Robotic Surgery for Cervical Cancer

The development of robotic technology has facilitated the application of minimally invasive techniques for the treatment and evaluation of patients with early, advanced, and recurrent cervical cancer. The application of robotic technology for selected patients with cervical cancer and the data available in the literature are addressed in the present review paper. The robotic radical hysterectomy technique developed at the Mayo Clinic Arizona is presented with data comparing 27 patients who underwent the robotic procedure with 2 matched groups of patients treated by laparoscopic (N = 31), and laparotomic radical hysterectomy (N = 35). A few other studies confirmed the feasibility and safety of robotic radical hysterectomy and comparisons to either to the laparoscopic or open approach were discussed. Based on data from the literature, minimally invasive techniques including laparoscopy and robotics are preferable to laparotomy for patients requiring radical hysterectomy, with some advantages noted for robotics over laparoscopy. A prospective randomised trial is currently being perfomred under the auspices of the American Association of Gyneoclogic Laparoscopists comparing minimally invasive radical hysterectomy (laparoscopy or robotics) with laparotomy. For early cervical cancer radical parametrectomy and fertility preserving trachelectomy have been performed using robotic technology and been shown to be feasible, safe, and easier to perform when compared to the laparoscopic approach. Similar benefits have been noted in the treatment of advanced and recurrent cervical cancer where complex procedures such as extraperitoneal paraortic lymphadenectomy and pelvic exenteration have been required. Conclusion: Robotic technology better facilitates the surgical approach as compared to laparoscopy for technically challenging operations performed to treat primary, early or advanced, and recurrent cervical cancer. Although patient advantages are similar or slightly improved with robotics, there are multiple advantages for surgeons.     

开放手术与关节镜手术治疗成人腘窝囊肿疗效对比

目的：对关节镜和传统开放手术的疗效进行对比,探讨成人腘窝囊肿的有效治疗方法。方法：自2007年6月至2012年12月,我科接受手术治疗并获随访的腘窝囊肿成人患者30例,将其中行关节镜囊肿内引流术14例作为治疗组,后路开放手术囊肿切除术16例为对照组。记录并比较两组术前及随访Rauschning和Lindgren分级,并行B超检查以明确囊肿复发情况。结果：术后30例均随访3～6个月,平均5．6个月。术前两组Rauschning和Lindgren分级比较差异无统计学意义（P=0．779）,术后两组Rauschning和Lindgren分级比较差异有统计学意义（P=0．029）,治疗组疗效优于对照组。治疗组无一例囊肿复发,对照组复发率31％（5／16）,两组复发率比较差异有统计学意义（P=0．041）。结论：关节镜手术治疗成人腘窝囊肿,疗效更好,术后复发率更低,优于传统开放手术。     

腹腔镜与开腹手术治疗良性卵巢囊肿的临床效果对比

目的 探讨采用腹腔镜与开腹手术治疗良性卵巢囊肿的临床疗效。方法 选取2012年6月~2018年8月在我院接受手术的60例良性卵巢囊肿剥除术患者,随机分为参照组和研究组,每组30例。参照组运用传统开腹手术治疗,研究组采用腹腔镜手术治疗,比较两组手术时间、手术出血量、肛门排气时间、住院时间以及并发症发生率。结果 研究组手术时间、手术出血量、肛门排气时间和住院时间分别为（77.29±9.84）min、（62.84±5.92）ml、（25.91±4.28）h 和（5.28±1.17）d,均优于参照组的（91.52±12.85）min、（102.75±12.49）ml、（39.07±6.24）h和（8.03±1.73）d,差异具有统计学意义（P＜0.05）。研究组术后并发症发生率为6.00%,低于参照组的20.00%,差异具有统计学意义（P＜0.05）。结论 采用腹腔镜与开腹手术治疗良性卵巢囊肿均可以达到良好的临床疗效,但是腹腔镜手术较开腹手术创伤更小,并发症更少,患者整体恢复情况更为理想。     

Methodology in Conventional Head and Neck Reconstruction Following Robotic Cancer Surgery: A Bridgehead Robotic Head and Neck Reconstruction

