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.
ObjectiveTo summarize the application and research progress of robotic-arm in total knee arthroplasty (TKA).MethodsRelevant literature at home and abroad was extensively reviewed to analyze the advantages and disadvantages of robotic-arm assisted TKA (RATKA).ResultsAccurate reconstruction of lower extremity alignment and rotation alignment, accurate osteotomy and implant prosthesis in TKA are very important to improve the effectiveness and prolong the life of the prosthesis. Traditional TKA deviations occur in key links such as osteotomy due to operator’s operation. RATKA solves the above problems to a certain extent and can assist accurate osteotomy and implant prosthesis, and protect the soft tissues around the knee joint. Patients’ satisfaction after RATKA is high, and the operator’s learning curve is shorter, which improves the efficiency of the operation. But it also has disadvantages such as prolonged operation time, increased complications and medical costs.ConclusionPreliminary clinical application studies have shown that RATKA has satisfactory effectiveness, but its definite advantages compared with traditional TKA need to be confirmed by a large number of randomized controlled trials and long-term follow-up.
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.
ObjectiveTo systematically review the clinical utilization of robotic bronchoscopes in diagnosis of pulmonary nodules, including MonarchTM and IonTM platforms, and then evaluate the efficacy and safety of the procedure. MethodsPubMed, EMbase, Web of Science and Cochrane Central Register of Controlled Trials databases were searched by computer for literature about the biopsy of pulmonary nodules with robotic bronchoscope from January 2018 to February 14, 2022. The quality of research was evaluated with Newcastle-Ottawa Scale. RevMan 5.4 software was used to conduct the meta-analysis. ResultsFinally, 19 clinical studies with 1 542 patients and 1 697 targeted pulmonary nodules were included, of which 13 studies used the IonTM platform and 6 studies used the MonarchTM platform. The overall diagnostic rate of the two systems was 84.96% (95%CI 62.00%-95.00%), sensitivity for malignancy was 81.79% (95%CI 43.00%-96.00%), the mean maximum diameter of the nodules was 16.22 mm (95%CI 10.98-21.47), the mean procedure time was 61.86 min (95%CI 46.18-77.54) and the rate of complications occurred was 4.76% (95%CI 2.00%-15.00%). There was no statistical difference in the outcomes between the two systems. Conclusion Robotic bronchoscope provides a high efficacy and safety in biopsy of pulmonary nodules, and has a broad application prospect for pulmonary nodules diagnosis.
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 explore the application effect of the individualized preoperative visit to the da Vinci Robotic lobectomy patients. MethodSixty lobectomy patients with 34 males and 26 females at age of 29 to 78 (58.4±12.4) years were divided into two groups according to the order of their medical treatment in our hospital between June 2014 and December 2014. In the control group we used conventional reoperative visit method, while in the observation group we used individualized preoperative visit method. And the rehabilitation effects of the two groups were compared. ResultsPostoperative drainage tube time (6.17±1.34 d vs. 7.13±1.17 d, P=0.004) and length of hospital stay (7.13±1.17 d vs. 8.37±1.92 d, P=0.004) were significantly shorter in the observation group than those in the control group. Postoperative pain score was significantly lower in the observation group than that in the control group (0.87±0.73 points vs. 2.60±0.81 points, P=0.000). Also in the observation group the patients had a higher degree of satisfaction with a statistical difference (P<0.05). ConclusionIndividualized preoperative visit relieves patients' concern of the effect of the robotic operation, effectively reduces the psychological pressure of patients, strengthens the confidence of patients to overcome the disease, so that patients can actively cooperate with the operation, which promote postoperative rehabilitation.
