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Short-term outcomes of robotic liver resection: An initial singleinstitution experience

World Journal of Hepatology 2022年第1期14卷 224-233页

作者： Manuel Durán Javier Briceño Ana Padial Ferdinando Massimiliano Anelli Juan Manuel Sánchez-Hidalgo María Dolores Ayllón Rafael Calleja-Lozano Carmen García-Gaitan Unit of Hepatobiliary Surgery and Liver Transplantation General and Digestive Surgery DepartmentReina Sofia University HospitalCordoba 14004Spain GC18 Translational Research in Surgery of Solid Organ Transplantation Maimonides Biomedical Research InstituteCórdoba 14004Spain GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery Maimonides Biomedical Research InstituteCórdoba 14004Spain Department of Anesthesiology and Resuscitation Reina Sofia University HospitalCordoba 14004Spain

BACKGROUND Liver surgery has traditionally been characterized by the complexity of its procedures and potentially high rates of morbidity and mortality in inexperienced hands.The robotic approach has gradually been introduced in liver surgery and has increased notably in recent years.However,few centers currently perform robotic liver surgery and experiences in robot-assisted surgical procedures continue to be limited compared to the laparoscopic approach.AIM To analyze the outcomes and feasibility of an initial robotic liver program implemented in an experienced laparoscopic hepatobiliary center.METHODS A total of forty consecutive patients underwent robotic liver resection(da vinci Xi,***,United States)between June 2019 and January 2021.Patients were prospectively followed and retrospectively reviewed.Clinicopathological characteristics and perioperative and short-term outcomes were analyzed.data are expressed as mean and standard deviation.The study was approved by the Institutional Review Board.RESULTS The mean age of patients was 59.55 years,of which 18(45%)were female.The mean body mass index was 29.41 kg/m^(2).Nine patients(22.5%)were cirrhotic.Patients were divided by type of resection as follows:Ten segmentectomies,three wedge resections,ten left lateral sectionectomies,six bisegmentectomies(two VVI bisegmentectomies and four IVb-V bisegmentectomies),two right anterior sectionectomies,five left hepatectomies and two right hepatectomies.Malignant lesions occurred in twenty-nine(72.5%)of the patients.The mean operative time was 258.11 min and two patients were transfused intraoperatively(5%).Inflow occlusion was used in thirty cases(75%)and the mean total clamping time was 32.62 min.There was a single conversion due to uncontrollable hemorrhage.Major postoperative complications(Clavien–Dindo>Ⅲb)occurred in three patients(7.5%)and mortality in one(2.5%).No patient required readmission to the hospital.The mean hospital stay was 5.6 d.CONCLUSION Although robotic hepatectomy is a safe and feasible procedure wi

关键词： Robotics Hepatectomy Minimally invasive surgery Liver surgery da vinci

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Robotic anterior resection of rectal cancer： technique and early outcome

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Chinese Medical Journal 2013年第1期126卷 51-54页

作者： DU Xiao-hui SHEN Di LI Rong LI Song-yan NING Ning ZHAO Yun-shan ZOU Zhen-yu LIU Na Department of General Surgery People's Liberation Army General Hospital Beijing 100853 China Hainan Branch People's Liberation Army General Hospital Beijing 100853 China

Background The da vinci system is a newly developed device for colorectal surgery. With advanced stereoscopic vision, lack of tremor, and the ability to rotate the instruments surgeons find that robotic systems are ideal laparoscopic tools. Since conventional laparoscopic total mesorectal excision is a challenging procedure, we have sought to assess the utility of the da vinci robotic system in anterior resections for rectal cancer. Methods Between November 2010 and December 2011, a total of 22 patients affected by rectal cancer were operated on with robotic technique, using the da vinci robot. data regarding the outcome and pathology reports were prospectively collected in a dedicated database. Results There were no conversions to open surgery and no postoperative mortality of any patient. Mean operative time was （220±46） minutes （range, 152-286 minutes）. The median number of lymph nodes harvested was （14.6±6.5）（range, 8-32）, and the circumferential margin was negative in all cases. The distal margin was （2.6±1.2） cm （range, 1.0-5.5 cm）. The mean length of hospital stay was （7.8±2.6） days （range, 7.0-13.0 days）. Macroscopic grading of the specimen was complete in 19 cases and nearly complete in three patients. Conclusions Robotic anterior resection for rectal surgery is safe and feasible in experienced hands. Outcome and pathology findings are comparable with those observed in open and laparoscopy procedures. This technique may facilitate minimally invasive radical rectal surgery.