PurposeRobotic head and neck surgery is widespread nowadays. However, in the reconstruction field, the use of robotic operations is not. This article aimed to examine methodologies for conventional head and neck reconstruction after robotic tumor surgery in an effort to obtain further options for future reconstruction manipulations.Materials and MethodsA retrospective review of all patients who received head and neck robot surgery and conventional reconstructive surgery between October 2016 and September 2021.ResultsIn total, 53 cases were performed. 67.9% of the tumors were greater than 4 cm. Regarding defect size, 47.2% of the lesions were greater than 8 cm. In terms of TNM stage, stage 3 disease was recorded in 26.4% and stage 4 in 52.8%. To make a deep and narrow field wider, we changed the patient’s posture in pre-op field, additional dissection was done. We used radial forearm flap mostly (62.2%).ConclusionConventional head and neck reconstruction after robotic ENT cancer surgery is possible. One key step is to secure additional space in the deep and narrow space left after robotic surgery. For this, we opted for a radial forearm flap mostly. This can be performed as a bridgehead to perform robotic head and neck reconstruction.     

Comparative Survival Outcome of Robot-Assisted Staging Surgery Using Three Robotic Arms versus Open Surgery for Endometrial Cancer

PurposeThere is lack of data on direct comparison of survival outcomes between open surgery and robot-assisted staging surgery (RSS) using three robotic arms for endometrial cancer. The purpose of this study was to compare the overall survival (OS) and disease-free survival (DFS) between open surgery and RSS using three robotic arms for endometrial cancer.Materials and MethodsConsecutive women with endometrial cancer who underwent surgery between May 2006 and May 2018 were identified. Robotic procedures were performed using the da Vinci robotic system, and the robotic approach consisted of three robotic arms including a camera arm. Propensity score matching, as well as univariate and multivariate Cox regression of OS and DFS were performed according to clinicopathologic data and surgical method.ResultsThe study cohort included 423 unselected patients with endometrial cancer, of whom 218 underwent open surgery and 205 underwent RSS using three robotic arms. Propensity score-matched cohorts of 146 women in each surgical group showed no significant differences in survival: 5-year OS of 91% vs. 92% and DFS of 86% vs. 89% in the open and robotic cohorts, respectively (hazard ratio, 1.02; 95% confidence interval, 0.82–1.67). In the univariate analysis with OS as the endpoint, surgical method, age, stage, type II histology, grade, and lymph node metastasis were independently associated with survival. Surgical stage, grade, and type II histology were found to be significant independent predictors for OS in the multivariate analysis.ConclusionRSS using three robotic arms and laparotomy for endometrial carcinoma had comparable survival outcomes.     

Robotic spine surgery: a review of the present status

Abstract

With technological advancements being introduced and dominating many fields, spine surgery is no exception. In view of the patient safety and surgeon’s comfort, robotics has been introduced in spine surgery. Due to small corridors for work, little room for inaccuracy, lengthy and tedious procedures, spine surgery is an ideal scenario for robotics to establish as the standard of care. Spine robotics received their first FDA clearance in 2004. New generation of spine robotics with integrated navigation systems has become available now. The primary role of spine robotics, at present, is to aid pedicle screw fixation. High quality studies have been performed to establish its role in increasing the accuracy of pedicle fixation. Studies have also reported decreased radiation and decreased operative time with spine robotics. However, few studies have reported otherwise. It is still in its nascent stage in both industrial view and surgeon familiarity. Continued research to overcome the challenges such as high cost and steep learning curve is crucial for its widespread use. Also, expanding the scope of spine robotics beyond pedicle screw fixation such as osteotomies and dural procedures would be an area for potential research. This review is intended to provide an overview of various studies in the field of robotic spine surgery and its present status.     

Retrospective evaluation of inpatients admitted to a tertiary hospital in Somalia for Pediatric surgery

ObjectiveThe aim is to reflect on the epidemiology of the patient population at a tertiary hospital for pediatric surgery, diagnostic pattern, and mortality in Somalia retrospectively.MethodsIn this study, 163 patient who were hospitalized to Pediatric Surgery Clinic of Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital in 2018 were included. Data regarding age, gender, diagnosis, surgical condition, mortality rate and cause of the death were recorded from the patient charts and the institutional digital databaseResultsOf 163 patients 47 were female (28.8%) and 116 were male (71.2%). The mean age of the patients was 6.4 ± 4.8 years. The main diagnoses were congenital malformation (34.4%), acute abdomen (25.8%), traumatic injury (23.3%), infection (9.8%) and neoplasm (6.1%). Mortality rate was 9.8% and the leading cause of death was sepsis by 87.5%. Perforated appendicitis, intestinal obstruction and intussusception were creating the 68.7% of the diseases that result in death.ConclusionsOur results show that two-thirds of the surgical deaths could be prevented with timely presentation. We think that the health policymakers in Somalia should focus on how to improve the access to surgical care, patient transfer, timely presentation, and training of pediatric surgeons and to overcome the poor surgical outcomes.     

