Institute of Scientific and Technical Information of China (English)

    Sijo J Parekattil; Ahmet Gudeloglu

    2013-01-01

    The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy,unparalleled to any previous visual loop or magnification techniques.This technology revolutionized techniques for microsurgery in andrology.Today,we may be on the verge of a second such revolution by the incorporation of robotic assisted platforms for microsurgery in andrology.Robotic assisted microsurgery is being utilized to a greater degree in andrology and a number of other microsurgical fields,such as ophthalmology,hand surgery,plastics and reconstructive surgery.The potential advantages of robotic assisted platforms include elimination of tremor,improved stability,surgeon ergonomics,scalability of motion,multi-input visual interphases with up to three simultaneous visual views,enhanced magnification,and the ability to manipulate three surgical instruments and cameras simultaneously.This review paper begins with the historical development of robotic microsurgery.It then provides an in-depth presentation of the technique and outcomes of common robotic microsurgical andrological procedures,such as vasectomy reversal,subinguinal varicocelectomy,targeted spermatic cord denervation (for chronic orchialgia) and robotic assisted microsurgical testicular sperm extraction (microTESE).

  6. 机器人辅助腹腔镜子宫全切术41例报告%Robotic-assisted Laparoscopic Hysterectomy: Report of 41 Cases

    Institute of Scientific and Technical Information of China (English)

    何晓琴; Mukesh Parekh

    2011-01-01

    Objective To investigate the techniques of robotic-assisted laparoscopic hysterectomy. Methods With the patients at dorsal lithotomy position, under general anesthesia, we placed a colpotomy ring and uterine manipulator to delineate the vaginal fornices, and then inserted a colpo-pneumo occluder. With an digital video system prepared, we determined one port for camera, and two ports for instrument arms, and one port for assistant trocars. A patient cart was positioned between the patient' s legs and locked, the camera arm and remained instrument arms were then docked, HotShears (Monopolar Curved Scissors) and PK Dissect Forceps were fixed at each side. When suturing, needle drivers was used at the both sides. Assistant trocar was used to help exposing surgical field and suction. By controlling the robotic arms, we completed the operation. Results The mean operation time was (82.5 ± 9.5) minutes [ console time (61.9 ± 7.9) minutes, docking time (7.0 ± 1.5 ) minutes ]; and intraoperative blood loss was (55.0 ± 12.8) ml. No intraoperative complications occurred. Two patients developed postoperative complications: hypertension in one and urological infection at 3 days postoperation in the other. Both cases were cured by conservative therapies. Follow-up was available in 41 cases for 42 days, during which no vaginal bleeding or abdominal pain was complained. Conclusions Robot-assisted hysterectomy is safe and reliable with few complications and quick recovery.%目的 探讨机器人辅助腹腔镜子宫全切术的临床应用.方法 全麻后取截石位,放置阴道环切环、子宫操纵器及阴道封堵球囊,准备数字电视摄像系统,确定一个内镜端口、2个器械端口及一个助手端口的位置并置入套管,自动操作仪器置于患者两腿间,对接自动操作仪器和内镜摄像臂,一侧端口安装双极电凝钳,一侧端口安装单极电剪.缝合时两侧端口均安装针持器.助手端口置入普通腔镜器械,由手术

  7. 达芬奇机器人辅助腹腔镜前列腺癌根治术的手术要点(附光盘)%Surgical techniques of Da Vinci robot-assisted laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    沈周俊; 王先进; 何威; 王晓晶; 钟山

    2013-01-01

    达芬奇机器人手术系统在泌尿外科领域的广泛应用和发展是当今世界临床医学发展的里程碑.达芬奇机器人辅助腹腔镜前列腺癌根治术(robot-assisted laparoscopic radical prostatectomy,RLRP)是所有泌尿外科机器人手术中,与开放和传统腹腔镜手术相比最具明显优势的微创手术.目前在前列腺癌高发的欧美国家,RLRP几乎成为治疗局限性前列腺癌的金标准,在国内RLRP也已取得快速发展.本文就机器人手术系统的国内外发展状况和发展趋势,RLRP的适应证和禁忌证、手术步骤和技巧、优缺点等做一概述.%The wide application and development of Da Vinci surgical system in the urology is a milestone in the development of clinical medicine. Da Vinci robot-assisted laparoscopic radical prostatectomy(RLRP)has the most obvious advantages of minimally invasive surgery among all robotic surgeries in urology compared to the laparoscopic surgeries. In the developed regions with high incidence of prostate cancer,RLRP has almost become the gold standard for the treatment of localized prostate cancer. Rapid development of RLRP has also been achieved in China. This review gives a brief account of the current situation and development trend of robotic surgical system and summarizes the main aspects of RLRP including the indications and contraindications, surgical procedures and techniques, ad vantages and disadvantages and so on.

  8. A Compact Modular Teleoperated Robotic System for Laparoscopic Surgery.

    Science.gov (United States)

    Berkelman, Peter; Ma, Ji

    2009-09-01

    Compared with traditional open surgery, minimally invasive surgical procedures reduce patient trauma and recovery time, but the dexterity of the surgeon in laparoscopic surgery is reduced owing to the small incisions, long instruments and limited indirect visibility of the operative site inside the patient. Robotic surgical systems, teleoperated by surgeons from a master control console with joystick-type manipulation interfaces, have been commercially developed yet their adoption into standard practice may be limited owing to their size, complexity, cost and time-consuming setup, maintenance and sterilization procedures. The goal of our research is to improve the effectiveness of robot-assisted surgery by developing much smaller, simpler, modular, teleoperated robotic manipulator systems for minimally invasive surgery.

  9. A Compact Modular Teleoperated Robotic System for Laparoscopic Surgery

    Science.gov (United States)

    Berkelman, Peter; Ma, Ji

    2011-01-01

    Compared with traditional open surgery, minimally invasive surgical procedures reduce patient trauma and recovery time, but the dexterity of the surgeon in laparoscopic surgery is reduced owing to the small incisions, long instruments and limited indirect visibility of the operative site inside the patient. Robotic surgical systems, teleoperated by surgeons from a master control console with joystick-type manipulation interfaces, have been commercially developed yet their adoption into standard practice may be limited owing to their size, complexity, cost and time-consuming setup, maintenance and sterilization procedures. The goal of our research is to improve the effectiveness of robot-assisted surgery by developing much smaller, simpler, modular, teleoperated robotic manipulator systems for minimally invasive surgery. PMID:21743765

  10. Prophylactic antibiotic treatment following laparoscopic robot-assisted radical prostatectomy for the prevention of catheter-associated urinary tract infections: did the AUA guidelines make a difference?

    Science.gov (United States)

    Haifler, Miki; Mor, Yoram; Dotan, Zohar; Ramon, Jacob; Zilberman, Dorit E

    2016-12-16

    We sought to evaluate the effectiveness of the American Urological Association (AUA) antibiotic prophylaxis guidelines in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP). Our prospective registry database was reviewed for all RALP cases. The following variables were evaluated: age, associated comorbidities, body mass index (BMI), total operative time, length of stay (LOS), prostate weight, pathological grade and stage. Until 11/2011, RALP patients were treated with antibiotics administered in the operating room and continued until urethral catheter removal. Since 11/2011, all patients were treated with a single intravenous dose of Cephalosporin and Aminoglycoside given within 30 min of surgical incision. The rate of catheter-associated urinary tract infection (CAUTI) was evaluated in both groups. 229 RALP patients were identified. The first 60 patients (26.2%) were treated according to the old protocol (Group 1) while the remaining 169 (73.8%) were treated according to the new protocol (Group 2). Group match was identified in all categories but LOS. Moreover, LOS was found to be longer in Group 1 compared with Group 2 (5.8 vs. 4.5 days, p < 0.001). CAUTI rate was similar in both groups (8.3 vs. 8.9%, respectively, p = 0.89). Logistic regression analysis did not demonstrate any association between treatment protocol and potential risk for CAUTI. Therefore, a single preoperative dose of antibiotics does not increase the rate of CAUTI following RALP compared with prolonged antibiotic treatment. Moreover, it was found to be associated with shorter LOS. Complying with the AUA guidelines may reduce morbidity and medical costs.

  11. A Critical Analysis of the Learning Curve and Postlearning Curve Outcomes of Two Experience- and Volume-Matched Surgeons for Laparoscopic and Robot-Assisted Radical Prostatectomy.

    Science.gov (United States)

    Good, Daniel W; Stewart, Grant D; Laird, Alexander; Stolzenburg, Jens-Uwe; Cahill, Declan; McNeill, S Alan

    2015-08-01

    There remains equipoise with regard to whether laparoscopic radical prostatectomy (LRP) or robot-assisted radical prostatectomy (RARP) has any benefit over the other. Despite this, there is a trend for the increasing adoption of RARP at great cost to health services across the world. The aim was to critically analyze the learning curve and outcomes for LRP and RARP for two experience- and volume-matched surgeons who have completed the learning curve for LRP and RARP. Two experience- and volume-matched LRP and RARP surgeons who have completed the learning curve were compared with respect to their learning curve and outcomes for RARP and LRP. There were 531 RARP and 550 LRPs analyzed from April 2003 until January 2012 at two relatively high-volume United Kingdom centers. Outcome measures included operative time, blood loss, complication rate (Clavien-Dindo grade III), positive surgical margin (PSM) rate, and early continence rate. Learning curves for blood loss, operative times, and complication rate were similar between groups. The overall PSM rate and pT2 PSM rate learning curves were longer for RARP compared with LRP but shorter for early continence. Apical PSM showed no learning curve for RARP; however, a long learning curve for LRP and the rate was lower for RARP than for LRP (P=learning curves. Despite the long learning curve for RARP, significant benefits in lower PSM rates and better early continence in comparison with LRP exist. There are benefits to patients with RARP over LRP, especially those linked to better apical dissection (apical PSM and early continence).

  12. 机器人辅助与传统腹腔镜进行胆囊手术效果的系统评价%Comparison of the Effect of Robot Assisted and Traditional Laparoscopic Cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    于艺; 解龙; 王长淼

    2015-01-01

    Objective To compare the safety and ef icacy of robot assisted surgery and laparoscopic surgery ingal bladder with respect to adult patients. Methods A systematic article search and review were performed. Foreign and Chinese database were used in our study.Published studies comparing robot assisted sugery versus laparoscopic surgery was eligible for inclusion. The main outcome were conversion rate, complication, blood loss and second outcomes were operation time, postoperative hospital stay. RevMan5.2 software was used to do statistical analysis. Results Five artical reporting data on 586 patients have been included in our study, There was no significant dif erences between robot assisted surgery and laparoscopic surgery in conversion rate, complication, bloodloss, operationtime, postoperative hospital stay. There was significant dif erence between robot assisted surgery and laparoscopic surgery in operative time. Conclusion Based on cur ent studies, we cannot concluded robot assisted surgery is bet er than laparoscopic surgery. We need more wel designed multicenter randomized control ed trial to assess the safety and ef icacy of robot-assisted surgery.%目的对机器人辅助与传统腹腔镜在胆囊微创外科的效果进行荟萃分析。方法制定并严格遵照文献的纳入与排除标准,从中外文数据库检索近10年的有关机器人和传统腹腔镜治疗胆囊疾病的公开发表的论文或会议论文。按照Cochrane风险评估偏倚工具进行文献质量评价,选取转开腹率、并发症、术中出血量为主要结局指标;选取住院时间、手术时间为次要结局指标。应用RevMan5.2软件对提取数据进行统计学分析。结果文献检索最终有5篇文献符合纳入标准,5篇文献中共报告了586例患者,其中机器人组309例,腹腔镜组277例。与腹腔镜手术系统相比,机器人手术系统在并发症发生率、中转开腹率、术中出血量及住院时间方面无明显

  13. ROBOTIC ASSISTANCE IN SPINE SURGERY

    Directory of Open Access Journals (Sweden)

    N. A. Konovalov

    2010-01-01

    Full Text Available Robotic assistance recently gains increasing popularity in spinal surgery. Robotic assistance provides higher effectiveness and safety especially in complex anatomy environment. 16 patients with degenerative disc disease were operated with robotic assistance device («SpineAssist»; MAZOR Surgical Technologies, Caesarea, Israel. The robot was used for automated intraoperative positioning of the instruments according to preoperatively planned trajectories. Robotic assistance enabled optimal screw placement even in complex anatomical cases (thin pedicles and rotational deformity. No implant-related complications were recorded.

  14. 机器人结直肠癌根治术的初步应用体会%Early experience of robot-assisted laparoscopic radical resection for colorectal carcinoma

    Institute of Scientific and Technical Information of China (English)

    王首寒; 王斌; 陈佳祺; 孙小单

    2016-01-01

    Objective To investigate early experience of Da Vinci robot-assisted laparoscopic radical resection for colorectal carcinoma. Methods The clinical outcomes of 63 colorectal cancer patients undergoing robot-assisted laparoscopic radical resection from October 2014 to May 2016 were retrospectively collected and analyzed. Results All operations were completed successfully. There were no conversions to open surgery and no postoperative mortality. The robot docking time was (15.24±5.69) min. The operative time was (176.43±59.39) min. The blood loss was (28.65±22.36) ml. The number of lymph nodes harvested was (14.47±5.67). The recover time of bowel function was(51.43±12.96) hours. The postoperative hospital stay was (8.22±1.52) days. Conclusions Da Vinci robot-assisted laparoscopic radical resection for colorectal carcinoma is safe and feasible. The robotic system is suitable for clinical application.%目的:探讨达芬奇机器人手术系统应用于结直肠癌手术的初步体会。方法回顾性收集吉林省肿瘤医院腹部肿瘤科2014年10月至2016年5月的63例结直肠癌行机器人手术患者临床数据,进行整理分析。结果63例手术均顺利完成,无一例中转开腹,无术后并发症,机器人安装时间为(15.24±5.69)min,手术时间为(176.43±59.39)min,术中出血量(28.65±22.36)mL,清扫淋巴结数(14.47±5.67)枚,术后排气时间(51.43±12.96)h,术后住院日(8.22±1.52)d。结论达芬奇机器人手术系统应用于结直肠癌的手术治疗安全可行,手术效果好,术后恢复快,适合临床应用。

  15. Abdominal Hysterectomy: Reduced Risk of Surgical Site Infection Associated with Robotic and Laparoscopic Technique.

    Science.gov (United States)

    Colling, Kristin P; Glover, James K; Statz, Catherine A; Geller, Melissa A; Beilman, Greg J

    2015-10-01

    Hysterectomy is one of the most common procedures performed in the United States. New techniques utilizing laparoscopic and robotic technology are becoming increasingly common. It is unknown if these minimally invasive surgical techniques alter the risk of surgical site infections (SSI). We performed a retrospective review of all patients undergoing abdominal hysterectomy at our institution between January 2011 and June 2013. International Classification of Diseases, Ninth edition (ICD-9) codes and chart review were used to identify patients undergoing hysterectomy by open, laparoscopic, or robotic approach and to identify patients who developed SSI subsequently. Chi-square and analysis of variance (ANOVA) tests were used to identify univariate risk factors and logistic regression was used to perform multivariable analysis. During this time period, 986 patients were identified who had undergone abdominal hysterectomy, with 433 receiving open technique (44%), 116 laparoscopic (12%), 407 robotic (41%), and 30 cases that were converted from minimally invasive to open (3%). Patients undergoing laparoscopic-assisted hysterectomy were significantly younger and had lower body mass index (BMI) and American Society of Anesthesiologists (ASA) scores than those undergoing open or robotic hysterectomy. There were no significant differences between patients undergoing open versus robotic hysterectomy. The post-operative hospital stay was significantly longer for open procedures compared with those using laparoscopic or robotic techniques (5.1, 1.7, and 1.6 d, respectively; physterectomy procedures was 4.2%. More SSI occurred in open cases (6.5%) than laparoscopic (0%) or robotic (2.2%) (pobesity were all associated with increased risk of SSI. Laparoscopic and robotic hysterectomies were associated with a significantly lower risk of SSI and shorter hospital stays. Body mass index, advanced age, and wound class were also independent risk factors for SSI.

  16. 机器人辅助腹腔镜下低位直肠癌根治术的护理配合%Nursing cooperation in robot-assisted radical resection of low rectal carcinoma under laparoscope

    Institute of Scientific and Technical Information of China (English)

    许晓晓; 张秋玲; 李凤云

    2014-01-01

    目的:探讨机器人辅助腹腔镜下低位直肠癌根治术的护理配合方法,提高护士的手术配合质量。方法对48例机器人辅助腹腔镜下低位直肠癌根治术的手术配合进行总结分析。结果48例机器人辅助腹腔镜下低位直肠癌根治术均顺利完成。结论充分的术前准备和完善的术中护理管理是保障手术顺利进行的关键。%Objective To probe into ways of nursing cooperation in robot-assisted radical resection of low rectal carcinoma under laparoscope, thus improve the quality of nursing cooperation. Methods Summarize and analyze 48 cases of nursing cooperation in robot-assisted radical resection of low rectal carcinoma under laparoscope. Results All the 48 cases have been performed successfully. Conclusion The full preoperative preparation and sound intraoperative nursing management are the guarantees of the smooth operation.

  17. Laparoscopically assisted pyeloplasty for ureteropelvic junction ...

    African Journals Online (AJOL)

    junction obstruction: a transperitoneal versus a retroperitoneal approach ... laparoscopic-assisted dismembered pyeloplasty (TLADP) ... to an open technique for two patients of the TLADP group; ... Annals of Pediatric Surgery 2012, 8:29–31.

  18. Robotic assisted minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Palep Jaydeep

    2009-01-01

    Full Text Available The term "robot" was coined by the Czech playright Karel Capek in 1921 in his play Rossom′s Universal Robots. The word "robot" is from the check word robota which means forced labor.The era of robots in surgery commenced in 1994 when the first AESOP (voice controlled camera holder prototype robot was used clinically in 1993 and then marketed as the first surgical robot ever in 1994 by the US FDA. Since then many robot prototypes like the Endoassist (Armstrong Healthcare Ltd., High Wycombe, Buck, UK, FIPS endoarm (Karlsruhe Research Center, Karlsruhe, Germany have been developed to add to the functions of the robot and try and increase its utility. Integrated Surgical Systems (now Intuitive Surgery, Inc. redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System ® classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist ® . It was approved by FDA in July 2000 for general laparoscopic surgery, in November 2002 for mitral valve repair surgery. The da Vinci robot is currently being used in various fields such as urology, general surgery, gynecology, cardio-thoracic, pediatric and ENT surgery. It provides several advantages to conventional laparoscopy such as 3D vision, motion scaling, intuitive movements, visual immersion and tremor filtration. The advent of robotics has increased the use of minimally invasive surgery among laparoscopically naοve surgeons and expanded the repertoire of experienced surgeons to include more advanced and complex reconstructions.

  19. The learning curve of robot-assisted laparoscopic fundoplication in children: a prospective evaluation and CUSUM analysis.

    Science.gov (United States)

    Cundy, Thomas P; Rowland, Simon P; Gattas, Nicholas E; White, Alan D; Najmaldin, Azad S

    2015-06-01

    Fundoplication is a leading application of robotic surgery in children, yet the learning curve for this procedure (RF) remains ill-defined. This study aims to identify various learning curve transition points, using cumulative summation (CUSUM) analysis. A prospective database was examined to identify RF cases undertaken during 2006-2014. Time-based surgical process outcomes were evaluated, as well as clinical outcomes. A total of 57 RF cases were included. Statistically significant transitions beyond the learning phase were observed at cases 42, 34 and 37 for docking, console and total operating room times, respectively. A steep early learning phase for docking time was overcome after 12 cases. There were three Clavien-Dindo grade ≥ 3 complications, with two patients requiring redo fundoplication. We identified numerous well-defined learning curve trends to affirm that experience confers significant temporal improvements. Our findings highlight the value of the CUSUM method for learning curve evaluation. Copyright © 2014 John Wiley & Sons, Ltd.

  20. Effect of a risk-stratified grade of nerve-sparing technique on early return of continence after robot-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Srivastava, Abhishek; Chopra, Sameer; Pham, Anthony; Sooriakumaran, Prasanna; Durand, Matthieu; Chughtai, Bilal; Gruschow, Siobhan; Peyser, Alexandra; Harneja, Niyati; Leung, Robert; Lee, Richard; Herman, Michael; Robinson, Brian; Shevchuk, Maria; Tewari, Ashutosh

    2013-03-01

    The impact of nerve sparing (NS) on urinary continence recovery after robot-assisted laparoscopic radical prostatectomy (RALP) has yet to be defined. To evaluate the effect of a risk-stratified grade of NS technique on early return of urinary continence. Data were collected from 1546 patients who underwent RALP by a single surgeon at a tertiary care center from December 2008 to October 2011. Patients were categorized preoperatively by a risk-stratified approach into risk grades 1-4, with risk grade 1 patients more likely to receive NS grade 1 or complete hammock preservation. This categorization was also conducted for risk grades 2-4, with grade 4 patients receiving a non-NS procedure. Risk-stratified grading of NS RALP. Univariate and multivariate analysis identified predictors of early return of urinary continence, defined as no pad use at ≤ 12 wk postoperatively. Early return of continence was achieved by 791 of 1417 men (55.8%); of those, 199 of 277 (71.8%) were in NS grade 1, 440 of 805 (54.7%) were in NS grade 2, 132 of 289 (45.7%) were in NS grade 3, and 20 of 46 (43.5%) were in NS grade 4 (preturn of urinary continence when NS grade 1 was the reference variable compared with NS grade 2 (preturn of urinary continence. Positive surgical margin rates were 7.2% (20 of 277) of grade 1 cases, 7.6% (61 of 805) of grade 2 cases, 7.6% (22 of 289) of grade 3 cases, and 17.4% (8 of 46) of grade 4 cases (p=0.111). Extraprostatic extension occurred in 6.1% (17 of 277) of NS grade 1 cases, 17.5% (141 of 805) of NS grade 2 cases, 42.5% (123 of 289) of NS grade 3 cases, and 63% (29 of 46) of NS grade 4 cases (prisk-stratified grade of NS technique and early return of urinary continence as patients with a lower grade (higher degree) of NS achieved an early return of urinary continence without compromising oncologic safety. Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  1. Laparoscopy-assisted Robotic Myomectomy Using the DA Vinci System

    Directory of Open Access Journals (Sweden)

    Shih-Peng Mao

    2007-06-01

    Conclusion: Minimally invasive surgery is the trend of the future. Robot-assisted laparoscopic surgery is a new technique for myomectomy. This robotic system provides a three-dimensional operative field and an easy-to-use control panel, which may be of great help when applying the suturing techniques and may shorten the learning curve. More experience with and long-term follow-up of robotic surgery may be warranted to further validate the role the robot-assisted approach in gynecologic surgery.

  2. Hand-assisted laparoscopic surgery using Gelport

    Directory of Open Access Journals (Sweden)

    Gupta Puneet

    2005-01-01

    Full Text Available Introduction: Minimally invasive surgery has revolutionized general surgery during the past 10 years. However, for more advanced surgical procedures, the acceptance of the minimally invasive approach has been slower than expected. Advanced laparoscopic surgery is complex and time-consuming. The major drawbacks of laparoscopic surgery are two-dimensional view, lack of depth perception and loss of tactile sensation. This has led to the innovation of hand-assisted laparoscopic surgery (HALS. The objective of the present study was to determine that safety of HALS. Materials and Methods: We preformed 18 HALS procedures in our department between July 2003 and January 2005 on patients who had given their informed consent for the use of Gelport. Out of these, 15 were colectomy, 2 nephrectomy and 1 splenectomy. Out of the 18 patients, 13 were males and 5 were females with the age group ranging from 44 to 72 years. Results: Hand-assisted laparoscopic surgery could be completed in 17 patients maintaining all the oncological principals of surgery. The mean operating times were 120 min for right haemicolectomy, 135 min for left colectomy, 150 min for splenectomy, and 150 min for nephrectomy. The patient undergoing radical nephrectomy by HALS had to be converted to open surgery. As the tumour was large and adherent to the spleen and posterior peritoneal wall. Postoperative recovery was excellent with an average hospital stay of 5 days. Histopathology report showed wide clearance and till date we have a good follow up of 30-380 days. Conclusion: Hand-assisted laparoscopic surgery allows tactile sensation and depth perception thereby may simplify the complex procedures. This may result in reduction of operating time and conversion rates at the same time maintaining all the oncological principles. Hand-assisted laparoscopic surgery strikes a perfect balance between an extended open laparotomy incision and an excessively tedious laparoscopic exercise. Hand

  3. Possible benefits of robot-assisted rectal cancer surgery regarding urological and sexual dysfunction

    DEFF Research Database (Denmark)

    Broholm Andersen, Malene; Pommergaard, H-C; Gögenür, I

    2015-01-01

    AIM: Robot-assisted surgery for rectal cancer may result in lower rates of urogenital dysfunction compared with laparoscopic surgery. A systematic review was conducted of studies reporting urogenital dysfunction after robot-assisted rectal cancer surgery. METHOD: PubMed, Embase and the Cochrane...... Library were systematically searched in February 2014. All studies investigating urogenital function after robot-assisted rectal cancer surgery were identified. The inclusion criteria for meta-analysis studies required comparison of robot-assisted with laparoscopic surgery and the evaluation of urological...... to four including 152 patients in the robotic group and 161 in the laparoscopic group, without heterogeneity. The IPSS score at 3 and 12 months favoured robot-assisted surgery [mean difference (MD) -1.58; 95% CI (-3.1, -0.0), [P = 0.04; and MD -0.90 (-1.81, -0.02), P = 0.05]. IIEF scores at 3 months...

  4. First Clinical Experience in Urologic Surgery with a Novel Robotic Lightweight Laparoscope Holder

    CERN Document Server

    Long, Jean-Alexandre; Lanchon, Cecilia; Voros, Sandrine; Medici, Maud; Descotes, Jean-Luc; Troccaz, Jocelyne; Cinquin, Philippe; Rambeaud, Jean-Jacques; Moreau-Gaudry, Alexandre

    2012-01-01

    Purpose: To report the feasibility and the safety of a surgeon-controlled robotic endoscope holder in laparoscopic surgery. Materials and methods: From March 2010 to September 2010, 20 patients were enrolled prospectively to undergo a laparoscopic surgery using an innovative robotic endoscope holder. Two surgeons performed 6 adrenalectomies, 4 sacrocolpopexies, 5 pyeloplasties, 4 radical prostatectomies and 1 radical nephrectomy. Demographic data, overall set-up time, operative time, number of assistants needed were reviewed. Surgeon's satisfaction regarding the ergonomics was assessed using a ten point scale. Postoperative clinical outcomes were reviewed at day 1 and 1 month postoperatively. Results: The per-protocol analysis was performed on 17 patients for whom the robot was effectively used for surgery. Median age was 63 years, 10 patients were female (59%). Median BMI was 26.8. Surgical procedures were completed with the robot in 12 cases (71 %). Median number of surgical assistant was 0. Overall set-up ...

  5. Update on laparoscopic/robotic kidney transplant: a literature review

    Directory of Open Access Journals (Sweden)

    He B

    2013-09-01

    Full Text Available Bulang He,1,2 Jeffrey M Hamdorf2 1Liver and Kidney Transplant Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia; 2School of Surgery, The University of Western Australia, Perth, WA, Australia Aims: The aim of this paper was to review the current status of laparoscopic/robotic kidney transplant and evaluate its feasibility and safety in comparison with conventional standard "open" kidney transplant. Methods: An electronic search of PubMed, Embase, and the Cochrane library database was performed to identify the papers between January 1980 and June 2013 that reported on laparoscopic/robotic kidney transplantation. The terms "laparoscopic kidney/renal transplant" and "robotic kidney/renal transplant (transplantation" were used. Cross-referencing was also used to find the further publications. Only English language reports were selected and accepted for descriptive analysis. Results: A total of 17 papers and abstracts were retrieved. There were two case-control studies of small volume. High-level evidence comparing the safety and efficacy of laparoscopic/robotic kidney transplant with conventional open kidney transplant was not available at the time of this review. Conclusion: The limited published data have suggested that laparoscopic/robotic kidney transplant may offer the advantages of less pain, better cosmesis, possible shorter hospital stay, and fewer wound complications, without compromising graft function. Accordingly, some immunosuppressive agents, such as sirolimus, might be able to be commenced earlier, after laparoscopic/robotic kidney transplant. The techniques are various at this early stage. A uniformed operative technique may be established in the near future. With refinement of laparoscopic devices, this technique may be widely employed. Further studies will be needed to demonstrate the advantages of laparoscopic/robotic kidney transplant over the conventional open kidney transplant. Keywords: laparoscopic surgery, robotic

  6. 全机器人辅助低温灌注下肾部分切除术的护理配合%Nursing cooperation of cold intravascular perfusion during Robot-assisted laparoscopic partial nephrectomy

    Institute of Scientific and Technical Information of China (English)

    王涛; 李丽霞; 董薪; 蔡康灵

    2014-01-01

    目的:探讨全机器人辅助低温灌注下肾部分切除术下的护理配合流程,提高护士的手术配合质量。方法通过配合10例全机器人辅助低温灌注下肾部分切除手术,对术前物品准备、手术间布局,术中体位摆放及手术精准配合进行总结。结果10例手术顺利完成,无中转开腹,手术配合满意。结论准备好特殊手术物品,熟练的手术操作步骤,与手术医生积极沟通,掌握机器人各系统的使用情况是确保手术成功的关键。%Objective To explore the nursing cooperation during cold intravascular perfusion during robot-assisted laparoscopic partial nephrectomy. Methods Ten patients with renal cancer underwent robot-assisted laparoscopic partial nephrectomy using renal arterial perfusion with cold,the experience including preoperative preparation,intraoperative positioning and cooperation, and perioperative management of devices were drawn. Results All operative procedures were successfully performed. Conclusion Preoperative preparation,intraoperative communication and the skillful use of robotˊs system play critical roles on the success of the procedure.

  7. 机器人手术系统辅助结肠癌手术13例%Robotic-assisted laparoscopic colectomy for colon cancer: a report of 13 cases

    Institute of Scientific and Technical Information of China (English)

    鲍扬; 江志伟; 谢立飞; 刘凤涛; 黎介寿

    2011-01-01

    Objective To investigate the safety and feasibility of robotic-assisted laparoscopic colectomy for colonic cancer. Methods The clinical outcomes of 13 patients with colon cancer undergoing robotic-assisted laparoscopic colectomy from May 2010 to November 2010 were retrospectively evaluated. Results All the operations were performed successfully, including 5 right colectomies, 3 left colectomies, and 3 sigmoidectomies. The operative time was (171.5±31.8) minutes. The estimated blood loss was (54.6±21.8) ml. Time to the return of bowel function was (60.9±15.8) hours and postoperative hospital stay was (6.4±3.6) days. There was one patient developed fat liquefaction at the incision. No bleeding, anastomotic fistula, anastomotic stenosis, or other complications were found. Conclusion Robotic-assisted laparoscopic colectomy is safe and feasible for colon cancer resection.%目的 探讨达芬奇机器人手术系统辅助结肠癌手术的安全性与可行性.方法 回顾性总结2010年5-11月实施的13例达芬奇机器人手术系统辅助结肠癌手术的治疗效果.结果 13例结肠癌患者行右半结肠切除5例、左半结肠切除3例、乙状结肠切除5例.手术均顺利完成,无中转开腹.手术时间(171.5±31.8)min,术中失血量(54.6±21.8)ml,术后肠蠕动恢复时间为(60.9±15.8)h,术后住院时间(6.4±3.6)d.术后除1例切口脂肪液化外,未出现出血、吻合口瘘、吻合口狭窄等并发症.结论 达芬奇机器人手术系统应用于结肠癌手术安全可行.

  8. Novel Port Placement and 5-mm Instrumentation for Robotic-Assisted Hysterectomy

    OpenAIRE

    Nezhat, Ceana H.; Katz, Adi; Dun, Erica C; Kho, Kimberly A.; Wieser, Friedrich A.

    2014-01-01

    Background and Objectives: The value of robotic surgery for gynecologic procedures has been critically evaluated over the past few years. Its drawbacks have been noted as larger port size, location of port placement, limited instrumentation, and cost. In this study, we describe a novel technique for robotic-assisted laparoscopic hysterectomy (RALH) with 3 important improvements: (1) more aesthetic triangular laparoscopic port configuration, (2) use of 5-mm robotic cannulas and instruments, an...

  9. Robotic-assisted hysterectomy: patient selection and perspectives

    Directory of Open Access Journals (Sweden)

    Smorgick N

    2017-03-01

    Full Text Available Noam Smorgick Departments of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Abstract: Minimally invasive hysterectomy via the laparoscopic or vaginal approach is beneficial to patients when compared with laparotomy, but has not been offered in the past to all women because of the technical difficulties and the long learning curve required for laparoscopic hysterectomy. Robotic-assisted hysterectomy for benign indications may allow for a shorter learning curve but does not offer clear advantages over conventional laparoscopic hysterectomy in terms of surgical outcomes. In addition, robotic hysterectomy is invariably associated with increased costs. Nevertheless, this surgical approach has been widely adopted by gynecologic surgeons. The aim of this review is to describe specific indications and patients who may benefit from robotic-assisted hysterectomy. These include hysterectomy for benign conditions in cases with high surgical complexity (such as pelvic adhesive disease and endometriosis, hysterectomy and lymphadenectomy for treatment of endometrial carcinoma, and obese patients. In the future, additional evidence regarding the benefits of single-site robotic hysterectomy may further modify the indications for robotic-assisted hysterectomy. Keywords: robotic-assisted hysterectomy, single-site laparoscopy, minimally invasive hysterectomy

  10. Day case robotic ventral rectopexy compared with day case laparoscopic ventral rectopexy: a prospective study.

    Science.gov (United States)

    Faucheron, J-L; Trilling, B; Barbois, S; Sage, P-Y; Waroquet, P-A; Reche, F

    2016-10-01

    Ventral rectopexy to the promontory has become one of the most strongly advocated surgical treatments for patients with full-thickness rectal prolapse and deep enterocele. Despite its challenges, laparoscopic ventral rectopexy with or without robotic assistance for selected patients can be performed with relatively minimal patient trauma thus creating the potential for same-day discharge. The aim of this prospective case-controlled study was to assess the feasibility, safety, and cost of day case robotic ventral rectopexy compared with routine day case laparoscopic ventral rectopexy. Between February 28, 2014 and March 3, 2015, 20 consecutive patients underwent day case laparoscopic ventral rectopexy for total rectal prolapse or deep enterocele at Michallon University Hospital, Grenoble. Patients were selected for day case surgery on the basis of motivation, favorable social circumstances, and general fitness. One out of every two patients underwent the robotic procedure (n = 10). Demographics, technical results, and costs were compared between both groups. Patients from both groups were comparable in terms of demographics and technical results. Patients operated on with the robot had significantly less pain (p = 0.045). Robotic rectopexy was associated with longer median operative time (94 vs 52.5 min, p case robotic ventral rectopexy is feasible and safe, but results in longer operative time and higher costs than classical laparoscopic ventral rectopexy for full-thickness rectal prolapse and enterocele.

  11. Use of 3-D HD auxiliary monitor by bedside assistant results in shorter console-time and ischemia-time in robot assisted laparoscopic partial tumor-nephrectomy

    NARCIS (Netherlands)

    Alamyar, M.; Bouma, H; ; Goossens, W.J.H.; Wieringa, F.P.; Kroon, B.K.; Eendebak, P.T.; Wijburg, C.J.; Smits, G.A.H.J.

    2014-01-01

    Recently, we have shown that connecting live three-dimensional (3D) monitors to all three available Da Vinci® robot (Intuitive) generations improved the impression of shared perception for the whole surgical team. Standardized dry lab experiments revealed that delicate teamwork was faster (up to 40%

  12. Learning Curve of Robotic-assisted Radical Prostatectomy With 60 Initial Cases by a Single Surgeon

    Directory of Open Access Journals (Sweden)

    Yen-Chuan Ou

    2011-04-01

    Conclusion: After gaining experience by performing an initial 30 robotic-assisted laparoscopic radical prostatectomies, the subsequent 30 surgeries established proficiency as determined by vesicourethral anastomosis time and early continence rate.

  13. 结直肠手术中机器人辅助与传统腹腔镜手术效果的meta分析%A meta-analysis of robotic-assisted and laparoscopic colorectal surgery

    Institute of Scientific and Technical Information of China (English)

    邓军; 童强; 吴珂; 卢晓明; 王国斌

    2012-01-01

    Objective:To access the safety and feasibility of robotic-assisted laparoscopie colorectal surgery. Method: A system review and a meta-analysis were conducted to compare several indexes between the robotic-assisted laparoscope and traditional laparoscope applied in colorectal surgery. A comprehensive search of electronic database: Pubmed and EMbase from building the database to Jan, 2012 was completed for controlled studies and random trails comparing robotic-assistant and laparoscope used in colorectal surgery. Two independent reviewers joined in the work of data admitting and excluding. All the statistical analysis was performed with Stata 10. 0. Result :15 articles including 1 182 patients met the criteria and were finally included in this meta-analysis. No statistically significant difference was found in estimated blood loss, number of dissected lymph nodes, distal resection margin, time of bowel function recovery, time to oral diet, hospital stay, total cost, number of total complications and number of conversion to open surgery between two groups. Conclusion: This systematic review demonstrated that robotic- assisted colorectal surgery is emerging as a safe and feasible option in colorectal surgery compared with traditional laparoscopic surgery.%目的:应用Meta分析的方法比较机器人和传统腹腔镜在结直肠手术应用中各项临床指标,以评价机器人辅助与传统腹腔镜治疗效果的安全性及差异.方法:本文在两个英文数据库:Pubmed和EMbase检索了建库至2012年1月关于机器人辅助腹腔镜与传统腹腔镜在结直肠手术中应用对比的文献,由两位不同的作者独立进行排除、纳入与数据提取,将符合标准的文献数据利用Stata10.0进行分析.结果:本文最终纳入了15篇符合标准的文献,共包含了 1 182个病人.总的机器人辅助手术并发症发生率为17%,中转开腹手术的转换率为2%,有死亡病例均为0.机器人辅助腹腔镜组手术时间比

  14. Robotic versus Laparoscopic Distal Pancreatectomy: A Meta-Analysis of Short-Term Outcomes.

    Directory of Open Access Journals (Sweden)

    Jia-Yu Zhou

    Full Text Available To compare the safety and efficacy of robotic-assisted distal pancreatectomy (RADP and laparoscopic distal pancreatectomy (LDP.A literature search of PubMed, EMBASE, and the Cochrane Library database up to June 30, 2015 was performed. The following key words were used: pancreas, distal pancreatectomy, pancreatic, laparoscopic, laparoscopy, robotic, and robotic-assisted. Fixed and random effects models were applied. Study quality was assessed using the Newcastle-Ottawa Scale.Seven non-randomized controlled trials involving 568 patients met the inclusion criteria. Compared with LDP, RADP was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, R0 resection rate, lymph nodes harvested, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.RADP is a safe and feasible alternative to LDP with regard to short-term outcomes. Further studies on the long-term outcomes of these surgical techniques are required.To date, there is no consensus on whether laparoscopic or robotic-assisted distal pancreatectomy is more beneficial to the patient. This is the first meta-analysis to compare laparoscopic and robotic-assisted distal pancreatectomy. We found that robotic-assisted distal pancreatectomy was associated with longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay. There was no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.

  15. Clinical comparison of robotic-assisted and traditional laparoscopic hysterectomy%机器人及传统腹腔镜全子宫切除术的临床比较

    Institute of Scientific and Technical Information of China (English)

    孙小单; 袁勇

    2015-01-01

    Objective To compare the clinical data of robotic-assisted laparoscopic hysterectomy (RALH)and traditional laparoscopic hysterectomy (LH)and to explore the advantages of robotic surgery system.Methods A retrospective analysis of patients in Jilin Province Tumor Hospital Department 2 of Gynecologic Oncology from Oct.2014 to Dec.2014 undergoing RALH (n =30)was carried out.A matched group of 30 patients undergoing LH (n =30)was selected as the control group.The operating time,blood loss,postoperative 24 hours drainage,postoperative bowel recovery time and postoperative hospitalization length were observed.Results The blood loss was significantly less in patients with robotic laparoscopic group,postoperative bowel recovery time and hospital stay were shorter than the laparoscopic group,The operating time was slightly longer than the laparoscopic group,the two sets of data were significantly different (P 0.05).Conclusion Robotic-assisted laparoscopy is feasible and safe,worthy of promotion for less bleeding,less damage,faster recovery,less pain for patients and shortens the mean length of stay.%目的:比较机器人辅助与传统腹腔镜两种手术方式行全子宫切除术的临床资料,探讨机器人手术系统的优势。方法回顾性分析吉林省肿瘤医院妇科肿瘤二科2014年10月至2014年12月使用机器人辅助腹腔镜下全子宫切除术(RALH)30例(机器人组),并选取同期与之匹配的采用传统腹腔镜全子宫切除术(LH)30例为腹腔镜组,观察数据包括两组的手术时间、术中出血量、术后24 h 引流量、术后首次排气时间及术后住院天数等。结果两组比较,机器人组术中出血量明显少于腹腔镜组,术后首次排气时间及住院时间均短于腹腔镜组,手术时间略长于腹腔镜组,差异有统计学意义(P <0.05);术后24 h 引流量比较,差异无统计学意义(P >0.05)。结论机器人辅助腹腔镜手术具备术中

  16. Robot-assisted endoscopic surgery

    NARCIS (Netherlands)

    Ruurda, J.P.

    2004-01-01

    During the last three years, robot-assisted surgery systems are increasingly being applied in endoscopic surgery. They were introduced with the objective to overcome the challenges of standard endoscopic surgery. With the improvements in manipulation and visualisation that robotic-assistance offers,

  17. Postoperative C-reactive protein concentration and clinical outcome: comparison of open cystectomy to robot-assisted laparoscopic cystectomy with extracorporeal or intracorporeal urinary diversion in a prospective study.

    Science.gov (United States)

    Kingo, Pernille Skjold; Nørregaard, Rikke; Borre, Michael; Jensen, Jørgen Bjerggaard

    2017-07-05

    This study aimed to compare clinical outcome and postoperative systemic inflammatory response using C-reactive protein (CRP) levels, to quantify the degree of tissue injury in open mini-laparotomy cystectomy (OMC) versus robot-assisted laparoscopic cystectomy with extracorporeal (RALC-EUD) or intracorporeal urinary diversion (RALC-IUD). From September 2012 to September 2015, 309 patients diagnosed with bladder cancer underwent radical cystectomy with urinary diversion. Of these, 175 patients were eligible for the study and underwent OMC (n = 125), RALC-EUD (n = 12) or RALC-IUD (n = 38). Blood samples were obtained preoperatively and postoperatively on days 1-7. Clinical and perioperative parameters, including demographics, comorbidity, tumour stage and postoperative outcomes, were collected from medical records. Age, American Society of Anesthesiologists score and Charlson score were significantly higher in OMC than in the robotic groups (p = 0.020, 0.012 and 0.008, respectively). Other demographic data showed no significant group differences. Estimated blood loss and blood transfusion volume were higher in OMC (p OMC and RALC-EUD (p OMC CRP levels were higher than RALC-EUD. In this study, robotic techniques seem less traumatic overall than open surgery, as OMC had higher postoperative CRP levels than RALC-EUD. The higher CRP levels in RALC-IUD may be more reflective of the urinary diversion technique than the true tissue trauma.