关键词： robotic surgery rectal cancer da vinci resection

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Outcomes after robot-assisted laparoscopic radical prostatectomy

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Asian Journal of Andrology 2009年第1期11卷 94-99页

作者： Declan G. Murphy Benjamin J. Challacombe Anthony J. Costello The Urology Centre Guy＇s ＆ St. Thomas ＇NHS Foundation Trust London SE1 9RT UK Department of Urology Royal Melbourne Hospital Melbourne VIC 3054 Australia

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.

关键词： da vinci laparoscopic outcomes prostate cancer radical prostatectomy robotic

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da vinci机器人系统辅助直肠癌APR手术护理配合

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中华结直肠疾病电子杂志 2014年第1期3卷 49-51页

作者：朱勤春韦烨汪珏方玲复旦大学附属中山医院普外科上海200032

手术机器人作为一种新型微创系统具有安全、高效的优势，标志着这是外科发展史上的一次革命，预示着第三代外科手术时代的来临。达芬奇机器人手术系统它提供给外科医生另一个微创手术的选择，该系统拥有先进的三维立体视野，能模拟人手... 详细信息

手术机器人作为一种新型微创系统具有安全、高效的优势，标志着这是外科发展史上的一次革命，预示着第三代外科手术时代的来临。达芬奇机器人手术系统它提供给外科医生另一个微创手术的选择，该系统拥有先进的三维立体视野，能模拟人手腕、手指的灵活动作。2000年获Fda批准为美国第一个可在手术室使用的机器人系统。目前已广泛应用于泌尿外科、心胸外科、普外科、妇产科等，该技术的应用不但改变了手术治疗模式、打破了传统的手术室护理配合模式，也给手术室护理工作带来了新视野、新角度及新技术，但国内运用da vinci S系统完成直肠癌APR手术的护理配合尚无相关报道。我院于2013年1月值2014年2月成功实施了6例经da vinci S系统完成直肠癌APR术，现将术中护理配合报道如下。

关键词：器械护士 da vinci 机器人人工智能术中护理配合超声刀直肠癌直肠肿瘤吸引器手术器械平车货车 APR 巡回护士支臂电刀

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Robotic liver surgery is the optimal approach as bridge to transplantation

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World Journal of Hepatology 2017年第4期9卷 224-226页

作者： Paolo Magistri Giuseppe Tarantino Roberto Ballarin Andrea Coratti Fabrizio Di Benedetto Department of Medical and Surgical Sciences and Translational Medicine Sapienza - University of Rome Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit University of Modena and Reggio Emilia Department of Oncology Division of Oncological and Robotic General Surgery Careggi University Hospital

The role of minimally invasive liver surgery as a bridge to transplantation is very promising but still underestimated. However, it should be noted that surgical approach for hepatocellular carcinomas(HCC) is not merely a technical or technological issue. Nowadays, the epidemiology of HCC is evolving due to the increasing role of non-alcoholic fatty-liver-disease, and the emerging concerns on direct-acting antivirals against hepatitis C virus in terms of HCC incidence. Therefore, a fully multidisciplinary study of the cirrhotic patient is currently more important than ever before, and the management of those patients should be reserved to tertiary referral hepatobiliary centers. In particular, minimally invasive approach to the liver showed several advantages compared to the classical open procedure, in terms of:(1) the small impact on abdominal wall;(2) the gentle manipulation on the liver;(3) the limited surgical trauma; and(4) the respect of venous shunts. Therefore, more direct indications should be outlined also in the Barcelona Clinic Liver Cancer model. We believe that treatment of HCC in cirrhotic patients should be reserved to tertiary referral hepatobiliary centers, that should offer patient-tailored approaches to the liver disease, in order to provide the best care for each case, according to the individual comorbidities, risk factors, and personal quality of life expectations.

