ObjectiveTo evaluate the efficacy of robotic intersphincteric resection (ISR) for rectal cancer.MethodsA literature search was performed using the China biomedical literature database, Chinese CNKI, Wanfang, PubMed, Embase, and the Cochrane library. The retrieval time was from the establishment of databases to April 1, 2019. Related interest indicators were brought into meta-analysis by Review Manager 5.2 software.ResultsA total of 510 patients were included in 5 studies, including 273 patients in the robot group and 237 patients in the laparoscopic group. As compared to the laparoscopic group, the robot group had significantly longer operative time [MD=43.27, 95%CI (16.48, 70.07), P=0.002], less blood loss [MD=–19.98.27, 95%CI (–33.14, –6.81), P=0.003], lower conversion rate [MD=0.20, 95%CI (0.04, –0.95), P=0.04], less lymph node harvest [MD=–1.71, 95%CI (–3.21, –0.21), P=0.03] and shorter hospital stay [MD=–1.61, 95%CI (–2.26, –0.97), P<0.000 01]. However, there were no statistically significant differences in the first flatus [MD=–0.01, 95%CI (–0.48, 0.46), P=0.96], time to diet [MD=–0.20, 95%CI (–0.67, 0.27), P=0.41], incidence of complications [OR=0.76, 95%CI (0.50, 1.14), P=0.18], distal resection margin [MD=0.00, 95%CI (–0.17, 0.17), P=0.98] and positive rate of circumferential resection margin [OR=0.61, 95%CI (0.27, 1.37), P=0.23].ConclusionsRobotic and laparoscopic ISR for rectal cancer shows comparable perioperative outcomes. Compared with laparoscopic ISR, robotic ISR has the advantages of less blood loss, lower conversion rate, and longer operation times. These findings suggest that robotic ISR is a safe and effective technique for treating low rectal cancer.
ObjectiveTo summarize the data of robotic hysterectomy in patients with large and super-large uterus in single center, and explore the relevant clinical experience and advantages of robotic surgery.MethodsThe medical records of the patients with large uterus caused by gynecological diseases who underwent robotic hysterectomy in the Chinese PLA General Hospital from January 2016 to December 2018 were retrospectively analyzed. The patients with uterine size from 12 to 16 weeks of gestation were divided into large uterus group and those with uterine volume larger than 16 weeks of gestation were divided into super large uterus group.ResultsA total of 62 patients were included, including 28 in the large uterus group with the average uterus size of (14.3±2.1) gestational weeks, and 34 in the super large uterus group with the average uterus size of (19.9±2.8) gestational weeks. There was no significant difference in mean age, body mass index, history of abdominal surgery or diagnostic composition between the two groups (P>0.05), except for the size of the uterus (t=8.772, P<0.001). The operation time in the large uterus group was less than that in the super-large uterus group [(75.4±22.6) vs. (91.7±27.8) min; t=2.495, P=0.015]. The incidence of complications after robotic hysterectomy was 14.5% (9/62) in the 62 patients, including 14.3% (4/28) in the large uterus group and 14.7% (5/34) in the super-large uterus group. There was no significant difference in the amount of bleeding, blood transfusion rate, ratio of conversion to open surgery, average hospitalization days or incidence of postoperative complications between the two groups (P>0.05).ConclusionsRobotic hysterectomy has the advantages of flexible manipulator, 3-D operative field of vision and stability of manipulation. In addition, increased uterine volume does not lead to increased surgical trauma, nor apparently affect the prognosis.
Objective To investigate the risk factors for arrhythmia after robotic cardiac surgery. Methods The data of the patients who underwent robotic cardiac surgery under cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed. According to whether arrhythmia occurred after operation, the patients were divided into an arrhythmia group and a non-arrhythmia group. Univariate analysis and multivariate logistic analysis were used to screen the risk factors for arrhythmia after robotic cardiac surgery. ResultsA total of 146 patients were enrolled, including 55 males and 91 females, with an average age of 43.03±13.11 years. There were 23 patients in the arrhythmia group and 123 patients in the non-arrhythmia group. One (0.49%) patient died in the hospital. Univariate analysis suggested that age, body weight, body mass index (BMI), diabetes, New York Heart Association (NYHA) classification, left atrial anteroposterior diameter, left ventricular anteroposterior diameter, right ventricular anteroposterior diameter, total bilirubin, direct bilirubin, uric acid, red blood cell width, operation time, CPB time, aortic cross-clamping time, and operation type were associated with postoperative arrhythmia (P<0.05). Multivariate binary logistic regression analysis suggested that direct bilirubin (OR=1.334, 95%CI 1.003-1.774, P=0.048) and aortic cross-clamping time (OR=1.018, 95%CI 1.005-1.031, P=0.008) were independent risk factors for arrhythmia after robotic cardiac surgery. In the arrhythmia group, postoperative tracheal intubation time (P<0.001), intensive care unit stay (P<0.001) and postoperative hospital stay (P<0.001) were significantly prolonged, and postoperative high-dose blood transfusion events were significantly increased (P=0.002). Conclusion Preoperative direct bilirubin level and aortic cross-clamping time are independent risk factors for arrhythmia after robotic cardiac surgery. Postoperative tracheal intubation time, intensive care unit stay, and postoperative hospital stay are significantly prolonged in patients with postoperative arrhythmia, and postoperative high-dose blood transfusion events are significantly increased.
