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31.
Pouya Javadian Alexander Juusela Farr Nezhat 《Journal of minimally invasive gynecology》2019,26(1):31
Study Objective
To illustrate a robotic-assisted laparoscopic resection for cervicovaginal myomectomy.Design
Step-wise instruction using video and case report (Canadian Task Force classification III).Setting
A tertiary referral center.Patient
A 39-year-old woman.Intervention
Robotic-assisted laparoscopy resection of leiomyoma.Measurements and Main Results
A 39-year-old woman, gravida 0, body mass index of 23.0?kg/m2, with a known cervicovaginal myoma that in the past underwent uterine artery embolization, presented with recurrence of her severe abnormal vaginal bleeding. She was referred for surgical resection of the mass. Magnetic resonance imaging revealed a 5-cm posterior cervicovaginal leiomyoma. The patient wanted to preserve her reproductive organs. A total robotic procedure lasted 123 minutes, with an estimated blood loss of 100?mL. She was discharged uneventfully on the day 0 postoperatively. Pathology results showed a 37-g leiomyoma of the uterus. The patient presented at her 2-weeks postoperative visit with no more complaint of vaginal bleeding.Conclusion
Robot-assisted laparoscopic surgery is a feasible approach for cervicovaginal myoma with minimal complications. 相似文献32.
Trimlett RH De Souza AC Coonar AS Jurgens KM Kuenzler R Pepper JR 《Surgical endoscopy》2004,18(2):319-322
Background: Here we explore a method of using robotics to reduce morbidity and mortality in conventional coronary surgery. Methods: Using a robotic surgical system two surgeons completed five steps: (1) 80 synthetic suture exercises; (2) 76 left internal thoracic artery to left anterior descending (LIMA-to-LAD) on porcine hearts; (3) cadaveric port placement for assessing optimal access; (4) endoscopic stabilization in the live porcine model; and, finally (5) eight clinical LIMA-to-LADs performed robotically. Results: After 70 hours training, mean dry lab times fell from 7.0 and 5.8 min to 5.7 and 5.1 min in the two surgeonstab series. Wet lab times fell from 40.1 and 28.5 min to 28.8 and 19.2 min. In the clinical series of eight patients there were no mortalities; all had uncomplicated postoperative recovery and all were angina free at 6-week follow-up. Conclusion: The learning curve for robotic training is short, and reproducible results can be achieved clinically, after appropriate training, resulting in real patient benefit. 相似文献
33.
Manual robot assisted endoscopic suturing: Time-action analysis in an experimental model 总被引:5,自引:4,他引:1
Ruurda JP Broeders IA Pulles B Kappelhof FM van der Werken C 《Surgical endoscopy》2004,18(8):1249-1252
Background Robotic surgery systems were introduced to overcome the disadvantages of endoscopic surgery. The goal of this study was to assess whether robot assistance could support endoscopic surgeons in performing a complex endoscopic task.Methods Five experienced endoscopic surgeons performed end-to-end anastomosis on post-mortem porcine small intestine. The procedure was performed both with standard endoscopic techniques and with robotic assistance (da Vinci system, Intuitive Surgical, Sunny vale, CA). It was performed in three different working directions with a horizontal, vertical, and diagonal position of the bowel. Anastomosis time, number of stitches, knots, time per stitch, suture ruptures, and the number of stitch errors were recorded. Also, an action analysis was performed.Results Anastomosis time, number of stitches, and the number of knots did not differ significantly between the two groups. The time needed per stitch was significantly shorter with robot assistance (81.4 sec/stitch vs 95.9 sec/stitch, p = 0.005). More suture ruptures occurred in the robot group (0 (0–2) vs 0 (0–0), p = 0.003). In the standard group more stitch errors were found (2 (0–5) vs 0 (0–3), p = 0.017). These results were comparable for three different working directions. The action analysis, however, showed significant benefits of robotic assistance. The benefits were greatest in a vertical bowel position.Conclusion Robot assistance might offer added value to experienced endoscopic surgeons in the performance of a small-bowel anastomosis in an experimental setup, even though total anastomosis time could not be demonstrated to be shorter and some suture tears occurred due to the lack of force feedback. 相似文献
34.