开腹手术和腹腔镜手术治疗急性胆源性胰腺炎的 对比性研究

目的 比较开腹手术和腹腔镜手术治疗急性胆源性胰腺炎的临床疗效。方法 选取2015年9月~2017年2月到我院就诊的急性胆源性胰腺炎患者130例,随机分为对照组和观察组,各65例。对照组患者采用开腹手术治疗,观察组患者采用腹腔镜手术进行治疗。比较两组患者出血量、止痛时间、住院时间及术后总恢复率。结果 观察组患者出血量为（84.81±0.27）ml、止痛时间（2.3±1.21）d、住院时间（14.21±3.27）d,低于对照组患者的出血量（145.42±0.16）ml、止痛时间（8.1±2.12）d以及住院时间（22.1±2.06）d,差异有统计学意义（P＜0.05）;观察组患者术后总恢复率（86.15%）高于对照组的总恢复率（76.92%）,差异有统计学意义（P＜0.05)。结论 采用腹腔镜手术治疗急性胆源性胰腺炎,可以降低手术出血量,止痛时间,也可以缩短患者的住院时间,创伤小,恢复率高。     

New Technologies Making Use of Sulfacrylate in Pediatric Surgery

Sulfacrylate glue composition was used in surgery for traumatic injuries to parenchymatous organs for attaining hemostasis and hermetic sealing of intestinal anastomoses and hollow organs, in cancer patients, in gynecological and thoracic surgery, and in correction of congenital defects. Glue composition ensures reliable intraoperative hemostasis, hermetic sealing of wounds in parenchymatous and hollow organs, prevents infection of the abdominal and thoracic cavities, thus reducing endotoxicosis and stimulating tissue regeneration. The use of Sulfacrylate optimized surgery, facilitated operative technology in difficult situations, and prevented the development of postoperative complications.     

小儿腹部外科急性胃肠功能衰竭的治疗（附43例分析）

目的探讨小儿腹部外科急性胃肠功能衰竭的治疗方案。方法 2000年2月至2010年2月小儿腹部外科出现急性胃肠功能衰竭病人,给予胃肠减压,应用大黄促进胃肠蠕动,抑酸剂抑制胃酸分泌,胃肠道出血后行止血治疗,并进行改善微循环、控制感染、营养支持等处理。结果全部病例43例,死亡18例,死亡率41.86%。其中早期干预胃肠功能障碍23例,死亡6例,死亡率为26.09%;晚期干预组20例,死亡12例,死亡率为60.00%,两组比较,差异有统计学意义（χ2=5.05,P〈0.05）。大黄组15例,死亡3例,死亡率为20.00%;非大黄使用组28例,死亡15例,死亡率为53.57%,两组比较,差异有统计学意义（χ2=4.52,P〈0.05）。本组均有上消化道出血,胃内用止血药16例,3例死亡;单纯静脉应用立止血、抑酸剂等药27例,死亡15例,显示胃有出血时从胃内用药明显优于单纯静脉用药（χ2=5.59,P〈0.05）。结论对小儿腹部外科危重症儿胃肠功能衰竭的早认识,早干预,采用胃肠减压、应用大黄、出现上消化道出血后应从胃管注入止血药等综合治疗措施,是降低病死率的关键。     

The early surgical period in robotic radical hysterectomy is related to the recurrence after surgery in stage IB cervical cancer

Objective: To identify the pattern of recurrence and assess the clinicopathologic prognostic factors for survival after robotic radical hysterectomy (RRH) in the treatment of stage IB cervical cancer.Methods: From December 2008 to March 2018, 64 cervical cancer patients who underwent RRH with pelvic lymph node dissection by a single surgeon were enrolled in this retrospective historical cohort timeline study. The patient''s status was estimated in terms of operative outcomes, pathologic results, and survival outcomes.Results: The median follow-up was 63 months. The recurrence rate was 9.4% (6/64). There were two recurrences at the vaginal vault, two in the pelvic cavity, and two at the peritoneum in the intraabdominal cavity. The overall survival rate was 95.3% (61/64). When patients were divided into three groups in order based on surgery date, the first surgical period showed significantly higher recurrence rate (21%) compared to both the second (10%) and the third period (0%) (p=0.037). Multivariate analysis showed that the early period of RRH (p=0.025) and clinical tumor size more than 3 cm (p=0.003) were prognostic factors related to the recurrence. Although there was no statistical significance, there has been no recurrence since a uterine manipulator was not used.Conclusion: The early surgical period and large tumor were related to the disease recurrence after RRH. We suggest that the achievement of proficiency and appropriate patient selection are critical for prognosis after RRH in stage IB cervical cancer.     