ObjectiveTo analyze the risk factors for complications after robotic segmentectomy.MethodsClinical data of 207 patients undergoing robot-assisted anatomical segmentectomy in our hospital from June 2015 to July 2019 were retrospectively analyzed, including 69 males and 138 females with a median age of 54.0 years. The relationship between clinicopathological factors and prolonged air leakage, pleural effusion, and pulmonary infection after surgery was analyzed.ResultsAfter robot-assisted segmentectomy, 20 (9.7%) patients developed prolonged air leakage (>5 d), 17 (8.2%) patients developed pleural effusion, and 4 (1.9%) patients developed pulmonary infection. Univariate logistic regression showed that body mass index (BMI, P=0.018), FEV1% (P=0.024), number of N1 lymph nodes resection (P=0.008) were related to prolonged air leakage after robot-assisted segmentectomy. Benign lesion was a risk factor for pleural effusion (P=0.013). The number of lymph node sampling stations was significantly related to the incidence of pulmonary infection (P=0.035). Multivariate logistic analysis showed that the BMI (OR=0.73, P=0.012) and N1 lymph node sampling (OR=1.38, P=0.001) had a negative and positive relationship with prolonged air leakage after robot-assisted segmentectomy, respectively.ConclusionThe incidence of pulmonary complications after robot-assisted segmentectomy is low. The lower BMI and more N1 lymph node sampling is, the greater probability of prolonged air leakage is. Benign lesions and more lymph node sampling stations are risk factors for pleural effusion and lung infection, respectively. Attention should be paid to the prevention and treatment of perioperative complications for patients with such risk factors.
Objective To evaluate the effects of robot-assisted Ivor Lewis esophagectomy (RAILE) in surgical treatment of esophageal cancer. Methods We retrospectively analyzed the clinical data of 70 patients diagnosed with mid-lower esophageal cancer undergoing RAILE in the Department of Thoracic Surgery in Ruijin Hospital Affiliated to Shanghai Jiaotong University between May 2015 and April 2018. There were 54 males and 16 females at average age of 62.0±7.6 years. Forty patients underwent circular end-to-end stapled intrathoracic anastomosis and 30 had a double-layered, completely hand-sewn intrathoracic anastomosis. Results The mean operating time was 308.7±60.6 minutes. And blood loss was 190.0±95.1 ml. There were 2 patients who underwent conversion to thoracotomy. There was no in-hospital and 30-day mortality. Overall complications were observed in 24 patients (34.3%), of whom 6 patients (8.6%) had anastomotic leakage. The median length of hospitalization was 9.0 (interquartile range, IQR, 5.0) days. The mean tumor size was 3.2±1.5 cm, and R0 resection was achieved in all patients. The mean number of totally dissected lymph nodes was 19.3±8.7. Conclusion RAILE is safe and technically feasible with satisfactory perioperative outcomes.
Spanning two decades since the 1st generation spinal robotics inception, the robot-assisted spine surgery (RSS) technology has evolved through generations, culminating in the 4th generation characterized by real-time visual navigation and wire-free screw placement. The fundamental principles of RSS technology include surgical planning, tracking, image registration, and robotic arm control technologies. Currently, RSS technology is maturely employed in thoracolumbar procedures and is progressively being applied in cervical surgeries, spinal tumor resections, and percutaneous operations, offering advantages in reducing tissue trauma and exposure to radiation, thereby improving patient outcomes. Emerging research also focuses on the cost-effectiveness of clinical applications and robot-specific complications. With the integration of artificial intelligence into surgical planning, RSS technology is poised to further incorporate emerging technologies and expand its application across a broader clinical spectrum.