  18. Effect of Positive End-Expiratory Pressure on the Sonographic Optic Nerve Sheath Diameter as a Surrogate for Intracranial Pressure during Robot-Assisted Laparoscopic Prostatectomy: A Randomized Controlled Trial

    Science.gov (United States)

    Chin, Ji-Hyun; Kim, Wook-Jong; Lee, Joonho; Han, Yun A.; Lim, Jinwook; Hwang, Jai-Hyun; Cho, Seong-Sik

    2017-01-01

    Background Positive end-expiratory pressure (PEEP) can increase intracranial pressure. Pneumoperitoneum and the Trendelenburg position are associated with an increased intracranial pressure. We investigated whether PEEP ventilation could additionally influence the sonographic optic nerve sheath diameter as a surrogate for intracranial pressure during pneumoperitoneum combined with the Trendelenburg position in patients undergoing robot-assisted laparoscopic prostatectomy. Methods After anesthetic induction, 38 patients were randomly allocated to a low tidal volume ventilation (8 ml/kg) without PEEP group (zero end-expiratory pressure [ZEEP] group, n = 19) or low tidal volume ventilation with 8 cmH2O PEEP group (PEEP group, n = 19). The sonographic optic nerve sheath diameter was measured prior to skin incision, 5 min and 30 min after pneumoperitoneum and the Trendelenburg position, and at the end of surgery. The study endpoint was the difference in the sonographic optic nerve sheath diameter 5 min after pneumoperitoneum and the Trendelenburg position between the ZEEP and PEEP groups. Results Optic nerve sheath diameters 5 min after pneumoperitoneum and the Trendelenburg position did not significantly differ between the groups [least square mean (95% confidence interval); 4.8 (4.6–4.9) mm vs 4.8 (4.7–5.0) mm, P = 0.618]. Optic nerve sheath diameters 30 min after pneumoperitoneum and the Trendelenburg position also did not differ between the groups [least square mean (95% confidence interval); 4.5 (4.3–4.6) mm vs 4.5 (4.4–4.6) mm, P = 0.733]. Conclusions An 8 cmH2O PEEP application under low tidal volume ventilation does not induce an increase in the optic nerve sheath diameter during pneumoperitoneum combined with the steep Trendelenburg position, suggesting that there might be no detrimental effects of PEEP on the intracranial pressure during robot-assisted laparoscopic prostatectomy. Trial Registration ClinicalTrial.gov NCT02516566 PMID:28107408

  19. The perioperative nursing of robot-assisted laparoscopic radical surgery for prostate cancer%机器人辅助腹腔镜前列腺癌根治术围手术期护理

    Institute of Scientific and Technical Information of China (English)

    丁华; 赵明; 赵姗

    2009-01-01

    目的 探讨机器人辅助腹腔镜前列腺癌根治术围手术期护理.方法 采取术前针对性的心理护理,充分做好肠道准备和详细术后的功能训练指导;术后严密观察生命体征和腹部情况的变化,做好引流管的观察和护理,指导制订合理的饮食.结果 14例患者术后1年随访恢复良好,无并发症发生.结论 围手术期有针对性的系统护理,对机器人辅助腹腔镜前列腺癌治术患者早日康复有重要作用.%Objective To discuss the perioperative nursing of the robot-assisted laparoscopic radical surgery for prostate cancer. Methods The pre-operative mental nursing was adopted. Preparations of intestinal tract and detailed guidelines of postoperative function exercises were fully did. The vital signs and the changes of situations in abdomen were closely observed. Good observation and care for drainage tube were did. And a reasonable diet was constituted. Results 14 patients had good recovery after a year with no complications, through a follow-up visit of one year after the operation. Conclusions Systemic nursing for individuals during peri-operation plays an important role in the speedy recovery of robotic-assisted laparoscopic surgery for patients with prostate cancer.

  20. 腹腔镜超声影像技术引导机器人辅助腹部手术的临床应用%Clinical effects of laparoscopic ultrasound imaging in robot-assisted abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    姜朋; 牟培源; 周宁新; 白媛媛

    2013-01-01

    AIM: To explore the clinical effects of laparo-scopic ultrasound imaging technique in robot-assisted abdominal surgery. METHODS: Twenty-eight patients (including three with intrahepatic bile duct stones, three with calculous cholecystitis, eight with hepatic tumor, seven with hilar cholangiocarcinoma, four with pancreatic tumor, and three with hypersplenism) who underwent laparoscopic ultrasound-guided robot-assisted abdominal surgery in our hospital were included in our study. Laparoscopic ultrasound was used to determine the location of lesions and their relation with nearby tissue, choose the optimal surgical method, guide the pathway and evaluate the effects during surgery. The clinical effects were evaluated by ultrasound, contrast-enhanced CT, MRCP and biochemical assays after surgery. RESULTS: All surgical procedures were performed successfully, and no serious intraopera-tive or postoperative complications occurred. Biochemical parameters returned or approached -to normal levels. In RFA regions, color Doppler ultrasound imaging showed no color signal and contrast-enhanced CT showed no enhancement. Ultrasonography, CT or MRCP detected no abnormity in the bile duct. The volume of the entire spleen and damaged part of the spleen from RFA regions were measured by enhanced CT, and the percentages of damaged part of the spleen were 43%, 45% and 49%. CONCLUSION: Laparoscopic ultrasound can not only determine the lesion and guide the operative route but also help surgeons to select the operative strategy. With the development of robot-assisted surgical system, laparoscopic ultrasound will become an indispensable part of this surgery.%目的:探讨腹腔镜超声影像技术引导机器人辅助腹部手术的临床应用效果.方法:对28例患者(肝内胆管结石3例,结石性胆囊炎3例,肝占位8例,肝门部胆管癌7例,胰腺占位4例,脾功能亢进3例)实施腹腔镜超声引导机器人辅助腹部手术治疗,手术过程中应用腹腔镜超声探

  1. Single port laparoscopic assisted pyloromyotomy: our experience

    Directory of Open Access Journals (Sweden)

    Appignani Antonino

    2013-10-01

    Full Text Available Background Ramstedt pyloromyotomy is the procedure of choice for infantile hypertrophic pyloric stenosis; however, the best way to approach the pylorus is debated. Recent literature reports many comparisons between various open and laparoscopic approaches. The purpose of this experience is to show a new approach to infantile hypertrophic pyloric stenosis: single-port, laparoscopic-assisted pyloromyotomy. Methods: 31 infants underwent single-port laparoscopic-assisted pyloromyotomy. The approach to the abdominal cavity is performed through a right circumbilical incision, and then a 12-mm trocar is inserted. After the pneumoperitoneum is established, an operative telescope is introduced. Once the telescope is inserted, the pylorus is easily located, and then grasped and exteriorized via the umbilical incision. At this point, conventional Ramstedt pyloromyotomy is performed. Once the pylorus is reintroduced in the abdomen, a new pneumoperitoneum is created to control mucosal integrity and hemostasis. Results. In all 31 cases operated on, an adequate pyloromyotomy was performed in a good ranging time without any intra- or post-operative complications, achieving also excellent cosmetic results. Conclusions The feasibility of single-port laparoscopic assisted pyloromyotomy obtained in this small sample suggests that this procedure could be an excellent alternative to open or laparoscopic pyloromyotomy as long as it acts as intermediary between the two techniques.

  2. Robot-assisted spleen preserving pancreatic surgery in MEN1 patients

    NARCIS (Netherlands)

    Nell, Sjoerd; Brunaud, Laurent; Ayav, Ahmet; Bonsing, Bert A.; Groot Koerkamp, Bas; Nieveen van Dijkum, Els J.; Kazemier, Geert; de Kleine, Ruben H J; Hagendoorn, Jeroen; Molenaar, I. Quintus; Valk, Gerlof D.; Borel Rinkes, Inne H M; Vriens, Menno R.

    2016-01-01

    Background: Multiple Endocrine Neoplasia type 1 (MEN1) patients often undergo multiple pancreatic operations at a young age. Objective: To describe robot-assisted and laparoscopic spleen-preserving pancreatic surgery in MEN1 patients, and to compare both techniques. Methods: Robot-assisted

  3. Robot-assisted spleen preserving pancreatic surgery in MEN1 patients

    NARCIS (Netherlands)

    Nell, Sjoerd; Brunaud, Laurent; Ayav, Ahmet; Bonsing, Bert A.; Koerkamp, Bas Groot; van Dijkum, Els J. Nieveen; Kazemier, Geert; de Kleine, Ruben H. J.; Hagendoorn, Jeroen; Molenaar, I. Quintus; Valk, Gerlof D.; Rinkes, Inne H. M. Borel; Vriens, Menno R.

    2016-01-01

    BackgroundMultiple Endocrine Neoplasia type 1 (MEN1) patients often undergo multiple pancreatic operations at a young age. ObjectiveTo describe robot-assisted and laparoscopic spleen-preserving pancreatic surgery in MEN1 patients, and to compare both techniques. MethodsRobot-assisted

  4. Towards an in vivo wireless mobile robot for surgical assistance.

    Science.gov (United States)

    Hawks, Jeff A; Rentschler, Mark E; Redden, Lee; Infanger, Roger; Dumpert, Jason; Farritor, Shane; Oleynikov, Dmitry; Platt, Stephen R

    2008-01-01

    The use of miniature in vivo robots that fit entirely inside the peritoneal cavity represents a novel approach to laparoscopic surgery. Previous work has demonstrated that mobile and fixed-base in vivo robots can be used to improve visualization of the surgical field and perform surgical tasks such as collecting biopsy tissue samples. All of these robots used tethers to provide for power and data transmission. This paper describes recent work focused on developing a modular wireless mobile platform that could be used for in vivo robotic sensing and manipulation applications. One vision for these types of self-contained in vivo robotic devices is that they could be easily carried and deployed by non-medical personnel at the site of an injury. Such wireless in vivo robots are much more transportable and lower cost than current robotic surgical assistants, and could ultimately allow a surgeon to become a remote first responder irrespective of the location of the patient.

  5. Comparison of robot-assisted total laparoscopic hysterectomy and total abdominal hysterectomy for treatment of endometrial cancer in obese and morbidly obese patients.

    Science.gov (United States)

    Nevadunsky, N; Clark, R; Ghosh, S; Muto, M; Berkowitz, R; Vitonis, A; Feltmate, C

    2010-12-01

    The objective of our study was to compare clinical and pathologic outcomes of robot-assisted and open abdominal techniques for treatment of uterine cancer in obese patients. Institutional review board approval was obtained. Patient demographic data, pathological data, and surgical data were collected by retrospective chart review. Data were analyzed using SAS statistical software. One-hundred and eighty-nine consecutive cases of suspected uterine cancer were identified from October 2003 until January 2009. Of these, 116 patients (61%) had a body mass index (BMI) over 30. There were 66 completed robot-assisted hysterectomies (RAHs), 43 total abdominal hysterectomies (TAHs), and seven patients that were converted from RAH to open abdominal hysterectomy. There were no significant differences in preoperative patient demographics, including body mass index (BMI), medical co-morbidities, or preoperative cytology, except for parity. There were no differences in postoperative grade, stage, lymph vascular space invasion, positive pelvic washings, mean number of pelvic lymph nodes, or proportion of patients undergoing pelvic lymphadenectomy. Length of stay and estimated blood loss were lower for the robotic technique; RAHs had a significantly longer operative time, however. Postoperative blood transfusions and wound infections were more frequent in the TAH group. Of the RAH group there were seven conversions to TAH (10%). Differences in surgical times with and without lymphadenectomy were least in patients in the largest BMI category of >50. Length of time required for RAH was significantly longer then TAH in obese and morbidly obese patients, however benefits to patients of a minimally invasive approach included reduced incidence of wound infections, reduced transfusion rates, reduced blood loss, and shortened length of stay. These data also suggest the greatest advantage of robotic technology over laparotomy in patients with BMI over 50.

  6. Current trends in robot assisted surgery: a survey of gynecologic oncologists.

    Science.gov (United States)

    duPont, Nefertiti C; Chandrasekhar, Rameela; Wilding, Gregory; Guru, Khurshid A

    2010-12-01

    To evaluate the perceptions of the importance and utility of robot assisted surgery in gynecologic oncology. A 39 question web-based survey was sent to members of the Society of Gynecologic Oncologists. The survey response rate was 28%, with 277 surveys completed. Nearly 40% of respondents felt robotic surgical training was required as a part of their career goals, and 73% of respondents have performed a robotic hysterectomy. Among respondents, 39% felt that robotic surgery was as good as laparoscopic surgery but 23% thought robot assisted surgery should be the gold standard for the treatment of endometrial cancer. Robot assisted surgery is gaining widespread acceptance and is perceived to be as good as laparoscopic surgery for the treatment of early stage endometrial and cervical cancers. Among respondents the greatest benefit of robot assisted surgery was its ease of use and perceived improvement in a patient's quality of life. Copyright © 2010 John Wiley & Sons, Ltd.

  7. A Pilot Study of Laparoscopic Doppler Ultrasound Probe to Map Arterial Vascular Flow within the Neurovascular Bundle during Robot-Assisted Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Ketan K. Badani

    2013-01-01

    Full Text Available Purpose. To report on the feasibility of a new Laparoscopic Doppler ultrasound (LDU technology to aid in identifying and preserving arterial blood flow within the neurovascular bundle (NVB during robotic prostatectomy (RARP. Materials and Methods. Nine patients with normal preoperative potency and scheduled for a bilateral nerve-sparing procedure were prospectively enrolled. LDU was used to measure arterial flow at 6 anatomic locations alongside the prostate, and signal intensity was evaluated by 4 independent reviewers. Measurements were made before and after NVB dissection. Modifications in nerve-sparing procedure due to LDU use were recorded. Postoperative erectile function was assessed. Fleiss Kappa statistic was used to evaluate inter-rater agreement for each of the 12 measurements. Results. Analysis of Doppler signal intensity showed maintenance of flow in 80% of points assessed, a decrease in 16%, and an increase in 4%. Plane of NVB dissection was altered in 5 patients (56% on the left and in 4 patients (44% on the right. There was good inter-rater reliability for the 4 reviewers. Use of the probe did not significantly increase operative time or result in any complications. Seven (78% patients had recovery of erections at time of the 8-month follow-up visit. Conclusions. LDU is a safe, easy to use, and effective method to identify local vasculature and anatomic landmarks during RARP, and can potentially be used to achieve greater nerve preservation.

  8. Perioperative nursing on robot-assistant laparoscopic nephron-sparing surgery%机器人辅助腹腔镜保留肾单位肾部分切除术的围手术期护理

    Institute of Scientific and Technical Information of China (English)

    周秀彬; 王岩; 张玲; 胡英娜; 付清清

    2011-01-01

    目的 探讨机器人辅助腹腔镜保留肾单位肾部分切除术的围手术期护理措施和效果.方法 对6例行达芬奇机器人(Da Vinci S手术机器人系统)辅助腹腔镜保留肾单位肾部分切除术的患者进行术前心理护理和术前准备,术后心理护理、生命体征监测、引流管护理、并发症的监测、活动训练、饮食护理等围手术期护理.结果 6例手术患者中,1例改开放性保留肾单位肾部分切除术,其余5例手术均成功.全体患者术后恢复顺利,无并发症发生.结论 围手术期系统护理可保证机器人辅助腹腔镜下保留肾单位肾部分切除术的顺利进行,加快患者康复,效果满意.%Objective To analyze and discuss the systemic nursing strategy and effectiveness for robotassistant laparoscopic nephron-sparing surgery. Methods A total of 6 patients had undergone robot-assistant laparoscopic nephron-sparing partial nephrectomy. All the patients were given systemic perioperative nursing which was described as the following: peroperative psychological nursing and preoperative preparation; the postoperative monitoring of patients' vital sign, drainage tube; the postoperative nursing of psychophysiology,food and drink and rehabilitation training; prophylactic nursing of postoperative complications. Results All procedures were successfully completed with one case open conversion. All the patients had successful postoperative recovery without postoperative complications. Conclusions The postoperative systemic nursing strategy was feasible and safe for robot-assistant laparoscopic nephron-sparing surgery.

  9. Robotic-assisted hysterectomy: patient selection and perspectives

    Science.gov (United States)

    Smorgick, Noam

    2017-01-01

    Minimally invasive hysterectomy via the laparoscopic or vaginal approach is beneficial to patients when compared with laparotomy, but has not been offered in the past to all women because of the technical difficulties and the long learning curve required for laparoscopic hysterectomy. Robotic-assisted hysterectomy for benign indications may allow for a shorter learning curve but does not offer clear advantages over conventional laparoscopic hysterectomy in terms of surgical outcomes. In addition, robotic hysterectomy is invariably associated with increased costs. Nevertheless, this surgical approach has been widely adopted by gynecologic surgeons. The aim of this review is to describe specific indications and patients who may benefit from robotic-assisted hysterectomy. These include hysterectomy for benign conditions in cases with high surgical complexity (such as pelvic adhesive disease and endometriosis), hysterectomy and lymphadenectomy for treatment of endometrial carcinoma, and obese patients. In the future, additional evidence regarding the benefits of single-site robotic hysterectomy may further modify the indications for robotic-assisted hysterectomy. PMID:28356774

  10. Affective robot for elderly assistance.

    Science.gov (United States)

    Carelli, Laura; Gaggioli, Andrea; Pioggia, Giovanni; De Rossi, Federico; Riva, Giuseppe

    2009-01-01

    Recently, several robotic solutions for the elderly have been proposed. However, to date, the diffusion of these devices has been limited: available robots are too cumbersome, awkward, and expensive to become widely adopted. Another key issue which reduces the appeal of assistive robots is the lack of socio-emotional interaction: affective interchanges represent key requirements to create sustainable relationships between elderly and robots. In this paper, we propose a new approach to enhance the acceptability of robotic systems, based on the introduction of affective dimensions in human-robot interaction. This strategy is aimed at designing a new generation of relational and cognitive robots fusing information from embodied unobtrusive sensory interfaces. The final objective is to develop embodied interfaces, which are able to learn and adapt their affective responses to the user's behavior. User and robot will engage in natural interactions, involving verbal and non-verbal communication, improving empathic exchange of moods and feelings. Relevant independent living and quality of life related issues will be addressed: on-going monitoring of health parameters, assistance in everyday's activities, social support and cognitive/physical exercises. We expect that the proposed strategy will enhance the user's acceptance and adoption of the assistive robotic system.

  11. Two years of experience with robot-assisted anti-reflux surgery

    DEFF Research Database (Denmark)

    Sanberg Jensen, Jonas; Kold Antonsen, Henning; Durup, Jesper

    2017-01-01

    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...... no particular advantages to performing antireflux surgery as robot-assisted procedures neither intra-operatively nor at follow-up.......-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...

  12. Multicenter analysis comparing robotic, open, laparoscopic, and vaginal hysterectomies performed by high-volume surgeons for benign indications.

    Science.gov (United States)

    Lim, Peter C; Crane, John T; English, Eric J; Farnam, Richard W; Garza, Devin M; Winter, Marc L; Rozeboom, Jerry L

    2016-06-01

    To compare perioperative outcomes between robotic-assisted benign hysterectomies and abdominal, vaginal, and laparoscopic hysterectomies when performed by high-volume surgeons. A multicenter data analysis compared 30-day outcomes from consecutive robotic-assisted hysterectomies performed by high-volume surgeons (≥60 prior procedures) at nine centers with records retrieved from the Premier Perspective database for abdominal, vaginal, and laparoscopic hysterectomies performed by high-volume gynecologic surgeons. Data on benign hysterectomy disorders from January 1, 2012 to September 30, 2013 were included. Data from 2300 robotic-assisted, 9745 abdominal, 8121 vaginal, and 11 952 laparoscopic hysterectomies were included. The robotic-assisted patient cohort had a significantly higher rate of adhesive disease compared with the vaginal (Plaparoscopic cohorts (Pobesity than the vaginal (Plaparoscopic cohorts (P250g) than the abdominal (Plaparoscopic cohorts (P=0.017). The robotic-assisted cohort experienced significantly fewer intraoperative complications than the abdominal (Physterectomy provided improved outcomes compared with abdominal, vaginal, and laparoscopic hysterectomy. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  13. Development of a vision integration framework for laparoscopic surgical robot.

    Science.gov (United States)

    Shin, Jung W; Park, Jun W; Lee, Chul H; Hong, Soyoung; Jo, Yungho; Choi, Jaesoon

    2006-01-01

    In order to realize intelligent laparoscopic surgical robot, a vision integrated system constitutes one of the fundamental components. The authors have constructed a vision framework in the current version of NCC (National Cancer Center) laparoscopic surgical robot controlled on a real-time OS (RTLinux-Pro, FSMLabs Inc., U.S.A.). Adding vision framework, we have been applying and testing image processing algorithms- edge detection of object for positioning surgical tool, Watersheds for recognizing object. This paper documents the implementation of the framework and preliminary results of the image segmentation using Watersheds algorithm. Finally the real-time processing capability of our vision system is discussed.

  14. Retzus-sparing robotic-assisted laparoscopic radical prostatectomy: a step–by-step technique description of this first brazilian experience

    Directory of Open Access Journals (Sweden)

    Marcos Tobias-Machado

    Full Text Available Abstract Introduction: Retzus-sparing robotic-assisted radical prostatectomy(RARP is a newly approach that preserve the Retzus structures and provide better recovery of continence and erectile function. In Brazil, this approach has not yet been previously reported. Objective: Our goal is to describe Step-by-Step the Retzus-sparing RARP surgical technique and report our first Brazilian experience. Methods: We present a case of a 60-year-old white man with low risk prostate cancer. Surgical materials were four arms Da Vinci robotic platform system, six transperitoneal portals, two prolene wires and Polymer Clips. This surgical technique was step-by-step described according to Galfano et al. One additional step was added as a modification of Galfano et al. Primary technique description: The closure of the Denovellier fascia. Results: We have operated one patient with this technique. The operative time was 180minutes, console time was135 min, the blood loss was 150ml, none perioperative or postoperative complications was found, hospital stay of 01 day. The anatomopathological classification revealed a pT2aN0M0 specimen with free surgical margins. The patient achieved continence immediately after bladder stent retrieval. Full erection reported after 30 days of surgery. Conclusion: Retzus-sparing RARP approach is feasible and reproducible. However, further comparative studies are necessary to demonstrate potential benefits in continence and sexual outcomes over the standard approaches.

  15. A user-friendly automated port placement planning system for laparoscopic robotic surgery

    Science.gov (United States)

    Torres, Luis G.; Azimian, Hamidreza; Enquobahrie, Andinet

    2014-03-01

    Laparoscopic surgery is a minimally invasive surgical approach in which surgical instruments are passed through ports placed at small incisions. This approach can benefit patients by reducing recovery times and scars. Surgeons have gained greater dexterity, accuracy, and vision through adoption of robotic surgical systems. However, in some cases a preselected set of ports cannot be accommodated by the robot; the robot's arms may cause collisions during the procedure, or the surgical targets may not be reachable through the selected ports. In this case, the surgeon must either make more incisions for more ports, or even abandon the laparoscopic approach entirely. To assist in this, we are building an easytouse system which, given a surgical task and preoperative medical images of the patient, will recommend a suitable port placement plan for the robotic surgery. This work bears two main contributions: 1) a high level user interface that assists the surgeon in operating the complicated underlying planning algorithm; and 2) an interface to assist the surgical team in implementation of the recommended plan in the operating room. We believe that such an automated port placement system would reduce setup time for robotic surgery and reduce the morbidity to patients caused by unsuitable surgical port placement.

  16. Laparoscopic assisted anorectal pull through: Reformed techniques

    OpenAIRE

    2009-01-01

    Aim: To assess the modifications in the technique of laparoscopic assisted anorectal pull through (LAARP) practiced at our institute and analyze the post operative outcome and associated complications. Materials and Methods: A retrospective study from January 2001 to May 2009 analyzing LAARP for high anorectal malformations. Results: A total of 40 patients - 34 males and six females, in the age group of two months to six years were studied. Staged procedure was done in 39 patients; one c...

  17. Operative coordination of robot assisted retroperitoneal laparoscopic partial nephrectomy%机器人辅助后腹腔镜肾部分切除术的手术配合

    Institute of Scientific and Technical Information of China (English)

    崔茜; 管春丽; 王涛

    2016-01-01

    Objective To investigate the nursing coordination for robot assisted retroperitoneal laparoscopic partial nephrectomy. Methods The nursing coordination for 117 cases of robot assisted retroperitoneal laparoscopic partial nephrectomy which were received and cured in the department of urology, chinese PLA general hospital from Dec. 2014 to Dec. 2015, was analysised. By means of preoperative interview and evaluate, adequate preparing of instruments and articles, reasonable layout of the operating room, standardized coordination during operation, postoperative nursing and interview, the patients pass through perioperative period successfully. Results Nursing coordination was successfully completed to the 117 cases, and the effect of medical coordination is satisfactory. No postoperative complication occurred by short term follow up. Conclusions Adequate preoperative preparation, reasonable layout of the operating room, skilled coordination during operation could improve the operating efficiency, which is the important link of successful operations.%目的:探讨机器人辅助后腹腔镜肾部分切除术的护理配合流程。方法对解放军总医院泌尿外科2014年12月至2015年12月的117例机器人辅助后腹腔镜肾部分切除术的护理配合进行分析,通过术前访视评估、器械及物品的充分准备、合理的手术间布局、术中精准化配合及术后护理及访视,使患者顺利度过围手术期。结果117例患者顺利完成,医护配合效果满意,短期随访无术后并发症发生。结论充分的术前准备,合理的手术间布局,熟练的术中配合能提高术者手术效率,手术顺利完成的重要环节。

  18. Ressecção hepática robótica. Relato de experiência pioneira na América Latina First robotic-assisted laparoscopic liver resection in Latin America

    Directory of Open Access Journals (Sweden)

    Marcel Autran C. Machado

    2009-03-01

    Full Text Available Graças ao melhor conhecimento da anatomia segmentar do fígado e desenvolvimento de novas técnicas, houve aumento no número de indicações de hepatectomias. O desenvolvimento da cirurgia minimamente invasiva ocorreu paralelamente e o aumento da experiência, aliado ao desenvolvimento de novos instrumentais, resultaram no crescimento exponencial das ressecções hepáticas videolaparoscópicas. A abordagem laparoscópica pode tornar viável a ressecção hepática em pacientes cirróticos com hipertensão portal que não tolerariam este mesmo procedimento por via laparotômica. A cirurgia robótica surgiu nos últimos anos como a última fronteira de desenvolvimento técnico aplicado à videocirurgia. O presente trabalho descreve a experiência pioneira de ressecção hepática totalmente com o uso de robótica na América Latina, em paciente com carcinoma hepatocelular e cirrose hepática. A hepatectomia laparoscópica com o uso do sistema robótico Da Vinci permite refinamentos técnicos graças à visualização tridimensional do campo cirúrgico e utilização de instrumentais precisos e com grande amplitude de movimentação que simulam os movimentos da mão humana.The surgical robotic system is superior to traditional laparoscopy in regards to 3-dimensional images and better instrumentations. Robotic surgery for hepatic resection has not yet been extensively reported. The aim of this paper is to report the first known case of liver resection with use of a computer-assisted, or robotic, surgical device in Latin America. A 72-year-old male with cryptogenic liver cirrhosis and hepatocellular carcinoma was referred for surgical treatment. Preoperative clinical evaluation and laboratory data disclosed a Child-Pugh class A patient. Magnetic resonance imaging showed a 2.2 cm tumor in segment 5. Liver size was decreased and there were signs of portal hypertension, such as splenomegaly and enlarged portal vein collaterals. Preoperative upper

  19. Renal artery injury during robot-assisted renal surgery.

    Science.gov (United States)

    Lee, Jae Won; Yoon, Young Eun; Kim, Dae Keun; Park, Sung Yul; Moon, Hong Sang; Lee, Tchun Yong

    2010-07-01

    Laparoscopic partial nephrectomy (LPN) is becoming the standard of care for incidentally diagnosed, small renal tumors. With its seven degrees of freedom and three-dimensional vision, the DaVinci robotic surgical system has been used to assist in LPNs. The main disadvantage of robot-assisted surgery, however, is the lack of tactile feedback. We present a case of renal artery injury during robot-assisted renal surgery. Robot-assisted partial nephrectomy (RPN) was planned for 47-year-old man with a 3.5-cm right renal mass. After standard bowel mobilization, renal hilar dissection was performed. In the attempt to complete the dissection posteriorly, however, there was sudden profuse bleeding. The intraperitoneal pressure immediately increased to 20 mm Hg, and an additional suction device was inserted through the 5-mm liver retractor port. On inspection, there was an injury at the takeoff of the posterior segmental artery. A decision was made to convert to robot-assisted laparoscopic radical nephrectomy. The main renal artery and renal vein were controlled with Hem-o-Lok clips. The estimated blood loss was 2,000 mL. Four units of packed red blood cells were transfused intraoperatively. The post-transfusion hemoglobin level was 12.6 g/dL. There were no other perioperative complications. The surgeon should keep in mind that the robotic arms are very powerful and can easily injure major vessels because of lack of tactile feedback. A competent and experienced tableside surgeon is very important in robot-assisted surgery because the unsterile console surgeon cannot immediately react to intraoperative complications.

  20. The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy:experience of a single surgeon with 500cases in Taiwan, China

    Institute of Scientific and Technical Information of China (English)

    YenChuan Ou; ChunKuang Yang; KuanghSi Chang; John Wang; SiuWan Hung; MinChe Tung; Ashutosh K Tewari; Vipul R Patel

    2014-01-01

    To analyze the learning curve for cancer control from an initial 250cases(GroupI) and subsequent 250cases(GroupII) of robotic‑assisted laparoscopic radical prostatectomy(RALP) performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups. Positive surgical margin(PSM) and biochemical recurrence(BCR) were assessed as cancer control outcomes. Patients in GroupII had signiifcantly more advanced prostate cancer than those in GroupI(22.2%vs 14.2%, respectively, with Gleason score 8–10,P=0.033; 12.8%vs 5.6%, respectively, with clinical stage T3,P=0.017). The incidence of PSM in pT3 was decreased signiifcantly from 49% in GroupI to 32.6% in GroupII. Ameaningful trend was noted for a decreasing PSM rate with each consecutive group of 50cases, including pT3 and high‑risk patients. Neurovascular bundle(NVB) preservation was signiifcantly inlfuenced by the PSM in high‑risk patients(84.1% in the preservation groupvs 43.9% in the nonpreservation group). The 3‑year, 5‑year, and 7‑year BCR‑free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased signiifcantly after 250cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50cases. NVB preservation during RALP for the high‑risk group is not suggested due to increasing PSM.

  1. 机器人辅助腹腔镜根治性膀胱切除正位新膀胱术的护理%Nursing study for robotic-assisted laparoscopic radical cystectomy and orthotopic bladder

    Institute of Scientific and Technical Information of China (English)

    周秀彬; 胡英娜; 安娜; 付清清; 张玲

    2011-01-01

    目的 分析应用da Vinci S机器人系统完成机器人辅助腹腔镜根治性膀胱切除(RARC)正位新膀胱术的疗效,探讨其围手术期临床护理体会.方法 2008年12月至2010年2月,4例男性患者接受RARC+正位新膀胱术.手术均获成功.术前着重于心理护理、肠道准备,术后进行严密的生命体征监测、引流管护理、新膀胱锻炼等护理的同时,采取积极预防措施预防并发症的发生.结果 全体患者术后恢复顺利,无严重并发症发生,疗效满意.结论 机器人辅助腹腔镜根治性膀胱切除(RARC)加正位膀胱术创伤小,安全可靠,患者术后康复快,疤痕少,值得推广、应用,但须严格护理过程.%Objective To analyze the efficacy of using da Vinci S robot system to complete the robotassisted laparoscopic radical cystectomy (RARC) orthotopic neobladder and explore the peri-operative nursing care.Methods December 2008 February 2010,four cases of male patients RARC + orthotopic neobladder.Procedure was successful. Focusing on the psychological care before surgery, bowel preparation, and postoperative care focuses on the monitoring of vital signs,drainage tube care,exercise and the new bladder,while actively preventing complications.Results All patients recovered well,without serious complications and with satisfactory effect.Conclusions Robot-assisted laparoscopic radical cystectomy (RARC) + orthotopic bladder was less trauma, safer, reliable, rapid postoperative rehabilitation, scars less, and worthy of application,but subjected to strict nursing process.

  2. 机器人辅助腹腔镜胰十二指肠切除术中护理问题评估及护理措施%Nursing Problem Evaluation and Nursing Measures in Robot-assisted Laparoscopic Pancreaticoduodenectomy

    Institute of Scientific and Technical Information of China (English)

    喻晓芬; 王知非; 何茫茫; 张琴芳

    2016-01-01

    [Summary] This paper summarized the nursing experience of 18 cases of robot-assisted laparoscopic pancreaticoduodenectomy (RLPD) from September 2014 to June 2015.The pertinent nursing measures were discussed .The operative duration was 370-495 min (mean, 405 ±35 min).During the operation, the robot and instrument malfunctions occurred for 5 times, all of which were successfully resolved.No complications occurred .According to patients ’ age and co-morbidities, a comprehensive assessment was carried out to propose probable nursing problems , and corresponding nursing measures were implemented to effectively prevent the nursing risk and to protect the safety of patients .%本文总结2014年9月~2015年6月18例机器人辅助腹腔镜胰十二指肠切除术的护理经验,探讨相应的护理措施。手术时间370~495 min,(405±35)min。术中发生机器人和器械故障5次,均顺利排除。无手术并发症。术前根据患者年龄、合并疾病进行全面评估,提出术中可能存在的护理问题,并实施相应护理措施,有效防范护理风险,保障患者安全。

  3. Assistive Technology Based on Robotics and Rise in China

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xiaoyu; WANG Kaixuan

    2013-01-01

    The concept of assistive technology based on robotics,rehabilitation robot and intelligent assistive devices.Domestic intelligence assistive devices include intelligent prosthetics,intelligent orthotics,intelligent walker,assistive devices for smart home environment control,intelligent life assistive devices; Domestic intelligent rehabilitation robot include upper limb rehabilitation robot,hand rehabilitation robot,lower limb rehabilitation robot,robotic smart wheelchair,intelligent nursing bed,daily care robot,the development trend of intelligent assistive devices and rehabilitation robot.

  4. 机器人辅助腹腔镜下前列腺癌根治术护理团队的建设和培训%Construction and Training of Robot-assisted Laparoscopic Prostatectomy Nursing Team

    Institute of Scientific and Technical Information of China (English)

    沈群; 杨波; 王燕; 过菲; 高旭; 盛夏

    2014-01-01

    Objective To discuss the progressive construction and training of robot‐assisted laparoscopic prostatectomy (RALP) nursing team .Methods Our accumulated experience in nursing team‐building for the RALP from March 2012 until now was retrospectively summarized .The whole training system include four stages:theoretical study ,simulation operation ,scene teaching and concentrate training .Results Over the study period ,100 consecutive cases of RALP were carried out in our hospital .Through this series ,the member of nurses mastered in surgical cooperation were increased from the initial 2 to the current 10 ,and a specialized step‐by‐step training system was establish with a series of improvement measures .With this training program ,the preoperative preparation time of the Da Vinci robot was significantly decreased .Con‐clusion RALP nursing team construction and training have significant improvement to surgical effective‐ness ,which is worthwhile for clinical trial .%目的:总结机器人辅助腹腔镜下前列腺癌根治术(robot‐assisted laparoscopic prostatectomy ,RALP)护理团队渐进式建设和培训的经验。方法回顾性分析并总结2012年3月至今第二军医大学长海医院开展RA L P护理团队的建设经验,整个培训体系包括4个阶段:理论学习,模拟操作,现场带教和集中强化。结果2012年3月至2013年10月,第二军医大学长海医院共开展RALP手术100例,熟练掌握手术配合的护士由最初的2人增加到目前的10人,建立了一个成熟的护理团队,形成了一套“阶梯式”的培训体系,摸索了一系列改进措施,机器人的术前准备时间明显缩短。结论 RALP护理团队的建设与培训对手术的进一步开展和提高手术效率具有积极意义,值得在临床推广应用。

  5. Laparoscopic-assisted enterolithotomy for gallstone ileus.

    Science.gov (United States)

    Gupta, Rahul A; Shah, Chetan R; Balsara, K P

    2013-06-01

    Gallstone ileus is a rare complication of cholelithiasis seen usually in elderly population with comorbidities. Most of the cases present as acute intestinal obstruction with the diagnosis being made intraoperatively. There exists controversy regarding appropriate emergency surgical treatment of gallstone ileus as to whether biliary tract surgery should be done during the first operation. Laparoscopy in recent years is also being used for management of such cases. We report a case of gallstone ileus diagnosed preoperatively and successfully treated by laparoscopic-assisted enterolithotomy.

  6. Anatomic robot-assisted radical cystectomy.

    Science.gov (United States)

    Richards, Kyle A; Hemal, Ashok K

    2012-12-01

    Robot-assisted laparoscopic radical cystectomy (RARC) was initially described in 2003 and has since been gaining popularity as a minimally invasive technique in both men and women of all ages with muscle-invasive bladder cancer, selected cases of high-risk nonmuscle invasive disease, and selected cases with advanced disease.(1,2) RARC offers the patient the benefits of less blood loss, shorter hospital stay, less postoperative pain, and early recuperation with improved cosmesis. For a surgeon, it facilitates fine dissection and intracorporeal suturing in a visually conducive three-dimensional environment with ergonomic comfort. For residents, fellows, and novice surgeons, RARC can shorten the learning curve in comparison with pure laparoscopic procedures. In selected cases, nerve-sparing, vaginal-sparing, uterus-sparing, and prostate-sparing RARC can be undertaken to maintain functional outcomes and fertility. We aim to succinctly describe the indications and contraindications, preoperative workup, preoperative preparation, instrumentation needed, surgical steps, postoperative care, and management of intraoperative and postoperative complications. New advances in technique and a summary of the major published series for RARC are also reported.

  7. 单孔机器人或腹腔镜手术在膀胱疾病治疗中的应用现状%Application of laparoscopic or robotic-assisted single-site surgery in the treatment of bladder diseases

    Institute of Scientific and Technical Information of China (English)

    祝强; 符伟军; 张旭

    2015-01-01

    Laparoscopic or robotic-assisted single-site surgery has been widely used in all kinds of operations in department of urology.The latest information on laparoscopic or robotic-assisted single-site surgery was summarized and analyzed to evaluate its application and development direction in the treatment of bladder diseases.A detailed re-view from electronic databases Medline was done.Analysis showed that the laparoscopic or robotic-assisted single-site surgery for bladder diseases has the advantages of minimal invasion and postoperative quick recovery.Improve-ment of surgical instruments and application of robot technology may be expected to further clarify the application and extension of single-site technology in minimally invasive urologic surgery.%单孔机器人或腹腔镜手术已广泛应用于泌尿外科各类手术。现应用 Medline 查询并总结相关文献用于系统性回顾,概述并分析最新资料,以评价现有的单孔机器人或腹腔镜手术在膀胱疾病治疗中的应用及发展方向。分析表明单孔机器人或腹腔镜手术治疗膀胱疾病具有创伤小、术后恢复快等益处。手术器械的改进和机器人技术的应用,有望进一步明确单孔技术在微创泌尿外科手术中的作用及推广应用。

  8. 机器人辅助腹腔镜下孤立肾肾部分切除术的临床研究%Clinical research of robot-assisted laparoscopic partial nephrectomy in solitary kidney

    Institute of Scientific and Technical Information of China (English)

    刘竞; 李波; 李利军; 王东

    2016-01-01

    目的 分析孤立肾肿瘤患者行机器人辅助肾部分切除术的临床数据,探讨该术式治疗孤立肾肿瘤的近期疗效.方法 回顾性分析2014年9月至2015年9月我科收治的9例行机器人辅助腹腔镜下肾部分切除术的孤立肾肿瘤患者的临床资料,男6例,女3例;年龄46 ~ 78岁,平均60岁.肾肿瘤位于左侧5例,右侧4例;肿瘤直径2.8~7.6 cm,平均4.5 cm.其中1例为先天性孤立肾,1例为对侧萎缩肾,2例曾因对侧肾脏良性疾患切除患肾,5例曾因对侧肾脏恶性肿瘤行根治性肾切除术.结果 9例手术均获成功,无中转开放病例.手术时间104 ~ 215 min,平均129 min;术中失血量50 ~350 ml,平均120 ml,术中无输血病例;热缺血时间10~28 min,平均18 min;无术中并发症发生.术后3~5d拔除引流管及导尿管,住院天数8~17d,平均12 d.术后1例出现肾脏切缘出血,1例出现漏尿,无透析病例.术后病理示:肾透明细胞癌7例,乳头状细胞癌1例,错构瘤1例,无阳性切缘病例.术后随访1 ~12个月,未见转移及复发.结论 机器人辅助腹腔镜肾部分切除术在肿瘤控制及肾功能保存等方面安全可靠,是治疗孤立肾肿瘤的一种安全有效的微创方法.%Objective To investigate the perioperative outcomes of robot-assisted laparoscopic partial nephrectomy in solitary kidney.Methods From September 2014 to September 2015, 9 patients underwent robot-assisted laparoscopic partial nephrectomy in solitary kidney.6 of these patients were male, while the others were female.The average age of these patients was 60 years, ranged from 46-78 years.The lesion was located in left kidney of 5 cases, and the remaining in right kidney.The average diameter of lesion was 4.5 cm, ranged from 2.8-7.6 cm.One case was congenital solitary kidney, one was contralateral atrophic kidney, 2 cases were performed nephrectomy due to benign lesion, 5 cases were performed radical nephrectomy due to malignancy.All the cases

  9. 机器人辅助腹腔镜手术治疗复杂性肾结石的临床研究%Clinical study of robot-assisted laparoscopic surgery for the treatment of complex nephrolithiasis

    Institute of Scientific and Technical Information of China (English)

    张祥; 许天源; 王晓晶; 夏磊磊; 秦亮; 王先进; 邵远; 沈周俊

    2015-01-01

    Objective To investigate the clinical efficacy and safety of robot-assisted laparoscopic surgery for the treatment of complex nephrolithiasis.Methods The retrospective analysis of 31 cases of robot-assisted laparoscopic surgery for the treatment of complex nephrolithiasis was carried out.20 of these patients were male,while the others were female.The average age of these patients was 47 years, ranged from 26-73.Sixteen patients had calculi located both in subrenal calyx and ureter, 7 cases of them had ureteropelvic junction obstruction while the subrenal calyx calculus were far away from ureteropelvic junction.Out of the total 31 cases, 9 were multiple renal calculi, 3 were staghorn calculi, 3 were congenital renal malformation with staghorn calculi.The average diameter of calculi was 33 mm, ranged from 15 to 78.19 cases had obvious pelvic separation presented by pre-operative ultrasonography, average 33 mm, ranged from 12 to 62 mm.All the cases were performed by robot-assisted laparoscopic surgery transperitoneally.Results All operations were successful without converting to laparoscopy or open surgery.The average operative time (robotic console time) was 64 min, ranged from 45 to 128 min.The average estimated blood loss during operation was 80 ml, ranged from 10-400 ml.The length of post-operative hospital stay were 4-11 days, average 6 days.The average removal time of drainage was 4 days, ranged from 2 to 7 days.There was no severe complications after operation.The diuretic renogram showed that the obstruction in patients with UPJO was cured or significantly improved.The average follow-up time was 7 months (ranged from 2 to 27 months).Post-operative KUB X-ray showed no residual calculi in 29 patients.The average value of serum creatinine (Cr) was 96.5 μmol/L (ranged from 88.4 to 126.5 μmol/L) in one month post-operative follow-up.The glomerular filtration rates of affected side recovered to 36.5-45.7 ml/min, average 41.3 ml/min, in those 3 patients who had

  10. Human assisted robotic exploration

    Science.gov (United States)

    Files, B. T.; Canady, J.; Warnell, G.; Stump, E.; Nothwang, W. D.; Marathe, A. R.

    2016-05-01

    In support of achieving better performance on autonomous mapping and exploration tasks by incorporating human input, we seek here to first characterize humans' ability to recognize locations from limited visual information. Such a characterization is critical to the design of a human-in-the-loop system faced with deciding whether and when human input is useful. In this work, we develop a novel and practical place-recognition task that presents humans with video clips captured by a navigating ground robot. Using this task, we find experimentally that human performance does not seem to depend on factors such as clip length or familiarity with the scene and also that there is significant variability across subjects. Moreover, we find that humans significantly outperform a state-of-the-art computational solution to this problem, suggesting the utility of incorporating human input in autonomous mapping and exploration techniques.