关键词： Hepatocellular 癌肝移植机器的外科桥牌到移植 da vinci 巴赛隆纳诊所肝癌症耐心的安全

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展其经营理念销其服务精神——记da vinci欧洲精品家具展销厅

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家具 1998年第5期 48-49页

作者：晓鹃维琳

在申城的淮海中路上一幢颇有欧洲古典风格的建筑终于撩开了神秘的面纱,来来往往的行人路过此地,也总要驻足观望一下这栋风格独特的建筑物,透过大玻璃窗往里看看,是一间间布置得典雅、温馨又华贵的卧室,原来,这幢以da vinci命名的楼宇,... 详细信息

在申城的淮海中路上一幢颇有欧洲古典风格的建筑终于撩开了神秘的面纱,来来往往的行人路过此地,也总要驻足观望一下这栋风格独特的建筑物,透过大玻璃窗往里看看,是一间间布置得典雅、温馨又华贵的卧室,原来,这幢以da vinci命名的楼宇,便是最近落户申城的"欧洲精品家具展销厅"。

关键词：家具 da vinci 申城木制品欧洲经营理念服务式公寓

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Robotic gastrectomy for gastric cancer

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Journal of Cancer Metastasis and Treatment 2018年第1期4卷 459-467页

作者： Masanori Tokunaga Masahiro Watanabe Shizuki Sugita Akiko Tonouchi Akio Kaito Takahiro Kinoshita Gastric Cancer Division National Cancer Center Hospital EastKashiwa 277-8577Japan

Robotic gastrectomy(RG)is increasingly performed,particularly in East Asia.With articulated devices,surgeons are able to perform every procedure more comfortably and meticulously,which makes RG ideal from the surgeon’s standpoint.However,it is still unclear whether it is a suitable treatment strategy from the patient’s viewpoint,due to the lack of solid evidence obtained from randomized controlled trials.The feasibility of RG has been demonstrated in many retrospective comparative studies,which showed similar trends,including relatively less estimated blood loss and longer operation time with RG than laparoscopic gastrectomy(LG),equivalent number of harvested lymph nodes and similar length of postoperative hospital stay between RG and LG.However,considering the higher medical expenses associated with RG,its superiority in terms of long-term survival outcomes will need to be confirmed for it to be accepted more widely.

关键词： da vinci robot gastric cancer robot assisted gastrectomy laparoscopic gastrectomy

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Role of robotic assistance in the learning of laparoscopy:Comparison of novice students’results in two FLS trials

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Open Journal of Obstetrics and Gynecology 2013年第2期3卷 292-295页

作者： Mélanie Frigenza Jérome Delotte Eric Fontas daniel Benchimol AndréBongain Jean Breaud Department of Obstetrics GynecologyReproductive Medicine and Fetal MedicineUniversity Hospital of NiceArchet 2 HospitalNice-Sophia Antipolis UniversityNiceFrance Delegation Unit for Clinical Research Cimiez HospitalNiceFrance General Surgery and Digestive Oncology Archet 2 HospitalNice-Sophia Antipolis UniversityNiceFrance Department of Pediatric Surgery Health Cooperation Group and University Hospital of LenvalNice-Sophia Antipolis UniversityNiceFrance

Background: To investigate the learning curve of “robotic surgery” versus “conventional laparoscopy” in two trials of the FLS program in a population of medical students with no experience in laparoscopy. Methods: A prospective trial. Students, all novices in training and surgical practice, were randomized into 2 groups: the “traditional laparoscopy” group and the “robotic assistance” group. Students were evaluated during two tests from the FLS: peg transfer and intracorporeal knot tying. Results: The median laparoscopic knot completion time was significantly lower in the “robotic surgery” group (p = 0.038). Conclusions: Robotic assistance training in neophytes is effective in improving the completion time of laparoscopic knots.