Surgery has played an important role in treating non-small cell lung cancer (NSCLC). Resection is usually the first choice for NSCLC patients in stage Ⅰ and stage Ⅱ, and it is also an important part of the comprehensive treatment for the stage ⅢA patients. Standard surgery of NSCLC includes resection of the primary tumor lesion and swee-ping of ipsilateral lymph nodes and mediastinal lymph nodes. The goal of treatment for lung cancer in early stage aims to decrease the rate of recurrence and mortality. In recent years, video-assisted thoracoscopic surgery and da Vinci robotic minimal invasive surgery have made gratifying achievements, especially for small peripheral lung nodules surgery. For patients with NSCLC at stage ⅢA, the central focus of research is about identifying patients who will benefit in the surgery combining with chemotherapy and radiotherapy, therefore to choose the appropriate surgery.
ObjectiveTo compare the effectiveness of robot-assisted (RA) minimally invasive surgery versus traditional fluoroscopy-assisted (FA) open posterior fixation surgery in treating thoracolumbar fractures with ankylosing spondylitis (AS). MethodsA clinical data of 21 cases of thoracolumbar fractures with AS who met the selection criteria between December 2016 and December 2023 was retrospectively analyzed. Ten cases underwent RA minimally invasive surgery group (RA group) and 11 cases underwent FA open posterior fixation surgery (FA group). There was no significant difference in gender, age, fracture segment distribution, fracture type, time from injury to surgery, visual analogue scale (VAS) score, and American Spinal Injury Association (ASIA) grading between RA group and FA group (P>0.05). The operation time, intraoperative blood loss, radiation exposure time, radiation dose, hospital stay, and complications of the two groups were recorded. According to Gertzbein-Robbins criteria, the accuracy of screw implantation was evaluated by CT within 1 week after surgery. During follow-up, pain and nerve function were evaluated by VAS score and ASIA grading. ResultsAll patients underwent surgery successfully, and there was no significant difference in operation time (P>0.05). The intraoperative blood loss and hospital stay in the RA group were significantly less than those in the FA group (P<0.05), and the radiation exposure time and radiation dose were significantly more than those in the FA group (P<0.05). A total of 249 pedicle screws were implanted in the two groups, including 118 in the RA group and 131 in the FA group. According to the Gertzbein-Robbins criteria, the proportion of clinically acceptable screws (grades A and B) in the RA group was significantly higher than that in the FA group (P<0.05). Patients in both groups were followed up 3-12 months, with an average of 6.8 months. The VAS scores of the two groups after surgery were significantly lower than those before surgery, and the differences were significant (P<0.05). The RA group had lower scores than the fluoroscopy group at 1 week and 3 months after surgery (P<0.05). There was no significant difference in neurological function grading between groups at 1 week and 3 months after surgery (P>0.05). In the FA group, 1 case of deep infection and 1 case of deep vein thrombosis of lower extremity occurred, while no complication occurred in the RA group, and there was no significant difference in the incidence of complications between groups (P>0.05). Conclusion Both RA minimally invasive surgery and FA open posterior fixation surgery can achieve good effectiveness. Compared with the latter, the former has more advantages in terms of intraoperative blood loss, hospital stay, and accuracy of pedicle screw insertion.
The robotic bronchoscopy system is a new technology for lung lesion location, biopsy and interventional therapy. Its safety and effectiveness have been clinically proven. Based on many advanced technologies carried by the robotic bronchoscopy system, it is more intelligent, convenient and stable when clinicians perform bronchoscopy operations. It has higher accuracy and diagnostic rates, and less complications than bronchoscopy with the assistance of magnetic navigation and ordinary bronchoscopy. This article gave a review of the progress of robotic bronchoscopy systems, and a prospect of the combination with artificial intelligence.
Minimally invasive cardiac surgeries are the trend in the future. Among them, robotic cardiac surgery is the latest iteration with several key-hole incision, 3-dimentional visualization, and articulated instrumentation of 7 degree of ergonomic freedom for those complex procedures in the heart. In particular, robotic mitral valve surgery, as well as coronary artery bypass grafting, has evolved over the last decade and become the preferred method at certain specialized centers worldwide because of excellent results. Other cardiac procedures are in various stages of evolution. Stepwise innovation of robotic technology will continue to make robotic operations simpler, more efficient, and less invasive, which will encourage more surgeons to take up this technology and extend the benefits of robotic surgery to a larger patient population.