  11. A new surgical approach for da Vinci robot-assisted laparoscopic partial nephrectomy%达芬奇机器人辅助腹腔镜下肾部分切除术手术入路的新选择

    Institute of Scientific and Technical Information of China (English)

    梁朝朝; 周骏; 邰胜; 王建忠; 杨诚; 徐汉江; 徐凌凡; 施浩强; 郝宗耀

    2016-01-01

    目的 总结经腰腹联合入路机器人辅助腹腔镜下肾部分切除术的手术方法,探讨机器人辅助腹腔镜下肾部分切除术手术入路的新选择.方法 回顾性分析2015年6月至2016年1月收治的13例行经腰腹联合入路机器人辅助腹腔镜下肾部分切除术患者的临床资料,男7例,女6例.年龄26 ~ 74岁,平均48岁.肿瘤位于左肾8例,右肾5例.肿瘤直径2.5 ~4.5 cm,平均3.5 cm.其中1例患者左肾有2枚肿瘤,直径分别为1.5 cm和3.0cm.所有患者术前均行CT检查,考虑为肾细胞癌,其中3例行双肾血管三维成像.术前行胸部X线片检查排除远处转移.13例术前血肌酐均在正常范围,2例伴2型糖尿病,2例伴高血压病.13例均行经腰腹入路腹腔镜下肾部分切除术.结果 本组13例手术均顺利完成.手术时间80~140 min,平均100 min.术中热缺血时间15~28 min,平均22 min.术中出血40 ~120 ml,平均60 ml,无术中输血病例.术后病理诊断为肾透明细胞癌12例,肾血管平滑肌脂肪瘤1例,无切缘阳性病例.术后随访1~7个月,术后1、3个月复查肾功能均在正常范围,复查B超未见肿瘤残留和复发.结论 经腰腹联合入路腹腔镜下肾部分切除术有效地将经腹膜外与经腹途径结合起来,既发挥了经腹膜外手术处理血管的优势,又满足了机器人手术对空间的要求,使其优势得以充分发挥.%Objective To investigate the advantages of combination of retroperitoneal and peritoneal approach for robotic-assisted laparoscopic partial nephrectomy.Methods 7 male patients and 6 female patients,aging between 26-74,underwent robotic-assisted laparoscopic partial nephrectomy via combination of retroperitoneal and peritoneal approach between July 2015 and January 2016.Before surgery,8 cases were found the lesions on the left side and the other 5 cases were found the lesions on the right side.The mean diameter of tumor was 3.5cm (ranging from 2.5 to 4.5cm).Among them

  12. Robotic versus laparoscopic resection for sigmoid diverticulitis with fistula.

    Science.gov (United States)

    Elliott, Peter A; McLemore, Elisabeth C; Abbass, Mohammad A; Abbas, Maher A

    2015-06-01

    Robotic abdominal surgery is growing despite a paucity of clinical reports to evaluate its impact on patient outcomes. In this retrospective case series, we aim to analyze our early experience with robotic resection in 11 consecutive patients with chronic colonic diverticulitis complicated by fistula to bladder, vagina, or skin and to compare the results of the robotic approach to 20 patients undergoing laparoscopic resection for the same indication. Our main outcome measures include operative time, blood loss, conversion rate, transfusion rate, hospital length of stay, complications, readmission, and fistula healing rate. In our study, we found robotic resection for colonic diverticulitis with fistula was technically feasible and yielded 100% fistula healing rate. The operative time, complication and readmission rates were similar to laparoscopy. A higher conversion rate, diverting stoma need, and longer hospital length of stay were noted in the robotic group; however, these findings could have been attributed to a higher number of cases involving rectal excision in the robotic group. Larger studies are needed to further examine the impact of robotic surgery on the outcome of patients with complicated chronic sigmoid diverticulitis.

  13. HAND-ASSISTED LAPAROSCOPIC DONOR NEPHRECTOMY. THE FIRST RUSSIAN EXPERIENCE

    Directory of Open Access Journals (Sweden)

    S. V. Gautier

    2010-01-01

    Full Text Available The first experience of hand-assisted laparoscopic donor nephrectomy is described in the article. A new technique of the operation and it’s results are discussed in details. Advantages of this type of the operation in comparison with open and full laparoscopic techniques are presented. 

  14. Development of miniaturized light endoscope-holder robot for laparoscopic surgery

    CERN Document Server

    Long, Jean-Alexandre; Troccaz, Jocelyne; Voros, Sandrine; Descotes, Jean-Luc; Berkelman, Peter; Letoublon, Christian; Rambeaud, Jean-Jacques

    2007-01-01

    PURPOSE: We have conducted experiments with an innovatively designed robot endoscope holder for laparoscopic surgery that is small and low cost. MATERIALS AND METHODS: A compact light endoscope robot (LER) that is placed on the patient's skin and can be used with the patient in the lateral or dorsal supine position was tested on cadavers and laboratory pigs in order to allow successive modifications. The current control system is based on voice recognition. The range of vision is 360 degrees with an angle of 160 degrees . Twenty-three procedures were performed. RESULTS: The tests made it possible to advance the prototype on a variety of aspects, including reliability, steadiness, ergonomics, and dimensions. The ease of installation of the robot, which takes only 5 minutes, and the easy handling made it possible for 21 of the 23 procedures to be performed without an assistant. CONCLUSION: The LER is a camera holder guided by the surgeon's voice that can eliminate the need for an assistant during laparoscopic s...

  15. Minilaparoscopy-assisted transumbilical laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    GERALDO JOSÉ DE SOUZA LIMA

    2016-06-01

    Full Text Available ABSTRACT The role of laparoscopy in the modern surgery era is well established. With the prospect of being able to improve the already privileged current situation, new alternatives have been proposed, such as natural orifice endoscopic surgery (NOTES, the method for single transumbilical access (LESS - Laparo-endoscopic single-site surgery and minilaparoscopy (MINI. The technique proposed by the authors uses a laparoscope with an operative channel like the flexible endoscope used in NOTES. All operative times are carried out through the umbilical trocar as in LESS, and assisted by a minilaparoscopy grasper. This new technic combines, and results from, the rationalization of technical particularities and synergy of these three approaches, seeking to join their advantages and minimize their disadvantages.

  16. [Robot assisted Frykman-Goldberg procedure. Case report].

    Science.gov (United States)

    Zubieta-O'Farrill, Gregorio; Ramírez-Ramírez, Moisés; Villanueva-Sáenz, Eduardo

    2017-01-16

    Rectal prolapse is defined as the protrusion of the rectal wall through the anal canal; with a prevalence of less than 0.5%. The most frequent symptoms include pain, incomplete defecation sensation with blood and mucus, fecal incontinence and/or constipation. The surgical approach can be perineal or abdominal with the tendency for minimal invasion. Robot-assisted procedures are a novel option that offer technique advantages over open or laparoscopic approaches. 67 year-old female, who presented with rectal prolapse, posterior to an episode of constipation, that required manual reduction, associated with transanal hemorrhage during defecation and occasional fecal incontinence. A RMI defecography was performed that reported complete rectal and uterine prolapse, and cystocele. A robotic assisted Frykman-Goldberg procedure wass performed. There are more than 100 surgical procedures for rectal prolapse treatment. We report the first robot assisted procedure in Mexico. Robotic assisted surgery has the same safety rate as laparoscopic surgery, with the advantages of better instrument mobility, no human hand tremor, better vision, and access to complicated and narrow areas. Robotic surgery as the surgical treatment is a feasible, safe and effective option, there is no difference in recurrence and function compared with laparoscopy. It facilitates the technique, improves nerve preservation and bleeding. Further clinical, prospective and randomized studies to compare the different minimal invasive approaches, their functional and long term results for this pathology are needed. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  17. Robotics and telesurgery--an update on their position in laparoscopic radical prostatectomy.

    Science.gov (United States)

    Rassweiler, J; Safi, K C; Subotic, S; Teber, D; Frede, T

    2005-01-01

    Laparoscopy is handicapped by the reduction of the range of motion from six to only four degrees of freedom. In complicated cases (i.e. radical prostatectomy), there is often a crossing of the hands of surgeon and assistant. Finally, standard laparoscopes allow only 2D-vision. This has a major impact on technically difficult reconstructive procedures such as laparoscopic radical prostatectomy. Solutions include the understanding of the geometry of laparoscopy, but also newly developed surgical robots. During the last five years, there has been an increasing development and experience with robotics in urology. This article reviews the actual results focussing on the benefits and problems of robotics in laparoscopic radical prostatectomy. Own experiences with robot-assisted surgery include more than 1200 laparoscopic radical prostatectomies using a voice-controlled camera-arm (AESOP) as well as six telesurgical interventions with the da Vinci-system. Substantial experimental studies have been performed focussing on the geometry of laparoscopy and new training concepts such as perfused pelvitrainers and models for simulation of urethrovesical anastomosis. The recent literature on robotics in urology has been reviewed based on a MEDLINE/PUBMED research. The geometry of laparoscopy includes the angles between the instruments which have to be in a range of 25 degrees to 45 degrees ; the angles between the instrument and the working plane that should not exceed 55 degrees ; and the bi-planar angle between the shaft of the needle holder and the needle which has to be adapted according to the anatomical situation in range of 90 degrees to 110 degrees . 3-D-systems have not yet proved to be effective due to handling problems such as shutter glasses, video helmets or reduced brightness. At the moment, there are only two robotic surgical systems (AESOP, da Vinci) in clinical use, of which only the da Vinci provides stereovision and all six degrees of freedom (DOF). To date

  18. Role of robotic-assisted surgery in benign esophageal diseases.

    Science.gov (United States)

    Saurabh, Shireesh; Unger, Eric; Grossman, Julie; Couto, Francisco; Singh, Namrata; Lind, David Scott; Panait, Lucian; Castellanos, Andres

    2014-06-01

    Laparoscopic treatment of benign esophageal conditions is technically complex with several inherent limitations. Robotic-assisted surgery provides technical improvement and helps to overcome some of these limitations. We therefore report a single surgeon's experience in management of benign esophageal diseases by robotic-assisted surgery. Over a period of 8 consecutive years, a retrospective chart review was performed of 105 patients who underwent robotic-assisted surgery for benign esophageal diseases by a single surgeon. Demographic data and outcome measures were studied. The robotic-assisted procedures included 85 Nissen fundoplications with and without mesh repair, 12 Heller myotomies and eight para-esophageal hernia repairs. The mean total operating time was lowest for the Nissen group (94 min) and highest for the para-esophageal group (183 min). Operating time decreased from a mean of 105 min in the first 20 cases to 84 min in the last 20 cases for the Nissen group (P = 0.014). The mean length of stay was 1.3, 1.6, 1.5 and 4.8 days for the groups, respectively. Persistent symptoms of dysphagia/reflux/dysphonia requiring further investigation were seen in nine (8 %) of these patients. Two of these patients required repeat Nissen fundoplication in the mesh group. Our complication rate, total operating time and length of stay for robotic-assisted benign esophageal surgery are comparable to those reported in the literature. When performed by an experienced surgeon, robotic-assisted surgery is safe and effective in the management of benign esophageal diseases.

  19. 手术机器人系统与腹腔镜辅助胃癌切除术的临床疗效对比%Comparative study on clinical efficacy of robot-assisted and laparoscopic gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    张小磊; 江志伟; 赵坤

    2012-01-01

    Objective To compare the clinical efficacy of robot-assisted procedure with laparoscopic surgery for gastric cancer.Methods The clinical data of patients who underwent gastrectomy in the Department of General Surgery in the Affiliated Jinling Hospital,Nanjing University Medical College from January 2009 to December 2011 were retrospectively analyzed.There were 97 patients undergoing robotic gastrectomy(ROB group) and 70 patients undergoing laparoscopic gastrectomy (LAP group).The following parameters were compared between these two groups:intraoperative factors,oncologic outcomes,and short-term surgical outcomes.Results All the operations were performed successfully without conversion.Compared with the LAP group,the ROB group had less intraoperative blood loss [(80.8±53.1) vs.(153.7±26.4) ml,P=0.001],more number of lymph node dissection [(23.1±5.4) vs.(20.0±4.3),P=0.001],longer operative time[ (272.3±46.1) vs.(240.3±89.1) min,P=0.001],earlier semifluid diet time[(3.2±0.8) vs.(3.6±1.2) d,P=0.002],shorter postoperative hospital stay[(6.1±2.6) vs.(6.9±2.3) d,P=0.037].There were no significant differences in the length of distal and proximal margin,postoperative ambulation time,ventilation time and postoperative complications (all P>0.05).Conclusions The robotic gastrectomy is safe and feasible for gastric cancer.It has many advantages such as less blood loss,more number of lynph node dissection and quicker recovery.Similar radical resection can be achieved compared to laparoscopic gastrectomy.%目的 对比分析达芬奇手术机器人系统与腹腔镜辅助胃癌根治术的临床疗效.方法 回顾性分析2009年1月至2011年12月南京军区南京总医院普通外科实施胃癌手术患者的临床资料.其中达芬奇手术机器人系统进行胃癌手术97例(机器人组),腹腔镜辅助胃癌手术70例(腹腔镜组),对比分析两组患者的手术指标、病理指标及短期疗效指标.结果 两组患者手术均顺利完成,无中

  20. Accuracy of Neutrophil Gelatinase-Associated Lipocalin in Detecting Acute Kidney Injury after Urogenital Robotic Assisted Laparoscopic Surgery under General Anesthesia

    Directory of Open Access Journals (Sweden)

    Orsolya MIHÁLY

    2012-06-01

    Full Text Available The aim of this study was to demonstrate the accuracy of NGAL in detecting acute kidney injury (AKI after urogenital robotic surgery in general anesthesia. Methods: A prospective longitudinal observational study, which included patients scheduled for elective robotic surgery under general anesthesia. The serum and urine NGAL at induction, 6 hours and 12 hours were determined. Serum creatinine was measured preoperatively and daily 4 days postoperatively. AKI was defined as the absolute growth of serum creatinine by 0.3 mg/dl over baseline within 48 hours postoperatively. Results: 24 patients were enrolled in the study. AKI occurred in 38% of patients. Serum NGAL increased significantly at 6 hours and 12h, compared to baseline, with a higher increase in the group of patents without AKI. There were no significant results for urine NGAL. A link was observed between the values of serum NGAL, with associated significance p<0.0001. The correlations between urine NGAL were not significant. The predictive value of NGAL, analyzed by cross-tabulation, OR was 3 for baseline value and 5.33 for the values measured at 6 hours and 12 hours, but with no statistical significance. Conclusions: The modifications of the NGAL levels, measured at 6 hours and 12 hours from the induction of anesthesia, were significant with more importance at 6 hours and in patients without AKI. Serum NGAL had no predictive value for AKI, but the risk to develop AKI was 3 times higher for baseline determination and 5 times at 6 and 12 hours.

  1. Are Costs of Robot-Assisted Surgery Warranted for Gynecological Procedures?

    Directory of Open Access Journals (Sweden)

    Peter van Dam

    2011-01-01

    Full Text Available The exponential use of robotic surgery is not the result of evidence-based benefits but mainly driven by the manufacturers, patients and enthusiastic surgeons. The present review of the literature shows that robot-assisted surgery is consistently more expensive than video-laparoscopy and in many cases open surgery. The average additional variable cost for gynecological procedures was about 1600 USD, rising to more than 3000 USD when the amortized cost of the robot itself was included. Generally most robotic and laparoscopic procedures have less short-term morbidity, blood loss, intensive care unit, and hospital stay than open surgery. Up to now no major consistent differences have been found between robot-assisted and classic video-assisted procedures for these factors. No comparative data are available on long-term morbidity and oncologic outcome after open, robotic, and laparoscopic gynecologic surgery. It seems that currently only for very complex surgical procedures, such as cardiac surgery, the costs of robotics can be competitive to open surgical procedures. In order to stay viable, robotic programs will need to pay for themselves on a per case basis and the costs of robotic surgery will have to be reduced.

  2. Robot-assisted excision of seminal vesicle cyst associated with ipsilateral renal agenesis

    Directory of Open Access Journals (Sweden)

    Marcello Scarcia

    2016-01-01

    Full Text Available Seminal vesicle cysts (SVCs associated with other genitourologic abnormalities are rare. Often associated with ipsilateral renal agenesis in a symptomatic patient. In symptomatic patients open surgical excision is the treatment of choice. The laparoscopic approach is a less invasive option. Recently robot-assisted management has gained a primary role for the treatment of this condition.

  3. Hardware design for a cable-free fully insertable wireless laparoscopic robotic camera.

    Science.gov (United States)

    Ning Li; Mancini, Gregory J; Jindong Tan

    2016-08-01

    The field of insertable laparoscopic robotic camera is gaining increasing attentions from researchers, surgeons, and also patients. Although many insertable laparoscope prototypes have been introduced, few of them get rid of the encumbrance tethering cable. In this paper, we proposed a hardware architecture for a magnetic actuated robotic surgical (MARS) camera, which facilitates a cable-free fully insertable laparoscopic surgical robotic camera with adequate in-vivo mobility. Modular design and preliminary test of on-board functional payloads have shown feasibility of a cable-free insertable wireless laparoscopic surgical camera based on off-the-shelf electronics and industrial wireless standards operating in ISM frequency bands at 2.4GHz. Potential improvements for laparoscopic surgery benefited from this hardware architecture include more dexterous in-vivo camera mobility and intuitive closed-loop robotic camera control.

  4. Effect of residents' previous laparoscopic surgery experience on initial robotic suturing experience.

    Science.gov (United States)

    Kilic, Gokhan Sami; Walsh, Teresa M; Borahay, Mostafa; Zeybek, Burak; Wen, Michael; Breitkopf, Daniel

    2012-01-01

    Objective. To assess the impact of gynecology residents' previous laparoscopic experience on the learning curve of robotic suturing techniques and the value of initial structured teaching in dry lab prior to surgery. Methods. Thirteen gynecology residents with no previous robotic surgery experience were divided into Group 1, consisting of residents with 2 or fewer laparoscopic experiences, and Group 2, consisting of residents with 3 or more laparoscopic experiences. Group 1 had a dry-laboratory training in suturing prior to their initial experience in the operating room. Results. For all residents, it took on average 382 ± 159 seconds for laparoscopic suturing and 326 ± 196 seconds for robotic suturing (P = 0.12). Residents in Group 1 had a lower mean suture time than residents in Group 2 for laparoscopic suturing (P = 0.009). The residents in Group 2, however, had a lower mean suture time on the robot compared to Group 1 (P = 0.5). Conclusion. Residents with previous laparoscopic suturing experience may gain more from a robotic surgery experience than those with limited laparoscopic surgery experience. In addition, dry lab training is more efficient than hands-on training in the initial phase of teaching for both laparoscopic and robotic suturing skills.

  5. Assistant Personal Robot (APR): conception and application of a tele-operated assisted living robot

    OpenAIRE

    Eduard Clotet; Dani Martínez; Javier Moreno; Marcel Tresanchez; Jordi Palacín

    2016-01-01

    This paper presents the technical description, mechanical design, electronic components, software implementation and possible applications of a tele-operated mobile robot designed as an assisted living tool. This robotic concept has been named Assistant Personal Robot (or APR for short) and has been designed as a remotely telecontrolled robotic platform built to provide social and assistive services to elderly people and those with impaired mobility. The APR features a fast hig...

  6. Robotic-assisted minimally invasive liver resection

    Directory of Open Access Journals (Sweden)

    Yao-Ming Wu

    2014-04-01

    Conclusion: Robotic assistance increased the percentage of minimally invasive liver resections and the percentage of major minimally invasive liver resections with comparable perioperative results. Robotic-assisted minimally invasive liver resection is feasible, but its role needs more accumulated experience to clarify.

  7. Study for comfortable supine for patients with partial nephrectomy by robot-assisted laparoscopic nephron-sparing surgery%机器人辅助腹腔镜肾部分切除患者术后舒适卧位探讨

    Institute of Scientific and Technical Information of China (English)

    胡英娜; 周秀彬

    2014-01-01

    目的:探讨机器人辅助腹腔镜肾部分切除手术后患者最舒适的卧位。方法抽取80例行机器人腹腔镜肾部分切除手术后的患者,随机分为观察组和对照组,观察组患者手术后经医生允许采用早期舒适卧位,即颈部垫软枕、腰部垫20 cm ×20 cm硬枕仰卧位;对照组患者术后按传统方法采用平卧位。术后前2 d进行观察比较,找出患者最舒适卧位。结果观察组患者睡眠、情绪稳定及腰肌酸痛情况明显优于对照组( P<0.05)。结论机器人辅助腹腔镜肾部分切除手术后卧床期间采取颈部垫软枕、腰部垫20 cm ×20 cm硬枕的仰卧位方式,患者最舒适。%Objective To study the most comfortable lying position for post-operative patients with robot assisted laparoscopic partial nephrectomy .Method 80 post-operative patients with robot assisted laparoscopic partial nephrec-tomy surgery were randomly divided into observation group and the control group ,patients observed by doctors after surgery to allow the use of early comfort lying ,that is ,a soft pillow neck cushion ,waist cushion 20 cm × 20 cm hard pillow supine position ,tupatients in control group by traditional methods in supine position ,after 2 days of ob-servation and comparison ,to find the most comfortable lying position .Result The sleep ,comfort and lumbar pain in observation group was obviously better than that of control group (P<0 .05) .Conclusion Robot assisted laparoscop-ic partial nephrectomy surgery took the neck cushion soft pillow ,lumbar pillow pad 20 cm × 20 cm hard way the su-pine position ,the patient feels most comfortable .

  8. Deep Infiltrating Colorectal Endometriosis Treated With Robotic-Assisted Rectosigmoidectomy

    Science.gov (United States)

    Schraibman, Vladimir; Okazaki, Samuel; Maccapani, Gabriel; Chen, Winston Jenning; Domit, Cassia Danielle; Kaufmann, Oskar Grau; Advincula, Arnold P.

    2013-01-01

    Background and Objective: Deep infiltrating pelvic endometriosis with bowel involvement is one of the most aggressive forms of endometriosis. Nowadays, robotic technology and telemanipulation systems represent the latest developments in minimally invasive surgery. The aim of this study is to present our preliminary results and evaluate the feasibility of robotic-assisted laparoscopic colorectal resection for severe endometriosis. Methods: Between September 2009 and December 2011, 10 women with colorectal endometriosis underwent surgery with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). We evaluated the following parameters: short-term complications, clinical outcomes and long-term follow-up, pain relief recurrence rate, and fertility outcomes. Results: Extensive ureterolysis was required in 8 women (80%). Ovarian cystectomy with removal of the cystic wall was performed in 7 women (70%). Torus resection was performed in all women, with unilateral and bilateral uterosacral ligament resection in 1 woman (10%) and 8 women (80%), respectively. In addition to segmental colorectal resection in all cases, partial vaginal resection was necessary in 2 women (20%). An appendectomy was performed in 2 patients (20%). The mean operative time with the robot was 157 minutes (range, 90–190 minutes). The mean hospital stay was 3 days. Six patients had infertility before surgery, with a mean infertility time of 2 years. After a 12-month follow-up period, 4 women (67%) conceived naturally and 2 (33%) underwent in vitro fertilization. Conclusion: We show that robotic-assisted laparoscopic surgery for the treatment of deep infiltrating bowel endometriosis is feasible, effective, and safe. PMID:23925016

  9. Laparoscopic assisted anorectal pull through: Reformed techniques

    Directory of Open Access Journals (Sweden)

    Bhandary Karthik

    2009-01-01

    Full Text Available Aim: To assess the modifications in the technique of laparoscopic assisted anorectal pull through (LAARP practiced at our institute and analyze the post operative outcome and associated complications. Materials and Methods: A retrospective study from January 2001 to May 2009 analyzing LAARP for high anorectal malformations. Results: A total of 40 patients - 34 males and six females, in the age group of two months to six years were studied. Staged procedure was done in 39 patients; one child with recto vestibular fistula underwent single stage procedure. All the patients withstood surgery well. One patient required conversion due to problems in gaining enough length for the distal rectum in a patient with rectovesical fistula so colostomy was closed and re-located at a proximal splenic flexure. The complications were mucosal prolapse (six cases, anal stenosis (three, adhesive obstruction (two, distal rectal necrosis (one, and urethral diverticulum (one. The patients were followed up with clinical evaluation and continence scoring. The progress has been satisfactory and weight-gain is adequate. Conclusions: The advantages of the reformed techniques are as follows: Transcutaneous bladder stitch provides excellent visualization; traction over the fistula helps in dissection of the puborectalis, dividing the fistula without ligation is safe, railroading of Hegar′s dilators over the suction canula creates adequate pull through channel, saves time and makes procedure simpler with reproducible comparable reports.

  10. The impact of marketing language on patient preference for robot-assisted surgery.

    Science.gov (United States)

    Dixon, Peter R; Grant, Robert C; Urbach, David R

    2015-02-01

    Robot-assisted surgery is gaining momentum as a new trend in minimally invasive surgery. With limited evidence supporting its use in place of the far less expensive conventional laparoscopic surgery, it has been suggested that marketing pressure is partly responsible for its widespread adoption. The impact of phrases that promote the novelty of robot-assisted surgery on patient decision making has not been investigated. We conducted a discrete choice experiment to elicit preference of partial colectomy technique for a hypothetical diagnosis of colon cancer. A convenience sample of 38 participants in an ambulatory general surgery clinic consented to participate. Each participant made 2 treatment decisions between robot-assisted surgery and conventional laparoscopic surgery, with robot-assisted surgery described as "innovative" and "state-of-the-art" in one of the decisions (marketing frame), and by a disclosure of the uncertainty of available evidence in the other (evidence-based frame). The magnitude of the framing effect was large with 12 of 38 subjects (31.6%, P = .005) selecting robot-assisted surgery in the marketing frame and not the evidence-based frame. This is the first study to our knowledge to demonstrate that words that highlight novelty have an important influence on patient preference for robot-assisted surgery and that use of more neutral language can mitigate this effect.

  11. Performance Evaluation Methods for Assistive Robotic Technology

    Science.gov (United States)

    Tsui, Katherine M.; Feil-Seifer, David J.; Matarić, Maja J.; Yanco, Holly A.

    Robots have been developed for several assistive technology domains, including intervention for Autism Spectrum Disorders, eldercare, and post-stroke rehabilitation. Assistive robots have also been used to promote independent living through the use of devices such as intelligent wheelchairs, assistive robotic arms, and external limb prostheses. Work in the broad field of assistive robotic technology can be divided into two major research phases: technology development, in which new devices, software, and interfaces are created; and clinical, in which assistive technology is applied to a given end-user population. Moving from technology development towards clinical applications is a significant challenge. Developing performance metrics for assistive robots poses a related set of challenges. In this paper, we survey several areas of assistive robotic technology in order to derive and demonstrate domain-specific means for evaluating the performance of such systems. We also present two case studies of applied performance measures and a discussion regarding the ubiquity of functional performance measures across the sampled domains. Finally, we present guidelines for incorporating human performance metrics into end-user evaluations of assistive robotic technologies.

  12. Smart tissue anastomosis robot (STAR): a vision-guided robotics system for laparoscopic suturing.

    Science.gov (United States)

    Leonard, Simon; Wu, Kyle L; Kim, Yonjae; Krieger, Axel; Kim, Peter C W

    2014-04-01

    This paper introduces the smart tissue anastomosis robot (STAR). Currently, the STAR is a proof-of-concept for a vision-guided robotic system featuring an actuated laparoscopic suturing tool capable of executing running sutures from image-based commands. The STAR tool is designed around a commercially available laparoscopic suturing tool that is attached to a custom-made motor stage and the STAR supervisory control architecture that enables a surgeon to select and track incisions and the placement of stitches. The STAR supervisory-control interface provides two modes: A manual mode that enables a surgeon to specify the placement of each stitch and an automatic mode that automatically computes equally-spaced stitches based on an incision contour. Our experiments on planar phantoms demonstrate that the STAR in either mode is more accurate, up to four times more consistent and five times faster than surgeons using state-of-the-art robotic surgical system, four times faster than surgeons using manual Endo360(°)®, and nine times faster than surgeons using manual laparoscopic tools.

  13. 达芬奇机器人辅助腹腔镜行肾部分切除术患者的护理%Nursing of Robot-assisted Laparoscopic Partial Nephrectomy

    Institute of Scientific and Technical Information of China (English)

    彭晓琼; 徐颖; 王先进; 郑洁琼; 徐萍; 端文婷; 张怡; 何威; 沈周俊

    2014-01-01

    Objective To summarize the nursing strategy of patients undergoing robot-assisted laparoscopic partial nephrectomy(RALPN).Methods The clinical data of 1 2 patients undergoing RALPN were analyzed retrospective-ly.RALPN group patients had postoperative assessment,psychological nursing,bowel preparation before the sur-gery,and had psychological nursing,strict monitoring of vital signs,operative incision and drain tube nursing, urethral catheter nursing,respiratory care,early functional exercise,diet nursing after surgery to prevent the post-operative complications.Results The surgery time was (177.6±26.4)min,renal artery block time was(30.7±8.6) min,blood loss(281.8±217.1)ml,passage of gas by anus recovery time(1.7±0.6 )d,drainage tube indwelling time (9.0±1.9)d,urethral catheter indwelling time(9.4±1.2)d,off bed activity time was(6.3±1.3)d,postoperative hos-pitalization time was(12.5±1.9)d.Postoperative pathological examination showed that 8 cases of patients had renal clear cell carcinoma,3 cases of renal angiomyolipoma,1 case of multilocular cystic renal cell carcinoma.Conclusion RALPN have obvious advantages with fewer traumas,faster postoperative recovery.It can significantly reduce the difficulty and workload of nursing care and improve the quality and efficiency of nursing care,which is worthwhile for clinical trial.%目的:探讨达芬奇机器人辅助腹腔镜行肾部分切除术(robot-assisted laparoscopic partial nephrectomy,RALPN)患者的护理措施。方法回顾性分析2011年5月至2013年2月瑞金医院泌尿外科治疗的12例RALPN患者的临床资料,所有患者术前重点进行术前评估、心理护理、肠道准备等,术后进行心理护理、严密的生命体征监测、切口护理、引流管护理、导尿管护理、呼吸道护理、活动训练、饮食护理,采取积极预防措施预防并发症的发生。结果患者手术时间为(177.6±26.4)min,肾动脉阻断时间为(30.7±8.6)min

  14. 机器人辅助腹腔镜下根治性膀胱切除加尿流改道术的临床分析%Clinical analysis of robot-assisted laparoscopic radical cystectomy with urinary diversion

    Institute of Scientific and Technical Information of China (English)

    陈光富; 张旭; 史立新; 马鑫; 郭刚; 许勇; 瓦斯里江·瓦哈甫

    2012-01-01

    目的 探讨采用da Vinci S机器人系统完成机器人辅助腹腔镜下根治性膀胱切除(robotic-assisted laparoscopic radical cystectomy,RARC)加尿流改道术的临床可行性,并总结技术特点和临床效果. 方法 2007年12月至2012年3月膀胱尿路上皮癌患者22例,男20例,女2例.年龄37~ 72岁,平均62岁.体质指数22.5 ~ 30.1 kg/m2,平均26.1 kg/m2.麻醉评分1~2分.术前肿瘤活检病理诊断为浸润性或高危的非肌层浸润性膀胱尿路上皮痛,术前检查均未发现有其他邻近脏器浸润、盆腔淋巴结转移或远处转移,临床分期均低于T2N0M0.全麻下行RARC加尿流改道术,其中行体外尿流改道术15例(原位新膀胱2例,回肠膀胱术13例),行完全腹腔镜下尿流改道术7例(回肠膀胱术2例,原位新膀胱5例). 结果 本组22例手术均获得成功.手术时间300 ~ 667 min,平均480 min;出血量100 ~ 1200 ml,平均550 ml;淋巴结清扫数目6~ 25枚,平均15枚.术后2~3d下地活动,3~4d肠功能恢复,术后住院时间8~35 d,平均16d.行原位新膀胱的患者术后1个月行膀胱造影确定无吻合口漏后拔除尿管和双侧输尿管支架管.术后随访4 ~ 49个月,平均32个月,复发2例,死亡1例,出现肾积水2例,其余病例肾功能均正常,尿控较满意. 结论 根据初期的手术操作过程和随访结果,RARC加尿流改道术在临床上是可行的.更多的操作经验、长期和随机的对照研究将有助于对这一技术进行评估和推广.%Objective To investigate the clinical feasibility of robotic-assisted laparoscopic radical cystectomy (RARC) by da Vinci surgical system and to summarize the operative technique and outcomes.Methods From December 2007 to March 2012,22 patients (20 males and 2 females) with the bladder urothelial carcinomas were enrolled.Patient age was from 37 -72 years (rnean 62 years) ; the body mass index was 22.5 - 30.1 kg/m2 ( mean 26.1 kg/m2 ) ; and the American Society of

  15. HAND-ASSISTED LAPAROSCOPIC NEPHROURETERECTOMY: INITIAL CASE REPORT

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Nephroureterectomy with removal of a bladder cuff was performed successfully on a 47-year -old man for transitional cell carcinoma of the right renal pelvis using hand-assisted laparoscopy. The results showed that hand-assisted laparoscopic nephroureterectomy is an efficacious altemative to open surgery and provides the urologist new to laparoscopy a shorter learning curve compared with standard laparoscopy.

  16. [Walking assist robot and its clinical application].

    Science.gov (United States)

    Kakou, Hiroaki; Shitama, Hideo; Kimura, Yoshiko; Nakamoto, Yoko; Furuta, Nami; Honda, Kanae; Wada, Futoshi; Hachisuka, Kenji

    2009-06-01

    The walking assist robot was developed to improve gait disturbance in patients with severe disabilities. The robot had a trunk supporter, power generator and operating arms which held patient's lower extremities and simulated walking, a control unit, biofeedback system, and a treadmill. We applied the robot-aided gait training to three patients with severe gait disturbance induced by stroke, axonal Guillan-Barré syndrome or spinal cord injury, and the walking assist robot turned out to be effective in improving the gait disturbance.

  17. Re: Robot-Assisted Renal Transplantation in the Retroperitoneum

    Directory of Open Access Journals (Sweden)

    Tsai MK

    2015-03-01

    Full Text Available The authors describe their first 10 cases of minimally invasive renal transplantation experience in the retroperitoneum with the aid of the da Vinci surgical system through a gas-less extra-peritoneal approach with a muscle sparing Gibson incision. The authors claim that they have utilized robotic arms for both vascular anastomosis and abdominal wall lifting which can be limiting in the obese patients. In recent years there is an increasing tendency for minimally invasive renal transplantation such as transperitoneal laparoscopic or robotic assisted renal transplantation. Those techniques still need modifications and search for a better technique is still in progress. In this study, mimicking the well-established open procedure with a smaller incision can be a better alternative, which requires confirmation in the future

  18. 机器人辅助腹腔镜行卵巢癌手术13例分析%Analysis of 13 cases of ovarian cancer with robot assisted laparoscopic surgery

    Institute of Scientific and Technical Information of China (English)

    叶明侠; 李立安; 李利; 范文生; 黄柯; 李亚里; 孟元光

    2015-01-01

    目的:探讨机器人系统在卵巢癌手术中的应用价值。方法回顾性分析2014年11月至2015年5月期间收治的卵巢癌手术患者46例。其中机器人辅助腹腔镜手术(机器人手术组)14例(其中1例机器人探查后中转开腹手术),同期经腹手术(开腹手术组)25例,经腹腔镜手术(腹腔镜手术组)7例。所有患者统计年龄、术前新辅助化疗次数、手术时间、手术方式、术中出血量、术中并发症、术后并发症、病理类型、清扫淋巴结数、术后排气时间、术后住院时间,对相应数据进行分析。结果机器人系统完成手术共13例,其中Ⅰ-Ⅱ期手术7例,Ⅲ期手术4例,复发癌手术2例。腹腔镜手术组中1例腹腔镜探查后中转开腹手术。机器人手术组与腹腔镜手术组相比,术中出血量、清扫淋巴结数及术后排气时间均无明显差异。结论机器人手术组在卵巢癌分期手术中安全、可靠,手术效果同腹腔镜手术组类似。对于晚期或复发性卵巢癌等复杂的手术,机器人系统更有优势。%Objectives To explore the application of robot system in the operation of ovarian cancer .Methods A total of 46 patients with ovarian cancer were retrospectively analyzed from Nov .2014 to May 2015 . 14 cases of the patients were performed by the robot . 25 cases were completed by laparotomyduring the same period .7 cases were performed by laparoscopic surgery .All the statistics were analized including the age , frequency of preoperative neoadjuvantchemotherapy , operation time, operationmethods, intraoperative blood loss , intraoperative and postoperative complications , pathological type, number of lymph nodes, postoperative exhaust time,time of anal exsufflation and hospitalization after operation.Results 13 cases of the pations with ovarian cancer were performed by robot to complete the operation, including 7 cases in stageⅠ-Ⅱ, 4 cases in stage Ⅲand 2

  19. A comparative study of open, laparoscopic and robotic partial nephrectomy in obese patients

    Directory of Open Access Journals (Sweden)

    Clairese M Webb

    2015-01-01

    Conclusions: Our study demonstrates that in obese patients, both laparoscopic and robotic partial nephrectomy are associated with less blood loss than open partial nephrectomy. Second, the length of the hospital stay was not related to the type of utilized intervention.

  20. Initial experience with robot-assisted varicocelectomy

    Institute of Scientific and Technical Information of China (English)

    Tung Shu; Shaya Taghechian; Run Wang

    2008-01-01

    Aim: To determine if robot-assisted varicocelectomy can be safely and effectively performed when compared microscopic inguinal varicocelectomy. Methods: Eight patients aged 29.1 ± 12.5 years underwent microscopic subinguinal varicocelectomies: seven patients with left-sided repair, and one patient with bilateral repair. Eight patients aged 22.0 ± 8.0 years underwent robot-assisted varicocelectomies: seven patients with left-sided repair and one patient with bilateral repair. Results: The average operative time for microscopic inguinal varicocelectomy was 73.9 ± 12.2 min, whereas the robot-assisted technique took 71.1 ± 21.1 min. There were no difficulties in identifying and isolating vessels and the vas deferens with robot-assisted subinguinal varicocelectomy. Hand tremor was eliminated using the robotic procedure. Patients who underwent either microscopic or robot-assisted varicocelectomies were able to resume daily activities on the day of surgery and full activities within 2 weeks. There were complications or recurrences of varicocele. Conclusion: From our experience, compared to microscopic surgery,robot-assisted varicocelectomy can be safely and effectively performed, with the added benefit of eliminating hand tremor.

  1. Laparoscopic-assisted cystotomy for urolith removal in geldings.

    Science.gov (United States)

    Röcken, Michael; Stehle, Christiane; Mosel, Gesine; Rass, Julia; Litzke, Lutz F

    2006-06-01

    To describe a technique for laparoscopic-assisted removal of cystic calculi in geldings and report outcome. Clinical report. Four geldings with cystic calculi. Laparoscopic-assisted cystotomy and urolith retrieval was performed in 4 anesthetized geldings positioned in dorsal recumbency. With a laparoscope portal located at the umbilicus, the abdomen was insufflated and then the surgical table was tilted (30 degrees head-down position) before an instrumental portal was created parallel and 2-3 cm medial to the left external inguinal ring. Laparoscopic grasping forceps were inserted to grasp the cranial aspect of the bladder and elevate it to the ventral abdominal wall. With the instrumental portal as mid-point, the parainguinal skin incision was longitudinally extended cranial and caudal (approximately 8-10 cm) to accommodate the size of the urolith. The apex of the bladder was exteriorized and sharply incised, the urolith extracted, and after cystotomy closure, the bladder was repositioned. The mini-laparotomy and trocar incisions were closed in layers. There were no intra- or post-operative complications. All horses had minor incisional swelling for 3-4 days. No signs of abdominal or incisional pain were observed. Hematuria and slight stranguria occurred until the 3rd or 4th day. Surgical time (skin incision to skin closure) was 35-40 minutes. On long-term follow-up (up to 12 months) no recurrence of clinical signs associated with cystic calculi occurred. Uroliths (6-8 cm diameter) can be removed by laparoscopic-assisted cystotomy in geldings. Laparoscopic-assisted cystotomy combines the advantages of the parainguinal laparocystotomy with laparoscopic technique for removal of cystic calculi while avoiding their disadvantages.

  2. Risk profiles and outcomes of total laparoscopic hysterectomy compared with laparoscopically assisted vaginal hysterectomy.

    Science.gov (United States)

    Hanwright, Philip J; Mioton, Lauren M; Thomassee, May S; Bilimoria, Karl Y; Van Arsdale, John; Brill, Elizabeth; Kim, John Y S

    2013-04-01

    With the increasing rates of minimally invasive hysterectomy procedures serving as impetus, the aim of this study was to analyze the 30-day risk profiles associated with total laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy (LAVH). The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent a total laparoscopic hysterectomy or LAVH operation between 2006 and 2010. Patient demographics and 30-day complication rates were calculated. Multivariable regression analyses were used to study the effect of hysterectomy approach on outcomes. A total of 6,190 patients underwent laparoscopic hysterectomy, with 66.3% receiving LAVH and 33.7% receiving a total laparoscopic hysterectomy. The patient cohorts were well-matched. Although total laparoscopic hysterectomy procedures were significantly longer than LAVH operations (2.66 hours compared with 2.20 hours; Plaparoscopic hysterectomy populations (7.05% compared with 6.3% for overall morbidity; 1.3% compared with 1.7% for reoperation). Regression analyses revealed that surgical approach was not a significant predictor of overall postoperative morbidity or reoperation in minimally invasive hysterectomy patients. Additionally, obesity did not demonstrate a significant association with morbidity or reoperation rates; however, operative time was found to be a significant predictor of reoperation (odds ratio 1.23, 95% confidence interval 1.07-1.42). Laparoscopic hysterectomy is well-tolerated with total laparoscopic hysterectomy and LAVH, yielding comparable rates of postoperative morbidity and reoperation. On average, LAVH procedures were 28 minutes faster than total laparoscopic hysterectomy. Additionally, increasing body mass index was not associated with higher rates of morbidity. II.

  3. ROAD: domestic assistant and rehabilitation robot.

    Science.gov (United States)

    Carrera, Isela; Moreno, Héctor A; Saltarén, Roque; Pérez, Carlos; Puglisi, Lisandro; Garcia, Cecilia

    2011-10-01

    This study introduces the concept design and analysis of a robotic system for the assistance and rehabilitation of disabled people. Based on the statistical data of the most common types of disabilities in Spain and other industrialized countries, the different tasks that the device must be able to perform have been determined. In this study, different robots for rehabilitation and assistance previously introduced have been reviewed. This survey is focused on those robots that assist with gait, balance and standing up. The structure of the ROAD robot presents various advantages over these robots, we discuss some of them. The performance of the proposed architecture is analyzed when it performs the sit to stand activity.

  4. Is the Learning Curve of Robotic Low Anterior Resection Shorter Than Laparoscopic Low Anterior Resection for Rectal Cancer?

    OpenAIRE

    Park, Eun Jung; Kim, Chang Woo; Cho, Min Soo; Kim, Dong Wook; MIN, BYUNG SOH; Baik, Seung Hyuk; Lee, Kang Young; Kim, Nam Kyu

    2014-01-01

    Abstract As robotic surgery was developed with ergonomic designs, there are expectations that the technical advantages of robotic surgery can shorten the learning curve. However, there is no comparative study, so far, to evaluate the learning curve between robotic and laparoscopic rectal cancer surgeries. Therefore, the aim of this study is to compare the learning curve of robotic low anterior resection (LAR) with laparoscopic LAR for rectal cancer. Patients who underwent robotic or laparosco...

  5. Urogenital function in robotic vs laparoscopic rectal cancer surgery: a comparative study

    OpenAIRE

    Panteleimonitis, Sofoklis; Ahmed, Jamil; Ramachandra, Meghana; Farooq, Muhammad; Harper, Mick; Parvaiz, Amjad

    2016-01-01

    Purpose - Urological and sexual dysfunction are recognised risks of rectal cancer surgery; however, there is limited evidence regarding urogenital function comparing robotic to laparoscopic techniques. The aim of this study was to assess the urogenital functional outcomes of patients undergoing laparoscopic and robotic rectal cancer surgery. Methods - Urological and sexual functions were assessed using gender-specific validated standardised questionnaires. Questionnaires were sent a minimum o...

  6. Robotic-assisted repair of a duodenal diaphragm in a child

    Directory of Open Access Journals (Sweden)

    Jennifer H. Myszewski

    2015-08-01

    Full Text Available The retroperitoneal location of the duodenum and the small volume of the peritoneal cavity in pediatric patients make the laparoscopic repair of congenital duodenal anomalies challenging. As a result, robotic-assisted repair of duodenal atresia in a pediatric patient has been reported only once in the literature. This report describes the robotic-assisted laparoscopic repair of a congenital duodenal diaphragm in a 2-year-old, 8 kg patient who presented with vomiting and failure to thrive. An upper gastrointestinal series revealed partial obstruction at the second part of the duodenum with proximal dilatation. These findings are consistent with a duodenal diaphragm. Traditional laparoscopy was utilized to kocherize the first and second parts of the duodenum and to identify a loop of proximal jejunum for the proposed anastomosis. A duodeno-jejunal anastomosis was then performed using intra-corporeal suturing with a daVinci SI robotic system. The patient had a quick and uneventful post-operative course. At 6 month follow-up, she was asymptomatic and the surgical incisions had healed with excellent cosmetic appearance. A combination of laparoscopic and robotic techniques offers a promising alternative to open or purely laparoscopic repair of congenital duodenal anomalies.