Performance and Symptom Validity Testing in Pediatric Assessment: A Review of the Literature

ABSTRACT

There has been an increased recognition that validity testing is an integral component of evaluations conducted with youth. The incorporation of validity testing provides an objective basis for placing confidence in the test data as an accurate assessment of the child’s or adolescent’s current ability level and/or an accurate indication of the child’s or adolescent’s current symptoms or behavioral functioning. The use of objective performance validity and symptom validity is consistent with the current emphasis of data-driven decision-making. This paper provides a review of the literature on performance and symptom validity tests for children and adolescents. The strengths and limitations of the available validity tests are discussed, and recommendations for use in pediatric assessments are provided.     

达芬奇机器人手术系统在胃癌中的应用

目的：总结应用达芬奇机器人手术系统行胃癌根治术的经验,评价其手术效果及应用价值。方法：回顾性分析我科2011年11月至2014年11月手术治疗的250例胃癌患者的临床、病理资料。其中机器人手术126例,腹腔镜手术124例,比较两组患者手术情况及短期疗效。结果：与腹腔镜组相比,机器人组患者术中失血量少、淋巴结清扫数目多、手术时间长,比较差异有统计学意义(P<0.05);术后胃肠道功能恢复时间、术后住院时间及并发症发生率,比较差异无统计学意义(P>0.05)。中位随访17.2(3~30)个月,机器人组复发转移10例,死亡3例;腹腔镜组复发转移12例,死亡2例。结论：达芬奇机器人手术可在微创条件下实现胃癌的标准D2根治术,手术操作安全,临床效果确实。     

A description of arterial variants in the transoral approach to the parapharyngeal space

This study demonstrates variations in the vascular anatomy of the parapharyngeal space (PPS) as seen from the transoral approach compared with the transcervical approach. The PPS was dissected in injected cadaveric specimens. Anatomical measurements, including those of branches of the external and internal carotid arteries (ECA and ICA) and the styloglossus and stylopharyngeus muscles, were recorded and analyzed. In 67% (8/12) of cases, the ascending palatine artery (APA) originated from the facial artery and crossed the styloglossus muscle. The diameter of the APA at its origin was 1.4 ± 0.3mm. In 75% (9/12) of cases, the ascending pharyngeal artery (aPA) arose from the medial surface of the ECA near its origin. In 58% (7/12) of cases, the aPA ascended vertically between the ICA and the lateral pharynx to the skull base, along the longus capitus muscle. The aPA crossed the styloglossus muscle 12.6 ± 3.9mm from the insertion into the tongue. In 92% (11/12) of cases, the ECA and ICA were separated by the styloid diaphragm and pharyngeal venous plexus. In 8% (1/12), the ECA bulged into the parapharyngeal fat between the styloglossus and stylopharyngeus muscles adjacent to the pharyngeal constrictors. Knowledge of the precise anatomy of the PPS is important for transoral robotic surgery (TORS). Control of the vessels that supply and traverse the PPS can help the TORS surgeon avoid those critical structures and reduce surgical morbidity and potential hemorrhage. Clin. Anat. 27:1016–1022, 2014. © 2014 Wiley Periodicals, Inc.     

电视胸腔镜手术与传统手术治疗胸腺瘤的疗效比较

目的 观察电视胸腔镜手术与传统手术治疗胸腺瘤的临床疗效。方法 选取2017年12月~2019年6月在我院治疗的84例胸腺瘤患者,随机分为对照组和观察组,各42例。对照组采用传统手术治疗,观察组采用电视胸腔镜手术治疗,比较两组临床治疗手术指标、治疗前后肺功能指标以及并发症发生情况。结果 观察组术中出血量、手术时间、下床活动时间、切口长度、术后引流量均低于对照组（P＜0.05）;两组FEV1、FVC与疲劳指数均低于治疗前,且对照组FEV1、FVC低于观察组,对照组疲劳指数高于观察组（P＜0.05）;观察组并发症发生率（4.76%）低于对照组（16.67%）（P＜0.05）。结论 电视胸腔镜手术治疗胸腺瘤疗效良好,且手术时间短、术中出血量少,下床时间早,术后引流量少,利于患者术后康复,且术后并发症发生率低,对肺功能影响小,较传统手术治疗效果比较明显,值得临床应用。     