术中自肠系膜下动脉下方切开乙状结肠系膜,游离Toldts间隙,暴露并保护左侧输尿管及生殖血管。切断肠系膜下动脉根部,清扫253组淋巴结。切开乙状结肠侧腹膜,游离乙状结肠下段。提起肠系膜下动脉血管蒂(已切断),沿Toldts层面分离直肠系膜与骶前间隙,环形完整游离直肠系膜,于肿瘤标记处远端约5cm处以直线切割闭合期切断直肠肠管。肠管断端提出体外,距离肿瘤近端约10cm,切断乙状结肠肠管,并包埋吻合器钉座。行乙状结肠-直肠端端吻合(Dixon手术) 相似文献
35.
Todd M. Beste Keith H. Nelson James A. Daucher 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2005,9(1):13-15
Objectives:
To describe the use of a robotic surgical system for total laparoscopic hysterectomy.Methods:
We report a series of laparoscopic hysterectomies performed using the da Vinci Robotic Surgical System. Participants were women eligible for hysterectomy by standard laparoscopy. Operative times and complications are reported.Results:
We completed 10 total laparoscopic hysterectomies between November 2001 and December 2002 with the use of the da Vinci Robotic Surgical System. Operative results were similar to those of standard laparoscopic hysterectomy. Operative time varied from 2 hours 28 minutes to 4 hours 37 minutes. Blood loss varied from 25 mL to 350 mL. Uterine weights varied from 49 g to 227 g. A cystotomy occurred in a patient with a history of a prior cystotomy unrelated to the robotic system.Conclusion:
Total laparoscopic hysterectomy is a complex surgical procedure requiring advanced laparoscopic skills. Tasks like lysis of adhesions, suturing, and knot tying were enhanced with the robotic surgical system, thus providing unique advantages over existing standard laparoscopy. Total laparoscopic hysterectomy can be performed using robotic surgical systems. 相似文献36.
David S. Yee Joel Gelman Douglas W. Skarecky Thomas E. Ahlering 《Journal of robotic surgery》2007,1(2):151-154
Fossa navicularis strictures following radical prostatectomy are reported infrequently. We recently experienced a series of
fossa strictures following robotic-assisted laparoscopic prostatectomy (RLP). We describe herein our experience to prevent
fossa strictures and to determine its etiologic factors. From June 2002 to May 2006, 424 patients underwent robotic-assisted
laparoscopic prostatectomy with the da Vinci surgical system. Fossa strictures were diagnosed based on the acute onset of
obstructive voiding symptoms and bougie calibration. During our series, we switched from the intra-operative use of an 18
French (F) catheter to that of a 22 F one to avoid inadvertent stapling of the urethra when dividing the dorsal venous complex.
After we observed a high incidence of fossa strictures, we reverted back to 18 F catheters during surgery. All patients had
an 18 F catheter indwelling for 1 week after surgery. Parameters were evaluated using Fisher’s exact test and Student’s t-test for means. The 18 F catheter group of patients (n = 293) developed one fossa stricture, whereas the 22 F catheter group (n = 131) developed nine fossa strictures (P < 0.01). The fossa stricture rate in the 18 F group was 0.3% versus 6.9% in the 22 F group. The two groups had no differences
in age, body mass index, cardiovascular disease, American Urological Association symptom score, urinary bother score, preoperative
prostate-specific antigen, operative time, estimated blood loss, cautery use, prostate size, or catheterization time. Based
on these results, a larger urethral catheter size – 20 F versus 18 F – during the intra-operative dissection would appear
to increase the risk for fossa stricture by more than 20-fold.
Statement of disclosure Dr. Thomas Ahlering is a meeting participant and lecturer for Intuitive Surgical Corp. The other authors have no direct or
indirect commercial financial incentives associated with publishing the article. No research or project support funding was
received. 相似文献
37.