  7. Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions.

    Science.gov (United States)

    Buffi, Nicolò Maria; Lughezzani, Giovanni; Hurle, Rodolfo; Lazzeri, Massimo; Taverna, Gianluigi; Bozzini, Giorgio; Bertolo, Riccardo; Checcucci, Enrico; Porpiglia, Francesco; Fossati, Nicola; Gandaglia, Giorgio; Larcher, Alessandro; Suardi, Nazareno; Montorsi, Francesco; Lista, Giuliana; Guazzoni, Giorgio; Mottrie, Alexandre

    2017-06-01

    Minimally invasive treatment of benign ureteral strictures is still challenging because of its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach. To evaluate outcomes for robotic ureteral repair in a multi-institutional cohort of patients treated for ureteropelvic junction obstruction and ureteral stricture (US) at four tertiary referral centres. This retrospective study reports data for 183 patients treated with standard robot-assisted pyeloplasty (PYP) and robotic uretero-ureterostomy (UUY) at four high-volume centres from January 2006 to September 2014. Robotic PYP and robot-assisted UUY were performed according to previously reported surgical techniques. Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. No robot-assisted UUY cases required surgical conversion, while 2.8% of PYP cases were not completed robotically. The median operative time was 120 and 150min for robot-assisted PYP and robot-assisted UUY, respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n=20) and complications were mostly of low grade. The high-grade complication rate was 2.2% (n=4). At median follow-up of 24 mo, the overall success rate was >90% for both procedures. The study limitations include its retrospective nature and the heterogeneity of the study population. Robotic surgery for benign US is safe and effective, with limited risk of high-grade complications and good intermediate-term results. In this study we review the use of robotic surgery at four different tertiary care centres in the treatment of patients affected by benign ureteral strictures. Our results demonstrate that robotic surgery is a safe alternative to the standard open approach in the treatment of ureteral strictures. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All

  8. Robot-assisted hysterectomy for endometrial and cervical cancers: a systematic review.

    Science.gov (United States)

    Nevis, Immaculate F; Vali, Bahareh; Higgins, Caroline; Dhalla, Irfan; Urbach, David; Bernardini, Marcus Q

    2017-03-01

    Total and radical hysterectomies are the most common treatment strategies for early-stage endometrial and cervical cancers, respectively. Surgical modalities include open surgery, laparoscopy, and more recently, minimally invasive robot-assisted surgery. We searched several electronic databases for randomized controlled trials and observational studies with a comparison group, published between 2009 and 2014. Our outcomes of interest included both perioperative and morbidity outcomes. We included 35 observational studies in this review. We did not find any randomized controlled trials. The quality of evidence for all reported outcomes was very low. For women with endometrial cancer, we found that there was a reduction in estimated blood loss between the robot-assisted surgery compared to both laparoscopy and open surgery. There was a reduction in length of hospital stay between robot-assisted surgery and open surgery but not laparoscopy. There was no difference in total lymph node removal between the three modalities. There was no difference in the rate of overall complications between the robot-assisted technique and laparoscopy. For women with cervical cancer, there were no differences in estimated blood loss or removal of lymph nodes between robot-assisted and laparoscopic procedure. Compared to laparotomy, robot-assisted hysterectomy for cervical cancer showed an overall reduction in estimated blood loss. Although robot-assisted hysterectomy is clinically effective for the treatment of both endometrial and cervical cancers, methodologically rigorous studies are lacking to draw definitive conclusions.

  9. Assistant Personal Robot (APR): Conception and Application of a Tele-Operated Assisted Living Robot.

    Science.gov (United States)

    Clotet, Eduard; Martínez, Dani; Moreno, Javier; Tresanchez, Marcel; Palacín, Jordi

    2016-04-28

    This paper presents the technical description, mechanical design, electronic components, software implementation and possible applications of a tele-operated mobile robot designed as an assisted living tool. This robotic concept has been named Assistant Personal Robot (or APR for short) and has been designed as a remotely telecontrolled robotic platform built to provide social and assistive services to elderly people and those with impaired mobility. The APR features a fast high-mobility motion system adapted for tele-operation in plain indoor areas, which incorporates a high-priority collision avoidance procedure. This paper presents the mechanical architecture, electrical fundaments and software implementation required in order to develop the main functionalities of an assistive robot. The APR uses a tablet in order to implement the basic peer-to-peer videoconference and tele-operation control combined with a tactile graphic user interface. The paper also presents the development of some applications proposed in the framework of an assisted living robot.

  10. Patient Perceptions of Open, Laparoscopic, and Robotic Gynecological Surgeries

    Directory of Open Access Journals (Sweden)

    Mohamad Irani

    2016-01-01

    Full Text Available Objective. To investigate patient knowledge and attitudes toward surgical approaches in gynecology. Design. An anonymous Institutional Review Board (IRB approved questionnaire survey. Patients/Setting. A total of 219 women seeking obstetrical and gynecological care in two offices affiliated with an academic medical center. Results. Thirty-four percent of the participants did not understand the difference between open and laparoscopic surgeries. 56% of the participants knew that laparoscopy is a better surgical approach for patients than open abdominal surgeries, while 37% thought that laparoscopy requires the surgeon to have a higher technical skill. 46% of the participants do not understand the difference between laparoscopic and robotic procedures. 67.5% of the participants did not know that the surgeon moves the robot’s arms to perform the surgery. Higher educational level and/or history of previous abdominal surgeries were associated with the highest rates of answering all the questions correctly (p<0.05, after controlling for age and race. Conclusions. A substantial percentage of patients do not understand the difference between various surgical approaches. Health care providers should not assume that their patients have an adequate understanding of their surgical options and accordingly should educate them about those options so they can make truly informed decisions.

  11. Robotic assisted hysterectomy in obese patients: a systematic review.

    Science.gov (United States)

    Iavazzo, Christos; Gkegkes, Ioannis D

    2016-06-01

    Robotic hysterectomy is an alternative approach to the management of female genital tract pathology. A systematic literature review was performed to evaluate the till now available literature evidence on robotic assisted hysterectomy in obese and morbidly obese patients. In total, robotic assisted hysterectomy was performed on 2769 patients. The most frequent indication for robotic hysterectomy was endometrial carcinoma (1832 out of 2769 patients, 66.2 %). Hypertension, diabetes mellitus, obstructive sleep apnea, chronic obstructive pulmonary disease and venous thromboembolism were the most common comorbidities reported. The conversion rate to laparotomy was 92 out of 2226 patients (4.1 %). The most frequent intraoperative complications for robotic hysterectomy were gastrointestinal injury (17 out of 2769 patients, 0.6 %), haemorrhage (five out of 2769 patients, 0.2 %) and bladder injury (five out of 2769 patients, 0.2 %). Wound infections/dehiscence (66 out of 2769 patients, 2.4 %), fever (56 out of 2769 patients, 2 %), pulmonary complications (55 out of 2769 patients, 1.9 %), urogenital complications (36 out of 2769 patients, 1.3 %) and postoperative ileus (28 out of 2769 patients, 1 %) were the most common postoperative complications. Death was reported in three out of 2769 patients (0.1 %). The ICU admitted patients were eight of 2226 patients (0.4 %). The robotic technique, especially in obese, can optimize the surgical approach and recovery of such patients with equally if not better outcomes compared to open and/or laparoscopic techniques.

  12. Robotic-assisted double-sleeve lobectomy

    Science.gov (United States)

    Qiu, Tong; Zhao, Yandong; Xuan, Yunpeng

    2017-01-01

    Double-sleeve lobectomy, which includes bronchoplasty and pulmonary arterial angioplasty, is required for certain cases of central-type lung cancer. It is usually done by open surgery or video-assisted thoracoscopic surgery (VATS). In recently, da Vinci system and robotic surgery have been applied in such complicated cases. Here we describe the details associated with robotic-assisted double-sleeve lobectomy. PMID:28203433

  13. Robot Assisted Renal Auto Transplantation: A Case Based Discussion of Unique Anaesthetic Considerations

    Directory of Open Access Journals (Sweden)

    Praveen Gupta

    2015-02-01

    Full Text Available Laparoscopic renal autotransplantation has serious perturbations on the body's homeostasis due to its non physiological positioning, use of pneumoperitoneum, changing fluid strategy at different points of time and on-going steps to maintain optimal environment for the transplanted kidney. Generally speaking, the anaesthetic management of renal auto-transplantation by open technique is not very complex and the perioperative management can be categorized in the intermediate level of clinical skill requirement. Adding to the comfort of the anaesthesiologist is the fact that these patients are not in end stage renal disease state and does not manifest the comorbidities, multisystem involvement and technical complexities of long term renal dysfunction and renal replacement therapy. In our case report surgeons used the da Vinci surgical robotic system for laparoscopic transplantation of the kidney at a new site. In this article we discuss the anaesthetic challenges of robot assisted laparoscopic renal auto-transplantation along with a description of our index case.

  14. Navigation of a robot-integrated fluorescence laparoscope in preoperative SPECT/CT and intraoperative freehand SPECT imaging data: a phantom study

    Science.gov (United States)

    van Oosterom, Matthias Nathanaël; Engelen, Myrthe Adriana; van den Berg, Nynke Sjoerdtje; KleinJan, Gijs Hendrik; van der Poel, Henk Gerrit; Wendler, Thomas; van de Velde, Cornelis Jan Hadde; Navab, Nassir; van Leeuwen, Fijs Willem Bernhard

    2016-08-01

    Robot-assisted laparoscopic surgery is becoming an established technique for prostatectomy and is increasingly being explored for other types of cancer. Linking intraoperative imaging techniques, such as fluorescence guidance, with the three-dimensional insights provided by preoperative imaging remains a challenge. Navigation technologies may provide a solution, especially when directly linked to both the robotic setup and the fluorescence laparoscope. We evaluated the feasibility of such a setup. Preoperative single-photon emission computed tomography/X-ray computed tomography (SPECT/CT) or intraoperative freehand SPECT (fhSPECT) scans were used to navigate an optically tracked robot-integrated fluorescence laparoscope via an augmented reality overlay in the laparoscopic video feed. The navigation accuracy was evaluated in soft tissue phantoms, followed by studies in a human-like torso phantom. Navigation accuracies found for SPECT/CT-based navigation were 2.25 mm (coronal) and 2.08 mm (sagittal). For fhSPECT-based navigation, these were 1.92 mm (coronal) and 2.83 mm (sagittal). All errors remained below the robot-integrated fluorescence laparoscope is feasible and may aid fluorescence-guided surgery procedures.

  15. Robot-assisted surgery: applications in urology

    Directory of Open Access Journals (Sweden)

    Mathew C Raynor

    2010-05-01

    Full Text Available Mathew C Raynor, Raj S PruthiDivision of Urologic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USAAbstract: The past decade has seen a dramatic shift in the surgical management of certain urologic conditions with the advent of a robotic surgical platform. In fact, the surgical management of prostate cancer has seen the most dramatic shift, with the majority of cases now being performed robotically. Technical refinements over the years have led to improved outcomes regarding oncologic and functional results. Recently, robotic surgery has also been utilized for the surgical management of bladder cancer, renal cancer, and other benign conditions. As further experience is gained and longer-term outcomes are realized, robotic surgery will likely play an increasing role in the surgical management of many urologic conditions.Keywords: robot-assisted surgery, robotic surgery, cystectomy, prostatectomy, partial nephrectomy

  16. Two Live Births following Robotic-Assisted Abdominal Cerclage in Nonpregnant Women

    Directory of Open Access Journals (Sweden)

    Ahmet Göçmen

    2013-01-01

    Full Text Available Introduction. To report the robotic-assisted abdominal cerclage performed in two nonpregnant women and the success of live birth outcomes. Presentation of Cases. A 36-year-old woman with a complaint of recurrent second trimester pregnancy losses and a 35-year-old patient with a complaint of preterm deliveries and cervical insufficiency underwent robotic assisted abdominal cervicoisthmic cerclage placement in nonpregnant period. The two patients had spontaneous pregnancy after the robotic-assisted abdominal cerclage and delivered healthy infants. Discussion. The limitations of traditional laparoscopic abdominal cerclage have been accomplished with robotic surgery advantages especially intuitive movements and increased range of motion. There are only a few studies in the literature including robotic assisted abdominal cerclage in nonpregnant women, and only five successful live birth outcomes were reported. In this paper, we reported the sixth and seventh cases of achieved live pregnancy after robotic assisted abdominal cerclage in the literature. Conclusion. Robotic assisted abdominal cerclage is a good alternative surgical method with successful pregnancy outcomes.

  17. Image reconstruction for robot assisted ultrasound tomography

    Science.gov (United States)

    Aalamifar, Fereshteh; Zhang, Haichong K.; Rahmim, Arman; Boctor, Emad M.

    2016-04-01

    An investigation of several image reconstruction methods for robot-assisted ultrasound (US) tomography setup is presented. In the robot-assisted setup, an expert moves the US probe to the location of interest, and a robotic arm automatically aligns another US probe with it. The two aligned probes can then transmit and receive US signals which are subsequently used for tomographic reconstruction. This study focuses on reconstruction of the speed of sound. In various simulation evaluations as well as in an experiment with a millimeter-range inaccuracy, we demonstrate that the limited data provided by two probes can be used to reconstruct pixel-wise images differentiating between media with different speeds of sound. Combining the results of this investigation with the developed robot-assisted US tomography setup, we envision feasibility of this setup for tomographic imaging in applications beyond breast imaging, with potentially significant efficacy in cancer diagnosis.

  18. Laparoscopic repair of diaphragmatic hernia after left ventricular assist device.

    Science.gov (United States)

    Farma, Jeffrey; Leeser, David; Furukawa, Satoshi; Dempsey, Daniel T

    2003-06-01

    This case report describes a patient with a symptomatic diaphragmatic hernia that developed after orthotopic heart transplantation and explantation of a left ventricular assist device. The hernia was repaired laparoscopically, and at 6-month follow-up, she is without evidence of recurrence.

  19. Knowing when to assist: developmental issues in lifelong assistive robotics.

    Science.gov (United States)

    Demiris, Yiannis

    2009-01-01

    Children and adults with sensorimotor disabilities can significantly increase their autonomy through the use of assistive robots. As the field progresses from short-term, task-specific solutions to long-term, adaptive ones, new challenges are emerging. In this paper a lifelong methodological approach is presented, that attempts to balance the immediate context-specific needs of the user, with the long-term effects that the robot's assistance can potentially have on the user's developmental trajectory.

  20. Knowing when to assist: Developmental issues in lifelong assistive robotics

    OpenAIRE

    Demiris1, Y.

    2009-01-01

    20.03.15 KB. Ok to add accepted version to spiral Children and adults with sensorimotor disabilities can significantly increase their autonomy through the use of assistive robots. As the field progresses from short-term, task-specific solutions to long-term, adaptive ones, new challenges are emerging. In this paper a lifelong methodological approach is presented, that attempts to balance the immediate context-specific needs of the user, with the long-term effects that the robots assistance...

  1. 机器人辅助腹腔镜肾部分切除术与腹腔镜肾部分切除术临床疗效对比的 Meta 分析%A meta-analysis of comparison for peri-operative outcomes of robot-assisted vs laparoscopic partial ne-phrectomy

    Institute of Scientific and Technical Information of China (English)

    张建华; 陈跃龙; 官润云; 刘孝东

    2015-01-01

    目的:比较机器人辅助腹腔镜肾部分切除术(robot-assisted laparoscopic partial ne-phrectomy,RALPN)与腹腔镜肾部分切除术(laparoscopic partial nephrectomy,LPN)两种手术的临床效果,运用 Meta 分析方法,对两种术式进行分析.方法收集相关研究,按照纳入与排除标准,经检索相关数据库获取相关文献,运用 Revman 5.2软件进行分析.结果入选10篇回顾性队列研究,共包括1863例患者,其中行 RALPN 1001例,行 LPN 862例.RALPN 与 LPN 在热缺血时间(P =0.04)、中转率(P <0.00001)、并发症率(P =0.03)、估计失血量(P <0.0001)方面存在统计学差异,且 RALPN 在以上方面具有优势;两者在年龄、性别、患肾左右、肿瘤大小、肿瘤良恶性、手术时间、切缘阳性率、住院时间方面无统计学差异.结论RALPN 为患者提供了一个更安全、更有益的选择.%Objective In order to compare the clinical value of two kinds of surgery,we collect related research literature and use the method of Meta analysis to find differences of the two kinds of surgery about operation time,warm ischemia time,blood loss,complications and other data. Methods Searched the English or Chinese data,according to inclusion and exclusion criteria collect the literature,evaluate the included studies,then the data were analyzed using Revman 5.2 software. Results Ten retrospective cohort studies were selected,including a total of 1 863 patients,while 1 001 patients received RLPN and 862 patients received LPN.The meta analysis indicate:compare robot assisted laparoscopic partial nephrectomy with laparoscopic partial nephrectomy,statistically significant difference found with warm ischemia time (P =0.04),the conversion (P <0.000 01),the rate of complications (P =0.03),the estimated blood loss (P < 0.000 1).And RALPN is more ad-vantageous about above all.No statistically significant difference found with age,gender,laterality, tumor size,tumor pathology

  2. Urogenital function in robotic vs laparoscopic rectal cancer surgery: a comparative study.

    Science.gov (United States)

    Panteleimonitis, Sofoklis; Ahmed, Jamil; Ramachandra, Meghana; Farooq, Muhammad; Harper, Mick; Parvaiz, Amjad

    2017-02-01

    Urological and sexual dysfunction are recognised risks of rectal cancer surgery; however, there is limited evidence regarding urogenital function comparing robotic to laparoscopic techniques. The aim of this study was to assess the urogenital functional outcomes of patients undergoing laparoscopic and robotic rectal cancer surgery. Urological and sexual functions were assessed using gender-specific validated standardised questionnaires. Questionnaires were sent a minimum of 6 months after surgery, and patients were asked to report their urogenital function pre- and post-operatively, allowing changes in urogenital function to be identified. Questionnaires were sent to 158 patients (89 laparoscopy, 69 robotic) of whom 126 (80 %) responded. Seventy-eight (49 male, 29 female) of the responders underwent laparoscopic and 48 (35 male, 13 female) robotic surgery. Male patients in the robotic group deteriorated less across all components of sexual function and in five components of urological function. Composite male urological and sexual function score changes from baseline were better in the robotic cohort (p function. However, composite female urological function score change from baseline was better in the robotic group (p = 0.003). Robotic rectal cancer surgery might offer better post-operative urological and sexual outcomes compared to laparoscopic surgery in male patients and better urological outcomes in females. Larger scale, prospective randomised control studies including urodynamic assessment of urogenital function are required to validate these results.

  3. Comparison of robotic versus laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair.

    Science.gov (United States)

    Waite, Kimberly E; Herman, Mark A; Doyle, Patrick J

    2016-09-01

    Despite growing popularity and potential advantages of robotics in general surgery, there is very little published data regarding robotic inguinal hernia repair. This study examines a single surgeon's early experience with robotic TAPP inguinal hernia repair compared with laparoscopic TAPP repair in terms of feasibility and cost. We performed a retrospective review of 63 consecutive patients (24 laparoscopic and 39 robotic) who underwent inguinal hernia repair between December 2012-December 2014 at a single institution by a single surgeon. Data examined included gender, age, BMI, operative times, recovery room times, pain scale ratings, and cost. Patient groups were the same in terms of age and BMI. The mean operative time (77.5 vs 60.7 min, p = 0.001) and room time (109.3 vs 93.0 min, p = 0.001) were significantly longer for the robotic vs the laparoscopic patients. Recovery room time (109.1 vs 133.5 min, p = 0.026) and average pain scores in recovery (2.5 vs 3.8, p = 0.02) were significantly less for the robotic group. The average direct cost of the laparoscopic group was $3216 compared with $3479 for the robotic group. The average contribution margin for the laparoscopic group was $2396 compared with $2489 for the robotic group. Robotic TAPP inguinal hernia repair had longer operative times, but patients spent less time in recovery and noted less pain than patients who underwent laparoscopic TAPP inguinal hernia repair. The direct cost and contribution margin are nearly equivalent. These results should allow the continued investigation of this technique without concern over excess cost.

  4. Laparoscopic assisted appendicectomy in District Hospital, Joypurhat, Bangladesh.

    Science.gov (United States)

    Bashar, M K; Alam, M Z; Aziz, M M; Nur-E-Elahi, M; Taher, M A; Jahan, I

    2014-01-01

    "Laparoscopic assisted appendicectomy" refers to visualization of abdominal cavity, identification of appendix, drawing the appendix out through the port wound and appendicectomy. The objective of this study is to evaluate the outcome of the procedure of laparoscopic assisted appendicectomy. In this prospective study patients with appendicitis were randomly selected for laparoscopic assisted appendicectomy from August 2007 to February 2009 in the Department of Surgery, Modernized District Hospital, Joypurhat, Bangladesh. Out of 73 patients Laparoscopic assisted appendicectomy was performed successfully in 95.89% cases and conversion rate was 4.11%. Male to female ratio was almost 1:2 with mean±SD age 18.62±9.16 years. The wound infection rate was 8.2% and urinary retention 2.7%. Early postoperative feeding was started within 24 hours in 86.3% cases and mean duration of hospital stay was 2 days in 76.71% patients. More than 82% returned to their home and started social activities within 5 days. Duration of surgery was almost similar in emergency and interval appendicectomy group (19.35±10.13 vs. 23.66±9.43) minutes. Postoperative morbidity in emergency appendicectomy group showed significantly higher morbidity than interval appendicectomy group (p=0.003). This study indicates that the laparoscopic assisted appendicectomy is feasible for the majority of the patients with appendicitis in both emergency and interval settings. It reduces the operative time, shortens hospital stay and helps in early resumption of normal activities with good cosmetic outcome and patients' satisfaction.

  5. Single trocar laparoscopic-assisted colostomy in newborns.

    Science.gov (United States)

    Liem, N T; Quynh, T A

    2013-06-01

    To present the technique and outcomes of single trocar laparoscopic-assisted colostomy in newborns. A rectangular skin flap was developed at the left subcostal area and detached from the fascia. Then the fascia and peritoneum were opened longitudinally around 11 mm, and then a 10-mm trocar was inserted into the abdominal cavity. The 10-mm operating laparoscope (Stema, Germany) was inserted through the trocar. The left transverse colon was inspected, grasped and brought outside the abdominal cavity with a Babcock grasper. The skin flap was inserted through a window created at the colon mesentery and secured to the opposite side to elevate the colon. A loop colostomy was performed. From August 2009 to December 2011, single trocar laparoscopic-assisted colostomy was performed for 39 newborns with anorectal malformations, including 26 boys and 13 girls. Mean operative time was 24 ± 4 min (range 20-30 min). There were no perioperative deaths or complications. Mean postoperative stay was 3 ± 0.6 days. Single trocar laparoscopic-assisted colostomy is a feasible and safe procedure in newborns.

  6. Robotic Partial Nephrectomy Using Robotic Bulldog Clamps

    OpenAIRE

    2011-01-01

    Background and Objectives: The need for a skilled assistant to perform hilar clamping during robotic partial nephrectomy is a potential limitation of the technique. We describe our experience using robotic bulldog clamps applied by the console surgeon for hilar clamping. Methods: A total of 60 consecutive patients underwent robotic partial nephrectomy, 30 using laparoscopic bulldog clamps applied by the assistant and 30 using robotic bulldog clamps applied with the robotic Prograsp instrument...

  7. The aching surgeon: a survey of physical discomfort and symptoms following open, laparoscopic, and robotic surgery.

    Science.gov (United States)

    Plerhoples, Timothy A; Hernandez-Boussard, Tina; Wren, Sherry M

    2012-03-01

    There is increasing interest in understanding the toll that operating takes on a surgeon's body. The effect of robotic surgery on surgeon discomfort has not been studied. We sought to document the discomfort of robotic surgery compared with open and laparoscopic surgery and to investigate the factors that affect the risk of physical symptoms. Nineteen-thousand eight-hundred and sixty-eight surgeons from all specialties trained in the use of robots were sent a 26-question online survey and 1,407 responded. One-thousand two-hundred and fifteen surgeons who practiced all three approaches were used in the analysis. Eight-hundred and seventy-one surgeons had physical discomfort or symptoms attributable to operating. Of those with symptoms, 55.4% attributed most of the symptoms to laparoscopic surgery, 36.3% to open surgery, and 8.3% to robotic surgery. A higher case load was predictive of increased symptoms for open and laparoscopic surgery, but not for robotic surgery. Robotic surgery was less likely than open or laparoscopic surgery to lead to neck, back, hip, knee, ankle, foot, and shoulder pain and less likely than laparoscopic surgery to lead to elbow and wrist pain. Robotic surgery was more likely than either open or laparoscopic surgery to lead to eye pain, and more likely than open surgery to lead to finger pain. Nearly a third (30.3%) of surgeons admit to giving consideration to their own discomfort when choosing an operative modality. Robotic surgery has promise in reducing the risk of physical discomfort for the operator. This is important as more surgeons consider their own health when choosing a surgical modality.

  8. Hemorrhage after transoral robotic-assisted surgery.

    Science.gov (United States)

    Asher, Scott A; White, Hilliary N; Kejner, Alexandra E; Rosenthal, Eben L; Carroll, William R; Magnuson, J Scott

    2013-07-01

    An increasing number of head and neck surgeons have begun using transoral robotic-assisted surgery. Our objective was to examine the postoperative bleeding complications we have encountered to determine risk factors and to discuss the topic of hemorrhage control. Case series with chart review. Medical records were reviewed in 147 consecutive patients undergoing transoral robotic-assisted surgery for any indication at one tertiary academic medical center between March 2007 and September 2011. Eleven of 147 (7.5%) patients undergoing transoral robotic-assisted surgery experienced some degree of postoperative hemorrhage, with 9 patients requiring reoperation for examination and/or control of bleeding. Bleeding occurred at a mean of 11.1 ± 9.2 days after initial operation. Eight of 11 (72%) patients who bled were on antithrombotic medication (anticoagulants or antiplatelet agents) for other medical comorbidities. The postoperative hemorrhage rate in patients taking antithrombotic medication (8/48 patients = 17%) was significantly higher than in those not taking antithrombotics (3/99 patients = 3%), P = .0057. While the bleeding rate in salvage surgery (3/29 = 10.3%) was slightly higher than in primary surgery (8/118 = 6.8%), this difference did not reach statistical significance. Potential for postoperative bleeding in association with antithrombotic medications in patients undergoing transoral robotic-assisted surgery should be recognized. Various effective techniques for management of these patients without robotic assistance were demonstrated.

  9. The pitfalls of laparoscopic surgery: challenges for robotics and telerobotic surgery.

    Science.gov (United States)

    Ballantyne, Garth H

    2002-02-01

    After its debut in 1988, laparoscopic cholecystectomy rapidly became the standard of care for cholelithiasis, yet very few surgeons use minimally invasive techniques for other abdominal operations. Why do most surgeons continue to perform traditional open gastrointestinal operations? We believe that the answer to this question lies in the fact that advanced laparoscopic operations are difficult to learn, perform, and master. A number of inherent pitfalls of laparoscopy hinder the performance of these operations even after the surgeon has accumulated years of experience. These pitfalls include an unstable video camera platform, limited motion (degrees of freedom) of straight laparoscopic instruments, two-dimensional imaging, and poor ergonomics for the surgeon. Inexperienced or bored laparoscopic camera-holders move the camera frequently and rotate it away from the horizon. The long, straight laparoscopic instruments are limited in their motion by the fixation enforced by the abdominal wall trocars. Similarly, the standard two-dimensional video imaging used in most laparoscopic operations impedes the surgeon's depth perception, compounding the limitations of laparoscopic instruments. In addition, surgeons are forced to assume ergonomically awkward stances in performing many laparoscopic operations. These four factors hinder a surgeon's efforts to learn and to perform advanced laparoscopic operations, significantly lengthening the learning curve. The articles presented in this issue suggest that robotics and telerobotics offer solutions to these nagging pitfalls of laparoscopic surgery.

  10. Laparoscopic-Assisted Cryptorchidectomy in an Adult Reindeer (Rangifer tarandus

    Directory of Open Access Journals (Sweden)

    Romain Pizzi

    2011-01-01

    Full Text Available A successful laparoscopic-assisted cryptorchidectomy is reported in a novel species, the reindeer (Rangifer tarandus. The procedure was performed in an 8-year-old adult positioned in dorsolateral oblique recumbency, with an open approach midline subumbilical placement of the primary 10 mm optical port and carbon dioxide insufflation at 12 mmHg. Three 5 mm instrument ports were inserted under visualization in the left caudal abdomen as the retained testicle was localized to the internal inguinal ring. A 5 mm flexible organ retractor was used to assist in localizing the retained testicle. This procedure provided a less invasive alternative to open laparotomy. The authors are unaware of any published reports of laparoscopy in reindeer, or of laparoscopic assisted cryptorchidectomy in deer species.

  11. Novel Port Placement and 5-mm Instrumentation for Robotic-Assisted Hysterectomy

    Science.gov (United States)

    Katz, Adi; Dun, Erica C.; Kho, Kimberly A.; Wieser, Friedrich A.

    2014-01-01

    Background and Objectives: The value of robotic surgery for gynecologic procedures has been critically evaluated over the past few years. Its drawbacks have been noted as larger port size, location of port placement, limited instrumentation, and cost. In this study, we describe a novel technique for robotic-assisted laparoscopic hysterectomy (RALH) with 3 important improvements: (1) more aesthetic triangular laparoscopic port configuration, (2) use of 5-mm robotic cannulas and instruments, and (3) improved access around the robotic arms for the bedside assistant with the use of pediatric-length laparoscopic instruments. Methods: We reviewed a series of 44 women who underwent a novel RALH technique and concomitant procedures for benign hysterectomy between January 2008 and September 2011. Results: The novel RALH technique and concomitant procedures were completed in all of the cases without conversion to larger ports, laparotomy, or video-assisted laparoscopy. Mean age was 49.9 years (SD 8.8, range 33–70), mean body mass index was 26.1 (SD 5.1, range 18.9–40.3), mean uterine weight was 168.2 g (SD 212.7, range 60–1405), mean estimated blood loss was 69.7 mL (SD 146.9, range 20–1000), and median length of stay was <1 day (SD 0.6, range 0–2.5). There were no major and 3 minor peri- and postoperative complications, including 2 urinary tract infections and 1 case of intravenous site thrombophlebitis. Mean follow-up time was 40.0 months (SD 13.6, range 15–59). Conclusion: Use of the triangular gynecology laparoscopic port placement and 5-mm robotic instruments for RALH is safe and feasible and does not impede the surgeon's ability to perform the procedures or affect patient outcomes. PMID:24960478

  12. Implementation of a Robotic Surgical Program in Gynaecological Oncology and Comparison with Prior Laparoscopic Series

    Directory of Open Access Journals (Sweden)

    Natalia Povolotskaya

    2015-01-01

    Full Text Available Background. Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy. An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data. Method. Following acquisition of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA, we prospectively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored. Data on age, BMI, pathology, surgery type, blood loss, morbidity, return to theatre, hospital stay, and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team. Results. A comparison of two consecutive series was made. The mean age was somewhat different, 55 years in the robotic versus 69 years in the laparoscopic group, but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06, respectively. This difference was not statistically significant (P=0.54. Three subgroups of minimal access surgical procedures were performed: total hysterectomy and bilateral salpingooophorectomy (TH + BSO, total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy (TH + BSO + BPLND, and radical hysterectomy plus bilateral pelvic lymphadenectomy (RH + BPLND. The mean time taken to perform surgery for TH + BSO was longer in the robotic group, 151.2 min compared to 126.3 min in the laparoscopic group. TH + BSO + BPLND surgical time was similar to 178.3 min in robotic group and 176.5 min in laparoscopic group. RH + BPLND surgical time was similar, 263.6 min (robotic arm and 264.0 min (laparoscopic arm. However, the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis. The rate of

  13. Implementation of a robotic surgical program in gynaecological oncology and comparison with prior laparoscopic series.

    Science.gov (United States)

    Povolotskaya, Natalia; Woolas, Robert; Brinkmann, Dirk

    2015-01-01

    Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy. An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data. Following acquisition of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA), we prospectively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored. Data on age, BMI, pathology, surgery type, blood loss, morbidity, return to theatre, hospital stay, and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team. A comparison of two consecutive series was made. The mean age was somewhat different, 55 years in the robotic versus 69 years in the laparoscopic group, but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06, respectively. This difference was not statistically significant (P = 0.54). Three subgroups of minimal access surgical procedures were performed: total hysterectomy and bilateral salpingooophorectomy (TH + BSO), total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy (TH + BSO + BPLND), and radical hysterectomy plus bilateral pelvic lymphadenectomy (RH + BPLND). The mean time taken to perform surgery for TH + BSO was longer in the robotic group, 151.2 min compared to 126.3 min in the laparoscopic group. TH + BSO + BPLND surgical time was similar to 178.3 min in robotic group and 176.5 min in laparoscopic group. RH + BPLND surgical time was similar, 263.6 min (robotic arm) and 264.0 min (laparoscopic arm). However, the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis. The rate of complications necessitating intervention

  14. Robotic versus conventional laparoscopic rectal cancer surgery in obese patients.

    Science.gov (United States)

    Gorgun, E; Ozben, V; Costedio, M; Stocchi, L; Kalady, M; Remzi, F

    2016-11-01

    Obesity adds to the technical difficulty of laparoscopic colorectal surgery. The robotic approach has the potential to overcome this limitation because of its proposed technical advantages over laparoscopy. The aim of this retrospective study was to compare the short-term outcomes of robotic surgery (RS) vs conventional laparoscopy surgery (LS) in this patient population. Patients with a body mass index ≥ 30 kg/m(2) undergoing RS or LS for rectal cancer between January 2011 and June 2014 were identified from an institutional database. Perioperative parameters, oncological findings and postoperative 30-day short-term outcomes were compared between the RS and LS groups. The RS and LS groups included 29 and 27 patients, respectively. Groups were comparable in terms of patient demographics, body mass index (34.9 ± 7.2 vs 35.2 ± 5.0 kg/m(2) , P = 0.71), comorbidities, surgical and tumour characteristics. Comparison of the intra-operative findings revealed no significant differences between the groups including operative time (329.0 ± 102.2 vs 294.6 ± 81.1 min, P = 0.13), blood loss (434.0 ± 612.4 vs 339.4 ± 271.9 ml, P = 0.68), resection margin involvement (6.9% vs 7.4%, P = 0.99), conversions (3.4% vs 18.5%, P = 0.09) and complications (6.9% vs 0%, P = 0.49). Regarding postoperative outcomes, there were no significant differences in morbidity except that robotic surgery was associated with a quicker return of bowel function (median 3 vs 4 days, P = 0.01) and shorter hospital stay (median 6 vs 7 days, P = 0.02). Robotic surgery for rectal cancer in obese patients has short-term outcomes similar to laparoscopy, but accelerated postoperative recovery. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  15. Meal assistance robot with ultrasonic motor

    Science.gov (United States)

    Kodani, Yasuhiro; Tanaka, Kanya; Wakasa, Yuji; Akashi, Takuya; Oka, Masato

    2007-12-01

    In this paper, we have constructed a robot that help people with disabilities of upper extremities and advanced stage amyotrophic lateral sclerosis (ALS) patients to eat with their residual abilities. Especially, many of people suffering from advanced stage ALS of the use a pacemaker. And they need to avoid electromagnetic waves. Therefore we adopt ultra sonic motor that does not generate electromagnetic waves as driving sources. Additionally we approach the problem of the conventional meal assistance robot. Moreover, we introduce the interface with eye movement so that extremities can also use our system. User operates our robot not with hands or foot but with eye movement.

  16. Knowledge assistant for robotic environmental characterization

    Energy Technology Data Exchange (ETDEWEB)

    Feddema, J.; Rivera, J.; Tucker, S.; Matek, J.

    1996-08-01

    A prototype sensor fusion framework called the {open_quotes}Knowledge Assistant{close_quotes} has been developed and tested on a gantry robot at Sandia National Laboratories. This Knowledge Assistant guides the robot operator during the planning, execution, and post analysis stages of the characterization process. During the planning stage, the Knowledge Assistant suggests robot paths and speeds based on knowledge of sensors available and their physical characteristics. During execution, the Knowledge Assistant coordinates the collection of data through a data acquisition {open_quotes}specialist.{close_quotes} During execution and postanalysis, the Knowledge Assistant sends raw data to other {open_quotes}specialists,{close_quotes} which include statistical pattern recognition software, a neural network, and model-based search software. After the specialists return their results, the Knowledge Assistant consolidates the information and returns a report to the robot control system where the sensed objects and their attributes (e.g., estimated dimensions, weight, material composition, etc.) are displayed in the world model. This report highlights the major components of this system.

  17. Robot-assisted surgery in gynecological oncology

    DEFF Research Database (Denmark)

    Kristensen, Steffen E; Mosgaard, Berit J; Rosendahl, Mikkel

    2017-01-01

    INTRODUCTION: Robot-assisted surgery has become more widespread in gynecological oncology. The purpose of this systematic review is to present current knowledge on robot-assisted surgery, and to clarify and discuss controversies that have arisen alongside the development and deployment. MATERIAL...... AND METHODS: A database search in PubMed and EMBASE was performed up until 4 March 2016. The search strategy was developed in collaboration with an information specialist, and by application of the PRISMA guidelines. Human participants and English language were the only restrictive filters applied. Selection...... was performed by screening of titles and abstracts, and by full text scrutiny. From 2001 to 2016, a total of 76 references were included. RESULTS: Robot-assisted surgery in gynecological oncology has increased, and current knowledge supports that the oncological safety is similar, compared with previous...

  18. Design and preliminary in vivo validation of a robotic laparoscope holder for minimally invasive surgery.

    Science.gov (United States)

    Herman, Benoît; Dehez, Bruno; Duy, Khanh Tran; Raucent, Benoît; Dombre, Etienne; Krut, Sébastien

    2009-09-01

    Manual manipulation of the camera is a major source of difficulties encountered by surgeons while performing minimally invasive laparoscopic surgery. A survey of laparoscopic procedures and a review of existing active and passive holders were conducted. Based on these analyses, essential requirements were highlighted for such devices. Pursuant to this, a novel active laparoscope manipulator was designed, paying particular attention to ergonomics and ease of use. Several trials on the pelvitrainer and a first in vivo procedure were performed to validate the original design of our device. Phantom experiments demonstrated ease of use of the robot and advantages of the intuitive joystick with omnidirectional displacements and speed control. The compactness of the device and image stability were appreciated during the surgical trial. A novel robotic laparoscope holder has been developed and produced. An in vivo trial proved its value in clinical practice, enabling surgeons to work more comfortably.

  19. Robot-assisted Therapy in Stroke Rehabilitation.

    Science.gov (United States)

    Chang, Won Hyuk; Kim, Yun-Hee

    2013-09-01

    Research into rehabilitation robotics has grown rapidly and the number of therapeutic rehabilitation robots has expanded dramatically during the last two decades. Robotic rehabilitation therapy can deliver high-dosage and high-intensity training, making it useful for patients with motor disorders caused by stroke or spinal cord disease. Robotic devices used for motor rehabilitation include end-effector and exoskeleton types; herein, we review the clinical use of both types. One application of robot-assisted therapy is improvement of gait function in patients with stroke. Both end-effector and the exoskeleton devices have proven to be effective complements to conventional physiotherapy in patients with subacute stroke, but there is no clear evidence that robotic gait training is superior to conventional physiotherapy in patients with chronic stroke or when delivered alone. In another application, upper limb motor function training in patients recovering from stroke, robot-assisted therapy was comparable or superior to conventional therapy in patients with subacute stroke. With end-effector devices, the intensity of therapy was the most important determinant of upper limb motor recovery. However, there is insufficient evidence for the use of exoskeleton devices for upper limb motor function in patients with stroke. For rehabilitation of hand motor function, either end-effector and exoskeleton devices showed similar or additive effects relative to conventional therapy in patients with chronic stroke. The present evidence supports the use of robot-assisted therapy for improving motor function in stroke patients as an additional therapeutic intervention in combination with the conventional rehabilitation therapies. Nevertheless, there will be substantial opportunities for technical development in near future.

  20. Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries.

    Science.gov (United States)

    Lee, Gyusung I; Lee, Mija R; Clanton, Tameka; Clanton, Tamera; Sutton, Erica; Park, Adrian E; Marohn, Michael R

    2014-02-01

    We conducted this study to investigate how physical and cognitive ergonomic workloads would differ between robotic and laparoscopic surgeries and whether any ergonomic differences would be related to surgeons' robotic surgery skill level. Our hypothesis is that the unique features in robotic surgery will demonstrate skill-related results both in substantially less physical and cognitive workload and uncompromised task performance. Thirteen MIS surgeons were recruited for this institutional review board-approved study and divided into three groups based on their robotic surgery experiences: laparoscopy experts with no robotic experience, novices with no or little robotic experience, and robotic experts. Each participant performed six surgical training tasks using traditional laparoscopy and robotic surgery. Physical workload was assessed by using surface electromyography from eight muscles (biceps, triceps, deltoid, trapezius, flexor carpi ulnaris, extensor digitorum, thenar compartment, and erector spinae). Mental workload assessment was conducted using the NASA-TLX. The cumulative muscular workload (CMW) from the biceps and the flexor carpi ulnaris with robotic surgery was significantly lower than with laparoscopy (p  0.05). Robotic surgery experts and novices had significantly higher performance scores with robotic surgery than with laparoscopy (p cognitive ergonomics with robotic surgery were significantly less challenging. Additionally, several ergonomic components were skill-related. Robotic experts could benefit the most from the ergonomic advantages in robotic surgery. These results emphasize the need for well-structured training and well-defined ergonomics guidelines to maximize the benefits utilizing the robotic surgery.

  1. 机器人辅助腹腔镜下前列腺癌根治术38例临床分析%Robot assisted laparoscopic radical prostatecto my:Cli nical analysis of 38 cases

    Institute of Scientific and Technical Information of China (English)

    孙康伟; 袁建林; 杨晓剑; 王延柱; 孟平; 张龙龙; 武鹏

    2014-01-01

    To-co-mpare-the-peri-operati-ve-cli-nical-data-,co-mplicati-ons-,postoperati-ve-functi-on-recovery-after-Leonardo's-robot-assisted-laparoscopic-radical-prostatecto-my-(RALRP-)vs-.retropubic-radical-prostatecto-my-(RRP-)for-l-ocal-prostate-cancer-,and-pri-maril-y-eval-uate-the-applied-val-ue-of-RALRP-.Methods-:The-cli-nical-data-of-38-cases-of-prostate-cancer-undergoi-ng-RALRP-perfor-med-by-the-sa-me-group-of-surgeons-fro-m-Jan-.201-3-to-Nov-.-201-3-were-retrospecti-vel-y-anal-yzed-.The-operati-ng-ti-me-,bl-ood-l-oss-,bl-ood-transfusi-on-,postoperati-ve-hospital-stay-and-postoperati-ve-foll-o-w--up-uri-nary-conti-nence-were-observed-i-n-RALRP-group-,and-co-mpared-with-those-i-n-20-cases-of-RRP-at-the-sa-me-peri-od-.Results-:In-RALRP-and-RRP-group-,the-average-operati-ve-ti-me-was-4-6-h-and-3-1-5-h-,and-the-average-bl-ood-l-oss-was-50-1-50-mL-and-850-1-500-mL-(P-<005-).The-bl-ood-transfusi-on-rate-i-n-RALRP-and-RRP-groups-was-0-and-85-%respecti-vel-y-(P-<0-.05-).The-conti-nence-rate-one-month-after-operati-on-i-n-RALRP-group-and-RRP-group-was-81-.6-%-and-55-%-respecti-vel-y-(P-<005-).The-average-postoperati-ve-hostal-stay-i-n-RALRP-group-and-RRP-group-was-53-days-and-1-0-.6-days-respecti-vel-y-(P-<005-).Conclusions-:The-pri-mary-results-suggest-that-RALRP-sho-ws-the-advantages-of-reduci-ng-bl-ood-l-oss-and-bl-ood-transfusi-on-,and-advanci-ng-the-controlled-micturiti-on-over-RRP-.%目的:对比达芬奇机器人辅助腹腔镜前列腺癌根治术(RAL-RP )与耻骨后前列腺癌根治术(RRP )两种手术方式治疗局限性前列腺癌的围手术期临床资料、并发症发生率、术后功能恢复等方面指标,初步评价机器人辅助腹腔镜前列腺癌根治术的价值。方法:回顾2013年1月~2013年11月由同一组医生行 RALRP 术38例临床资料。观察手术时间、出血量、输血情况、术后住院时间、随访控尿等情况,与同期该组医生行 RRP 术20例临床资料相比较并进行统计学分析。结果:RALRP

  2. Synchronous single-port access laparoscopic right hemicolectomy and laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy

    Science.gov (United States)

    Ybañez-Morano, Jessica; Tiu, Andrew C.