关键词： da vinci Learning Curve Medical Student Laparoscopy

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Robots in Cancer Surgery: A Boon or Bane

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Journal of Cancer Therapy 2020年第12期11卷 803-823页

作者： Yusuf Jamal Abdulrahman M. Alshahrani Jamal M. Arif Feras M. Almarshad Faculty of Medicine Ternopil National Medical University Ternopil Ukraine Department of Internal Medicine College of Medicine Shaqra University Shaqra KSA Department of Biochemistry College of Medicine Shaqra University Shaqra KSA

It is an ongoing task to keep exploring and applying the best available technology to alleviate the pain and sufferings of the cancer patients. Since the discovery of robotic surgery, da vinci surgical systems have played a special and significant role in cancer surgeries worldwide, however, surgeons are still skeptical with the clinical and oncological outcomes which are almost comparable to the laparoscopic approach in several cancers. Many meta-analyses using mostly retrospective studies indicated significant advantage of robotic surgery over laparoscopic or open surgery approaches for various cancers, however, scarcity of technically sound robot savvy surgeons and quality multicentered, multinational, coordinated, random clinical trials had not done justice to the positives of robotic surgery which were quite often suppressed by the negative factors like operative cost and oncological outcomes. Nevertheless, robotic surgery approach has been clinically accepted for hysterectomy and prostatectomy. This overview briefly discusses the comparative approaches (open, laparoscopic, robotic assisted) and their clinical outcomes in the surgery of various cancers.

关键词： da vinci Robotic Surgery Laparoscopic Surgery Cancers Oncologic Outcomes

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三维重建技术在胸外科机器人手术中的应用

三维重建技术在胸外科机器人手术中的应用

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作者：温佳新中国人民解放军医学院

学位级别：硕士

目的：研究应用三维重建技术选择胸外科机器人手术切口的方法。探索该方法的可行性，并将其应用于临床手术。使之成为一种确定机器人手术切口的新方法。方法：本课题在第一部分中研究了应用三维重建技术选择机器人手术切口... 详细信息

目的：研究应用三维重建技术选择胸外科机器人手术切口的方法。探索该方法的可行性，并将其应用于临床手术。使之成为一种确定机器人手术切口的新方法。方法：本课题在第一部分中研究了应用三维重建技术选择机器人手术切口的方法，在术前应用苹果公司研发的OSIRIX医学影像处理软件对胸部CT进行三维重建，明确肿物的位置、大小、与周围组织器官的毗邻关系以及在体表的投影位置。依据机器人手术操作系统的指导原则，在电脑上模拟切口可能的位置，并测量检测其位置是否合理，最终选定适合的切口。在第二部分将该方法应用于临床病例中，记录手术时间、术前准备、手术操作时间等数据，跟既往数据进行对比，讨论三维重建技术在机器人手术中的实际应用价值，以及发展前景。结果：本课题在第一部分成功将三维重建技术应用于机器人手术切口的选择中，在第二部分将该方法应用于筛选出的4例手术病例中。所选病例的肿物位于胸腔不同位置，并且性质和密度均不同。均成功在三维重建后的图像中寻找到目标肿物，并能准确的定位，确定手术切口。经过手术的验证，此方法能简单快速的确定手术切口，有效的减少了手术准备时间，提供适当的视野，足够的操作空间，保证手术顺利完成。结论：本课题中探索的利用三维重建选择机器人手术切口的方法，可在术前为术者提供明确的肿瘤位置及空间的毗邻关系，使得术者对肿瘤有直观的判断。此外利用此方法选择的手术切口，符合机器人手术操作系统的要求，给术者提供了适合的视野及方便的操作空间，而且此方法简单易行，加快了术前准备的速度，减少了手术时间。可见三维重建技术辅助机器人手术选择切口的方法简单易行，且实用性较强，值得推广，尤其是对复杂机器人手术的开展提供了帮助。但本课题的样本量有限，未能进行客观的统计学分析，需要进一步对大样本病例应用，得到客观数据支持。

关键词：三维重建机器人手术微创手术胸外科 da vinci

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