Surgery of the alimentary tract for benign and malignant disease with the novel robotic platform HUGOTM RAS. A first world report of safety and feasibility

Introduction

As robotic surgery increases its reach, novel platforms are being released. We present the first 17 consecutive cases of alimentary tract surgery performed with the Hugo^TM RAS (Medtronic).

Methods

patients were selected to undergo surgery from February through April 2023. Exclusion criteria were age <16 years, BMI>60, ASA IV.

Results

17 patients underwent ileocaecal resection for Chrons disease (2 M and 1 F) and pseudo-obstruction of the terminal ileum (1 M), cholecystectomy (3 M and 5 F), subtotal gastrectomy with D2 lymphadenectomy (1 F), sleeve gastrectomy (1 F), hiatal hernia repair with Nissen fundoplication (1 M), right hemicolectomy (1 M) and sigmoidectomy (1 M). No conversion to an open approach or any arm collisions requiring corrective actions were reported.

Conclusions

Our preliminary experience with the Hugo^TM RAS point to safety and feasibility for a rather wide spectrum of surgical procedures of the alimentary tract.     

Urological robotic surgery: Preliminary experience with the Zeus system

AIM: We performed robotic or robotically-assisted laparoscopic surgery for urological diseases, and evaluated the ef ficacy and safety of this surgery. METHODS: Between November 2003 and June 2004, we performed laparoscopic surgery with the Zeus system in eight cases. Three adrenalectomy cases of cortical adenoma presenting with Cushing syndrome and primary aldosteronism, and two cases of nephrectomy for renal cell carcinoma in dialyzed patients were performed solely with Zeus. In two cases of ureteral stenosis, Zeus was used for ureteral anastomosis after partial ureterectomy by manual laparoscopy. In one prostatectomy case, vesico-urethral anastomosis was performed with Zeus after extraperitoneal prostatectomy by manual laparoscopy. RESULTS: All of the cases were successfully treated without any complications during or after operation. All patients were discharged from hospital within 12 days postoperatively. As for adrenalectomy, nephrectomy and pyeloplasty, this may be the fi rst report in Japan. CONCLUSIONS: Our preliminary experiences suggest that such a robot system, which is being developed day by day, might become more beneficial in future in urological laparoscopic surgery.     

Robotic cholecystectomy: learning curve, advantages, and limitations

BACKGROUND: Robotic cholecystectomy is safe, feasible procedure. Initial studies showed significant set up time and operating time but no clear clinical advantage of the robotic involvement. We have investigated the learning curve, advantages and limitation of the procedure. MATERIAL AND METHODS: We reviewed all (n = 51) robotic cholecystectomies performed between July 2004 and December 2005. The surgery was performed using the da Vinci system. We recorded operative time, setup time of robotics instrumentation, conversion to laparoscopic or open cholecystectomy and complication of the procedure. RESULTS: Forty-eight of the 51 procedures (94%) were completed robotically. We did not experience any significant complications directly related to robotics surgery. The mean +/- SD operating time was 77 +/- 22.3 min. The mean setup time for robotics (from incision until robot was in place, including draping the robot) was 24 +/- 8.8 min. However, the setup time significantly improved as we gained more experience: from 30.6 +/- 10.7 min (first 16 cases) to 18.3 +/- 4.0 min (cases 33-48). The mean robotic time was 34 +/- 16.1 min. We observed no significant improvement in robotic procedure time. CONCLUSIONS: Robotic cholecystectomy offers significant advantages such as three-dimensional view, easier instrument manipulations and possibility of remote site surgery. We observed some shortcomings of robotic surgery such as need for larger and additional ports, and need for undocking the machine in case of cholangiography or change of patient position. Our data shows that the learning curve is between 16 to 32 procedures to significantly decrease the setup time and total operating time.     

应用达芬奇机器人手术系统肺切除技术总结

目的总结应用达芬奇机器人手术系统进行肺切除手术的经验和教训。 方法回顾性分析2012年3月至2015年11月沈阳军区总医院胸外科应用达芬奇机器人手术系统对206例肺癌患者进行肺切除手术的临床资料,其中男性120例,女性86例;平均年龄61岁。按年度分别统计,分析机器人肺叶切除的学习曲线。 结果206例肺癌患者均应用达芬奇机器人完成肺叶切除(或联合肺叶切除)和淋巴结清除术,其中右肺上叶切除58例,右肺下叶切除48例,右肺中叶切除11例,左肺上叶切除35例,左肺下叶切除53例,另有1例同期行左肺上叶病灶切除和右肺上叶切除;所有患者行系统淋巴结清除术。其中3例因肺动脉出血辅助小切口行肺动脉修补,无中转开胸病例。术后病理检查显示腺癌157例(双肺同期手术患者双侧均为腺癌),鳞癌17例,腺鳞癌19例,小细胞癌7例,其他6例。无围手术期死亡病例。 结论应用达芬奇机器人手术系统行肺切除手术总体安全有效,稳定和配合默契的手术团队有助于手术安全和效率的提高。     

遥控手术机器人动物实验模型的建立

目的 建立机器人外科手术动物模型,掌握遥控外科机器人(Zeus)的基本性能和手术方法,建立手术操作常规。方法 应用Zeus外科机器人系统完成3例腹腔镜猪胆囊切除术,观察术前准备时间、手术时间、出血量、手术并发症及术后生存情况。结果 3只接受胆囊切除术后的猪均恢复顺利,随着手术经验的积累,术前准备时间由120min缩短为60min,手术时间由60min缩短到15 min,出血量由20 ml减少到5 ml,除1只猪在术中有胆囊破裂、胆汁泄漏外,其余2只无任何并发症的发生。结论 Zeus手术机器人具有术野图像更清晰稳定、操作更精确、轻柔和可实施远程手术优势,可安全应用于临床。