    2017-01-01

    Laparoscopic surgery through a single incision is gaining popularity with different stakeholders. The advantages of improved cosmetics, decreased postoperative pain and blood loss continue to attract patients from different surgical fields. Multidisciplinary approach to different surgical entities through a single incision has just been introduced. We report the first case of a synchronous single-port access (SPA) laparoscopic right hemicolectomy and laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy through a single incision above the umbilicus in a 48-year-old female with ascending colon mass and uterine mass with good postoperative outcomes. SPA laparoscopic surgery is feasible for multidisciplinary approach in resectable tumors. PMID:28096321

  3. Laser assisted robotic surgery in cornea transplantation

    Science.gov (United States)

    Rossi, Francesca; Micheletti, Filippo; Magni, Giada; Pini, Roberto; Menabuoni, Luca; Leoni, Fabio; Magnani, Bernardo

    2017-03-01

    Robotic surgery is a reality in several surgical fields, such as in gastrointestinal surgery. In ophthalmic surgery the required high spatial precision is limiting the application of robotic system, and even if several attempts have been designed in the last 10 years, only some application in retinal surgery were tested in animal models. The combination of photonics and robotics can really open new frontiers in minimally invasive surgery, improving the precision, reducing tremor, amplifying scale of motion, and automating the procedure. In this manuscript we present the preliminary results in developing a vision guided robotic platform for laser-assisted anterior eye surgery. The robotic console is composed by a robotic arm equipped with an "end effector" designed to deliver laser light to the anterior corneal surface. The main intended application is for laser welding of corneal tissue in laser assisted penetrating keratoplasty and endothelial keratoplasty. The console is equipped with an integrated vision system. The experiment originates from a clear medical demand in order to improve the efficacy of different surgical procedures: when the prototype will be optimized, other surgical areas will be included in its application, such as neurosurgery, urology and spinal surgery.

  4. Hand-assisted laparoscopic nephrectomy in living donor

    Directory of Open Access Journals (Sweden)

    Luiz S. Santos

    2003-02-01

    Full Text Available OBJECTIVE: Report the authors’ initial experience with hand-assisted laparoscopic nephrectomy technique in renal donors for transplantation. MATERIALS AND METHODS: Twenty-seven donors submitted to hand-assisted laparoscopic nephrectomy were retrospectively analyzed from February 2001 to June 2002. Technical aspects of the donor surgery, results, and complications, are discussed, as well as recipient’s complications and outcomes. RESULTS: Among 27 hand-assisted laparoscopic nephrectomies, left kidney was withdrew in 18 donors (66.6%, and right kidney in 9 (33.3%. The operative time ranged from 55 to 210 minutes (mean 132.7 ± 37.6 min, and the time of hot ischemia ranged from 2 to 11 minutes (mean 4.7 ± 2.5 min, with an estimated mean blood loss during the intraoperative period of 133.3 mL. Conversion to open surgery was necessary for 1 (3.7% patient due to vascular lesion. In graft evaluation, immediate diuresis was observed in 26 (96.3% cases, and mean serum creatinine in PO day 7 was 1.5 ± 1.1 mg/dL. Renal vein thrombosis occurred in 1 (3.7% patient requiring graft removal. Lymphocele was observed in 3 recipients (11.1%, and urinary leakage due to ureteral necrosis in 1 case (3.7%. CONCLUSION: Hand-assisted laparoscopic nephrectomy in living donors is a safe procedure and an effective alternative to open nephrectomy. In this series, the procedure presented low morbidity after surgery providing to the recipient a good morphological and functional quality of the graft.

  5. Assistive social robots in elderly care: a review

    NARCIS (Netherlands)

    Broekens, J.; Heerink, M.; Rosendal, H.

    2009-01-01

    Assistive social robots, a particular type of assistive robotics designed for social interaction with humans, could play an important role with respect to the health and psychological well-being of the elderly. Objectives: Assistive social robots are believed to be useful in eldercare for two reason

  6. Assistive social robots in elderly care: a review

    NARCIS (Netherlands)

    Broekens, J.; Heerink, M.; Rosendal, H.

    2009-01-01

    Assistive social robots, a particular type of assistive robotics designed for social interaction with humans, could play an important role with respect to the health and psychological well-being of the elderly. Objectives: Assistive social robots are believed to be useful in eldercare for two

  7. Hand-assisted right laparoscopic nephrectomy in living donor

    Directory of Open Access Journals (Sweden)

    Fernando Meyer

    2005-02-01

    Full Text Available OBJECTIVE: To assess results obtained with the authors' technique of right hand-assisted laparoscopic nephrectomy in living kidney donors. MATERIALS AND METHODS: We retrospectively analyzed 16 kidney donors who underwent hand-assisted right laparoscopic nephrectomy from February 2001 to July 2004. Among these patients, 7 were male and 9 were female, with mean age ranging between 22 and 58 years (mean 35.75. RESULTS: Surgical time ranged from 55 to 210 minutes (mean 127.81 min and warm ischemia time from 2 to 6 minutes (mean 3.78 min with mean intra-operative blood loss estimated at 90.62 mL. There was no need for conversion in any case. Discharge from hospital occurred between the 3rd and 6th days (mean 3.81. On the graft assessment, immediate diuresis was seen in 15 cases (93.75% and serum creatinine on the 7th post-operative day was 1.60 mg/dL on average. Renal vein thrombosis occurred in 1 patient (6.25% who required graft removal, and lymphocele was seen in 1 recipient (6.25%. CONCLUSION: Hand-assisted right laparoscopic nephrectomy in living donors is a safe and effective alternative to open nephrectomy. Despite a greater technical difficulty, the procedure presented low postoperative morbidity providing good morphological and functional quality of the graft on the recipient.

  8. Hand-assisted laparoscopic surgery of abdominal large visceral organs

    Institute of Scientific and Technical Information of China (English)

    Li-Hua Dai; Bo Xu; Guang-Hui Zhu

    2006-01-01

    AIM: To design a hand-assisted laparoscopic approach in an attempt to provide an option for laparoscopic resection of abdominal large viscera.METHODS: A 5-6 cm incision (for HandPort) and 2 trocars were employed. The main vessel of the target organ was taken as a "core", and all tissues around the core were taken as peripheral structures. The peripheral structures were dissected first, and the core vessels were treated last. Twenty-six patients underwent laparoscopic deroofing of the hepatic huge cysts, resection of the segments lying at the outer edge of the liver (segments 2 to 6), splenectomy, hemicolectomy, ileocecectomy and subtotal gastrectomy with HandPort device, harmonic scalpel, or Ligasure.RESULTS: The duration of the procedure was within 2 hours. Blood loss amounted to 8-120 mL. The conversion rate was 3.8% (1/26). All patients had uneventful postoperative courses with less pain, earlier oral intake,and faster recovery, compared with conventional surgery.CONCLUSION: This method combines the advantages of both open and laparoscopic techniques, achieving better hemostasis effect, shortening the operative time,and is beneficial to the patients.

  9. 机器人辅助腹腔镜治疗巨输尿管症患者的护理配合%Nursing Cooperation of Robot-assisted Laparoscopic in the Treatment of Congenital Megaureter

    Institute of Scientific and Technical Information of China (English)

    崔冬冬; 蔡康灵; 王晓芳

    2015-01-01

    目的:探讨机器人辅助腹腔镜治疗巨输尿管症患者的护理方法.方法回顾性分析并总结2014年1-8月,解放军总医院泌尿外科收治的机器人辅助腹腔镜治疗巨输尿管症患者10例的临床资料.结果10例患者均顺利完成手术,无中转开腹;手术时间平均为(153.5±3.56)min,术后住院时间平均为(6.5±0.76)d,无继发漏尿、出血等术后并发症发生.结论机器人辅助腹腔镜治疗巨输尿管症安全可行,而手术室护士的精心护理和熟练操作是确保手术成功的关键.%Objective To disucss the nursing method of robot-assisted laparascopic surgery in the treat-ment of congenital megaureter,to increase the nursing quality.Methods Clinical data of 10 patients under-went robot-assisted laparascopic in the treatment of congenital megaureter were analyzed retrospectively. Results All the 10 cases were successfully performed without conversion to open operation.The mean operation time was(153.5±3.56)min,the postoperative hospitalization time was(6.5±0.76)d,there was no obvious complication such as urine leakage and secondary bleeding.Conclusion Robot-assisted laparas-copic reconstructive surgery in congenital megaureter treatment is a safe and effective approach,and the thoughtful care and proficiency are the keys to ensure the success operation.

  10. Anaesthetic management of laparoscopic assisted bilateral ...

    African Journals Online (AJOL)

    2011-04-13

    Apr 13, 2011 ... assisted bilateral adrenalectomy in a five-year-old child with Cushing's ... and her vocal cords visualised and sprayed with 2 ml 2% lignocaine. .... crossmatched. Medical therapy of Cushing's disease includes the drugs,.

  11. Application of the daVinci robot assisted laparoscopic technique in urinary surgery%达芬奇手术机器人辅助腹腔镜技术在泌尿外科的应用

    Institute of Scientific and Technical Information of China (English)

    刘竞; 邱明星

    2015-01-01

    达芬奇机器人手术系统是一种智能化手术平台,是微创外科手术的飞跃,其突出特点是三维立体视野与具有七个自由度机械手腕设计,精细解剖及精准吻合将有助于完成高难复杂手术。该系统在泌尿外科广泛应用,最成功的是以前列腺根治术为代表的肿瘤根治术与保留肾单位手术的修复重建手术。本文就达芬奇机器人手术系统在泌尿外科的应用现状作一综述。%The daVinci Robotic Surgical System is an intelligent surgical platform and represents a leap of minimal invasive surgery.Its prominent features are a 3D-vision and a designation of 7 degree-of-freedom of wrists.Fine anatomy and precise anastomosis help to finish highly difficult complex operations.This system has been generally applied in urinary surgery.The most successful appli-cation was robotic assisted radical prostatectomy and repairmen and reconstruction of nephron sparing operation.Its present application status in urinary surgery is reviewed in this paper.

  12. Videocirurgia colorretal com assistência robótica: o próximo passo? Robotic assisted colorrectal surgery

    Directory of Open Access Journals (Sweden)

    Sergio Eduardo Alonso Araujo

    2008-09-01

    Full Text Available O desenvolvimento de técnicas minimamente invasivas é um dos mais importantes avanços da cirurgia colorretal. A assistência robótica integra o arsenal de técnicas em cirurgia minimamente invasiva, e vem sendo aplicado em cirurgia colorretal por um restrito grupo de cirurgiões em alguns centros ao redor do mundo com resultados iniciais que merecem atenção. O objetivo do presente estudo é analisar os resultados do emprego da assistência robótica em videocirurgia colorretal. Dentre as vantagens associadas ao emprego de robôs em videocirurgia colorretal, figuram o incremento na precisão dos movimentos e a visão tridimensional. A experiência clínica é ainda pequena, e advém de uma série de casos e estudos comparativos com a videocirurgia colorretal sem assistência robótica com ainda pequeno número de casos. A dissecção pélvica com incremento da preservação autonômica parece ser a maior vantagem associada à assistência robótica em videocirurgia colorretal. Somente através do treinamento de um número mais representativo de cirurgiões colorretais, bem como com a expansão da experiência clínica será possível prever com maior precisão o papel da assistência robótica em videocirurgia colorretal.The development of minimally invasive surgical techniques represents an important aspect of modern surgical research. Robot-assisted minimally invasive colorectal surgery represents a way of assisting laparoscopic colorectal procedures. Robotic technology overcomes some of these limitations by successfully providing intuitive motion and enhanced precision and accuracy, in an environment that is much more ergonomic. A restrict number of surgeons in specialized centers around the world have been applying robotics. In this review, current evidence about different technologies and its place in colorectal surgery is evaluated. The feasibility of performing robot-assisted colorectal operations has been demonstrated though case

  13. A robotic needle driver to facilitate vescico-urethral anastomosis during laparoscopic radical prostatectomy.

    Science.gov (United States)

    Varca, Virginia; Benelli, Andrea; Pietrantuono, Francesco; Suardi, Nazareno; Gregori, Andrea; Gaboardi, Franco

    2017-06-19

    The completion of the vescico-urethral anastomosis (VUA) represents the most critical step of laparoscopic radical prostatectomy (LRP), and it can often discourage the use of minimally invasive surgery in less experienced laparoscopic surgeons. The aim of this paper is to evaluate the usefulness of a new robotic needle driver named Dextérité in performing the VUA after LRP. This prospective randomized clinical study enrolled 40 consecutive patients eligible for LRP, which were randomized into four groups: group A, patients undergoing LRP done by an expert surgeon; group B, patients undergoing robotic-assisted radical prostatectomy (RARP) performed by the same expert surgeon; group C, patients undergoing LRP performed by a young surgeon at the beginning of the learning curve; group D, patients undergoing LRP performed by another young surgeon at the beginning of the learning curve with the aid of Dextérité needle driver for completion of the VUA. The two young urologists performed the same steps of LRP so that they are at the same step of the learning curve. All the anastomosis were performed with the same technique in order to be comparable. We use interrupted sutures with Vicryl 2/0 and a 5/8 needle; we performed the Rocco stitch technique before all the anastomosis (6) and we applied bladder neck sparing technique. All patients underwent an ultrasound control of the anastomosis on the seventh postoperative day, as we usually do (9, 10). We consider continent who utilised no pad. Operative VUA completion time was 24.9 vs. 25 vs. 86.7 vs. 61 minutes, respectively. When comparing VUA completion time in group 3 and 4, the use of the Dextérité needle driver resulted in a reduction in VUA time. Urinary leakage was seen in zero out of 10 patients in groups 1 and 2 and in three out of 10 and one in 10 patients, respectively, in groups 3 and 4. All urinary leakages were managed conservatively. One-year continence rates were 95%, 97%, 93% and 95%, respectively. Only

  14. 达芬奇机器人辅助腹腔镜下肾癌根治术的疗效及其对护理的影响%Effects of da Vinci robot-assisted laparoscopic radical nephrectomy on renal cancer and nursing

    Institute of Scientific and Technical Information of China (English)

    张曌; 陆建平

    2011-01-01

    目的 探讨达芬奇机器人辅助腹腔镜下肾癌根治术的疗效及其对护理的影响.方法 观察9例行达芬奇机器人辅助腹腔镜下肾癌根治术患者(试验组)与10例行传统开放肾癌根治术患者(对照组)的术中出血量、手术时间、下床活动时间、引流管拔除时间以及术后住院天数等,以及两种手术对护理的影响,再进行比较和统计学分析.结果 试验组在术中出血量、引流管拔除时间、下床活动时间、术后住院天数等方面均优于对照组(P<0.05).结论 达芬奇机器人辅助腹腔镜肾癌根治术是一种创伤小、出血昔少和术后恢复快的新医疗方法,能降低护理难度和提高护理的质苗与效率.%Objective To study the outcome and effects of da Vinci robotic surgery on renal tumors and nursing. Methods 19 elderly patients with renal cancer were divided into experimental group (n=9) underwent laparoscopic radical nephrectomy by da Vinci robotic surgery and control group (n = 10) treated with traditional open surgery. The Blood loss, operative time, ambulation time, time to drainage tube removal, and postoperative hospital stay days were evaluated, while the effects of the two kinds of surgeries on the nursing were assessed and compared. Results The blood loss, drainage tube removal time, ambulation time, postoperative hospital stay days in the experimental group were better than the control group. Conclusion da Vinci robot-assisted laparoscopic radical nephrectomy is a new medical treatment because of its less invasion, less blood loss and rapid postoperative recovery and can reduce the difficulty of nursing care and improve nursing care quality and efficiency.

  15. The Role of Robotic Surgery for Rectal Cancer: Overcoming Technical Challenges in Laparoscopic Surgery by Advanced Techniques.

    Science.gov (United States)

    Park, Seungwan; Kim, Nam Kyu

    2015-07-01

    The conventional laparoscopic approach to rectal surgery has several limitations, and therefore many colorectal surgeons have great expectations for the robotic surgical system as an alternative modality in overcoming challenges of laparoscopic surgery and thus enhancing oncologic and functional outcomes. This review explores the possibility of robotic surgery as an alternative approach in laparoscopic surgery for rectal cancer. The da Vinci® Surgical System was developed specifically to compensate for the technical limitations of laparoscopic instruments in rectal surgery. The robotic rectal surgery is associated with comparable or better oncologic and pathologic outcomes, as well as low morbidity and mortality. The robotic surgery is generally easier to learn than laparoscopic surgery, improving the probability of autonomic nerve preservation and genitourinary function recovery. Furthermore, in very complex procedures such as intersphincteric dissections and transabdominal transections of the levator muscle, the robotic approach is associated with increased performance and safety compared to laparoscopic surgery. The robotic surgery for rectal cancer is an advanced technique that may resolve the issues associated with laparoscopic surgery. However, high cost of robotic surgery must be addressed before it can become the new standard treatment.

  16. Evaluation of three laparoscopic modalities: robotics versus three-dimensional vision laparoscopy versus standard laparoscopy.

    Science.gov (United States)

    LaGrange, Chad A; Clark, Curtis J; Gerber, Eric W; Strup, Stephen E

    2008-03-01

    Standard laparoscopy has undergone many recent advances with the advent of three-dimensional visual systems and robotic surgical systems. In evaluating the usefulness of these new systems, it is difficult to objectively measure their advantages in the operating room. Therefore, we designed a trial using three different laparoscopic modalities to evaluate the strengths and weaknesses of each modality. Twenty-seven subjects were entered into the study. Three different laparoscopic modalities were tested. These included standard laparoscopy with two-dimensional cameras, the 3Di Endosite visual system, and the daVinci Robotic Surgical System. A standard laparoscopic trainer was utilized and testing consisted of three different tasks: peg transfer, ring manipulation, and cannulation. Of the 27 subjects, 16 (60%) reported some degree of laparoscopic experience. The number of pegs transferred with standard laparoscopy and the Endosite 3Di system was significantly greater than with the robot. The number of errors committed during the peg transfer test and the amount of time required was significantly lower with the Endosite 3Di system compared to the robot. Subjects completed the ring manipulation task significantly faster with the robot, but the number of errors committed was no different among the three modalities. Subjects were able to complete the cannulation task with their dominant hand significantly faster with the robot compared to the Endosite 3Di system or standard laparoscopy, and committed fewer errors using the robot compared to standard laparoscopy. This study showed improved performance using three-dimensional optics on some tasks, but not a significant improvement in overall results. Three-dimensional vision does appear beneficial during performance of some complex tasks. The wrist-like action of the robot improved performance on some tasks, while the lack of tactile feedback likely was a source of errors on other tasks.

  17. Assistant Personal Robot (APR: Conception and Application of a Tele-Operated Assisted Living Robot

    Directory of Open Access Journals (Sweden)

    Eduard Clotet

    2016-04-01

    Full Text Available This paper presents the technical description, mechanical design, electronic components, software implementation and possible applications of a tele-operated mobile robot designed as an assisted living tool. This robotic concept has been named Assistant Personal Robot (or APR for short and has been designed as a remotely telecontrolled robotic platform built to provide social and assistive services to elderly people and those with impaired mobility. The APR features a fast high-mobility motion system adapted for tele-operation in plain indoor areas, which incorporates a high-priority collision avoidance procedure. This paper presents the mechanical architecture, electrical fundaments and software implementation required in order to develop the main functionalities of an assistive robot. The APR uses a tablet in order to implement the basic peer-to-peer videoconference and tele-operation control combined with a tactile graphic user interface. The paper also presents the development of some applications proposed in the framework of an assisted living robot.

  18. Advances in training for laparoscopic and robotic surgery

    NARCIS (Netherlands)

    Schreuder, H.W.R.

    2011-01-01

    Laparoscopic surgery is rapidly becoming a standard in many surgical procedures. This surgical technique should be mastered, up to a certain level, by all surgeons. Several unique psychomotor skills are required from the surgeon in order to perform laparoscopic surgery safely. These skills can be le

  19. Advances in training for laparoscopic and robotic surgery

    NARCIS (Netherlands)

    Schreuder, H.W.R.

    2011-01-01

    Laparoscopic surgery is rapidly becoming a standard in many surgical procedures. This surgical technique should be mastered, up to a certain level, by all surgeons. Several unique psychomotor skills are required from the surgeon in order to perform laparoscopic surgery safely. These skills can be

  20. On the Effectiveness of Robot-Assisted Language Learning

    Science.gov (United States)

    Lee, Sungjin; Noh, Hyungjong; Lee, Jonghoon; Lee, Kyusong; Lee, Gary Geunbae; Sagong, Seongdae; Kim, Munsang

    2011-01-01

    This study introduces the educational assistant robots that we developed for foreign language learning and explores the effectiveness of robot-assisted language learning (RALL) which is in its early stages. To achieve this purpose, a course was designed in which students have meaningful interactions with intelligent robots in an immersive…

  1. Histologic artifacts in abdominal, vaginal, laparoscopic, and robotic hysterectomy specimens: a blinded, retrospective review.

    Science.gov (United States)

    Krizova, Adriana; Clarke, Blaise A; Bernardini, Marcus Q; James, Sarah; Kalloger, Steve E; Boerner, Scott L; Mulligan, Anna Marie

    2011-01-01

    Total laparoscopic hysterectomy (LH) is a minimally invasive technique, which results in comparable morbidity and better cosmesis compared with total abdominal hysterectomy. The literature is discrepant as to whether it is associated with a higher incidence of positive peritoneal cytology compared with total abdominal hysterectomy and recently, associated artifacts, including vascular pseudoinvasion (VPI), have been described. A retrospective histopathologic review of 266 hysterectomy specimens from 2 centers was performed. The observers, blinded to the surgical technique, assessed for the presence of artifactual changes including disruption of the endometrial lining, nuclear crush artifact, VPI, endomyometrial cleft artifact with or without epithelial displacement, inflammatory debris within vessels, serosal carryover, and intratubal contaminants. In addition, the rates of positive peritoneal washings over a 5-year period, and the use of immunohistochemistry (IHC) to aid in cell typing over a 3-year period, were compared between hysterectomies in which a uterine manipulator (UM) device had and had not (nonmanipulated hysterectomies) been used. The hysterectomies were performed for malignant (n=160) and benign (n=102) uterine disease or for ovarian or cervical disease (n=4), and included total abdominal (n=108), vaginal (n=17), laparoscopy-assisted vaginal (n=24), laparoscopy converted to laparotomy (n=10), nonrobotic laparoscopic (n=51), and robot-assisted laparoscopic (n=56) hysterectomies. One hundred and two (38%) of these hysterectomies involved the use of a UM. Artifactual changes of disruption of the endometrial lining, endomyometrial clefts, intratubal contaminants, nuclear crush artifact, intravascular inflammatory debris, and VPI were significantly more common with LH and with the use of a UM, independent of whether the endometrial pathology was benign or malignant. IHC to aid in endometrial cancer subtyping was more likely to be used in manipulated

  2. An informationally structured room for robotic assistance.

    Science.gov (United States)

    Tsuji, Tokuo; Mozos, Oscar Martinez; Chae, Hyunuk; Pyo, Yoonseok; Kusaka, Kazuya; Hasegawa, Tsutomu; Morooka, Ken'ichi; Kurazume, Ryo

    2015-04-22

    The application of assistive technologies for elderly people is one of the most promising and interesting scenarios for intelligent technologies in the present and near future. Moreover, the improvement of the quality of life for the elderly is one of the first priorities in modern countries and societies. In this work, we present an informationally structured room that is aimed at supporting the daily life activities of elderly people. This room integrates different sensor modalities in a natural and non-invasive way inside the environment. The information gathered by the sensors is processed and sent to a centralized management system, which makes it available to a service robot assisting the people. One important restriction of our intelligent room is reducing as much as possible any interference with daily activities. Finally, this paper presents several experiments and situations using our intelligent environment in cooperation with our service robot.

  3. Health resource utilization and costs during the first 90 days following robot-assisted hysterectomy.

    Science.gov (United States)

    Dandolu, Vani; Pathak, Prathamesh

    2017-08-07

    To compare health resource utilization, costs and readmission rates between robot-assisted and non-robot-assisted hysterectomy during the 90 days following surgery. The study used 2008-2012 Truven Health MarketScan data. All patients admitted as inpatients with a CPT code for hysterectomy between January 2008 and September 2012 were identified and the first hysterectomy-related admission in each patient was included. Patients were categorized based on the route of their hysterectomy and the use of laparoscopy as: total abdominal hysterectomy, vaginal hysterectomy (VH), laparoscopy-assisted supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy' and total laparoscopic hysterectomy (TLH). Hospitalization costs, including hospital, physician, pharmacy and facility costs, were calculated for the index admissions and for the 90-day follow-up periods. Health resource utilization was determined in terms of inpatient readmissions, outpatient visits, and emergency room visits, RESULTS: There were 302,923 hysterectomies performed over 5 years for benign indications in the inpatient setting (55% abdominal, 17% vaginal, and 28% laparoscopic). Concurrent use of robot assistance steadily increased and was reported in 50% of TLH procedures in 2012. The rates of readmission overall were 4.9% for robot-assisted procedures and 4.3% for procedures without robot assistance (OR 0.89, CI 0.82-0.97). Readmission rates were lowest for VH (3.2%) and highest for TLH (5.6%). Following robot-assisted hysterectomy and VH, 8.3% and 4.6% of patients, respectively, had more than ten outpatient visits in the 90-day follow-up period. The average total cost for 90 days was $16,820 for robot-assisted hysterectomy and $13,031 for procedures without robot assistance. Of the additional costs for robot-assisted surgery, 25% were incurred in the 90-day follow-up period. The study using private insurance data found that robot-assisted hysterectomy was associated with higher health

  4. Robotic-Assisted Simple Prostatectomy: An Overview.

    Science.gov (United States)

    Holden, Marc; Parsons, J Kellogg

    2016-08-01

    Despite widespread use of medical therapy for benign prostatic hyperplasia, a need remains for robust surgical therapy in select patients. Robotic-assisted simple prostatectomy (RASP) is an efficacious and safe therapy for patients with bladder outlet obstruction owing to large volume prostates. Data from 13 published cohorts suggest functional outcomes equivalent to open simple prostatectomy with substantially decreased length of hospital stay and risk of transfusion. However, there are few longer term data.

  5. Surgical Residents are Excluded From Robot-assisted Surgery

    DEFF Research Database (Denmark)

    Broholm, Malene; Rosenberg, Jacob

    2015-01-01

    PURPOSE: Implementation of a robotic system may influence surgical training. The aim was to report the charge of the operating surgeon and the bedside assistant at robot-assisted procedures in urology, gynecology, and colorectal surgery. MATERIALS AND METHODS: A review of hospital charts from...... performed. In 10 (1.3%) of these procedures, a resident attended as bedside assistant and never as operating surgeon in the console. CONCLUSIONS: Our results demonstrate a severe problem with surgical education. Robot-assisted surgery is increasingly used; however, robotic surgical training during residency...... surgical procedures during a 1-year period from October 2013 to October 2014. All robot-assisted urologic, gynecologic, and colorectal procedures were identified. Charge of both operating surgeon in the console and bedside assistant were registered. RESULTS: A total of 774 robot-assisted procedures were...

  6. Intelligent assistive robots recent advances in assistive robotics for everyday activities

    CERN Document Server

    Moreno, Juan; Kong, Kyoungchul; Amirat, Yacine

    2015-01-01

    This book deals with the growing challenges of using assistive robots in our everyday activities along with providing intelligent assistive services. The presented applications concern mainly healthcare and wellness such as helping elderly people, assisting dependent persons, habitat monitoring in smart environments, well-being, security, etc. These applications reveal also new challenges regarding control theory, mechanical design, mechatronics, portability, acceptability, scalability, security, etc.  

  7. Hand-Assisted Laparoscopic Hepatectomy for Primary Clear Cell Hepatocellular Carcinoma of the Liver

    Directory of Open Access Journals (Sweden)

    Kazutoshi Kida

    2012-05-01

    Full Text Available We report a case of primary clear cell hepatocellular carcinoma of the liver (PCCCL for which we performed hand-assisted laparoscopic hepatectomy. A 71-year-old female with hepatitis C infection and diabetes mellitus was admitted to our department for a hepatic tumor with gallstone. Abdominal computed tomography revealed a tumor 25 mm in diameter on the surface in segment 5 of the liver. The imaging results suggested small hepatocellular carcinoma located on the surface in segment 5 of the liver, and we performed laparoscopic surgery aiming at a minimally invasive procedure. We performed laparoscopic cholecystectomy and hand-assisted laparoscopic hepatectomy. Histopathological findings showed moderately differentiated hepatocellular carcinoma, and as the proportion of clear cells was 75%, the tumor was diagnosed as PCCCL. This is the first report of hand-assisted laparoscopic hepatectomy for PCCCL. Laparoscopic hepatectomy is a useful minimally invasive surgical procedure when the tumor is located on the surface of the liver.

  8. Robotic assisted radical prostatectomy: a different treatment for prostate cancer?

    OpenAIRE

    Julio,Alexandre Den; Ahlering,Thomas Edward; Korkes, Fernando; Lopes Neto,Antonio Correa; Tobias-Machado,Marcos; Pompeo, Antonio Carlos Lima; Wroclawski,Eric Roger

    2010-01-01

    ABSTRACTConsidering the Health Care System in Brazil, a developing country, and public healthcare policies, robotic surgery is a reality to very few citizens. Therefore, robotic assisted radical prostatectomy is far removed from the daily practice of the vast majority of Brazilian urologists. Scientific evidence of the superiority of robotic assisted radical prostatectomy does not presently justify public investments for widespread development of robotic centers. Maybe over time and with redu...

  9. Robotic vs laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer: a retrospective comparative mono-institutional study.

    Science.gov (United States)

    Cianchi, Fabio; Indennitate, Giampiero; Trallori, Giacomo; Ortolani, Manuela; Paoli, Beatrice; Macrì, Giuseppe; Lami, Gabriele; Mallardi, Beatrice; Badii, Benedetta; Staderini, Fabio; Qirici, Etleva; Taddei, Antonio; Ringressi, Maria Novella; Messerini, Luca; Novelli, Luca; Bagnoli, Siro; Bonanomi, Andrea; Foppa, Caterina; Skalamera, Ileana; Fiorenza, Giulia; Perigli, Giuliano

    2016-09-20

    Robotic surgery has been developed with the aim of improving surgical quality and overcoming the limitations of conventional laparoscopy in the performance of complex mini-invasive procedures. The present study was designed to compare robotic and laparoscopic distal gastrectomy in the treatment of gastric cancer. Between June 2008 and September 2015, 41 laparoscopic and 30 robotic distal gastrectomies were performed by a single surgeon at the same institution. Clinicopathological characteristics of the patients, surgical performance, postoperative morbidity/mortality and pathologic data were prospectively collected and compared between the laparoscopic and robotic groups by the Chi-square test and the Mann-Whitney test, as indicated. There were no significant differences in patient characteristics between the two groups. Mean tumor size was larger in the laparoscopic than in the robotic patients (5.3 ± 0.5 cm and 3.0 ± 0.4 cm, respectively; P = 0.02). However, tumor stage distribution was similar between the two groups. The mean number of dissected lymph nodes was higher in the robotic than in the laparoscopic patients (39.1 ± 3.7 and 30.5 ± 2.0, respectively; P = 0.02). The mean operative time was 262.6 ± 8.6 min in the laparoscopic group and 312.6 ± 15.7 min in the robotic group (P < 0.001). The incidences of surgery-related and surgery-unrelated complications were similar in the laparoscopic and in the robotic patients. There were no significant differences in short-term clinical outcomes between the two groups. Within the limitation of a small-sized, non-randomized analysis, our study confirms that robotic distal gastrectomy is a feasible and safe surgical procedure. When compared with conventional laparoscopy, robotic surgery shows evident benefits in the performance of lymphadenectomy with a higher number of retrieved and examined lymph nodes.

  10. Robot-assisted pyeloplasty for pelvi-ureteric junction obstruction of lower moiety in partial duplex system: A technical challenge

    Directory of Open Access Journals (Sweden)

    Girdhar S Bora

    2016-01-01

    Full Text Available Management of pelvi-ureteric junction obstruction (PUJO in a duplex system is technically challenging as dissection at the pelvis may jeopardize the vascularity of the normal moiety ureter. Anastomosing the pelvis to the one single ureter will have a risk of future development of stricture which then will risk both the moieties. Robotic assistance enables appropriate tissue dissection; minimal handling of normal ureter and precision in suturing, overcoming the potential challenges involved in the minimally invasive management of such complex cases. We report the feasibility and efficacy of robot-assisted laparoscopic pyeloplasty in such case.

  11. Human-robot interaction strategies for walker-assisted locomotion

    CERN Document Server

    Cifuentes, Carlos A

    2016-01-01

    This book presents the development of a new multimodal human-robot interface for testing and validating control strategies applied to robotic walkers for assisting human mobility and gait rehabilitation. The aim is to achieve a closer interaction between the robotic device and the individual, empowering the rehabilitation potential of such devices in clinical applications. A new multimodal human-robot interface for testing and validating control strategies applied to robotic walkers for assisting human mobility and gait rehabilitation is presented. Trends and opportunities for future advances in the field of assistive locomotion via the development of hybrid solutions based on the combination of smart walkers and biomechatronic exoskeletons are also discussed. .

  12. Robotic-assisted microsurgery for an elective microsurgical practice.

    Science.gov (United States)

    Gudeloglu, Ahmet; Brahmbhatt, Jamin V; Parekattil, Sijo J

    2014-02-01

    Robotic-assisted microsurgery can be utilized for either intracorporal or extracorporeal surgical procedures. Three-dimensional high-definition magnification, a stable ergonomic platform, elimination of physiologic tremor, and motion scaling make the robotic platform attractive for microsurgeons for complex procedures. Additionally, robotic assistance enables the microsurgeon to take microsurgery to challenging intracorporeal locations in a minimally invasive manner. Recent adjunctive technological developments offer the robotic platform enhanced optical magnification, improved intraoperative imaging, and more precise ablation techniques for microsurgical procedures. The authors present the current state-of-the art tools available in the robotic-assisted microsurgical platform.

  13. Techniques to resect the distal ureter in robotic/laparoscopic nephroureterectomy

    Directory of Open Access Journals (Sweden)

    Weil R. Lai

    2016-07-01

    Full Text Available Treatment of clinically-organ confined high grade urothelial carcinoma of the upper tract has historically comprised open nephroureterectomy, with the distal ureter and bladder cuff mobilized through a separate open pelvic incision. To decrease morbidity, urologists have increasingly adopted laparoscopy and robotics in performing nephroureterectomy. In many published series of laparoscopic nephroureterectomy, the distal ureter and bladder cuff are detached from the bladder endoscopically by a variation of the “pluck” technique, with the resulting bladder defect left to heal by prolonged indwelling urethral catheter drainage. While the distal ureter and bladder cuff can be excised laparoscopically, it does require advanced laparoscopic skills. With the wrist articulation and stereoscopic vision in robotic surgery, robotic nephroureterectomy (RNU and bladder cuff excision can be performed in antegrade fashion to mimic the open technique together with the ability to intracorporeally close the bladder defect in a watertight, mucosa to mucosa fashion after excising the bladder cuff. In this review, we discuss the published minimally invasive techniques in resecting the distal ureter and bladder cuff during laparoscopic and RNU.

  14. Urologic robots and future directions

    OpenAIRE

    Mozer, Pierre; Troccaz, Jocelyne; Stoianovici, Dan

    2008-01-01

    International audience; PURPOSE OF REVIEW: Robot-assisted laparoscopic surgery in urology has gained immense popularity with the daVinci system, but a lot of research teams are working on new robots. The purpose of this study is to review current urologic robots and present future development directions. RECENT FINDINGS: Future systems are expected to advance in two directions: improvements of remote manipulation robots and developments of image-guided robots. SUMMARY: The final goal of robot...

  15. Comparison of Short-term Surgical Outcomes between a Robotic Colectomy and a Laparoscopic Colectomy during Early Experience

    OpenAIRE

    Shin, Jin Yong

    2012-01-01

    Purpose Although robotic surgery was invented to overcome the technical limitations of laparoscopic surgery, the role of a robotic (procto)colectomy (RC) for the treatment of colorectal cancer compared to that of a laparoscopic (procto)colectomy (LC) was not well defined during the initial adoption periods of both procedures. This study aimed to evaluate the efficacy and the safety of a RC for the treatment of colorectal cancer by comparing the authors' initial experiences with both a RC and ...

  16. Outcomes of obese versus non-obese subjects undergoing robotic-assisted hysterectomy: a multi-institutional study.

    Science.gov (United States)

    Davenport, W B; Lowe, M P; Chamberlin, D H; Kamelle, S A; Johnson, P R; Tyndall, M; Tillmanns, T D

    2013-03-01

    The goal of our study was to determine whether there was a difference in operative outcomes in obese versus non-obese subjects undergoing robotic-assisted hysterectomies of varying levels of difficulty. Secondarily, we sought to analyze the published outcomes between robotic-assisted hysterectomy and total laparoscopic hysterectomy in obese women at each of these levels of difficulty. This was a multi-institutional retrospective cohort study of all patients undergoing robotic-assisted hysterectomy by five gynecologic oncologists at four geographically separate locations from April 2003 to March 2008. The cohort was stratified into obese vs. non-obese groups, and defined surgical outcomes compared between groups, then further divided into three subgroups based on case difficulty level. Univariate analysis and regression analysis using SAS 9.1 was performed. We then conducted a literature search of total laparoscopic hysterectomy outcomes in obese women, dividing the resulting studies into three comparative subgroups based on surgical difficulty levels for comparison with our robotic-assisted hysterectomy results. Our cohort had 228 obese and 323 non-obese subjects. Overall, the obese group had higher blood loss and longer operative time. When further stratified by level of difficulty, obese subjects also had a higher average blood loss and longer operative time in the hysterectomy-alone subgroup. No clinically significant differences in operative outcomes exist between obese and non-obese women when utilizing the da Vinci robotic system to perform a hysterectomy, independent of case difficulty level. More prospective, controlled studies which compare the two surgical approaches of robotic-assisted and laparoscopic hysterectomy approaches are needed.

  17. Socially assistive robotics for post-stroke rehabilitation

    OpenAIRE

    Feil-Seifer David J; Eriksson Jon; Matarić Maja J; Winstein Carolee J

    2007-01-01

    Abstract Background Although there is a great deal of success in rehabilitative robotics applied to patient recovery post stroke, most of the research to date has dealt with providing physical assistance. However, new rehabilitation studies support the theory that not all therapy need be hands-on. We describe a new area, called socially assistive robotics, that focuses on non-contact patient/user assistance. We demonstrate the approach with an implemented and tested post-stroke recovery robot...

  18. Robot-assisted low anterior resection in fifty-three consecutive patients: an Indian experience.

    Science.gov (United States)

    Kenawadekar, R D; Dhange, R Z; Pandit, A; Bandawar, M S; Joshi, S; Agarwal, G; Jagtap, A P; Puntambekar, S

    2013-12-01

    From December 2005 to December 2009, we performed 150 laparoscopic colorectal procedures. Based on this experience, we started offering robot-assisted colorectal surgery from December 2009. This study is a prospective evaluation of consecutive patients in order to study the technical feasibility and oncological outcome of robot-assisted low anterior resection. This investigation was conducted at a single minimal access surgery institute. Between December 2009 and December 2011, 53 consecutive patients with rectal adenocarcinoma underwent a robot-assisted low anterior resection (LAR) or ultralow anterior resection (ULAR) with total mesorectal excision (TME), using the standard da Vinci 'S' model. Patient demographics, mean operative time, mean postoperative hospital stay, blood loss, days to first flatus, resumption of oral feeds, urinary incontinence, and sexual dysfunction were studied. Surgical and pathological outcomes such as quality of TME, free circumferential margins, and number of lymph nodes dissected were also evaluated. Robot docking and undocking times were noted. Of the 53 patients, 41 were men and 12 were women. Their mean age was 66.7 years (range 37-90 years). The ASA grades were distributed as follows: ASA I 15 (28.3 %), ASA II 25 (47.16 %), ASA III 12 (22.64 %), ASA IV 1 (1.88 %). The mean operative time was 180 min (150-230 min) and the mean blood loss was 101.6 ml (50-300 ml). The robot docking time was 10 min (15-25 min) and the undocking time was 5 min (3-10 min). The mean hospital stay was 8 days (7-15 days). None of the patients was converted to either laparoscopic or open procedure. The longitudinal and circumferential margins were negative in all patients. Histopathological reports of 45 patients showed complete TME while 8 patients showed nearly complete TME. No repositioning of the robot was needed for splenic flexure mobilization, thus decreasing the operative time. Along with TME, even the splenic flexure mobilization

  19. Robot-assisted laparoscopic prostatectomy: a costs and break-even point analysis for decision-making in a university hospital and a regional healthcare system in Northern Italy

    Directory of Open Access Journals (Sweden)

    Elisa Fabbro

    2014-12-01

    Full Text Available BACKGROUND: Robotic Assisted Radical Prostatectomy (RALP is one of the most expensive urological innovations. Prices of the “Da Vinci System” range from € 761.105 to € 1.902.762 for each unit, without taking into account the cost of maintenance and the use of additional devices. We evaluated outcomes, and costs retrospectively, comparing RALP to open retro-pubic radical prostatectomy (RRP performed in our hospital between December 2009 and December 2010.METHODS: We compared 53 RALP, and 50 RRP in terms of costs, and clinical outcomes. We also implemented a Break Even Analysis in order to evaluate if the public reimbursement covered the total cost of RALP.RESULTS: According to our analysis, RALP showed lower hospitalization (p < 0,0001, higher early continence rate  (p < 0,0001, better potency rate in nerve sparing procedures  (p < 0,0142, and required no transfusions. Excluding the cost of purchasing and maintenance, single case costs were € 6.046,08 for RALP and € 4.834,11 for RRP, respectively. Considering the affordability of the technology, the point where the total revenue is sufficient to cover the total costs is an average of 60 cases performed per year, only in presence of additional reimbursement.CONCLUSIONS: Although our clinical analysis shows better results in favour of RALP, the economical analysis shows that RALP's costs are consistently higher than RRP. Considering also the purchasing costs, we demonstrate that the health gain of the technology does not necessarily offset the higher costs, even in a large, university hospital (1.000 beds. 

  20. Robotically assisted MRgFUS system

    Science.gov (United States)

    Jenne, Jürgen W.; Krafft, Axel J.; Maier, Florian; Rauschenberg, Jaane; Semmler, Wolfhard; Huber, Peter E.; Bock, Michael

    2010-03-01

    Magnetic resonance imaging guided focus ultrasound surgery (MRgFUS) is a highly precise method to ablate tissue non-invasively. The objective of this ongoing work is to establish an MRgFUS therapy unit consisting of a specially designed FUS applicator as an add-on to a commercial robotic assistance system originally designed for percutaneous needle interventions in whole-body MRI systems. The fully MR compatible robotic assistance system InnoMotion™ (Synthes Inc., West Chester, USA; formerly InnoMedic GmbH, Herxheim, Germany) offers six degrees of freedom. The developed add-on FUS treatment applicator features a fixed focus ultrasound transducer (f = 1.7 MHz; f' = 68 mm, NA = 0.44, elliptical shaped -6-dB-focus: 8.1 mm length; O/ = 1.1 mm) embedded in a water-filled flexible bellow. A Mylar® foil is used as acoustic window encompassed by a dedicated MRI loop coil. For FUS application, the therapy unit is directly connected to the head of the robotic system, and the treatment region is targeted from above. A newly in-house developed software tool allowed for complete remote control of the MRgFUS-robot system and online analysis of MRI thermometry data. The system's ability for therapeutic relevant focal spot scanning was tested in a closed-bore clinical 1.5 T MR scanner (Magnetom Symphony, Siemens AG, Erlangen, Germany) in animal experiments with pigs. The FUS therapy procedure was performed entirely under MRI guidance including initial therapy planning, online MR-thermometry, and final contrast enhanced imaging for lesion detection. In vivo trials proved the MRgFUS-robot system as highly MR compatible. MR-guided focal spot scanning experiments were performed and a well-defined pattern of thermal tissue lesions was created. A total in vivo positioning accuracy of the US focus better than 2 mm was estimated which is comparable to existing MRgFUS systems. The newly developed FUS-robotic system offers an accurate, highly flexible focus positioning. With its access

  1. Minimally assistive robot training for proprioception enhancement.

    Science.gov (United States)

    Casadio, Maura; Morasso, Pietro; Sanguineti, Vittorio; Giannoni, Psiche

    2009-04-01

    In stroke survivors, motor impairment is frequently associated with degraded proprioceptive and/or somatosensory functions. Here we address the question of how to use robots to improve proprioception in these patients. We used an 'assist-as-needed' protocol, in which robot assistance was kept to a minimum and was continuously adjusted during exercise. To specifically train proprioceptive functions, we alternated blocks of trials with and without vision. A total of nine chronic stroke survivors participated in the study, which consisted of a total of ten 1-h exercise sessions. We used a linear mixed-effects statistical model to account for the effects of exercise, vision and the degree of assistance on the overall performance, and to capture both the systematic effects and the individual variations. Although there was not always a complete recovery of autonomous movements, all subjects exhibited an increased amount of voluntary control. Moreover, training with closed eyes appeared to be beneficial for patients with abnormal proprioception. Our results indicate that training by alternating vision and no-vision blocks may improve the ability to use proprioception as well as the ability to integrate it with vision. We suggest that the approach may be useful in the more general case of motor skill acquisition, in which enhancing proprioception may improve the ability to physically interact with the external world.