Predictors of Red Blood Cell Transfusion in Bimaxillary Orthognathic Surgery: A Retrospective Study

Background: Orthognathic surgery requires red blood cell (RBC) transfusions more frequently than other oral and maxillofacial surgeries. The purpose of this study was to identify reliable predictors for RBC transfusion during bimaxillary orthognathic surgery (BOS).Methods: This retrospective study reviewed 1,616 electronic medical records of patients who underwent BOS during a 5-year period at Seoul National University Dental Hospital. The perioperative variable data were collected from electronic medical records and analyzed by dividing patients into the two groups (non-transfusion and transfusion group).Results: Of the 1,616 patients, 1,311 patients were excluded. The remaining 305 patients were divided into non-transfusion (NTF, n = 256) and transfusion (TF, n = 49) groups. Univariate logistic regression analysis revealed that age, body mass index, the presence of several adjunctive surgeries (including genioplasty, extraction, and mandibular angle reduction), preoperative hemoglobin (Hb) and prothrombin time, surgical time, amount of fluid infusion and blood loss, and mean pulse rate during surgery were significant factors predicting RBC transfusion. Multivariate logistic regression analysis revealed that preoperative Hb and blood loss amount during surgery were significantly related to RBC transfusion in BOS patients.Conclusion: Since blood loss amounts could not be measured preoperatively, we found that the independent predictor associated with RBC transfusion during BOS was a low preoperative Hb level.     

Comparison of Techniques for Correction of Magnification of Pelvic X-rays for Hip Surgery Planning

The aim of this study was to develop an accurate method for correction of magnification of pelvic x-rays to enhance accuracy of hip surgery planning. All investigated methods aim at estimating the anteroposterior location of the hip joint in supine position to correctly position a reference object for correction of magnification. An existing method—which is currently being used in clinical practice in our clinics—is based on estimating the position of the hip joint by palpation of the greater trochanter. It is only moderately accurate and difficult to execute reliably in clinical practice. To develop a new method, 99 patients who already had a hip implant in situ were included; this enabled determining the true location of the hip joint deducted from the magnification of the prosthesis. Physical examination was used to obtain predictor variables possibly associated with the height of the hip joint. This included a simple dynamic hip joint examination to estimate the position of the center of rotation. Prediction equations were then constructed using regression analysis. The performance of these prediction equations was compared with the performance of the existing protocol. The mean absolute error in predicting the height of the hip joint center using the old method was 20 mm (range −79 mm to +46 mm). This was 11 mm for the new method (−32 mm to +39 mm). The prediction equation is: height (mm) = 34 + 1/2 abdominal circumference (cm). The newly developed prediction equation is a superior method for predicting the height of the hip joint center for correction of magnification of pelvic x-rays. We recommend its implementation in the departments of radiology and orthopedic surgery.     

超声引导下麦默通乳腺微创旋切术与传统手术治疗 乳腺良性肿瘤的疗效比较

目的 对比超声引导下麦默通乳腺微创旋切术与传统手术治疗乳腺良性肿瘤的疗效。方法 选取2015年6月~2018年12月本院收治的乳腺良性肿瘤患者112例,随机分为观察组和对照组,每组56例。观察组行超声引导下麦默通乳腺微创旋切术治疗,对照组行传统手术治疗,比较两组手术相关指标、术后创面疼痛程度、切口愈合时间及并发症情况。结果 观察组术中出血量、手术时间、VAS评分、切口愈合时间均优于对照组［（4.52±2.12）ml vs（10.64±3.25）ml］、［（17.52±4.58）min vs（31.48±10.25）min］、［（2.87±1.12）分vs（4.35±1.21）分］、［（3.29±1.16）d vs（6.15±2.14）d］,差异有统计学意义（P＜0.05）。观察组并发症总发生率为3.57%,低与对照组的14.29%,差异有统计学意义（P＜0.05）。结论 与传统手术相比,超声引导下麦默通乳腺微创旋切术对乳腺良性肿瘤患者创伤较小,利于减轻患者术后疼痛程度,促进切口愈合,且安全性更高。