Yen-Chuan Ou Chi-Rei Yang John Wang Chen-Li Cheng Vipul R. Patel 《Journal of robotic surgery》2008,2(3):173-179
Robotic-assisted laparoscopic radical prostatectomy (RALP) is an established trend in surgical treatment for localized prostate
cancer in the USA; however, RALP is still in its infancy in Taiwan. We have tracked various indicators of proficiency as a
single Taiwanese surgeon became familiar with the procedure through experience with 30 initial RALP surgeries using the da
Vinci system between December 2005 and April 2007. Here, we report the changes in these proficiency indicators, and the short-term
outcomes for the patients. Thirty consecutive patients were classified into group 1 (cases 1–15) and group 2 (cases 16–30).
Preoperative clinical characteristics, including age, body mass index (BMI), American Society of Anesthesiologists anesthetic
surgical risks class (ASA), prostate-specific antigen levels (PSA), and Gleason scores were similar between the groups. The
clinical stage (T1/T2) was significantly higher in group 2 than in group 1 (p = 0.028). Group 1 needed more frequent insertion of a double-J stent (60% versus 0%) before surgery and evaluation by cystogram
before removal of urethral catheter (80% versus 6.7%) than group 2; these differences were statistically significant. Blood
loss and transfusion rates were lower in group 2, but complication and conversion rates were higher in group 1. These differences
were not statistically significant. Positive surgical margins, continence rates, potency, and intercourse rates at 12 months
were similar between the groups. Console time was 262 min in group 1 and 190 min in group 2 (p = 0.033); this appeared to be the best indicator of proficiency. Establishing proficiency as determined by functional outcomes
required about 30 cases, but the positive surgical margin rates indicate that experience with more than 30 cases was needed
to ascend the learning curve with respect to oncological outcomes. 相似文献
38.
Ee-Rah Sung Sung Yul Park Won Sik Ham Wooju Jeong Woo Jung Lee Koon Ho Rha 《Journal of robotic surgery》2008,2(3):209-211
We report a case of scrotal bladder hernia in a 68-year-old man who was also diagnosed with prostate cancer. We fixed the
herniated portion of the bladder using robotics after having successfully accomplished robotic prostatectomy. To the best
of our knowledge, this is the first case report on simultaneous repair of scrotal bladder hernia and prostate cancer where
both pathological findings have been treated with the assistance of robotics at a single operation. 相似文献
39.
A 74-year-old man with multiple medical comorbidities and a 3.6 cm right posterior renal hilar mass, biopsy-confirmed as papillary
renal cell carcinoma, underwent a robot-assisted retroperitoneal renal cryoablation. We report the feasibility of robot-assisted
retroperitoneal cryoablation of a renal tumor and describe our technique. 相似文献
40.
N. P. Pardalidis N. A. Andriopoulos A. Tsiga N. Giannakou E. Kosmaoglou 《Journal of robotic surgery》2008,2(2):77-80
Radical prostatectomy is the treatment of choice for management of organ-confined prostate cancer. Minimally invasive treatments,
as an alternative, have refined been recently by the introduction of da Vinci robotic technology which has the potential to
improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy.
We report on our experience with robotic radical prostatectomy using the first da Vinci robotic system in our country. During
8 months, 40 robotic radical prostatectomies were performed by a single surgical team at Athens Medical Centre (Marousi, Greece).
Preoperative data collection included basic demographics, prostate-specific antigen (PSA), clinical stage, and Gleason score.
Operative outcomes included operative time, estimated blood loss, and complications. Postoperative outcomes included hospital
stay, pain, catheter time, pathology, PSA, return of continence, and potency. Average operative time was 186.25 min with an
estimated mean blood loss of 135 ml. There were no intra-operative complications. Ninety per cent of the patients were discharged
home on postoperative day 1 with mean haematocrit 36.7 (range 29–43). All patients reported minimal postoperative pain and
resumed regular diet on the first postoperative day. Average catheter time was 6.6 days (range 5–10). Early continence was
observed in 47.5% of the patients, seven days after catheter removal. Continence at 1, 3, and 6 months was 75, 82.5 and 95%,
respectively. The overall positive margin rate was 17.5%. Ninety-five per cent of the patients had undetectable postoperative
PSA levels (less than 0.1 ng/ml) at a median follow-up of 6 months. Our initial experience with robotic radical prostatectomy
is very promising. The learning curve was approximately 10–12 cases. With a methodical approach we were able to implement
the method safely and effectively in our practice, combining minimal morbidity with good oncological and functional outcomes. 相似文献