  2. Current status of robotic assisted pelvic surgery and future developments.

    Science.gov (United States)

    Ahmed, Kamran; Khan, Mohammad Shamim; Vats, Amit; Nagpal, Kamal; Priest, Oliver; Patel, Vanash; Vecht, Joshua A; Ashrafian, Hutan; Yang, Guang-Zhong; Athanasiou, Thanos; Darzi, Ara

    2009-10-01

    The aim of this review is to assess the role of robotics in pelvic surgery in terms of outcomes. We have also highlighted the issues related to training and future development of robotic systems. We searched MEDLINE, EMBASE and the Cochrane Databases from 1980 to 2009 for systematic reviews of randomised controlled trials, prospective observational studies, retrospective studies and case reports assessing robotic surgery. During the last decade, there has been a tremendous rise in the use of robotic surgical systems for all forms of precision operations including pelvic surgery. The short-term results of robotic pelvic surgery in the fields of urology, colorectal surgery and gynaecology have been shown to be comparable to the laparoscopic and open surgery. Robotic surgery offers an opportunity where many of these obstacles encountered during open and laparoscopic surgery can be overcome. Robotic surgery is a continually advancing technology, which has opened new horizons for performing pelvic surgery with precision and accuracy. Although its use is rapidly expanding in all surgical disciplines, particularly in pelvic surgery, further comparative studies are needed to provide robust guidance about the most appropriate application of this technology within the surgical armamentarium.

  3. Real-Time Augmented Reality for Robotic-Assisted Surgery

    DEFF Research Database (Denmark)

    Jørgensen, Martin Kibsgaard; Kraus, Martin

    2015-01-01

    Training in robotic-assisted minimally invasive surgery is crucial, but the training with actual surgery robots is relatively expensive. Therefore, improving the efficiency of this training is of great interest in robotic surgical education. One of the current limitations of this training is the ...

  4. Intelligence for Human-Assistant Planetary Surface Robots

    Science.gov (United States)

    Hirsh, Robert; Graham, Jeffrey; Tyree, Kimberly; Sierhuis, Maarten; Clancey, William J.

    2006-01-01

    The central premise in developing effective human-assistant planetary surface robots is that robotic intelligence is needed. The exact type, method, forms and/or quantity of intelligence is an open issue being explored on the ERA project, as well as others. In addition to field testing, theoretical research into this area can help provide answers on how to design future planetary robots. Many fundamental intelligence issues are discussed by Murphy [2], including (a) learning, (b) planning, (c) reasoning, (d) problem solving, (e) knowledge representation, and (f) computer vision (stereo tracking, gestures). The new "social interaction/emotional" form of intelligence that some consider critical to Human Robot Interaction (HRI) can also be addressed by human assistant planetary surface robots, as human operators feel more comfortable working with a robot when the robot is verbally (or even physically) interacting with them. Arkin [3] and Murphy are both proponents of the hybrid deliberative-reasoning/reactive-execution architecture as the best general architecture for fully realizing robot potential, and the robots discussed herein implement a design continuously progressing toward this hybrid philosophy. The remainder of this chapter will describe the challenges associated with robotic assistance to astronauts, our general research approach, the intelligence incorporated into our robots, and the results and lessons learned from over six years of testing human-assistant mobile robots in field settings relevant to planetary exploration. The chapter concludes with some key considerations for future work in this area.

  5. Young Children Using Assistive Robotics for Discovery and Control.

    Science.gov (United States)

    Cook, Albert M.; Cavalier, Albert R.

    1999-01-01

    Discusses the use of robotics with children with severe disabilities. Spotlights a toddler with developmental delays and quadriplegic athetoid cerebral palsy who is able to use a robotic arm and computer control systems to reach and manipulate objects. Provides guidelines for selecting and using assistive robotics. (CR)

  6. Robotic Teaching Assistance for the "Tower of Hanoi" Problem

    Science.gov (United States)

    Thien, Nguyen Duc; Terracina, Annalisa; Iocchi, Luca; Mecella, Massimo

    2016-01-01

    In this work the authors investigate the effectiveness of robotics in education. Rather than creating excitement for children when playing with robots in games, they are examining the overall learning environment where a robot acts as a teaching assistant. They designed a suitable lesson plan when groups of teenagers participate in activities…

  7. Hand-assisted versus straight laparoscopic sigmoid colectomy on a training simulator: what is the difference? A stepwise comparison of hand-assisted versus straight laparoscopic sigmoid colectomy performance on an augmented reality simulator.

    LENUS (Irish Health Repository)

    Leblanc, Fabien

    2010-12-01

    We hypothesized that simulator-generated metrics and intraoperative errors may be able to differentiate the technical differences between hand-assisted laparoscopic (HAL) and straight laparoscopic (SL) approaches.

  8. Robotic versus Laparoscopic Sleeve Gastrectomy for Morbid Obesity: a Systematic Review and Meta-analysis.

    Science.gov (United States)

    Magouliotis, Dimitrios E; Tasiopoulou, Vasiliki S; Sioka, Eleni; Zacharoulis, Dimitrios

    2017-01-01

    We aim to review the available literature on obese patients treated with robotic or laparoscopic sleeve gastrectomy, in order to compare the clinical outcomes and intraoperative parameters of the two methods. A systematic literature search was performed in PubMed, Cochrane Library and EBSCOhost databases, in accordance with the PRISMA guidelines. Sixteen studies met the inclusion criteria incorporating 29,787 patients. Robotic sleeve gastrectomy (RSG) technique showed significantly higher mean operative time and increased length of hospital stay. Post-operative incidence of leakage, wound infection and bleeding, along with weight reduction, were comparable. The majority of the studies assessing charges found increased cost in RSG population. Well-designed, randomized controlled studies, comparing RSG to laparoscopic sleeve gastrectomy (LSG), are necessary to assess further their clinical outcomes and cost-effectiveness.

  9. Laparoscopic, robotic and open method of radical hysterectomy for cervical cancer: A systematic review

    Directory of Open Access Journals (Sweden)

    Puliyath Geetha

    2012-01-01

    Full Text Available Background : Over the last two decades, numerous studies have indicated the feasibility of minimally invasive surgery for early cervical cancer without compromising the oncological outcome. Objective : Systematic literature review and meta analysis aimed at evaluating the outcome of laparoscopic and robotic radical hysterectomy (LRH and RRH and comparing the results with abdominal radical hysterectomy (ARH. Search Strategy : Medline, PubMed, Embase, Cochrane library and Reference lists were searched for articles published until January 31 st 2011, using the terms radical hysterectomy, laparoscopic radical hysterectomy, robotic radical hysterectomy, surgical treatment of cervical cancer and complications of radical hysterectomy. Selection Criteria : Studies that reported outcome measures of radical hysterectomy by open method, laparoscopic and robotic methods were selected. Data collection and analysis: Two independent reviewers selected studies, abstracted and tabulated the data and pooled estimates were obtained on the surgical and oncological outcomes. Results : Mean sample size, age and body mass index across the three types of RH studies were similar. Mean operation time across the three types of RH studies was comparable. Mean blood loss and transfusion rate are significantly higher in ARH compared to both LRH and RRH. Duration of stay in hospital for RRH was significantly less than the other two methods. The mean number of lymph nodes obtained, nodal metastasis and positive margins across the three types of RH studies were similar. Post operative infectious morbidity was significantly higher among patients who underwent ARH compared to the other two methods and a higher rate of cystotomy in LRH. Conclusions : Minimally invasive surgery especially robotic radical hysterectomy may be a better and safe option for surgical treatment of cervical cancer. The laparoscopic method is not free from complications. However, experience of surgeon may

  10. Robotic assisted adrenalectomy: Is it ready for prime time?

    Science.gov (United States)

    Teo, Xin Ling; Lim, Sey Kiat

    2016-12-01

    Adrenal surgery is undergoing continuous evolution and minimally invasive surgery is increasingly being used for the surgical management of adrenal masses. With robotic-assisted surgery being a widely accepted surgical treatment for many urological conditions such as prostate carcinoma and renal cell carcinoma, the use of the robot has been expanded to include robotic-assisted adrenalectomy, offering an alternative minimally invasive platform for adrenal surgery. We performed a literature review on robotic-assisted adrenalectomy, reviewing the current surgical techniques and perioperative outcomes.

  11. A comparison of hand-assisted and pure laparoscopic techniques in live donor nephrectomy

    Directory of Open Access Journals (Sweden)

    Anibal Wood Branco

    2008-01-01

    Full Text Available PURPOSE: To compare hand-assisted laparoscopic donor nephrectomy and pure laparoscopic live donor nephrectomy techniques in live donor nephrectomy. METHODS: In this retrospective study, we included all patients submitted to hand-assisted laparoscopic donor nephrectomy and pure laparoscopic live donor nephrectomy between May 2002 and December 2007. The operative data and post-operative courses were reviewed. Information was collected on the operative time, warm ischemia time, estimated blood loss, intra-operative complications, time to first oral intake, length of hospital stay, and post-operative complications. The data were analyzed using Student's t -tests and Fisher exact tests as appropriate, with statistical significance defined as p < 0.05. RESULTS: The means of the operative duration, warm ischemia time and intra-operative bleeding were 83 min, 3.6 min and 130.9 cc, respectively, for hand-assisted laparoscopic donor nephrectomy, and 78.4 min, 2.5 min and 98.9 cc, respectively, for pure laparoscopic live donor nephrectomy (p=0.29, p<0.0001 and p=0.08, respectively. Intra-operative complications occurred in 6% of patients submitted to hand-assisted laparoscopic donor nephrectomy and in 4.5% of those submitted to pure laparoscopic live donor nephrectomy (p=0.68. Only one patient from each group required conversion to open surgery; one person receiving hand-assisted laparoscopic donor nephrectomy had bleeding and one person receiving pure laparoscopic live donor nephrectomy had low carbon dioxide levels during the warm ischemia period. Compared with patients receiving hand-assisted laparoscopic donor nephrectomy, patients submitted to pure laparoscopic live donor nephrectomy were able to take their first meal earlier (12.5 vs. 9.2 hours, p=0.046, were discharged home sooner (2.8 vs. 1.4 days, p<0.0001 and had fewer post-operative complications (7.5% vs. 0.6%, p=0.04. CONCLUSIONS: Pure laparoscopic live donor nephrectomy had some advantages

  12. Robot-assisted radical prostatectomy is a safe procedure

    DEFF Research Database (Denmark)

    Thomsen, Frederik Birkebæk; Berg, Kasper Drimer; Hvarness, Helle

    2013-01-01

    We present our departmental experience with robot-assisted radical prostatectomy and describe complications and early results for the first 239 consecutive patients.......We present our departmental experience with robot-assisted radical prostatectomy and describe complications and early results for the first 239 consecutive patients....

  13. Lending a helping hand: toward novel assistive robotic arms

    NARCIS (Netherlands)

    Groothuis, Stefan; Stramigioli, Stefano; Carloni, Raffaella

    Assistive robotics is an increasingly popular research field, which has led to a large number of commercial and noncommercial systems aimed at assisting physically impaired or elderly users in the activities of daily living. In this article, we propose five criteria based on robotic arm usage

  14. Robot-assisted radical prostatectomy is a safe procedure

    DEFF Research Database (Denmark)

    Thomsen, Frederik Birkebæk; Berg, Kasper Drimer; Hvarness, Helle

    2013-01-01

    We present our departmental experience with robot-assisted radical prostatectomy and describe complications and early results for the first 239 consecutive patients.......We present our departmental experience with robot-assisted radical prostatectomy and describe complications and early results for the first 239 consecutive patients....

  15. A Single Surgeon's Experience with Open, Laparoscopic, and Robotic Partial Nephrectomy.

    Science.gov (United States)

    Klaassen, Zachary; Kohut, Robert M; Patel, Dhruti; Terris, Martha K; Madi, Rabii

    2014-01-01

    Objective. To report the perioperative outcomes of patients treated with partial nephrectomy by a single surgeon using three surgical modalities-open, laparoscopic, and robotic. Methods. Between August 2006 and February 2012, 106 consecutive patients underwent open partial nephrectomy (OPN) (n = 23), laparoscopic partial nephrectomy (LPN) (n = 48), and robotic partial nephrectomy (RPN) (n = 35) by a single surgeon. Clinical variables, operative parameters, and renal functional outcomes were analyzed. Results. Preoperative patient characteristics were similar except for baseline glomerular filtration rate (GFR), which was highest in the RPN group (P = 0.004). Surgery time was longest in the RPN group (244 minutes) and shortest in the OPN group (163 minutes, P < 0.0001). Patients who had OPN had the highest incidence of 30-day complications (30%), while the RPN approach had the lowest (14%, P = 0.008). Conclusions. When performed by a single surgeon, robotic partial nephrectomy appears to be associated with fewer complications than both open and laparoscopic partial nephrectomy. Kidney function was not affected by surgical approach.

  16. 延续护理在机器人辅助腹腔镜膀胱全切尿流改道术患者中的应用效果%Application effect of Continuation Nursing in Robot Assisted Laparoscopic Radical Cystectomy and Urinary Diversion Surgery

    Institute of Scientific and Technical Information of China (English)

    丁华; 赵美玲; 侯翠翠; 王芳

    2015-01-01

    Objective To explore the application effect of continuation nursing in robot assisted laparoscopic radical cystectomy and urinary diversion surgery.Methods To establish the ward continued nursing team, standardizing the continued nursing forms,refinement of continuing nursing content.By convenience sampling,70 cases of robot assisted laparoscopic radical cystectomy and urinary diversion surgery were selected,and investigated by using the knowledge of disease questionnaire and general quality of life assessment questionnaire when discharge and 1 and 3 months after discharge.Results Patients were lack of disease relevant knowledge when discharge,with the continues of the continuation nursing,patients’mastery level of relevant knowledge was getting better compared with the time of discharge.The score of quality of life at three month of discharge were lower than the time of discharge and first month of discharge (all P <0.05).Conclusion Continuing nursing can improve patient’s cognitive level and the quality of life,reduce the incidence of complications and twice admission rate,reduce the financial burden on families,save medical resources and improve the trust degree of patients to the medical staffs and the reputation of the hospital.%目的:探讨延续护理在机器人辅助腹腔镜膀胱全切尿流改道术患者中的应用效果。方法2009年1月至2014年3月,建立病区延续护理团队,规范延续护理形式,细化延续护理内容。便利抽样法选取在解放军总医院海南分院泌尿外科采用机器人辅助腹腔镜膀胱全切尿流改道术后出院患者70例为研究对象,患者出院时、出院后1、3个月分别采用疾病知识调查表及生活质量综合评定问卷表对其进行测评。结果患者出院时对所患疾病相关知识掌握欠佳,随着延续护理的持续,患者对疾病康复知识掌握情况较出院时有提高;出院3个月后患者的生活质量评分

  17. 机器人辅助腹腔镜胰十二指肠切除术%Robot-assisted pancreatoduodenectomy

    Institute of Scientific and Technical Information of China (English)

    王知非; Anusak Yiengpruksawan; Nino Carnevale; 周宁新

    2009-01-01

    Pancreatoduodenectomy (PD) is considered as a complex and difficult surgical procedure even to the experi-enced surgeons, and it is thought to be the last frontier for mini-really invasive surgeons. Laparoscopic PD, despite the initial enthusiasm towards it, discourages laparoscopic surgeons by its long operating time and procedure-related fatigue resulting from technical difficulties associated with laparoscopic instruments and unstable camera platform. Although robotic surgical system with its known advantages has successfully overcome the limita-tions of traditional laparoscopic surgery, and completed the com-plex and advanced surgical procedures required in PD, reports on robot-assisted (laparobotic) PD remain few. Furthermore, there has not yet been a single report detailing PD techniques modified to take advantage of the Da Vinci platform. In this report, laparobotic PD was successfully performed on 7 patients. Five patients underwent pyloric preserving PD and 2 had stand-ard PD. All the 7 patients have been followed up till January 2009. The overall mean operative time was 326 minutes (290-400 minutes) and the mean length of postoperative stay was 10.2 days (5-30 days). There was no mortality. Five patients had perioperative complications but went on well after manage-ment. The stepwise cando-cranial approach PD is a unique approach, which is ideal for robotic platform. Although it has been shown to be feasible, safe, efficient, and reproducible in this small series, a larger scale multi-institutional study is needed to validate its efficacy.

  18. 右美托咪定对老年患者机器人腹腔镜下前列腺癌根治手术谵妄的影响%The effects of dexmedetomidine on delirium in elderly patients undergoing robot-assisted laparoscopic prostatectomy

    Institute of Scientific and Technical Information of China (English)

    方铮; 徐雯; 杨旅军

    2016-01-01

    目的 观察行机器人腹腔镜下前列腺癌根治手术(robot-assisted laparoscopic prostatectomy,RALP)的老年患者手术结束前30 min给予右美托咪定(dexmedetomidine,DEX)对麻醉苏醒期谵妄的影响.方法 选择全麻下择期行RALP的老年患者60例,随机分为两组,观察组30例于手术结束前30 min将DEX以0.8 μg· kg-1·h-1的速率静脉泵注10 min,对照组30例以同等剂量生理盐水静脉泵注10 min.监测患者进入麻醉复苏室拔管前后的心率、平均动脉压和血氧饱和度,采用Ramsay镇静评分、简化ICU意识模糊评估法、舒适度评分及视觉模拟评估法对患者进行评估.结果 拔管后观察组比对照组血流动力学更加平稳,谵妄评分较低且有更高的舒适度评分.结论 DEX后处理可降低RALP术后老年患者苏醒期谵妄的发生率.

  19. Laparoscopic approach to hysterectomy

    Directory of Open Access Journals (Sweden)

    Hakan Nazik

    2013-04-01

    Full Text Available Modern laparoscopic surgery is widely used throughout the world as it offers greater advantages than open procedures. The laparoscopic approach to hysterectomy has evolved over the last 20 years. Hysterectomies are performed abdominally, vaginally, laparoscopically or, more recently, with robotic assistance. Indications for a total laparoscopic hysterectomy are similar to those for total abdominal hysterectomy, and most commonly include uterine leiomyomata, pelvic organ prolapse, and abnormal uterine bleeding. When hysterectomy is going to be performed, the surgeon should decide which method is safer and more cost-effective. This paper aims to make a review of the indications, techniques and advantages of laparoscopic hysterectomy as well as the criteria to be used for appropriate patient selection.

  20. Robot-assisted versus other types of radical prostatectomy: population-based safety and cost comparison in Japan, 2012-2013.

    Science.gov (United States)

    Sugihara, Toru; Yasunaga, Hideo; Horiguchi, Hiromasa; Matsui, Hiroki; Fujimura, Tetsuya; Nishimatsu, Hiroaki; Fukuhara, Hiroshi; Kume, Haruki; Changhong, Yu; Kattan, Michael W; Fushimi, Kiyohide; Homma, Yukio

    2014-11-01

    In 2012, Japanese national insurance started covering robot-assisted surgery. We carried out a population-based comparison between robot-assisted and three other types of radical prostatectomy to evaluate the safety of robot-assisted prostatectomy during its initial year. We abstracted data for 7202 open, 2483 laparoscopic, 1181 minimal incision endoscopic, and 2126 robot-assisted radical prostatectomies for oncological stage T3 or less from the Diagnosis Procedure Combination database (April 2012-March 2013). Complication rate, transfusion rate, anesthesia time, postoperative length of stay, and cost were evaluated by pairwise one-to-one propensity-score matching and multivariable analyses with covariants of age, comorbidity, oncological stage, hospital volume, and hospital academic status. The proportion of robot-assisted radical prostatectomies dramatically increased from 8.6% to 24.1% during the first year. Compared with open, laparoscopic, and minimal incision endoscopic surgery, robot-assisted surgery was generally associated with a significantly lower complication rate (odds ratios, 0.25, 0.20, 0.33, respectively), autologous transfusion rate (0.04, 0.31, 0.10), homologous transfusion rate (0.16, 0.48, 0.14), lower cost excluding operation (differences, -5.1%, -1.8% [not significant], -10.8%) and shorter postoperative length of stay (-9.1%, +0.9% [not significant], -18.5%, respectively). However, robot-assisted surgery also resulted in a + 42.6% increase in anesthesia time and +52.4% increase in total cost compared with open surgery (all P robotic surgery led to a dynamic change in prostate cancer surgery. Even in its initial year, robot-assisted radical prostatectomy was carried out with several favorable safety aspects compared to the conventional surgeries despite its having the longest anesthesia time and the highest cost.

  1. A hybrid brain interface for a humanoid robot assistant.

    Science.gov (United States)

    Finke, Andrea; Knoblauch, Andreas; Koesling, Hendrik; Ritter, Helge

    2011-01-01

    We present an advanced approach towards a semi-autonomous, robotic personal assistant for handicapped people. We developed a multi-functional hybrid brain-robot interface that provides a communication channel between humans and a state-of-the-art humanoid robot, Honda's Humanoid Research Robot. Using cortical signals, recorded, processed and translated by an EEG-based brain-machine interface (BMI), human-robot interaction functions independently of users' motor control deficits. By exploiting two distinct cortical activity patterns, P300 and event-related desynchronization (ERD), the interface provides different dimensions for robot control. An empirical study demonstrated the functionality of the BMI guided humanoid robot. All participants could successfully control the robot that accomplished a shopping task.

  2. Vision and task assistance using modular wireless in vivo surgical robots.

    Science.gov (United States)

    Platt, Stephen R; Hawks, Jeff A; Rentschler, Mark E

    2009-06-01

    Minimally invasive abdominal surgery (laparoscopy) results in superior patient outcomes compared to conventional open surgery. However, the difficulty of manipulating traditional laparoscopic tools from outside the body of the patient generally limits these benefits to patients undergoing relatively low complexity procedures. The use of tools that fit entirely inside the peritoneal cavity represents a novel approach to laparoscopic surgery. Our previous work demonstrated that miniature mobile and fixed-based in vivo robots using tethers for power and data transmission can successfully operate within the abdominal cavity. This paper describes the development of a modular wireless mobile platform for in vivo sensing and manipulation applications. Design details and results of ex vivo and in vivo tests of robots with biopsy grasper, staple/clamp, video, and physiological sensor payloads are presented. These types of self-contained surgical devices are significantly more transportable and lower in cost than current robotic surgical assistants. They could ultimately be carried and deployed by nonmedical personnel at the site of an injury to allow a remotely located surgeon to provide critical first response medical intervention irrespective of the location of the patient.

  3. Dealing with robot-assisted surgery for rectal cancer: Current status and perspectives.

    Science.gov (United States)

    Biffi, Roberto; Luca, Fabrizio; Bianchi, Paolo Pietro; Cenciarelli, Sabina; Petz, Wanda; Monsellato, Igor; Valvo, Manuela; Cossu, Maria Laura; Ghezzi, Tiago Leal; Shmaissany, Kassem

    2016-01-14

    The laparoscopic approach for treatment of rectal cancer has been proven feasible and oncologically safe, and is able to offer better short-term outcomes than traditional open procedures, mainly in terms of reduced length of hospital stay and time to return to working activity. In spite of this, the laparoscopic technique is usually practised only in high-volume experienced centres, mainly because it requires a prolonged and demanding learning curve. It has been estimated that over 50 operations are required for an experienced colorectal surgeon to achieve proficiency with this technique. Robotic surgery enables the surgeon to perform minimally invasive operations with better vision and more intuitive and precise control of the operating instruments, thus promising to overcome some of the technical difficulties associated with standard laparoscopy. It has high-definition three-dimensional vision, it translates the surgeon's hand movements into precise movements of the instruments inside the patient, the camera is held and moved by the first surgeon, and a fourth robotic arm is available as a fixed retractor. The aim of this review is to summarise the current data on clinical and oncologic outcomes of robot-assisted surgery in rectal cancer, focusing on short- and long-term results, and providing original data from the authors' centre.

  4. Current and emerging robotic assisted intervention for Notes.

    Science.gov (United States)

    Zuo, Siyang; Wang, Shuxin

    2016-12-01

    Natural orifices transluminal endoscopic surgery (notes) procedures are limited by a number of factors including closure of the internal entry point, loss of triangulation, and unstable operative platform. Areas covered: In this paper, new technical developments in different aspects of robotic assisted NOTES interventions are reviewed. We further address new research opportunities for more widespread clinical acceptance of robotic assisted NOTES procedures. Expert commentary: The application of robotics in NOTES intervention is still in its infancy. The development of more compact, smart and intuitive robotic NOTES systems holds much promise for the future of NOTES application.

  5. Robotics in gynecologic surgery.

    Science.gov (United States)

    Frick, A C; Falcone, T

    2009-06-01

    Robotic surgery has evolved from an investigational surgical approach to a clinically useful adjunct in multiple surgical specialties over the past decade. Advocates of robotic-assisted gynecologic surgery revere the system's wristed instrumentation, ergonomic positioning, and three-dimensional high-definition vision system as significant improvements over laparoscopic equipment's four degrees of freedom and two-dimensional laparoscope that demand the surgeon stand throughout a procedure. The cost, lack of haptic feedback, and the bulky size of the equipment make robotics less attractive to others. Studies evaluating outcomes in robotic-assisted gynecologic surgery are limited. Multiple small retrospective studies demonstrate the safety and feasibility of robotic hysterectomy. With increased surgeon experience, operative times are similar to, or shorter than, laparoscopic cases. Robotic assistance can facilitate suturing in laparoscopic myomectomies, and is associated with decreased blood loss and a shorter hospital stay, although may require longer operative times. Robotic assistance has also been applied to multiple procedures in the subspecialties of infertility, urogynecology and gynecologic oncology with good success and relatively low morbidity. However, further research is warranted to better evaluate the relative benefits and costs of robotic assisted gynecologic surgery.

  6. Advantages of robot-assisted laparoscopic surgery in urinary bladder and prostate :an initial clinical experience with 4 cases%机器人外科手术系统辅助腹腔镜在膀胱及前列腺手术中的优势(附4例报道)

    Institute of Scientific and Technical Information of China (English)

    沈周俊; 钟山; 何威; 张荣明; 祝宇; 王浩飞; 王先进

    2011-01-01

    目的 探讨机器人外科手术系统辅助腹腔镜在根治性膀胱切除术和根治性前列腺切除术中的操作体会.方法 上海交通大学附属瑞金医院于2010年3-10月间应用达芬奇S机器人外科系统辅助腹腔镜行下尿路手术4例,其中3例前列腺癌患者行根治性前列腺切除术,1例膀胱癌患者行根治性膀胱切除+原位双U形回肠代膀胱术.结果 3例前列腺癌患者的手术时间为200~270 min(包括体位摆放及机器人外科手术系统到位的时间共45 min),术中失血量为300~800 mL,输血0~400 mL.术后无1例发生尿漏,术后第5天拔除左侧引流管,第6天拔除右侧引流管.术后1周复查前列腺特异性抗原(PSA)均<0.17 ng/mL.术后3周拔除导尿管,可自行排尿,排尿控制良好.1例膀胱癌患者的手术时间为330 min,其中全膀胱切除的时间为165 min,原位膀胱术的时间为120 min.术中失血量为800 mL,输血300 mL.术后病理检查提示膀胱尿路上皮癌.术后第10天拔除双侧输尿导管,术后3周拔除导尿管,可自行排尿,排尿控制良好.结论 达芬奇S机器人外科手术系统辅助腹腔镜下尿路手术的创伤更小,更适用于高龄、高危前列腺癌等下尿路肿瘤患者,是一种具有广泛应用前景的手术方法,但须充分关注手术的潜在风险.%Objective To assess the feasibility and safety of robot-assisted laparoscopic radical cystectomy (RLRC) with double U-shaped ileal neobladder and robot-assisted laparoscopic radical prostatectomy (RLRP).Methods One patient with bladder carcinoma underwent RLRC with double U-shaped ileal neobladder and three patients with prostate carcinoma underwent RLRP using the da Vinci robotic surgical system during March 2010 to October 2010.All patients had histologically-confirmed adenocarcinoma of prostate or bladder biopsy and a negative bone scan.Peri-operative and early surgical outcome data were collected prospectively and functional recovery was

  7. Present and future of robot-assisted endoscopic thyroid surgery

    Institute of Scientific and Technical Information of China (English)

    FAN Lin-jun; JIANG Jun

    2012-01-01

    Objective Robot-assisted endoscopic surgery has been increasingly accepted because of its unique three-dimensional vision and precise simulation-based technology.However,the utilization of robotic systems in thyroid surgery is limited.We conducted a systematic review to assess the application and development of robot-assisted endoscopic surgical technique in thyroid surgery.Data sources Articles published in PubMed before June,2011 about robot-assisted endoscopic surgery were selected.Study selection Original articles and critical reviews selected were related to robot-assisted (thyroid) surgery or endoscopic thyroid surgery,and a total of 3540 relevant articles were retrieved and 34 were finally cited.Results Robot-assisted operation of benign thyroid diseases were successfully performed,although the operation time is too long to exhibit its advantages.Nevertheless,the superiority of robot-assisted endoscopic surgical technique compared to conventional endoscopic surgery in the treatment of thyroid carcinoma were obvious,since robotic radical thyroidectomy with central and lateral neck lymph node dissection could be achieved while maintaining operative results and cosmetic outcomes equivalent to or better than conventional endoscopic surgery.Furthermore,the learning curve duration of robot-assisted endoscopic thyroid surgery was shorter than that of conventional endoscopy,especially for the novices without any endoscopic surgical basis.Conclusion Robot-assisted endoscopic thyroid surgery,with its safety,feasibility,thoroughness,cosmetic benefits,and ability to overcome the limitations of conventional endoscopic surgery,will be further improved and applied,and is worthy of attention.

  8. The McCarus-Volker ForniSee®: A Novel Trans-illuminating Colpotomy Device and Uterine Manipulator for Use in Conventional and Robotic-Assisted Laparoscopic Hysterectomy.

    Science.gov (United States)

    Gutierrez, Melissa M; Pedroso, Jasmine D; Volker, K Warren; Howard, David L; McCarus, Steven D

    2017-07-25

    The purpose of this paper is to introduce a novel trans-illuminating culdotomy and uterine manipulator device. The study was a prospective, non-randomized, non-blinded observational clinical study involving 50 female patients undergoing total laparoscopic hysterectomy (TLH) or laparoscopic supracervical hysterectomy (LSH) for benign indications. The surgeries were performed from March through May 2012 at two institutions. The primary study objectives were to demonstrate the safety and adequate clinical performance of the uterine manipulator device and to illustrate its potential widespread future use in minimally invasive gynecologic procedures. Average patient age was 45.1 years and, of the 50 patients, 33 had undergone previous intra-abdominal surgery. There were no reports of adverse events, difficulty with placement of the instrument, multiple attempts at placement, or difficulty with uterine manipulation. There was only one device-related uterine perforation, and pneumoperitoneum was maintained in all cases during culdotomy. Vaginal tissue left on subjects was less than 5mm. Overall, there were no ureteral injuries, there were two reported incidental cystotomies, and average blood loss was 99.0cc. Postoperative courses were normal for all patients, with only two reported postoperative complications: a possible vaginal cuff abscess and a 2cm vaginal mucosal cuff separation. The McCarus-Volker ForniSee® (LSI Solutions, Inc., Victor, New York) is a novel trans-illuminating culdotomy device and uterine manipulator that is safe, efficient, functional, and easy to use. Trans-illumination additionally delineates and enhances identification of critical anatomic planes, such as the vesicovaginal junction and cervicovaginal junction.

  9. Clipless management of the renal vein during hand-assist laparoscopic donor nephrectomy

    Directory of Open Access Journals (Sweden)

    Rosenblatt Gregory S

    2006-09-01

    Full Text Available Abstract Background Laparoscopic live donor nephrectomy has become the preferred method of donor nephrectomy at many transplant centers. The laparoscopic stapling device is commonly used for division of the renal vessels. Malfunction of the stapling device can occur, and is often due to interference from previously placed clips. We report our experience with a clipless technique in which no vascular clips are placed on tributaries of the renal vein at or near the renal hilum in order to avoid laparoscopic stapling device misfires. Methods From December 20, 2002 to April 12, 2005, 50 patients underwent hand-assisted laparoscopic left donor nephrectomy (LDN at our institution. Clipless management of the renal vein tributaries was used in all patients, and these vessels were divided using either a laparoscopic stapling device or the LigaSureTM device (Valleylab, Boulder, CO. The medical and operative records of the donors and recipients were reviewed to evaluate patient outcomes. Results The mean follow-up time was 14 months. Of the 50 LDN procedures, there were no laparoscopic stapling device malfunctions and no vascular complications. All renal allografts were functioning at the time of follow-up. Conclusion Laparoscopic stapling device failure due to deployment across previously placed surgical clips during laparoscopic live donor nephrectomy can be prevented by not placing clips on the tributaries of the renal vein. In our series, there were no vascular complications and no device misfires. We believe this clipless technique improves the safety of laparoscopic donor nephrectomy.

  10. External force estimation and implementation in robotically assisted minimally invasive surgery.

    Science.gov (United States)

    Sang, Hongqiang; Yun, Jintian; Monfaredi, Reza; Wilson, Emmanuel; Fooladi, Hadi; Cleary, Kevin

    2017-06-01

    Robotically assisted minimally invasive surgery can offer many benefits over open surgery and laparoscopic minimally invasive surgery. However, currently, there is no force sensing and force feedback. This research was implemented using the da Vinci research kit. An external force estimation and implementation method was proposed based on dynamics and motor currents. The dynamics of the Patient Side Manipulator was modeled. The dynamic model was linearly parameterized. The estimation principle of external force was derived. The dynamic parameters were experimentally identified using a least squares method. Several experiments including dynamic parameter identification, joint torque estimation, and external force estimation were performed. The results showed that the proposed method could implement force estimation without using a force sensor. The force estimation method was proposed and implemented and experimental results showed the method worked and was feasible. This method could be used for force sensing in minimally invasive surgical robotics in the future. Copyright © 2017 John Wiley & Sons, Ltd.

  11. Research advances in control methods of wearable walking assist robots

    Directory of Open Access Journals (Sweden)

    Xia ZHANG

    2016-04-01

    Full Text Available As the proportion of the elderly in China increases, the need for robotic assist walking is growing. The assisted-as-needed (AAN property of a wearable walking assist robot matches a user’s biological need and improves the flexibility, appetency and friendliness of a mechanical system. To realize AAN walking and aiming at realizing master/slave flexible assist, a new hybrid control method consisting of hip joint control based on central pattern generators and knee joint impedance structured control is proposed. The adaptation of a robot's master/slave motion mode to a user's physical function, the continuous switching method for knee joint impedance structured control and its stability, and the AAN effect of the Hybrid control theory are studied, which provides a new thought for the development of wearable walking assist robots.

  12. Robotic-assisted pyeloplasty:recent developments in efficacy, outcomes, and new techniques.

    Science.gov (United States)

    Seideman, Casey A; Bagrodia, Aditya; Gahan, Jeffrey; Cadeddu, Jeffrey A

    2013-02-01

    Within the last decade, the adaptation of robotic urologic surgery has had a profound impact on surgical practice, with robotic upper tract reconstruction for ureteropelvic junction obstruction gaining rapid acceptance. Recent advances in robotic reconstruction demonstrate efficacious outcomes of robotic pyeloplasty, as compared with conventional laparoscopic pyeloplasty, even in the case of secondary surgery. Furthermore, efforts to continue to reduce the morbidity of laparoscopic surgery have led to the development and implementation of laparoendoscopic single-site (LESS) surgery. The recent applications of the da Vinci robotic surgical platform to LESS pyeloplasty (R-LESS) has demonstrated the potential to further decrease morbidity, improve surgeon ergonomics, and improve cosmesis.

  13. Human-Robot Interaction: Does Robotic Guidance Force Affect Gait-Related Brain Dynamics during Robot-Assisted Treadmill Walking?

    Directory of Open Access Journals (Sweden)

    Kristel Knaepen

    Full Text Available In order to determine optimal training parameters for robot-assisted treadmill walking, it is essential to understand how a robotic device interacts with its wearer, and thus, how parameter settings of the device affect locomotor control. The aim of this study was to assess the effect of different levels of guidance force during robot-assisted treadmill walking on cortical activity. Eighteen healthy subjects walked at 2 km.h-1 on a treadmill with and without assistance of the Lokomat robotic gait orthosis. Event-related spectral perturbations and changes in power spectral density were investigated during unassisted treadmill walking as well as during robot-assisted treadmill walking at 30%, 60% and 100% guidance force (with 0% body weight support. Clustering of independent components revealed three clusters of activity in the sensorimotor cortex during treadmill walking and robot-assisted treadmill walking in healthy subjects. These clusters demonstrated gait-related spectral modulations in the mu, beta and low gamma bands over the sensorimotor cortex related to specific phases of the gait cycle. Moreover, mu and beta rhythms were suppressed in the right primary sensory cortex during treadmill walking compared to robot-assisted treadmill walking with 100% guidance force, indicating significantly larger involvement of the sensorimotor area during treadmill walking compared to robot-assisted treadmill walking. Only marginal differences in the spectral power of the mu, beta and low gamma bands could be identified between robot-assisted treadmill walking with different levels of guidance force. From these results it can be concluded that a high level of guidance force (i.e., 100% guidance force and thus a less active participation during locomotion should be avoided during robot-assisted treadmill walking. This will optimize the involvement of the sensorimotor cortex which is known to be crucial for motor learning.

  14. Human-Robot Interaction: Does Robotic Guidance Force Affect Gait-Related Brain Dynamics during Robot-Assisted Treadmill Walking?

    Science.gov (United States)

    Knaepen, Kristel; Mierau, Andreas; Swinnen, Eva; Fernandez Tellez, Helio; Michielsen, Marc; Kerckhofs, Eric; Lefeber, Dirk; Meeusen, Romain

    2015-01-01

    In order to determine optimal training parameters for robot-assisted treadmill walking, it is essential to understand how a robotic device interacts with its wearer, and thus, how parameter settings of the device affect locomotor control. The aim of this study was to assess the effect of different levels of guidance force during robot-assisted treadmill walking on cortical activity. Eighteen healthy subjects walked at 2 km.h-1 on a treadmill with and without assistance of the Lokomat robotic gait orthosis. Event-related spectral perturbations and changes in power spectral density were investigated during unassisted treadmill walking as well as during robot-assisted treadmill walking at 30%, 60% and 100% guidance force (with 0% body weight support). Clustering of independent components revealed three clusters of activity in the sensorimotor cortex during treadmill walking and robot-assisted treadmill walking in healthy subjects. These clusters demonstrated gait-related spectral modulations in the mu, beta and low gamma bands over the sensorimotor cortex related to specific phases of the gait cycle. Moreover, mu and beta rhythms were suppressed in the right primary sensory cortex during treadmill walking compared to robot-assisted treadmill walking with 100% guidance force, indicating significantly larger involvement of the sensorimotor area during treadmill walking compared to robot-assisted treadmill walking. Only marginal differences in the spectral power of the mu, beta and low gamma bands could be identified between robot-assisted treadmill walking with different levels of guidance force. From these results it can be concluded that a high level of guidance force (i.e., 100% guidance force) and thus a less active participation during locomotion should be avoided during robot-assisted treadmill walking. This will optimize the involvement of the sensorimotor cortex which is known to be crucial for motor learning.

  15. Intelligent Personal Assistant and Surveillance Robot using Zigbee Communication

    Directory of Open Access Journals (Sweden)

    KRISHNASWAMY KANNAN

    2012-10-01

    Full Text Available The modern world meets an innovation every day! Innovation is aimed at reducing human effort as well as providing a secure environment. With this in mind, we propose a Zigbee Network System which is centered on an Intelligent Robot that provides both security and control of the entire house. The Robot acts as a virtual assistant by monitoring the house to detect the presence of intruders and simultaneously providing electronic control of the entire house from a single place. The house is monitored through a wireless video cameramounted on the robot, which is in turn controlled through Zigbee IEEE 802.15.4 standard. The appliances are interfaced to the Robot using relays while the entire house is monitored and controlled through the Zigbee Network. Thus, the proposed robot serves as a simple, yet powerful, low cost alternative to the assistant robots by simultaneously providing Home Security and Home Automation.

  16. A statically balanced and bi-stable compliant end effector combined with a laparoscopic 2DoF robotic arm

    Directory of Open Access Journals (Sweden)

    J. Lassooij

    2012-12-01

    Full Text Available This article presents the design of a newly developed 2DoF robotic arm with a novel statically balanced and bi-stable compliant grasper as the end effector for laparoscopic surgery application. The arm is based on internal motors actuating 2 rotational DoFs: pitch and roll. The positive stiffness of the monolithic grasper has been compensated using pre-curved straight guided beams that are preloaded collinear with the direction of actuation of the grasper. The result is a fully compliant statically balanced laparoscopic grasper. The grasper has been successfully adapted to a robotic arm. The maximum force and stiffness compensations were measured to be 94% and 97% (i.e. near zero stiffness respectively. Furthermore, the feasibility of adjusting for bi-stable behavior has been shown. This research can be a preliminary step towards the design of a statically balanced fully compliant robotic arm for laparoscopic surgery and similar areas.

  17. Care routines, feeding assistive robotics and the disabled body

    DEFF Research Database (Denmark)

    Nickelsen, Niels Christian Mossfeldt

    Care routines, feeding assistive robotics and the disabled body Niels Christian Mossfeldt NickelsenAbstract for 4S, Barcelona, track 62. Short abstract 300 signs including spacesSeveral feeding assistive robotics are described in the literature, but few studies have explored the reception. I report...... from an ethnographic study of the British Neater-Eater robot in a housing institution for the disabled. Due to a number of values the implementation is something of a balancing act.Long abstract 248 wordsSeveral feeding assistive robotics (FAR) are described in the literature; Neater-Eater; My Spoon...... the result is demeaning (Nickelsen, 2013). During the last decade feeding has broadly been eliminated from nurses’ responsibilities and relegated to non-professionals (Martinsen et al. 2007). It has become low status work and as such it is currently robotized. Despite the lack of knowledge...

  18. Point-and-Command Paradigm for Interaction with Assistive Robots

    Directory of Open Access Journals (Sweden)

    Razvan Gabriel Boboc

    2015-06-01

    Full Text Available This paper presents a multi-modal interface for the interaction between a human user and an assistive humanoid robot. The interaction is performed through gestural commands and a dialogue mechanism to provide a ‘natural’ means for the user to command an assistive robot to perform several given tasks. A “Point-and-Command” interaction concept was proposed with the aim of providing the user with an easy-to-use and intuitive interface and to improve the efficiency of human-robot collaboration. Likewise, a decision support system (DSS was implemented based on fuzzy logic, in order to warn the user when an active robot is about to become unusable and should be replaced. Thus, the interaction time, which depends on the robot's battery life, can be increased by replacing the assistant with another more fully charged one, making the interaction seem more natural.

  19. Mobile robotic assistive balance trainer - an intelligent compliant and adaptive robotic balance assistant for daily living.