Objective To compare the perioperative outcomes of atypical segmentectomy between robotic-assisted thoracoscopic surgery (RATS) and conventional video-assisted thoracoscopic surgery (VATS) in early-stage non-small cell lung cancer (NSCLC). MethodsThe data of patients who underwent minimally invasive anatomic atypical segmentectomy in our hospital from October 2016 to December 2021 were collected. These patients were divided into a RATS group and a VATS group according to the operation method. Propensity score (PS) matching was used to select patients with close clinical baseline characteristics, and the perioperative results of the two groups were compared. ResultsA total of 1 048 patients were enrolled, including 320 males and 728 females, with a mean age of 53.51±11.13 years. There were 277 patients in the RATS group and 771 patients in the VATS group. After 1∶1 PS matching, 277 pairs were selected. Both groups were well balanced for age, sex, smoking history, body mass index, Charlson comorbidity index, pulmonary function, tumor size, tumor location, and histological type. All patients were R0 resection, and there were no deaths within 30 days after surgery. The RATS group had shorter operative time [85 (75, 105) min vs. 115 (95, 140) min, P<0.001] and less blood loss [50 (30, 100) mL vs. 60 (50, 100) mL, P=0.001]. There were no statistical differences between the two groups in lymph node resection, conversion to thoracotomy, thoracic drainage time, total amount of thoracic drainage or postoperative complications (P>0.05). ConclusionBoth RATS and VATS atypical segmentectomies are safe and feasible for early-stage NSCLC. RATS can effectively shorten the operative time, and reduce blood loss.
ObjectiveTo investigate the feasibility and advantage of the da Vinci S Surgical System in operation of the mediastinal tumor without chest tube. MethodsFrom March 2011 up to March 2015, 39 patients in our hospital with mediastinal tumor underwent resection without a chest tube by da Vinci System were as a no chest tube group with 24 males and 15 females at age of 47.28 (18-73) years. In the same period, 50 patients with mediastinal cyst underwent resection with a chest tube insertion by da Vinci System were as a chest tube group with 25 males and 25 females at age of 49.24 (22-82) years. Clinical data of the two groups were collected and compared. ResultThere were statistical differences in mean operative time (61.97±16.41min vs. 79.90±33.19 min, P=0.003), time of ICU stay (1.23±0.48 d vs. 2.16±0.82 d, P=0.000), time of postoperative hospitalization (3.77±1.16 d vs. 5.62±2.22 d, P=0.000), and visual analogue scale (VAS) score (3.05±1.76 vs. 4.54±1.83). The clinical results in the no chest tube group were better than those in the chest tube group. All the procedures were successfully completed by da Vinci System in all the patients without conversions and any compilcation. ConclusionIt's safe and beneficial for patients without a chest tube after a mediastinal tumor resection with da Vinci S Surgical System with shorter hospital stay.
Objective?To approach feasibility, safety, and the application range of pure laparoscopic resection （PLR）, hand-assisted laparoscopic resection （HALR）, and robotic liver resection （RLR） in the minimally invasive liver resection （MILR）. Methods?The clinical data of 128 patients underwent MILR in the Surgical Department of the Shanghai Ruijin Hospital from September 2004 to January 2012 were analyzed retrospectively. According to the different methods, the patients were divided into PLR group, HALR group, and RLR group. The intraoperative findings and postoperative recovery of patients in three groups were compared.?Results?There were 82 cases in PLR group, 3 cases of which were transferred to open surgery；the mean operating time was （145.4±54.4） minutes （range：40-290 minutes）；the mean blood loss was （249.3±255.7） ml （range：30-1 500 ml）；abdominal infection was found in 3 cases and biliary fistula in 5 cases after operation, but all recovered after conservative treatment；the mean length of hospital stay was （7.1±3.8） days （range：2-34 days）. There were 35 cases in HALR group, 3 cases of which were transferred to open surgery；the mean operating time was （182.7±59.2） minutes （range：60-300 minutes）；the mean blood loss was （754.3±785.2） ml （range：50-3 000 ml）；abdominal infection was found in 1 case, biliary fistula in 2 cases, and operative incision infection in 2 cases after operation, but all recovered after conservative treatment；the mean length of hospital stay was （15.4±3.7） days （range：12-30 days）. There were 11 cases in RLR group, 2 cases of which were transferred to open surgery； the mean operating time was （129.5±33.5） minutes （range：120-200 minutes）； the mean blood loss was （424.5±657.5） ml （range：50-5 000 ml）； abdominal infection was found in 1 case and biliary fistula in 1 case after operation, but all recovered after conservative treatment； the mean length of hospital stay was （6.4±1.6） days （range：5-9 days）. The operating time （P=0.001） and length of hospital stay （P=0.000） of the RLR group were shortest and the blood loss （P=0.000） of the PLR group was least among three groups. Conclusions?Minimally invasive resection is a safe and feasible. Different surgical procedures should be chosen according to different cases. The robotic liver resection provides new development for treatment of liver tumor.