    Science.gov (United States)

    Tiseo, Carlo; Lim, Zhen Yi; Shee, Cheng Yap; Ang, Wei Tech

    2014-01-01

    Balance control probably has the greatest impact on independence in activities of daily living (ADL), because it is a fundamental motor skill and prerequisite to the maintenance of a myriad of postures and mobile activities. We propose a new rehabilitation therapy to administer standing and mobile balance control training, enabled by a Mobile Robotic Assistive Balance Trainer (MRABT). The targeted group for this initial work is post stroke patients, although it can be extended to subjects with other neurological insults in the future. The proposed system consists of a mobile base and a parallel robotic arm which provides support to the patient at the hip. The compliant robotic arm with intelligent control algorithm will only provide support and assistance to the patient when the center of mass of the body deviates beyond the predefined safety boundary, mimicking the helping hands of a parent when a toddler learns to walk. In this paper, we present our initial work in the design and kinematic analysis of the system.

  20. Robot-assisted ureterocalycostomy: A single centre contemporary experience in adults.

    Science.gov (United States)

    Chhabra, Jaspreet S; Balaji Sudharsan, S; Singh, Abhishek; Mishra, Shashikant; Ganpule, Arvind; Sabnis, Ravindra; Desai, Mahesh R

    2016-03-01

    To present our technique and experience of robot-assisted ureterocalycostomy (RAUC) in managing secondary pelvi-ureteric junction obstruction (PUJO) in adults. We retrospectively reviewed all patients from our centre who underwent RAUC, between 2011 and 2015, for secondary PUJO resulting from previous surgical intervention. Six procedures in five patients, including a bilateral RAUC were performed. The median (range) patient age was 33.7 (18-41) years. The outcome variables included operative time, duration of hospital stay, and objective evidence of unimpeded drainage on urography. The mean (range) operating time was 172 (144-260) min and estimated blood loss was 100 (50-250) mL. There were no conversions to open or laparoscopic surgery, and no intraoperative complications. Two patients had Clavien-Dindo Grade I complications that were managed conservatively and one patient had a Grade IIIb complication, which required balloon dilatation and re-stenting. After a median (range) follow-up of 11 (7-48) months, five of the six renal units had successful outcomes. The robot-assisted approach appears to be ideally suited for redo cases demanding fine dissection with meticulous suturing. In our present series of adult patients, we could safely and successfully perform RAUC with minimal morbidity. However, a larger multi-institutional outcome analysis is required to substantiate the role of the robot-assisted approach in performing UC.

  1. A surface-matching technique for robot-assisted registration.

    Science.gov (United States)

    Glozman, D; Shoham, M; Fischer, A

    2001-01-01

    Successful implementation of robot-assisted surgery (RAS) requires coherent integration of spatial image data with sensing and actuating devices, each having its own coordinate system. Hence, accurate estimation of the geometric relationships between relevant reference frames, known as registration, is a crucial procedure in all RAS applications. The purpose of this paper is to present a new registration scheme, along with the results of an experimental evaluation of a robot-assisted registration method for RAS applications in orthopedics. The accuracy of the proposed registration is appropriate for specified orthopedic surgical applications such as Total Knee Replacement. The registration method is based on a surface-matching algorithm that does not require marker implants, thereby reducing surgical invasiveness. Points on the bone surface are sampled by the robot, which in turn directs the surgical tool. This technique eliminates additional coordinate transformations to an external device (such as a digitizer), resulting in increased surgical accuracy. The registration technique was tested on an RSPR six-degrees-of-freedom parallel robot specifically designed for medical applications. A six-axis force sensor attached to the robot's moving platform enables fast and accurate acquisition of positions and surface normal directions at sampled points. Sampling with a robot probe was shown to be accurate, fast, and easy to perform. The whole procedure takes about 2 min, with the robot performing most of the registration procedures, leaving the surgeon's hands free. Robotic registration was shown to provide a flawless link between preoperative planning and robotic assistance during surgery.

  2. Robot-assisted Radical Prostatectomy: How I Do It

    Directory of Open Access Journals (Sweden)

    Cemil Uygur

    2016-06-01

    Full Text Available In this article, we describe surgical technique for robot assisted radical prostatectomy using the four-arm da Vinci robotic surgical system (SI, Intuitive Surgical, Sunnyvale, CA, USA. We have continually refined our technique to improve patient outcomes.

  3. Using assistive robots to promote inclusive education.

    Science.gov (United States)

    Encarnação, P; Leite, T; Nunes, C; Nunes da Ponte, M; Adams, K; Cook, A; Caiado, A; Pereira, J; Piedade, G; Ribeiro, M

    2017-05-01

    This paper describes the development and test of physical and virtual integrated augmentative manipulation and communication assistive technologies (IAMCATs) that enable children with motor and speech impairments to manipulate educational items by controlling a robot with a gripper, while communicating through a speech generating device. Nine children with disabilities, nine regular and nine special education teachers participated in the study. Teachers adapted academic activities so they could also be performed by the children with disabilities using the IAMCAT. An inductive content analysis of the teachers' interviews before and after the intervention was performed. Teachers considered the IAMCAT to be a useful resource that can be integrated into the regular class dynamics respecting their curricular planning. It had a positive impact on children with disabilities and on the educational community. However, teachers pointed out the difficulties in managing the class, even with another adult present, due to the extra time required by children with disabilities to complete the activities. The developed assistive technologies enable children with disabilities to participate in academic activities but full inclusion would require another adult in class and strategies to deal with the additional time required by children to complete the activities. Implications for Rehabilitation Integrated augmentative manipulation and communication assistive technologies are useful resources to promote the participation of children with motor and speech impairments in classroom activities. Virtual tools, running on a computer screen, may be easier to use but further research is needed in order to evaluate its effectiveness when compared to physical tools. Full participation of children with motor and speech impairments in academic activities using these technologies requires another adult in class and adequate strategies to manage the extra time the child with disabilities may

  4. Robot-assisted Therapy in Stroke Rehabilitation

    OpenAIRE

    Chang, Won Hyuk; Kim, Yun-Hee

    2013-01-01

    Research into rehabilitation robotics has grown rapidly and the number of therapeutic rehabilitation robots has expanded dramatically during the last two decades. Robotic rehabilitation therapy can deliver high-dosage and high-intensity training, making it useful for patients with motor disorders caused by stroke or spinal cord disease. Robotic devices used for motor rehabilitation include end-effector and exoskeleton types; herein, we review the clinical use of both types. One application of...

  5. Socially assistive robotics for post-stroke rehabilitation

    Science.gov (United States)

    Matarić, Maja J; Eriksson, Jon; Feil-Seifer, David J; Winstein, Carolee J

    2007-01-01

    Background Although there is a great deal of success in rehabilitative robotics applied to patient recovery post stroke, most of the research to date has dealt with providing physical assistance. However, new rehabilitation studies support the theory that not all therapy need be hands-on. We describe a new area, called socially assistive robotics, that focuses on non-contact patient/user assistance. We demonstrate the approach with an implemented and tested post-stroke recovery robot and discuss its potential for effectiveness. Results We describe a pilot study involving an autonomous assistive mobile robot that aids stroke patient rehabilitation by providing monitoring, encouragement, and reminders. The robot navigates autonomously, monitors the patient's arm activity, and helps the patient remember to follow a rehabilitation program. We also show preliminary results from a follow-up study that focused on the role of robot physical embodiment in a rehabilitation context. Conclusion We outline and discuss future experimental designs and factors toward the development of effective socially assistive post-stroke rehabilitation robots. PMID:17309795

  6. Socially assistive robotics for post-stroke rehabilitation

    Directory of Open Access Journals (Sweden)

    Feil-Seifer David J

    2007-02-01

    Full Text Available Abstract Background Although there is a great deal of success in rehabilitative robotics applied to patient recovery post stroke, most of the research to date has dealt with providing physical assistance. However, new rehabilitation studies support the theory that not all therapy need be hands-on. We describe a new area, called socially assistive robotics, that focuses on non-contact patient/user assistance. We demonstrate the approach with an implemented and tested post-stroke recovery robot and discuss its potential for effectiveness. Results We describe a pilot study involving an autonomous assistive mobile robot that aids stroke patient rehabilitation by providing monitoring, encouragement, and reminders. The robot navigates autonomously, monitors the patient's arm activity, and helps the patient remember to follow a rehabilitation program. We also show preliminary results from a follow-up study that focused on the role of robot physical embodiment in a rehabilitation context. Conclusion We outline and discuss future experimental designs and factors toward the development of effective socially assistive post-stroke rehabilitation robots.

  7. Care of the patient undergoing robotic-assisted prostatectomy.

    Science.gov (United States)

    Starnes, Danielle N; Sims, Terran Warren

    2006-04-01

    Prostate cancer has many treatment options. In addition to open retropubic and perineal approaches to radical prostatectomy, laparoscopic robotic prostatectomy is available as a newer surgical option. Potential advantages of robotic surgery include reduced pain and trauma, less blood loss, reduced infection risk, shorter hospital stay, faster recovery, and less scarring (Intuitive Surgical, 2005). A variety of nursing care considerations involving pre-operative education and preparation, intra-operative and immediate postoperative care issues, and long-term followup must be understood to meet the needs of a robotic surgical patient. Patient selection is very important to optimize a positive surgical outcome. Just as certain criteria make a good surgical candidate, there are factors that could complicate the surgery or adversely affect recovery.

  8. The robotic-assisted laparoscopic surgery treating urological diseases: experiences of 600 cases in a single medical center%机器人辅助腔镜技术处理泌尿系统疾病:单中心600例报道

    Institute of Scientific and Technical Information of China (English)

    夏丹; 来翀; 王平; 景泰乐; 叶孙益; 秦杰; 孔德波; 汪朔

    2016-01-01

    目的 总结单中心机器人辅助泌尿外科手术的临床资料,提高对机器人技术在泌尿系疾病处理中的认识.方法 回顾性分析2014年9月至2015年11月本中心600例应用da Vinci手术机器人系统进行泌尿外科手术的临床资料.男473例,女127例.年龄17 ~ 82岁,平均(67.2±6.8)岁.对病例的分布、手术方式、围术期和术后情况进行总结.结果 600例机器人辅助腹腔镜手术均顺利完成,无中转开放手术.其中根治性前列腺切除术304例,肾癌手术185例(包括根治性肾切除术9例,肾部分切除术174例,根治性肾切除术+腔静脉取癌栓术2例),肾盂输尿管离断成形术27例,根治性膀胱切除术12例(包括Bricker膀胱术11例,Studer原位新膀胱术1例),其他手术共72例(包括肾上腺切除术、腹膜后肿瘤切除术、腹膜后淋巴清扫术、腔静脉后输尿管成形术、左肾静脉移位吻合术等).117例(19.5%)患者术后出现并发症,无一例死亡.对根治性前列腺切除术和肾部分切除术重点进行了经腹腔和经腹膜后两种手术入路的比较.经腹膜后途径与经腹腔途径相比并不增加住院时间和切缘阳性率(P>O.05).结论 da Vinci机器人手术系统在泌尿系疾病处理中应用广泛,尤其适用于需要腔内缝合及在狭小空间内操作的手术类型.经腹膜后途径行根治性前列腺切除术和肾部分切除术安全、可行.%Objective To analyze and summarize the clinical data of 600 robotic-assisted urological surgeries at a single center,aiming to acquire a better understanding of the robotic techniques and emphasize its role in treating urological diseases.Methods Six hundred patients with urological diseases underwent robotic-assisted laparoscopic surgeries from September 2014 to November 2015,including 473 males and 127 females with a mean age of (67.2 ± 6.8) years.The disease categary,surgical procedure selection,intraand post-operative data and short

  9. Concept and design of a cooperative robotic assistant surgery system

    OpenAIRE

    Castillo Cruces, Raúl Armando

    2008-01-01

    The modular interactive computer-assisted surgery (modiCAS) project, settled in the Center for Sensor System (ZESS) at the University of Siegen, in Germany, is engaged to develop an integral solution for different surgical problems by the combination of a navigation system and a robot arm with hands-on capabilities. The robotic system may be thought of as a smart surgical tool that extends surgeon's ability to treat patients, giving him/her surgical assistant by working in cooperative fashion...

  10. Human-robot interaction tests on a novel robot for gait assistance.

    Science.gov (United States)

    Tagliamonte, Nevio Luigi; Sergi, Fabrizio; Carpino, Giorgio; Accoto, Dino; Guglielmelli, Eugenio

    2013-06-01

    This paper presents tests on a treadmill-based non-anthropomorphic wearable robot assisting hip and knee flexion/extension movements using compliant actuation. Validation experiments were performed on the actuators and on the robot, with specific focus on the evaluation of intrinsic backdrivability and of assistance capability. Tests on a young healthy subject were conducted. In the case of robot completely unpowered, maximum backdriving torques were found to be in the order of 10 Nm due to the robot design features (reduced swinging masses; low intrinsic mechanical impedance and high-efficiency reduction gears for the actuators). Assistance tests demonstrated that the robot can deliver torques attracting the subject towards a predicted kinematic status.

  11. Potassium-titanyl-phosphate laser assisted robotic partial nephrectomy in a porcine model: can robotic assistance optimize the power needed for effective cutting and hemostasis?

    Science.gov (United States)

    Boris, Ronald S; Eun, Daniel; Bhandari, Akshay; Lyall, Kathryn; Bhandari, Mahendra; Rogers, Craig; Alassi, Osama; Menon, Mani

    2007-01-01

    A potassium-titanyl-phosphate (KTP) laser through robotic endo-wrist instrument has been evaluated as an ablative and hemostatic tool in robotic assisted laparoscopic partial nephrectomy (RALPN). Ten RALPN were performed in five domestic female pigs. The partial nephrectomies were performed with bulldog clamping of the pedicle. Flexible glass fiber carrying 532-nm green light laser was used through a robotic endowrist instrument in two cases. Power usage from 4 to 10 W was tested. The laser probe was explored both as a cutting knife and for hemostasis. The pelvicalyceal system was closed with a running suture. Partial nephrectomies using KTP laser were performed without complications. Mean operative times and warm ischemia times for laser cases were 96 and 18 min, respectively. Mean estimated blood loss was 60 ml compared with 50 ml for non-laser cases. Complete hemostasis with the laser alone could be achieved with a power of 4 W and was found to be effective. In our hands the laser fiber powered up to 10 W was not effective as a quick cutting agent. Histopathologic analysis of the renal remnant revealed a cauterized surface effect with average laser penetration depth less than 1 mm and minimal surrounding cellular injury. The new robotic endowrist instrument carrying flexible glass fiber transmitting 532-nm green light laser is a useful addition to the armamentarium of the robotic urologic setup. Its control by the console surgeon enables quicker and more complete hemostasis of the cut surface in renal sparing surgery using a porcine model. Histologically proven lased depth of less than 1 mm suggests minimal parenchyma damage in an acute setting. Laser application as a cutting agent, however, requires further investigation with interval power settings beyond the limits of this preliminary study. We estimate that effective cutting should be possible with a setting lower than traditionally recommended for solid organs.

  12. Totally robot-assisted biliary pancreatic diversion with duodenal switch: single dock technique and technical outcomes.

    Science.gov (United States)

    Sudan, Ranjan; Podolsky, Erica

    2015-01-01

    The biliopancreatic diversion with duodenal switch (BPD/DS) requires operating in three different abdominal quadrants. Previous techniques have used either two docks or a hybrid technique in which the robot is used only to suture the duodeno-ileal anastomosis, while the rest of the operation was performed laparoscopically. Recently, a modification in technique has allowed all operative steps to be completed robotically with a single dock. The operative technique and its technical results are described. Operative technique is described. Baseline demographics, operative duration, length of stay, and adverse events (intraoperative, 30-days, and 1-year) of all primary totally robot BPD/DS cases are reported. From Nov. 2011 to Jan. 2014, 59 totally robotic BPD/DS operations were attempted. One was completed hybrid, and the rest were totally robotic. No robotic operation was converted to an open operation. Five trocars were placed, the small bowel was anchored to the anterior abdominal wall, and the robot was docked. Mean age was 44 ± 10 years with a mean preoperative BMI of 56 ± 9 kg/m(2). 69 % was female, and 71 % was Caucasian. Mean operative duration was 306 ± 80 min (60 min less than the hybrid technique). There were no mortality, leaks, venous thromboembolism, or bleeding requiring transfusion. Mean length of stay was 4.6 ± 4.3 days. Three patients were readmitted for nausea and vomiting. There was one superficial wound infection, and three patients needed reoperations in the first year, two for strictures, and one for debriding a suture abscess. All key technical components of the BPD/DS were performed with low morbidity and mortality with a single dock. Since the surgeon performed all key parts of the operation from the console, the need for experienced bedside assistance was minimized, resulting in shorter operative duration compared to the hybrid technique.

  13. Advances in Robotic-Assisted Radical Prostatectomy over Time

    Directory of Open Access Journals (Sweden)

    Emma F. P. Jacobs

    2013-01-01

    Full Text Available Since the introduction of robot-assisted radical prostatectomy (RALP, robotics has become increasingly more commonplace in the armamentarium of the urologic surgeon. Robotic utilization has exploded across surgical disciplines well beyond the fields of urology and prostate surgery. The literature detailing technical steps, comparison of large surgical series, and even robotically focused randomized control trials are available for review. RALP, the first robot-assisted surgical procedure to achieve widespread use, has recently become the primary approach for the surgical management of localized prostate cancer. As a result, surgeons are constantly trying to refine and improve upon current technical aspects of the operation. Recent areas of published modifications include bladder neck anastomosis and reconstruction, bladder drainage, nerve sparing approaches and techniques, and perioperative and postoperative management including penile rehabilitation. In this review, we summarize recent advances in perioperative management and surgical technique for RALP.

  14. Laparoscopically Assisted Low Anterior Resection for Lower Rectal Endometriosis: Usefulness of Laparoscopic Surgery

    Directory of Open Access Journals (Sweden)

    Hiroki Sugishita

    2009-11-01

    Full Text Available A 34-year-old woman presented with pain during menstruation and was diagnosed with endometriosis of the lower rectum. Despite treatment with an LH-RH agonist, she was unable to become pregnant and surgical removal of her endometriosis was recommended. Preoperative magnetic resonance imaging revealed endometriosis localized between the neck of the uterus and rectum with indentation and scuffing. Laparoscopically assisted low anterior resection was performed. Exfoliation was started from the right side of the rectum to the presacral and retrorectal space, and the rectococcygeus ligament was transected. Exfoliation of the retrorectal space was continued to the levator ani muscle and mobilization of the right side of the rectum was performed. In front of the rectum, exfoliation was started posterior to the wall of the vagina, but layers became unclear near the tumor as the tissue was solid in this region. The left hypogastric nerve close to the tumor was inflamed and it was cut. The layer of the exfoliation was connected to the right side of the rectum, the tumor was isolated from the vagina, and the lower rectum was transected at a point 1 cm distal to the tumor with a 60-mm linear stapler. Reconstruction with a 31-mm circular stapler was performed using the double stapling technique. Operative time was 520 min with a blood loss of 320 ml. On the 9th post operative day, a rectovaginal fistula occurred, and ileostomy was performed. The patient was discharged from the hospital on the 25th postoperative day, and 4 months later, stoma closure was performed.

  15. Surgical approach to right colon cancer: From open technique to robot. State of art.

    Science.gov (United States)

    Fabozzi, Massimiliano; Cirillo, Pia; Corcione, Francesco

    2016-08-27

    This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical

  16. The learning curve and factors affecting warm ischemia time during robot-assisted partial nephrectomy

    Directory of Open Access Journals (Sweden)

    Hitesh Dube

    2015-01-01

    Full Text Available Introduction: The learning curve for robotic partial nephrectomy was investigated for an experienced laparoscopic surgeon and factors associated with warm ischemia time (WIT were assessed. Materials and Methods: Between 2007 and 2014, one surgeon completed 171 procedures. Operative time, blood loss, complications and ischemia time were examined to determine the learning curve. The learning curve was defined as the number of procedures needed to reach the targeted goal for WIT, which most recently was 20 min. Statistical analyses including multivariable regression analysis and matching were performed. Results: Comparing the first 30 to the last 30 patients, mean ischemia time (23.0-15.2 min, P < 0.01 decreased while tumor size (2.4-3.4 cm, P = 0.02 and nephrometry score (5.9-7.0, P = 0.02 increased. Body mass index (P = 0.87, age (P = 0.38, complication rate (P = 0.16, operating time (P = 0.78 and estimated blood loss (P = 0.98 did not change. Decreases in ischemia time corresponded with revised goals in 2011 and early vascular unclamping with the omission of cortical renorrhaphy in selected patients. A multivariable analysis found nephrometry score, tumor diameter, cortical renorrhaphy and year of surgery to be significant predictors of WIT. Conclusions: Adoption of robotic assistance for a surgeon experienced with laparoscopic surgery was associated with low complication rates even during the initial cases of robot-assisted partial nephrectomy. Ischemia time decreased while no significant changes in blood loss, operating time or complications were seen. The largest decrease in ischemia time was associated with adopting evidence-based goals and new techniques, and was not felt to be related to a learning curve.

  17. Robotic-assisted thermal ablation of liver tumours

    Energy Technology Data Exchange (ETDEWEB)

    Abdullah, Basri Johan Jeet; Yeong, Chai Hong [University of Malaya, Department of Biomedical Imaging and University of Malaya Research Imaging Centre, Faculty of Medicine, Kuala Lumpur (Malaysia); University of Malaya, Department of Internal Medicine, Faculty of Medicine, Kuala Lumpur (Malaysia); Goh, Khean Lee [University of Malaya, Department of Internal Medicine, Faculty of Medicine, Kuala Lumpur (Malaysia); Yoong, Boon Koon [University of Malaya, Department of Surgery, Faculty of Medicine, Kuala Lumpur (Malaysia); Ho, Gwo Fuang [University of Malaya, Department of Oncology, Faculty of Medicine, Kuala Lumpur (Malaysia); Yim, Carolyn Chue Wai [University of Malaya, Department of Anesthesia, Faculty of Medicine, Kuala Lumpur (Malaysia); Kulkarni, Anjali [Perfint Healthcare Corporation, Florence, OR (United States)

    2015-01-15

    This study aimed to assess the technical success, radiation dose, safety and performance level of liver thermal ablation using a computed tomography (CT)-guided robotic positioning system. Radiofrequency and microwave ablation of liver tumours were performed on 20 patients (40 lesions) with the assistance of a CT-guided robotic positioning system. The accuracy of probe placement, number of readjustments and total radiation dose to each patient were recorded. The performance level was evaluated on a five-point scale (5-1: excellent-poor). The radiation doses were compared against 30 patients with 48 lesions (control) treated without robotic assistance. Thermal ablation was successfully completed in 20 patients with 40 lesions and confirmed on multiphasic contrast-enhanced CT. No procedure related complications were noted in this study. The average number of needle readjustment was 0.8 ± 0.8. The total CT dose (DLP) for the entire robotic assisted thermal ablation was 1382 ± 536 mGy.cm, while the CT fluoroscopic dose (DLP) per lesion was 352 ± 228 mGy.cm. There was no statistically significant (p > 0.05) dose reduction found between the robotic-assisted versus the conventional method. This study revealed that robotic-assisted planning and needle placement appears to be safe, with high accuracy and a comparable radiation dose to patients. (orig.)

  18. Application requirements for Robotic Nursing Assistants in hospital environments

    Science.gov (United States)

    Cremer, Sven; Doelling, Kris; Lundberg, Cody L.; McNair, Mike; Shin, Jeongsik; Popa, Dan

    2016-05-01

    In this paper we report on analysis toward identifying design requirements for an Adaptive Robotic Nursing Assistant (ARNA). Specifically, the paper focuses on application requirements for ARNA, envisioned as a mobile assistive robot that can navigate hospital environments to perform chores in roles such as patient sitter and patient walker. The role of a sitter is primarily related to patient observation from a distance, and fetching objects at the patient's request, while a walker provides physical assistance for ambulation and rehabilitation. The robot will be expected to not only understand nurse and patient intent but also close the decision loop by automating several routine tasks. As a result, the robot will be equipped with sensors such as distributed pressure sensitive skins, 3D range sensors, and so on. Modular sensor and actuator hardware configured in the form of several multi-degree-of-freedom manipulators, and a mobile base are expected to be deployed in reconfigurable platforms for physical assistance tasks. Furthermore, adaptive human-machine interfaces are expected to play a key role, as they directly impact the ability of robots to assist nurses in a dynamic and unstructured environment. This paper discusses required tasks for the ARNA robot, as well as sensors and software infrastructure to carry out those tasks in the aspects of technical resource availability, gaps, and needed experimental studies.

  19. Robot assistance of motor learning: A neuro-cognitive perspective.

    Science.gov (United States)

    Heuer, Herbert; Lüttgen, Jenna

    2015-09-01

    The last several years have seen a number of approaches to robot assistance of motor learning. Experimental studies have produced a range of findings from beneficial effects through null-effects to detrimental effects of robot assistance. In this review we seek an answer to the question under which conditions which outcomes should be expected. For this purpose we derive tentative predictions based on a classification of learning tasks in terms of the products of learning, the mechanisms involved, and the modulation of these mechanisms by robot assistance. Consistent with these predictions, the learning of dynamic features of trajectories is facilitated and the learning of kinematic and dynamic transformations is impeded by robotic guidance, whereas the learning of dynamic transformations can profit from robot assistance with error-amplifying forces. Deviating from the predictions, learning of spatial features of trajectories is impeded by haptic guidance, but can be facilitated by divergent force fields. The deviations point to the existence of additional effects of robot assistance beyond the modulation of learning mechanisms, e.g., the induction of a passive role of the motor system during practice with haptic guidance.

  20. Enhanced Recovery After Robot-assisted Radical Cystectomy: EAU Robotic Urology Section Scientific Working Group Consensus View.

    Science.gov (United States)

    Collins, Justin W; Patel, Hiten; Adding, Christofer; Annerstedt, Magnus; Dasgupta, Prokar; Khan, Shamim M; Artibani, Walter; Gaston, Richard; Piechaud, Thierry; Catto, James W; Koupparis, Anthony; Rowe, Edward; Perry, Matthew; Issa, Rami; McGrath, John; Kelly, John; Schumacher, Martin; Wijburg, Carl; Canda, Abdullah E; Balbay, Meviana D; Decaestecker, Karel; Schwentner, Christian; Stenzl, Arnulf; Edeling, Sebastian; Pokupić, Sasa; Stockle, Michael; Siemer, Stefan; Sanchez-Salas, Rafael; Cathelineau, Xavier; Weston, Robin; Johnson, Mark; D'Hondt, Fredrik; Mottrie, Alexander; Hosseini, Abolfazl; Wiklund, Peter N

    2016-10-01

    Radical cystectomy (RC) is associated with frequent morbidity and prolonged length of stay (LOS) irrespective of surgical approach. Increasing evidence from colorectal surgery indicates that minimally invasive surgery and enhanced recovery programmes (ERPs) can reduce surgical morbidity and LOS. ERPs are now recognised as an important component of surgical management for RC. However, there is comparatively little evidence for ERPs after robot-assisted radical cystectomy (RARC). Due to the multimodal nature of ERPs, they are not easily validated through randomised controlled trials. To provide a European Association of Urology (EAU) Robotic Urology Section (ERUS) policy on ERPs to guide standardised perioperative management of RARC patients. The guidance was formulated in four phases: (1) systematic literature review of evidence for ERPs in robotic, laparoscopic, and open RC; (2) an online questionnaire survey formulated and sent to ERUS Scientific Working Group members; (3) achievement of consensus from an expert panel using the Delphi process; and (4) a standardised reporting template to audit compliance and outcome designed and approved by the committee. Consensus was reached in multiple areas of an ERP for RARC. The key principles include patient education, optimisation of nutrition, RARC approach, standardised anaesthetic, analgesic, and antiemetic regimens, and early mobilisation. This consensus represents the views of an expert panel established to advise ERUS on ERPs for RARC. The ERUS Scientific Working Group recognises the role of ERPs and endorses them as standardised perioperative care for patients undergoing RARC. ERPs in robotic surgery will continue to evolve with technological and pharmaceutical advances and increasing understanding of the role of surgery-specific ERPs. There is currently a lack of high-level evidence exploring the benefits of enhanced recovery programmes (ERPs) in patients undergoing robot-assisted radical cystectomy (RARC). We

  1. A statically balanced and bi-stable compliant end effector combined with a laparoscopic 2DoF robotic arm

    NARCIS (Netherlands)

    Lassooij, J.; Tolou, N.; Tortora, G.; Caccavaro, S.; Menciassi, A.; Herder, J.L.

    2012-01-01

    This article presents the design of a newly developed 2DoF robotic arm with a novel statically balanced and bi-stable compliant grasper as the end effector for laparoscopic surgery application. The arm is based on internal motors actuating 2 rotational DoFs: pitch and roll. The positive stiffness of

  2. A statically balanced and bi-stable compliant end effector combined with a laparoscopic 2DoF robotic arm

    NARCIS (Netherlands)

    Lassooij, J.; Tolou, N.; Tortora, G.; Caccavaro, S.; Menciassi, A.; Herder, J.L.

    2012-01-01

    This article presents the design of a newly developed 2DoF robotic arm with a novel statically balanced and bi-stable compliant grasper as the end effector for laparoscopic surgery application. The arm is based on internal motors actuating 2 rotational DoFs: pitch and roll. The positive stiffness of

  3. Optimized Assistive Human-Robot Interaction Using Reinforcement Learning.

    Science.gov (United States)

    Modares, Hamidreza; Ranatunga, Isura; Lewis, Frank L; Popa, Dan O

    2016-03-01

    An intelligent human-robot interaction (HRI) system with adjustable robot behavior is presented. The proposed HRI system assists the human operator to perform a given task with minimum workload demands and optimizes the overall human-robot system performance. Motivated by human factor studies, the presented control structure consists of two control loops. First, a robot-specific neuro-adaptive controller is designed in the inner loop to make the unknown nonlinear robot behave like a prescribed robot impedance model as perceived by a human operator. In contrast to existing neural network and adaptive impedance-based control methods, no information of the task performance or the prescribed robot impedance model parameters is required in the inner loop. Then, a task-specific outer-loop controller is designed to find the optimal parameters of the prescribed robot impedance model to adjust the robot's dynamics to the operator skills and minimize the tracking error. The outer loop includes the human operator, the robot, and the task performance details. The problem of finding the optimal parameters of the prescribed robot impedance model is transformed into a linear quadratic regulator (LQR) problem which minimizes the human effort and optimizes the closed-loop behavior of the HRI system for a given task. To obviate the requirement of the knowledge of the human model, integral reinforcement learning is used to solve the given LQR problem. Simulation results on an x - y table and a robot arm, and experimental implementation results on a PR2 robot confirm the suitability of the proposed method.

  4. An Exoskeleton Robot for Human Forearm and Wrist Motion Assist

    Science.gov (United States)

    Ranathunga Arachchilage Ruwan Chandra Gopura; Kiguchi, Kazuo

    The exoskeleton robot is worn by the human operator as an orthotic device. Its joints and links correspond to those of the human body. The same system operated in different modes can be used for different fundamental applications; a human-amplifier, haptic interface, rehabilitation device and assistive device sharing a portion of the external load with the operator. We have been developing exoskeleton robots for assisting the motion of physically weak individuals such as elderly or slightly disabled in daily life. In this paper, we propose a three degree of freedom (3DOF) exoskeleton robot (W-EXOS) for the forearm pronation/ supination motion, wrist flexion/extension motion and ulnar/radial deviation. The paper describes the wrist anatomy toward the development of the exoskeleton robot, the hardware design of the exoskeleton robot and EMG-based control method. The skin surface electromyographic (EMG) signals of muscles in forearm of the exoskeletons' user and the hand force/forearm torque are used as input information for the controller. By applying the skin surface EMG signals as main input signals to the controller, automatic control of the robot can be realized without manipulating any other equipment. Fuzzy control method has been applied to realize the natural and flexible motion assist. Experiments have been performed to evaluate the proposed exoskeleton robot and its control method.

  5. [Laparoscopic surgery in Europe. Where are we going?].

    Science.gov (United States)

    Cuschieri, Alfred

    2006-01-01

    The most important factors that have facilitated the development of laparoscopic surgery (LS) are technological innovations and the vision of a small number of surgeons who took advantage of these advances. There are few surgical innovations that have stimulated such controversies and concerns and have raised so many medico-legal issues as LS. Although much progress has been made in LS, some important controversies remain unresolved, which are reviewed in the present article: 1. Evolution of the laparoscopic approach: total laparoscopic approach through positive-pressure capnoperitoneum, gasless laparoscopy, hand-assisted laparoscopy, and laparoscopy-assisted surgery. 2. Classification of current instrumental technology in laparoscopic surgery: a) facilitating instruments (high-power ultrasonic dissection systems); b) enabling instruments (endostapling and linear dissection devices), and c) complementary instruments: the Da Vinci robotic system. 3. Current laparoscopic surgical practice: a) interventions that definitively improve the patient's outcome (diagnostic and staging laparoscopy, cholecystectomy, adrenalectomy, splenectomy, antireflux surgery, cardiomyotomy, bariatric surgery, laparoscopic colon surgery, living donor nephrectomy); b) interventions that seem to be useful to the patient (distal pancreatic surgery, laparoscopic left hepatic resection, gastric and esophageal resections, hernioplasty), and c) interventions with uncertain benefit (right hepatectomy, pancreatoduodenectomy). 4. Future lines of development: video monitors in laparoscopic surgery, endoluminal surgery, robotic surgery, and finally, 5. Problems faced by laparoscopic surgery: quality guarantees in laparoscopic surgery, training the future laparoscopic generation, and allocation of sufficient material and human resources to laparoscopic surgery and its subspecialties.

  6. Robot-musculoskeletal dynamic biomechanical model in robot-assisted diaphyseal fracture reduction.

    Science.gov (United States)

    Li, Changsheng; Wang, Tianmiao; Hu, Lei; Zhang, Lihai; Zhao, Yanpeng; Du, Hailong; Wang, Lifeng; Tang, Peifu

    2015-01-01

    A number of issues that exist in common fracture reduction surgeries can be mitigated by robot-assisted fracture reduction. However, the safety of patients and the performance of the robot, which are closely related to the muscle forces, are important indexes that restrict the development of robots. Though researchers have done a great deal of work on the biomechanics of the musculoskeletal system, the dynamics of the musculoskeletal system, particularly the aspects related to the function of the robot, is not well understood. For this reason, we represent the complex biological system by establishing a dynamic biomechanical model based on the Hill muscle model and the Kane method for the robot that we have developed and the musculoskeletal system. We analyzed the relationship between the motion and force of the bone fragments and the robot during a simulation of a robot-assisted fracture reduction. The influence of the muscle force on the robot system was predicted and managed. The simulation results provide a basis for a fracture reduction path plan that ensures patient safety and a useful reference for the mechanical design of the robot.

  7. Umbilical incision laparoscopic surgery with one assist port for an elderly patient with recurrent sigmoid volvulus.

    Science.gov (United States)

    Matsuoka, Tasuku; Osawa, Naoshi; Yoh, Taiho; Hirakawa, Kosei

    2012-12-12

    Single-port access laparoscopic surgery has recently emerged as a method to improve morbidity and cosmetic benefit of conventional laparoscopic surgery. Herein, we report the experience of transumbilical incision laparoscopic sigmoidectomy with one assist port in a 71-year-old man who had developed recurrent sigmoid volvulus in these several years since his first visit to the hospital. The patient presented abdominal distension and severe constipation. A plain x-ray film and CT of the abdomen showed grossly distended sigmoid colon loops and stenosis of recto-sigmoid colon. Sigmoid volvulus associated with megacolon was diagnosed and emergence endoscopic decompression was performed. After his condition improved, transumbilical incision laparoscopic sigmoidectomy was carried out as the minimally invasive approach, due to the several risk of patient such as aging and pulmonary disorder. Postoperative course was uneventful and on postoperative visit to the hospital he reported resolution of abdominal distension.

  8. A lower-limb power-assist robot with perception-assist.

    Science.gov (United States)

    Hayashi, Yoshiaki; Kiguchi, Kazuo

    2011-01-01

    In order to assist the motion in the daily lives of physically weak persons such as elderly persons, many kinds of power-assist robots have been developed. In the case of some physically weak persons, the ability to perceive the environment is sometimes deteriorated also. A method of perception-assist has been proposed to assist not only the user's motion but also the user's interaction with an environment, by applying the modification force to the user's motion if it is necessary. In this paper, the perception-assist for a lower-limb power-assist exoskeleton robot is proposed. In the daily life, the walking is very important for persons to achieve desired tasks. Basically, the robot assists the user's muscle force according to the user's motion intention which is estimated based on EMG signals. If the robot has found problems which might lead the user to dangerous situation such as the falling down, the robot tries to modify the user's motion in addition to the ordinal power-assists to make the user walk properly. Since the user might fall down by the effect of the additional modification force of the perception-assist, the robot automatically prevents the user from falling down by considering ZMP (Zero Moment Point). The effectiveness of the proposed method has been evaluated by performing experiments.

  9. Salvage robot-assisted radical prostatectomy after brachytherapy: our experience

    Directory of Open Access Journals (Sweden)

    A. V. Govorov

    2014-01-01

    Full Text Available In case of recurrence of prostate cancer after radiation therapy patient may be offered salvage radical prostatectomy (both open and laparoscopic/robotic, hormone therapy, and a number of alternative techniques such as salvage cryoablation, HIFU-therapy and brachytherapy. Results of monitoring of patients for 10 years after salvage treatment of prostate cancer are known only after salvage prostatectomy. Technically radical prostatectomy after radiation therapy is associated with a large number of complications if compared with primary radical prostatectomy. The most frequent complications after salvage prostatectomy include incontinence, stricture formation of urethrovesical anastomosis, rectal injury, acute urinary retention and infectious complications.

  10. Laparoscopic-assisted treatment of pyometra associated with mammary fibroadenomatous hyperplasia in a cat

    Directory of Open Access Journals (Sweden)

    Lucas Marques Colomé

    2014-03-01

    Full Text Available This paper describes a case of laparoscopic-assisted ovariohysterectomy in a female cat presenting pyometra and mammary fibroadenomatous hyperplasia. Using four portals, mesovarium were ligated by titanium ligature clips whereas the uterine vessels were occluded by video-assisted conventional ligatures. There were no postoperative complications. Video-assisted technique can be an alternative method for treatment of pyometra and cystic endometrial hyperplasia in female cats.

  11. An egocentric vision based assistive co-robot.

    Science.gov (United States)

    Zhang, Jingzhe; Zhuang, Lishuo; Wang, Yang; Zhou, Yameng; Meng, Yan; Hua, Gang

    2013-06-01

    We present the prototype of an egocentric vision based assistive co-robot system. In this co-robot system, the user is wearing a pair of glasses with a forward looking camera, and is actively engaged in the control loop of the robot in navigational tasks. The egocentric vision glasses serve for two purposes. First, it serves as a source of visual input to request the robot to find a certain object in the environment. Second, the motion patterns computed from the egocentric video associated with a specific set of head movements are exploited to guide the robot to find the object. These are especially helpful for quadriplegic individuals who do not have needed hand functionality for interaction and control with other modalities (e.g., joystick). In our co-robot system, when the robot does not fulfill the object finding task in a pre-specified time window, it would actively solicit user controls for guidance. Then the users can use the egocentric vision based gesture interface to orient the robot towards the direction of the object. After that the robot will automatically navigate towards the object until it finds it. Our experiments validated the efficacy of the closed-loop design to engage the human in the loop.

  12. A new application of the four-arm standard da Vinci® surgical system: totally robotic-assisted left-sided colon or rectal resection.

    Science.gov (United States)

    Koh, Dean Chi-Siong; Tsang, Charles Bih-Shou; Kim, Seon-Hahn

    2011-06-01

    The key to successful rectal cancer resection is to perform complete total mesorectal excision (TME). Laparoscopic TME can be challenging, especially in the narrow confines of the pelvis. Robotic-assisted surgery can overcome these limitations through superior three-dimensional (3-D) visualization and the increased range of movements provided by the endowrist function. To date, all totally robotic resections of the rectum have been described using da Vinci® S or Si systems. Due to the limitations of the standard system, only hybrid procedures have been described so far. To evaluate the feasibility and short-term outcomes of performing totally robotic-assisted laparoscopic colorectal resections using the standard da Vinci® system with a fourth arm extension. The standard system was docked from the patient's left hip. Four 8-mm robotic trocars were inserted. Upon completion of phase 1 (pedicle ligation, colonic mobilization, splenic flexure takedown), the two left-sided arms are repositioned to allow phase 2 (pelvic dissection), enabling the entire procedure except for the distal transection and anastomosis to be performed robotically. Twenty-one robotic procedures were performed from August 2008 to September 2009. The mean age of the patients was 61 years (13 males). The procedures performed included seven anterior resections, seven low anterior resections, five ultralow anterior resections, one abdominoperineal resection, and one resection rectopexy. The majority of the cases were performed in patients with colon or rectal cancer. Operative time ranged from 232 to 444 (mean 316) min. Postoperative morbidity occurred in three patients (14.3%) with no mortalities or conversions. Average hospital stay was 6.4 days. Mean lymph node yield for the cases with cancer was 17.8. The standard da Vinci® system with four arms can be used to perform totally robotic-assisted colorectal procedures for the left colon and rectum with short-term outcomes similar to those of

  13. Hand-assisted laparoscopic sigmoid colectomy skills acquisition: augmented reality simulator versus human cadaver training models.

    Science.gov (United States)

    Leblanc, Fabien; Senagore, Anthony J; Ellis, Clyde N; Champagne, Bradley J; Augestad, Knut M; Neary, Paul C; Delaney, Conor P

    2010-01-01

    The aim of this study was to compare a simulator with the human cadaver model for hand-assisted laparoscopic colorectal skills acquisition training. An observational prospective comparative study was conducted to compare the laparoscopic surgery training models. The study took place during the laparoscopic colectomy training course performed at the annual scientific meeting of the American Society of Colon and Rectal Surgeons. Thirty four practicing surgeons performed hand-assisted laparoscopic sigmoid colectomy on human cadavers (n = 7) and on an augmented reality simulator (n = 27). Prior laparoscopic colorectal experience was assessed. Trainers and trainees completed independently objective structured assessment forms. Training models were compared by trainees' technical skills scores, events scores, and satisfaction. Prior laparoscopic experience was similar in both surgeon groups. Generic and specific skills scores were similar on both training models. Generic events scores were significantly better on the cadaver model. The 2 most frequent generic events occurring on the simulator were poor hand-eye coordination and inefficient use of retraction. Specific events were scored better on the simulator and reached the significance limit (p = 0.051) for trainers. The specific events occurring on the cadaver were intestinal perforation and left ureter identification difficulties. Overall satisfaction was better for the cadaver than for the simulator model (p = 0.009). With regard to skills scores, the augmented reality simulator had adequate qualities for the hand-assisted laparoscopic colectomy training. Nevertheless, events scores highlighted weaknesses of the anatomical replication on the simulator. Although improvements likely will be required to incorporate the simulator more routinely into the colorectal training, it may be useful in its current form for more junior trainees or those early on their learning curve. Copyright 2010 Association of Program

  14. Robot Teleoperation and Perception Assistance with a Virtual Holographic Display

    Science.gov (United States)

    Goddard, Charles O.

    2012-01-01

    Teleoperation of robots in space from Earth has historically been dfficult. Speed of light delays make direct joystick-type control infeasible, so it is desirable to command a robot in a very high-level fashion. However, in order to provide such an interface, knowledge of what objects are in the robot's environment and how they can be interacted with is required. In addition, many tasks that would be desirable to perform are highly spatial, requiring some form of six degree of freedom input. These two issues can be combined, allowing the user to assist the robot's perception by identifying the locations of objects in the scene. The zSpace system, a virtual holographic environment, provides a virtual three-dimensional space superimposed over real space and a stylus tracking position and rotation inside of it. Using this system, a possible interface for this sort of robot control is proposed.

  15. Hand-assisted right laparoscopic live donor nephrectomy

    Directory of Open Access Journals (Sweden)

    Anibal W. Branco

    2005-10-01

    Full Text Available PURPOSE: Laparoscopic live donor nephrectomy has acquired an important role in the era of minimally invasive surgery. Laparoscopic harvesting of the right kidney is technically more challenging than that of the left kidney because of the short right renal vein and the need to retract the liver away from the right kidney. The aim of this article is to report our experience with right laparoscopic live donor nephrectomies. MATERIALS AND METHODS: We performed a retrospective review of 28 patients who underwent right laparoscopic donor nephrectomies at our service. Operative data and postoperative outcomes were collected, including surgical time, estimated blood loss, warm ischemia time, length of hospital stay, conversion to laparotomy and complications. RESULTS: The procedure was performed successfully in all 28 patients. The mean operative time was 83.8 minutes (range 45 to 180 minutes, with an estimated blood loss of 111.4 mL (range 40 to 350 mL and warm ischemia time of 3 minutes (range 1.5 to 8 minutes. No donor needed conversion to open surgery and all kidneys showed immediate function after implantation. The average time to initial fluid intake was 12 hours (range 8 to 24 hours. Two cases of postoperative ileus and a case of hematoma on the hand-port site were observed. The mean postoperative hospital stay was 3 days (range 1 to 7 days. CONCLUSIONS: Our data confirm the safety and feasibility of right laparoscopic donor nephrectomy and we believe that the right kidney should not be avoided for laparoscopic donor nephrectomy when indicated.

  16. Remote Control of an Assistive Robot using Force Feedback

    OpenAIRE

    Nadrag, Paul; Temzi, Lounis; Arioui, Hichem; Hoppenot, Philippe

    2011-01-01

    International audience; In this paper, we consider the haptic teleoperation of an assistive mobile robot, used for exploring a domestic environment. The goal of the paper is to help the remote operator to pilot the robot by giving him not only video feedback but also haptic feedback. They are both complementary as they do not require the same kind of attention from the user. The proposed haptic architecture was found to improve operator perception of the remote environment under time delay co...

  17. Computer- and robot-assisted urological surgery

    CERN Document Server

    Troccaz, Jocelyne

    2006-01-01

    The author reviews the computer and robotic tools available to urologists to help in diagnosis and technical procedures. The first part concerns the contribution of robotics and presents several systems at various stages of development (laboratory prototypes, systems under validation or marketed systems). The second part describes image fusion tools and navigation systems currently under development or evaluation. Several studies on computerized simulation of urological procedures are also presented.

  18. Experimental evaluation of assistive behaviors for man-portable robots

    Science.gov (United States)

    Pierce, C.; Baran, D.; Bodt, B.

    2010-04-01

    Man portable robots have been fielded extensively on the battlefield to enhance mission effectiveness of soldiers in dangerous conditions. The robots that have been deployed to date have been teleoperated. The development of assistive behaviors for these robots has the potential to alleviate the cognitive load placed on the robot operator. While full autonomy is the eventual goal, a range of assistive capabilities such as obstacle detection, obstacle avoidance, waypoint navigation, can be fielded sooner in a stand-alone fashion. These capabilities increase the level of autonomy on the robots so that the workload on the soldier can be reduced. The focus of this paper is on the design and execution of a series of scientifically rigorous experiments to quantifiably assess operator performance when operating a robot equipped with some of these assistive behaviors. The experiments helped to determine a baseline for teleoperation and to evaluate the benefit of Obstacle Detection and Obstacle Avoidance (OD/OA) vs. teleoperation and OD/OA with Open Space Planning (OSP) vs. teleoperation. The results of these experiments are presented and analyzed in the paper.

  19. Usability Assessment of Two Different Control Modes for the Master Console of a Laparoscopic Surgical Robot

    Directory of Open Access Journals (Sweden)

    Xiaoli Zhang

    2012-01-01

    Full Text Available The objective of this study is to evaluate potential interface control modes for a compact four-degree-of-freedom (4-DOF surgical robot. The goal is to improve robot usability by incorporating a sophisticated haptics-capable interface. Two control modes were developed using a commercially available haptic joystick: (1 a virtually point-constrained interface providing an analog for constrained laparoscopic motion (3-DOF rotation and 1-DOF translation, and (2 an unconstrained Cartesian input interface mapping more directly to the surgical tool tip motions. Subjects (n = 5 successfully performed tissue identification and manipulation tasks in an animal model in point-constrained and unconstrained control modes, respectively, with speed roughly equal to that achieved in similar manual procedures, and without a steep learning curve. The robot control was evaluated through bench-top tests and a subsequent qualitative questionnaire (n = 15. The results suggest that the unconstrained control mode was preferred for both camera guidance and tool manipulations.

  20. Knowledge assistant: A sensor fusion framework for robotic environmental characterization

    Energy Technology Data Exchange (ETDEWEB)

    Feddema, J.T.; Rivera, J.J.; Tucker, S.D.

    1996-12-01

    A prototype sensor fusion framework called the {open_quotes}Knowledge Assistant{close_quotes} has been developed and tested on a gantry robot at Sandia National Laboratories. This Knowledge Assistant guides the robot operator during the planning, execution, and post analysis stages of the characterization process. During the planning stage, the Knowledge Assistant suggests robot paths and speeds based on knowledge of sensors available and their physical characteristics. During execution, the Knowledge Assistant coordinates the collection of data through a data acquisition {open_quotes}specialist.{close_quotes} During execution and post analysis, the Knowledge Assistant sends raw data to other {open_quotes}specialists,{close_quotes} which include statistical pattern recognition software, a neural network, and model-based search software. After the specialists return their results, the Knowledge Assistant consolidates the information and returns a report to the robot control system where the sensed objects and their attributes (e.g. estimated dimensions, weight, material composition, etc.) are displayed in the world model. This paper highlights the major components of this system.

  1. Comparison of Two Endovascular Steerable Robotic Catheters for Percutaneous Robot-Assisted Fibroid Embolization.

    Science.gov (United States)

    Del Giudice, C; Pellerin, O; Nouri Neville, M; Amouyal, G; Fitton, I; Leré-Déan, C; Sapoval, M

    2017-09-08

    To compare outcomes of percutaneous robot-assisted uterine fibroid embolization (UFE) using two different endovascular robotic catheters. Twenty-one patients with a symptomatic uterine fibroid were prospectively enrolled in a single-center study to be treated with a percutaneous robot-assisted embolization using the Magellan system. Fourteen patients were treated using a first generation steerable robotic catheter, version 1.0 (group 1), and seven were treated using the new version 1.1 (group 2). Demographic, pathologic, and procedural variables were recorded. Dose Area Product (DAP) and physician equivalent doses were registered for each procedure. Procedural related complications and clinical midterm outcomes were also evaluated. Successful robot-assisted UFE was obtained in eight patients (57.1%) in group 1 and 7 patients (100%) in group 2 (p = 0.01). A successful robot-assisted catheterization of the internal iliac artery anterior branch was performed in all patients of both groups. Median selective target vessel catheterization time was 21.0 ± 12.8 vs 13.4 ± 7 min (p = 0.04) and total fluoroscopy time was 30.3 ± 11.2 vs 19.3 ± 5.9 min, respectively, in group 1 and 2. Mean DAP decreased from 18472.6 ± 15622 to 5469.1 ± 4461.0 cGy·cm(2) (p = 0.04). All patients obtained a symptoms relief at 6 months follow-up. Robot-assisted uterine fibroid embolization is safe and effective. New version of steerable robotic catheter allows performing a faster procedure without related adverse events compared to old version.

  2. Assistance dogs provide a useful behavioral model to enrich communicative skills of assistance robots

    Science.gov (United States)

    Gácsi, Márta; Szakadát, Sára; Miklósi, Ádám

    2013-01-01

    These studies are part of a project aiming to reveal relevant aspects of human–dog interactions, which could serve as a model to design successful human-robot interactions. Presently there are no successfully commercialized assistance robots, however, assistance dogs work efficiently as partners for persons with disabilities. In Study 1, we analyzed the cooperation of 32 assistance dog–owner dyads performing a carrying task. We revealed typical behavior sequences and also differences depending on the dyads' experiences and on whether the owner was a wheelchair user. In Study 2, we investigated dogs' responses to unforeseen difficulties during a retrieving task in two contexts. Dogs displayed specific communicative and displacement behaviors, and a strong commitment to execute the insoluble task. Questionnaire data from Study 3 confirmed that these behaviors could successfully attenuate owners' disappointment. Although owners anticipated the technical competence of future assistance robots to be moderate/high, they could not imagine robots as emotional companions, which negatively affected their acceptance ratings of future robotic assistants. We propose that assistance dogs' cooperative behaviors and problem solving strategies should inspire the development of the relevant functions and social behaviors of assistance robots with limited manual and verbal skills. PMID:24399986

  3. Radical nephrectomy performed by open, laparoscopy with or without hand-assistance or robotic methods by the same surgeon produces comparable perioperative results

    OpenAIRE

    Tanya Nazemi; Anton Galich; Samuel Sterrett; Douglas Klingler; Lynette Smith; Balaji, K. C.

    2006-01-01

    PURPOSE: Radical nephrectomy can be performed using open or laparoscopic (with or without hand assistance) methods, and most recently using the da Vinci Surgical Robotic System. We evaluated the perioperative outcomes using a contemporary cohort of patients undergoing radical nephrectomy by one of the above 4 methods performed by the same surgeon. MATERIALS AND METHODS: The relevant clinical information on 57 consecutive patients undergoing radical nephrectomy from September 2000 until July 2...

  4. Robot assisted physiotherapy to support rehabilitation of facial paralysis.

    Science.gov (United States)

    Jayatilake, Dushyantha; Isezaki, Takashi; Teramoto, Yohei; Eguchi, Kiyoshi; Suzuki, Kenji

    2014-05-01

    We have been developing the Robot Mask with shape memory alloy based actuators that follows an approach of manipulating the skin through a minimally obtrusive wires, transparent strips and tapes based pulling mechanism to enhance the expressiveness of the face. For achieving natural looking facial expressions by taking the advantage of specific characteristics of the skin, the Robot Mask follows a human anatomy based criteria in selecting these manipulation points and directions. In this paper, we describe a case study of using the Robot Mask to assist physiotherapy of a hemifacial paralyzed patient. The significant differences in shape and size of the human head between different individuals demands proper customizations of the Robot Mask. This paper briefly describes the adjusting and customizing stages employed from the design level to the implementation level of the Robot Mask. We will also introduce a depth image sensor data based analysis, which can remotely evaluate dynamic characteristics of facial expressions in a continuous manner. We then investigate the effectiveness of the Robot Mask by analyzing the range sensor data. From the case study, we found that the Robot Mask could automate the physiotherapy tasks of rehabilitation of facial paralysis. We also verify that, while providing quick responses, the Robot Mask can reduce the asymmetry of a smiling face and manipulate the facial skin to formations similar to natural facial expressions.

  5. Impact of robotic assistance on precision of vitreoretinal surgical procedures.

    Directory of Open Access Journals (Sweden)

    Yasuo Noda

    Full Text Available PURPOSE: To elucidate the merits of robotic application for vitreoretinal maneuver in comparison to conventional manual performance using an in-vitro eye model constructed for the present study. METHODS: Capability to accurately approach the target on the fundus, to stabilize the manipulator tip just above the fundus, and to perceive the contact of the manipulator tip with the fundus were tested. The accuracies were compared between the robotic and manual control, as well as between ophthalmologists and engineering students. RESULTS: In case of manual control, ophthalmologists were superior to engineering students in all the 3 test procedures. Robotic assistance significantly improved accuracy of all the test procedures performed by engineering students. For the ophthalmologists including a specialist of vitreoretinal surgery, robotic assistance enhanced the accuracy in the stabilization of manipulator tip (from 90.9 µm to 14.9 µm, P = 0.0006 and the perception of contact with the fundus (from 20.0 mN to 7.84 mN, P = 0.046, while robotic assistance did not improve pointing accuracy. CONCLUSIONS: It was confirmed that telerobotic assistance has a potential to significantly improve precision in vitreoretinal procedures in both experienced and inexperienced hands.

  6. Da Vinci Xi Robot-Assisted Penetrating Keratoplasty.

    Science.gov (United States)

    Chammas, Jimmy; Sauer, Arnaud; Pizzuto, Joëlle; Pouthier, Fabienne; Gaucher, David; Marescaux, Jacques; Mutter, Didier; Bourcier, Tristan

    2017-06-01

    This study aims (1) to investigate the feasibility of robot-assisted penetrating keratoplasty (PK) using the new Da Vinci Xi Surgical System and (2) to report what we believe to be the first use of this system in experimental eye surgery. Robot-assisted PK procedures were performed on human corneal transplants using the Da Vinci Xi Surgical System. After an 8-mm corneal trephination, four interrupted sutures and one 10.0 monofilament running suture were made. For each procedure, duration and successful completion of the surgery as well as any unexpected events were assessed. The depth of the corneal sutures was checked postoperatively using spectral-domain optical coherence tomography (SD-OCT). Robot-assisted PK was successfully performed on 12 corneas. The Da Vinci Xi Surgical System provided the necessary dexterity to perform the different steps of surgery. The mean duration of the procedures was 43.4 ± 8.9 minutes (range: 28.5-61.1 minutes). There were no unexpected intraoperative events. SD-OCT confirmed that the sutures were placed at the appropriate depth. We confirm the feasibility of robot-assisted PK with the new Da Vinci Surgical System and report the first use of the Xi model in experimental eye surgery. Operative time of robot-assisted PK surgery is now close to that of conventional manual surgery due to both improvement of the optical system and the presence of microsurgical instruments. Experimentations will allow the advantages of robot-assisted microsurgery to be identified while underlining the improvements and innovations necessary for clinical use.

  7. Influence of obesity on early surgical outcomes of laparoscopic-assisted gastrectomy in gastric cancer.

    Science.gov (United States)

    Kim, Min Gyu; Yook, Jeong Hwan; Kim, Kap Choong; Kim, Tae Hwan; Kim, Hee Sung; Kim, Beom Su; Kim, Byung Sik

    2011-06-01

    The aim of this study is to estimate the impact of obesity on surgical outcomes of laparoscopic-assisted gastrectomy for gastric cancer. Between January 2005 and January 2010, 1100 consecutive patients who underwent laparoscopic-assisted distal gastrectomy for gastric cancer were reviewed to evaluate the impact of obesity. The patients were classified into 3 groups according to the World Health Organization classification, as normal weight [body mass index (BMI) 18.5 to 24.9 kg/m], overweight (BMI 25 to 29.9 kg/m), and obese patients (BMI ≥30 kg/m). The postoperative complication rates for normal weight, overweight, and obese patients were 5.7%, 10.0%, 15.4%, respectively. Overweight and obese patients had a significantly prolonged operation time, increased intraoperative blood loss, prolonged first flatus, day of commencement of soft diet, increased number of administration of analgesics, and prolonged hospital stay. Overweight and obesity were associated with poor early surgical outcomes of laparoscopic-assisted gastrectomy. This study suggested that greater cautions and improved surgical techniques were required to improve early surgical outcomes of laparoscopic-assisted gastrectomy for overweight and obese patients.

  8. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction - An alternative surgical technique for central pancreatic mass resection

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2010-09-01

    Full Text Available Context: Central pancreatectomy has gained popularity in the past decade as treatment of choice for low malignant potential tumor in the midpancreas due to its ability to achieve optimal preservation of pancreatic parenchyma. Simultaneously, advancement in minimally invasive approach has contributed to numerous novel surgical techniques with significantly lower morbidity and mortality. With the purpose of improving patient outcomes, we describe a laparoscopic assisted central pancreatectomy with pancreaticogastrostomy as an alternative method to the previously described open central pancreatectomy with roux-en-y pancreaticojejunostomy reconstruction. Case Report: A 39 year old man presented to our clinic with a 2.5 cm neuroendocrine tumor at the neck of the pancreas. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction was successfully performed. Operative time was 210 minutes with blood loss of 200 ml. Postoperative course was uneventful except for a minimal pancreatic leak which was controlled by an intraoperatively placed closed suction drain. At 2 week follow up, patient was asymptomatic with well preserved pancreatic endo and exocrine functions. Permanent pathology findings showed a well differentiated neuroendocrine tumor with negative margins and nodes. Conclusions: Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction is feasible and safe for a centrally located tumor. Laparoscopic assisted technique facilitates application of minimally invasive approach by increasing surgical feasibility in typically complex pancreatic operations.

  9. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction - An alternative surgical technique for central pancreatic mass resection

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2010-01-01

    Full Text Available Context: Central pancreatectomy has gained popularity in the past decade as treatment of choice for low malignant potential tumor in the midpancreas due to its ability to achieve optimal preservation of pancreatic parenchyma. Simultaneously, advancement in minimally invasive approach has contributed to numerous novel surgical techniques with significantly lower morbidity and mortality. With the purpose of improving patient outcomes, we describe a laparoscopic assisted central pancreatectomy with pancreaticogastrostomy as an alternative method to the previously described open central pancreatectomy with roux-en-y pancreaticojejunostomy reconstruction. Case Report: A 39 year old man presented to our clinic with a 2.5 cm neuroendocrine tumor at the neck of the pancreas. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction was successfully performed. Operative time was 210 minutes with blood loss of 200 ml. Postoperative course was uneventful except for a minimal pancreatic leak which was controlled by an intraoperatively placed closed suction drain. At 2 week follow up, patient was asymptomatic with well preserved pancreatic endo and exocrine functions. Permanent pathology findings showed a well differentiated neuroendocrine tumor with negative margins and nodes. Conclusions: Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction is feasible and safe for a centrally located tumor. Laparoscopic assisted technique facilitates application of minimally invasive approach by increasing surgical feasibility in typically complex pancreatic operations.

  10. Hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy: HARP-trial

    Directory of Open Access Journals (Sweden)

    Alwayn Ian PJ

    2010-03-01

    Full Text Available Abstract Background Transplantation is the only treatment offering long-term benefit to patients with chronic kidney failure. Live donor nephrectomy is performed on healthy individuals who do not receive direct therapeutic benefit of the procedure themselves. In order to guarantee the donor's safety, it is important to optimise the surgical approach. Recently we demonstrated the benefit of laparoscopic nephrectomy experienced by the donor. However, this method is characterised by higher in hospital costs, longer operating times and it requires a well-trained surgeon. The hand-assisted retroperitoneoscopic technique may be an alternative to a complete laparoscopic, transperitoneal approach. The peritoneum remains intact and the risk of visceral injuries is reduced. Hand-assistance results in a faster procedure and a significantly reduced operating time. The feasibility of this method has been demonstrated recently, but as to date there are no data available advocating the use of one technique above the other. Methods/design The HARP-trial is a multi-centre randomised controlled, single-blind trial. The study compares the hand-assisted retroperitoneoscopic approach with standard laparoscopic donor nephrectomy. The objective is to determine the best approach for live donor nephrectomy to optimise donor's safety and comfort while reducing donation related costs. Discussion This study will contribute to the evidence on any benefits of hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy. Trial Registration Dutch Trial Register NTR1433

  11. Promising early results after hand-assisted laparoscopic partial nephrectomy in carefully selected patients

    DEFF Research Database (Denmark)

    Azawi, Nessn H; Christensen, Tom

    2012-01-01

    was dissected using hand-assisted laparoscopic technique, the gerotic fascia was dissected and a complete exploration of the kidney was achieved. A vascular bulldog clamp was removed from the renal artery immediately after the tumour resection bed had been closed with a running suture with Hem-o-Lok clips...

  12. Electroencephalography (EEG) Based Control in Assistive Mobile Robots: A Review

    Science.gov (United States)

    Krishnan, N. Murali; Mariappan, Muralindran; Muthukaruppan, Karthigayan; Hijazi, Mohd Hanafi Ahmad; Kitt, Wong Wei

    2016-03-01

    Recently, EEG based control in assistive robot usage has been gradually increasing in the area of biomedical field for giving quality and stress free life for disabled and elderly people. This study reviews the deployment of EGG based control in assistive robots, especially for those who in need and neurologically disabled. The main objective of this paper is to describe the methods used for (i) EEG data acquisition and signal preprocessing, (ii) feature extraction and (iii) signal classification methods. Besides that, this study presents the specific research challenges in the designing of these control systems and future research directions.

  13. Laparoscopic-assisted cytoreduction for primary advanced ovarian cancer: success, morbidity and survival.

    Science.gov (United States)

    Fanning, James; Yacoub, Emmanuel; Hojat, Rod

    2011-10-01

    The purpose of this paper is to evaluate laparoscopic-assisted cytoreduction for primary advanced ovarian cancer: feasibility, morbidity, response to chemotherapy and survival. All patients with presumed stage 3/4 primary ovarian cancer underwent attempted laparoscopic cytoreduction. All patients had CT evidence of omental metastasis and ascites. A five port (5-mm) transperitoneal approach was used. A bilateral salpingo-oophorectomy, supracervical hysterectomy and omentectomy were performed with the PlasmaKinetic (PK) cutting forceps. A laparoscopic 5-mm Argon-Beam Coagulator was used to coagulate tumor in the pelvis, abdominal peritoneum, intestinal mesentery, and diaphragm. Twenty-three cases (92%) were successfully cytoreduced laparoscopically without conversion to laparotomy. Median operative time was 2.3h and median blood loss was 340 cc. All tumors were debulked to less than 2 cm and 36% had no residual disease. Median length of stay was 1 day. Median VAS pain score was 4-discomforting. Six patients (24%) had post-operative complications, none grades 3-4. Median overall survival is 3.5 years. Laparoscopic-assisted cytoreduction for primary advanced ovarian cancer was successful, resulting in minimal morbidity, and acceptable survival. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Role of robotics for prostate cancer.

    Science.gov (United States)

    McCullough, T Casey; Barret, Eric; Cathelineau, Xavier; Rozet, Francois; Galiano, Marc; Vallancien, Guy

    2009-01-01

    To describe how robotics became involved in prostate cancer as well as to highlight the most important developments in robotic prostate cancer treatment during the last year. Refinements in technique during robotic-assisted laparoscopic prostatectomy have improved the early return of continence postoperatively. Mean positive surgical margin rates were lowest for robotic-assisted laparoscopic prostatectomy as compared to pure laparoscopic or open radical prostatectomy series. Sexual potency rates were similar among all surgical treatments of prostate cancer. As the implementation of robotic technologies to treat prostate cancer continues to grow, randomized controlled trials will eventually provide a better comparison of results. The role of robotics in prostate cancer treatment is established, and continued technical advancements will ultimately improve patient outcomes.

  15. 泌尿外科机器人辅助腹腔镜手术系统临床培训项目实践与思考%Practice and rethinking of the clinical training model of urological robotic-assisted laparoscopic surgery

    Institute of Scientific and Technical Information of China (English)

    符伟军; 张旭; 高江平; 董隽; 马鑫; 李宏召; 陈光富; 史立新; 徐阿祥

    2014-01-01

    解放军总医院在国内最早引进并开展机器人手术,积累了丰富的机器人手术临床及教学经验.针对具有一定泌尿外科腹腔镜手术基础的人员,提出泌尿外科机器人手术规范化阶梯渐进五阶段分组培训项目.具体包括多媒体基础理论学习阶段,重点是让学员掌握机器人手术基础技能知识,取得在线培训合格证书;模拟训练器模块操作阶段,主要训练各种机器人手术技能,采用手术模拟训练器系统自动评分;实物操作练习阶段,体会机器人手臂的操作过程,培养手术视觉感及手感,测定每个学员操作时间并评分;动物活体手术阶段,使学员在活体内掌握机器人手术器械的规范操作方法和体会操作感觉;观摩手术录像及演示阶段,掌握泌尿外科常用机器人手术体位及穿刺点选择,理解三维立体重要解剖标志及其临床应用,学习机器人手术步骤及并发症预防和处理原则.%By first introducing and carrying out the robotic surgery,we accumulated affluent clinical and teaching experiences of robotic surgery.Based on that,we proposed a novel standardized step-by-step robotic surgery training model for urological surgeons who have some experiences of laparoscopic surgery.The first stage is basic theory study by internet multimedia,which is to get an online certification by fully understanding the basic knowledge of robotic surgery.Then comes the simulation module training device operation,mainly focused on the training of vary robotic surgical skills,which are evaluated by the system automatically.In virtual reality simulators training stage,trainees can experience the open anatomy signs and its clinical application,learn the operating procedure and how to prevent and handle the complications and every student' operating time and score can be determined.In animal in vivo operation stage,trainees are enabled to master the standard operation method in vivo by robotic arms

  16. BellBot - A Hotel Assistant System Using Mobile Robots

    Directory of Open Access Journals (Sweden)

    Joaquín López

    2013-01-01

    Full Text Available There is a growing interest in applying intelligent technologies to assistant robots. These robots should have a number of characteristics such as autonomy, easy reconfiguration, robust perception systems and they should be oriented towards close interaction with humans. In this paper we present an automatic hotel assistant system based on a series of mobile platforms that interact with guests and service personnel to help them in different tasks. These tasks include bringing small items to customers, showing them different points of interest in the hotel, accompanying the guests to their rooms and providing them with general information. Each robot can also autonomously handle some daily scheduled tasks. Apart from user-initiated and scheduled tasks, the robots can also perform tasks based on events triggered by the building's automation system (BAS. The robots and the BAS are connected to a central server via a local area network. The system was developed with the Robotics Integrated Development Environment (RIDE and was tested intensively in different environments.

  17. Unusual presentation of obscure Meckel diverticulum treated with robot-assisted diverticulectomy

    Science.gov (United States)

    Pandey, Sagar; Fan, Miao; Xu, Zhe; Yan, Chaogui; Zhu, Junfeng; Li, Xiuhong

    2016-01-01

    Abstract Introduction: Meckel diverticulum (MD) is the most common congenital abnormality of gastrointestinal tract. Tough believed to occur in 2% of population, most of them remain veiled because majority are clinically asymptomatic and remain obscure in radiological examination. Clinical Findings and Diagnosis: A 26-year-old male with episodic black colored stool since last 10 years. Tough symptomatic, diagnosis of pathological lesion, and the bleeding site could not be established with any of the sophisticated diagnostic technique. After 10 years, it was finally diagnosed as MD with careful observation of bowel loops on computed tomography enterography (CTE) where remnant of vitelline vessel and hyper-enhancing nodule are seen along the wall of diverticular loop. Interventions and outcomes: The patient underwent robot assisted laparoscopic surgery with excision of diverticular loop. To the best of our knowledge, this robot-assistant Meckel diverculectomy is probably the first reported surgical procedure in PubMed. Follow-up for 3 month showed no complication or recurrence. Conclusion: Every case is unique and we must be aware and remain alert in tracing the possible morphological variation of the case. Here, we present one unique but rare feature of MD, which helped us in making diagnosis. PMID:27741148

  18. Assistive/Socially Assistive Robotic Platform for Therapy and Recovery: Patient Perspectives

    Directory of Open Access Journals (Sweden)

    Matthew White

    2013-01-01

    Full Text Available Improving adherence to therapy is a critical component of advancing outcomes and reducing the cost of rehabilitation. A robotic platform was previously developed to explore how robotics could be applied to the social dimension of rehabilitation to improve adherence. This paper aims to report on feedback given by end users of the robotic platform as well as the practical applications that socially assistive robotics could have in the daily life activities of a patient. A group of 10 former and current patients interacted with the developed robotic platform during a simulated exercise session before taking an experience-based survey. A portion of these participants later provided verbal feedback as part of a focus group on the potential utility of such a platform. Identified applications included assistance with reaching exercise goals, managing to-do lists, and supporting participation in social and recreational activities. The study participants expressed that the personality characteristics of the robotic system should be adapted to individual preferences and that the assistance provided over time should align with the progress of their recovery. The results from this study are encouraging and will be useful for further development of socially assistive robotics.

  19. An accessible interface for programming an assistive robot

    Directory of Open Access Journals (Sweden)

    Juan G Victores

    2014-09-01

    Full Text Available In this paper, we present an accessible interface in the context of our work on bringing advanced robotics closer to everyday domestic users. This interface allows inexperienced users to be capable of programming an assistive robotic arm to perform a specific desired task in a household environment. The programming process is performed through the developed Web Browsable interface, within which a Task Creator Wizard plays an essential role. The robot's open architecture enables flexible multi-modal interaction. In addition to the touch buttons provided by the Web Browsable interface when presented on a touch screen, voice commands and the use of the Wii RemoteTM controller for intuitive robotic movement have also been enabled. The Web Browsable interface has been designed to provide high accessibility while taking aesthetic details into account, in order to prevent distraction caused by boredom of the user.

  20. Postural Mechatronic Assistant for Laparoscopic Solo Surgery (PMASS)

    OpenAIRE

    Martinez, Arturo Minor; Espinoza, Daniel Lorias

    2010-01-01

    The use of new technology in surgery is enabling surgeons to operate solo in some procedures. The advantages are adequate work space on the operating table and maneuverability. However, although active and passive systems offer these advantages, the time required to relocate or reaccommodate optics and clean the laparoscope between operations has not been reduced. In addition, there is a perceptual difference between what the surgeon wishes to see and the proximity he/she achieves with the ac...

  1. Laparoscopic assisted percutaneous nephrolithotomy in chronic kidney disease patients with ectopic pelvic kidney

    Science.gov (United States)

    Patwardhan, Sujata K.; Shelke, Umesh Ravikant; Patil, Bhushan P.; Pamecha, Yash R.

    2017-01-01

    Purpose: Patients with deranged renal functions have a number of associated factors which can impair healing of wound and increase postoperative morbidity. This study was conducted to assess the problems while managing ectopic pelvic kidney calculi using laparoscopic approach for percutaneous nephrolithotomy (PCNL) in chronic kidney disease patients. Subjects and Methods: Patients with calculi in ectopic kidney with increased serum creatinine level secondary to obstruction were included in the study. Initially, obstruction was relieved. Patients later underwent laparoscopic-assisted PCNL. Patients were monitored postoperatively. Results: Three patients with large renal calculi in ectopic pelvic kidney had presented in 2 years. Laparoscopic-assisted PCNL was done to remove the stone. Patients had persistent urine leak post-operatively. Mean duration for removal of nephrostomy tube and drain removal were 4.67 days and 6.67 days, respectively. These patients also had paralytic ileus for prolonged duration. Conclusion: Although laparoscopic assisted PCNL is an option in the management of patients with stone disease in ectopic pelvic kidney, prolonged time for healing of tract may increase postoperative morbidity in these patients with impaired renal function. PMID:28794593

  2. Single Incision, Laparoscopic-Assisted Ovariohysterectomy for Mucometra and Pyometra in Dogs.

    Science.gov (United States)

    Wallace, Mandy L; Case, J Brad; Singh, Ameet; Ellison, Gary W; Monnet, Eric

    2015-07-01

    To describe a single-incision, laparoscopic-assisted technique for ovariohysterectomy and its application for treatment of mucometra and pyometra in dogs. Prospective case series. Seven dogs. Dogs were included if they had an open or closed pyometra or mucometra and an approximate uterine body diameter of less than 5 cm based on ultrasound or abdominal radiographs. Each dog underwent a laparoscopic-assisted ovariohysterectomy through a single-incision laparoscopic port. The procedure was performed in 6 dogs with pyometra and 1 dog with mucometra. Conversion to an open procedure was necessary in 1 dog with uterine rupture. A 2nd port was necessary in 1 dog to exteriorize the uterine body. Median uterine body diameter was 2.2 cm (range 2-3.9). The median surgical time was 85 minutes (range 40-110). Six of 7 dogs were released from the hospital at 1 day postoperative. Follow up ranged from 7 to 421 days and no complications were reported. A single-incision, laparoscopic-assisted technique for pyometra was feasible in dogs, given restricted case selection and experience with single-incision laparoscopy. © Copyright 2015 by The American College of Veterinary Surgeons.

  3. The bedside assistant in robotic surgery--keys to success.

    Science.gov (United States)

    Yuh, Bertram

    2013-01-01

    Taking on the position of bedside assistant for a surgical robotic team can be a daunting task. Keys to success include preparation, proper operation set up, effective use of instruments to augment the actions of the console surgeon, and readiness for surgical emergencies. Effective communication, repetitive execution, and readiness facilitate the efforts of the surgical team.

  4. Evaluation of a robot-assisted video-assisted thoracoscopic surgery programme

    Science.gov (United States)

    HE, YONG; COONAR, AMANS; GELVEZ-ZAPATA, SABIN; SASTRY, POST; PAGE, ARCHER

    2014-01-01

    At present, there is increasing interest in surgical procedures using a robot-assisted device. The aim of this study was to investigate whether robot-assisted video-assisted thoracoscopic surgery (VATS) was more effective than conventional VATS. A total of 64 VATS lobectomies in Papworth Hospital (Cambridge, UK) were included in the study. In 34 cases the lobectomies were performed using conventional VATS (CV group), while in the remaining 30 cases the lobectomies were performed using robot-assisted VATS (Robotic group). In the robot-assisted VATS, FreeHand®, a thoracoscopic camera controller produced by Freehand 2010 Ltd. (Eastleigh, UK), was used. The duration of the thoracoscopic surgery in the Robotic group was 145.50±10.43 min, whereas in the CV group the duration was 162.79±9.40 min. The surgery duration in the Robotic group was 10.62% shorter than that in the CV group (P<0.05). The rates of bleeding, pulmonary infection, arrhythmia and prolonged air leak (≥5 days) in the Robotic group were 0, 3.33, 26.67 and 13.33%, respectively, while the corresponding rates in the CV group were 2.94, 5.88, 20.59 and 17.65%, respectively. No significant differences were identified in the postoperative complication rates between the two groups (P≥0.05). There was no perioperative mortality in the study. Compared with conventional VATS, FreeHand-assisted VATS provides a similar rate of postoperative complications and a reduced surgery duration, and may be beneficial for the recovery of the patients following VATS. PMID:24669243

  5. [Comparative research of traumatic injury of open hand-assisted laparoscopic anterior resection of the rectum].

    Science.gov (United States)

    Khitar'yan, A G; Glumov, E E; Veliev, K S

    2015-01-01

    The article made a comparative assessment of traumatic injury of open hand-assisted laparoscopic anterior resection of the rectum in lateral and spinal positions. The presented technique of hand-assisted laparoscopic colon and rectal surgery is simple. There are advantages in case of obesity presence (IMT more than 30 kg/m2), in significant shortening of the mesocolon and mesentery, high fixation of splenic flexure and intimate fixation of the spleen, in case of bad preparation of the bowels in partial intestinal obstruction or in case of emergency operation, big cancer size, expressed perifocal inflammation. A comparative analysis of dynamics of hormone stress content and metabolism (cortisol, adrenaline, thyrothrophic hormone) showed their expressed increase in blood during operation after traditional surgery. Less stressed reaction was noted after hand-assisted surgery, especially in overweight patients. An application of low invasive method allowed reduction of hemorrhage, pain syndrome, terms of patient's activation and restoration of intestinal motility after operation.

  6. Robotic right colectomy: A worthwhile procedure? Results of a meta-analysis of trials comparing robotic versus laparoscopic right colectomy

    Directory of Open Access Journals (Sweden)

    Niccolή Petrucciani

    2015-01-01

    Full Text Available Background: Robotic right colectomy (RRC is a complex procedure, offered to selected patients at institutions highly experienced with the procedure. It is still not clear if this approach is worthwhile in enhancing patient recovery and reducing post-operative complications, compared with laparoscopic right colectomy (LRC. Literature is still fragmented and no meta-analyses have been conducted to compare the two procedures. This work aims at reducing this gap in literature, in order to draw some preliminary conclusions on the differences and similarities between RRC and LRC, focusing on short-term outcomes. Materials and Methods: A systematic literature review was conducted to identify studies comparing RRC and LRC, and meta-analysis was performed using a random-effects model. Peri-operative outcomes (e.g., morbidity, mortality, anastomotic leakage rates, blood loss, operative time constituted the study end points. Results: Six studies, including 168 patients undergoing RRC and 348 patients undergoing LRC were considered as suitable. The patients in the two groups were similar with respect to sex, body mass index, presence of malignant disease, previous abdominal surgery, and different with respect to age and American Society of Anesthesiologists score. There were no statistically significant differences between RRC and LRC regarding estimated blood loss, rate of conversion to open surgery, number of retrieved lymph nodes, development of anastomotic leakage and other complications, overall morbidity, rates of reoperation, overall mortality, hospital stays. RRC resulted in significantly longer operative time. Conclusions: The RRC procedure is feasible, safe, and effective in selected patients. However, operative times are longer comparing to LRC and no advantages in peri-operative and post-operative outcomes are demonstrated with the use of the robotic surgical system.

  7. Laparoscopic Assisted Surgery for Crohn's Disease an Initial Experience and Results

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The inflammatory process associated with Crohn's disease often makes dissection difficult, even in open surgery. The aim of this study was to assess the technical feasibility, safety and indication of laparoscopic assisted procedures performed in patients with Crohn's disease. Records of patients undergoing surgical operation for Crohn's disease from 1993 to 1998 at our hospital were reviewed. Intestinal resection was performed laparoscopically in 24 patients (LAP) and by open technique in 23 patients (OPEN). No significant differences existed as to age, gender, body-mass-index and previous surgery. In the laparoscopic group, seven operations (CON) were converted to open laparotomy (29 %) because of large inflammatory mass and/or fistula. The mean intraoperative blood loss was significantly higher in CON- and OPEN-groups than in LAP-group (P<0. 01 ). Major complications occurred only in one patient who underwent laparoscopic assisted high anterior resection. Patients who underwent laparoscopic operation tolerated p.o. liquids sooner than patients who underwent open surgery (median: 2 vs. 5 day, P<0. 05). Compared with the CON- and OPEN-groups, patients in LAP-group had lower analgesic requirements (median: 3 vs. 6 and 5 day, P<0. 01). The median postoperative length of stay was significantly shorter in LAP-group than in OPEN-group (median: 11 vs. 14 day, P<0. 05). Our study showed that LAP is technically feasible for Crohn's disease. The preoperative correct diagnosis and selection of indications are very important, because the laparoscopic mobilization and resection may be difficult or impossible in patients with large fixed masses, multiple complx fistulas, or recurrent Crohn'sdisease.

  8. A parallel robot to assist vitreoretinal surgery

    Energy Technology Data Exchange (ETDEWEB)

    Nakano, Taiga; Sugita, Naohiko; Mitsuishi, Mamoru [University of Tokyo, School of Engineering, Tokyo (Japan); Ueta, Takashi; Tamaki, Yasuhiro [University of Tokyo, Graduate School of Medicine, Tokyo (Japan)

    2009-11-15

    This paper describes the development and evaluation of a parallel prototype robot for vitreoretinal surgery where physiological hand tremor limits performance. The manipulator was specifically designed to meet requirements such as size, precision, and sterilization; this has six-degree-of-freedom parallel architecture and provides positioning accuracy with micrometer resolution within the eye. The manipulator is controlled by an operator with a ''master manipulator'' consisting of multiple joints. Results of the in vitro experiments revealed that when compared to the manual procedure, a higher stability and accuracy of tool positioning could be achieved using the prototype robot. This microsurgical system that we have developed has superior operability as compared to traditional manual procedure and has sufficient potential to be used clinically for vitreoretinal surgery. (orig.)

  9. Robot-assisted surgery for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Minimally invasive surgery for gastric cancer is a relativelynew research field, with convincing results mostlystemming from Asian countries. The use of the roboticsurgery platform, thus far assessed as a safe procedure,which is also easier to learn, sets the background fora wider spread of minimally invasive technique in thetreatment of gastric cancer. This review will cover theliterature published so far, analyzing the pros and consof robotic surgery and highlighting the remaining studyquestions.

  10. Robot-assisted microscope for neurosurgery.

    Science.gov (United States)

    Giorgi, C; Eisenberg, H; Costi, G; Gallo, E; Garibotto, G; Casolino, D S

    1995-01-01

    We describe the implementation of a robotic arm connected to a neurosurgical operative microscope. A force feedback sensor drives the motors of the arm in response to the positioning of the microscope by the surgeon. Computer graphic techniques allow tracking of the current position of the microscope within the volumetric reconstruction of the brain. The integration of the prototype into the neurosurgical operating room is currently being evaluated. Preliminary comments on this experimental phase are offered.

  11. Active MRI tracking for robotic assisted FUS

    Science.gov (United States)

    Xiao, Xu; Huang, Zhihong; Melzer, Andreas

    2017-03-01

    MR guided FUS is a noninvasive method producing thermal necrosis at the position of tumors with high accuracy and temperature control. Because the typical size of the ultrasound focus is smaller than the area of interested treatment tissues, focus repositioning become necessary to achieve multiple sonications to cover the whole targeted area. Using MR compatible mechanical actuators could help the ultrasound beam to reach a wider treatment range than using electrical beam steering technique and more flexibility in position the transducer. An active MR tracking technique was combined into the MRgFUS system to help locating the position of the mechanical actuator and the FUS transducer. For this study, a precise agar reference model was designed and fabricated to test the performance of the active tracking technique when it was used on the MR-compatible robotics InnoMotion™ (IBSMM, Engineering spol. s r.o. / Ltd, Czech Republic). The precision, tracking range and positioning speed of the combined robotic FUS system were evaluated in this study. Compared to the existing MR guided HIFU systems, the combined robotic system with active tracking techniques provides a potential that allows the FUS treatment to operate in a larger spatial range and with a faster speed, which is one of the main challenges for organ motion tracking.

  12. Robotically-Assisted Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Thierry A. Folliguet

    2010-01-01

    Full Text Available Objectives. Robotic surgery enables to perform coronary surgery totally endoscopically. This report describes our experience using the da Vinci system for coronary artery bypass surgery. Methods. Patients requiring single-or-double vessel revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart. Results. From April 2004 to May 2008, fifty-six patients were enrolled in the study. Twenty-four patients underwent robotic harvesting of the mammary conduit followed by minimal invasive direct coronary artery bypass (MIDCAB, and twenty-three patients had a totally endoscopic coronary artery bypass (TECAB grafting. Nine patients (16% were converted to open techniques. The mean total operating time for TECAB was 372±104 minutes and for MIDCAB was 220±69 minutes. Followup was complete for all patients up to one year. There was one hospital death following MIDCAB and two deaths at follow up. Forty-eight patients had an angiogram or CT scan revealing occlusion or anastomotic stenoses (>50% in 6 patients. Overall permeability was 92%. Conclusions. Robotic surgery can be performed with promising results.

  13. A wearable robotic orthosis with a spring-assist actuator.

    Science.gov (United States)

    Seungmin Jung; Chankyu Kim; Jisu Park; Dongyoub Yu; Jaehwan Park; Junho Choi

    2016-08-01

    This paper introduces a wearable robotic orthosis with spring-assist actuators, which is designed to assist people who have difficulty in walking. The spring-assist actuator consists of an electrical motor and a spring, which are attached to a rotational axis in parallel to each other. The spring-assist actuator is developed based on the analysis on the stiffness of the knee and hip joints during walking. "COWALK-Mobile," which is a wearable robotic orthosis, is developed using the spring-assist actuators to reduce the required motor torque during walking. The COWALK-Mobile has active hip and knee joints and passive ankle joints to provide assistive torque to the wearer. The required joint torque is generated by the spring as well as the electrical motor, which results in a decrease of maximum required torque for the motor. In order to evaluate the performance of the spring-assist actuator, experiments are carried out. The experiments show that the spring-assist actuators reduced the required motor torque during walking.

  14. [Sexual functions after laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) in preoperatively asymptomatic women].

    Science.gov (United States)

    Kuzel, D; Weiss, P; Kubínová, K; Masková, L; Sosna, O; Bartosová, L; Horák, P; Tóth, D; Fanta, M; Mára, M

    2009-04-01

    To find the consequences of laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) for sexual functions in preoperatively asymptomatic women. Prospective study. Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Teaching Hospital in Prague. In 100 women without subjective complaints hysterectomy was performed for benign uterine pathology. In all the women the uterus weighted less than 250 g, there were no salpingooophorectomies and no perioperative complications. Women were alternativelly assigned for LAVH (n = 50) or TLH (n = 50). Clinical documentation and questionnaires about sexual functions were evaluated in 87 women (in 40 women after LAVH and in 47 after TLH) 18 months after surgery or later. According to our findings the type of surgery did not influence the frequency of sexual activity after surgery, there was no change in sexual manners using during coitus as well as no change in preferred way how to reach the sexual arousal (clitoridally, vaginally or combined). The type of surgery did not influence frequency, quality and duration of orgasm. From all the evaluated parameters there were only two significantly different: the presence of postoperative sexual activity (positive answer in all women from LAVH group and only in 85% women from TLH group, F test, p = 0.009) and the frequency of sexual satisfaction (in terms of both increase and also decrease in TLH group chi2 8,376, p = 0.015). The type of laparoscopic hysterectomy (LAVH or TLH) does not significantly affect the sexual functions (frequency of sexual satisfaction, type of sexual arousability, intensity and duration of orgasm) in preoperatively asymptomatic women.

  15. The current status of robot-assisted radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Prokar Dasgupta; Roger S.Kirby

    20