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Transabdominal sacrocolpopexy has been shown, in multiple long-term studies of its success and durability, to be the definitive
treatment option for post-hysterectomy vaginal vault prolapse. It is, however, associated with greater morbidity than vaginal
repair. We describe a minimally invasive technique for vaginal vault prolapse repair and present our experience with a minimum
of one-year follow-up. The surgical technique involves five laparoscopic ports—three for the da Vinci robot and two for the
assistant. After appropriate dissection a polypropylene mesh is attached to the sacral promontory and to the vaginal apex
by use of Gore-Tex sutures. The mesh material is then covered by the peritoneum. Patient analysis focused on complications,
urinary continence, patient satisfaction, and morbidity, with a minimum of 12 months follow-up. Forty-two patients with post-hysterectomy
vaginal vault prolapse underwent robot-assisted laparoscopic sacrocolpopexy at our institute and 35 have a minimum of 12 months
follow-up, with a mean follow-up of 36 months (range 12–48) in the group. Mean age was 67 (47–83) years and mean operating
time was 3.1 (2.15–4.75) h for the entire cohort. All but one patient were discharged home on postoperative day one; one patient
left on postoperative day two. One developed recurrent grade three rectocele, one had recurrent vault prolapse, and two suffered
from vaginal extrusion of mesh. All patients were satisfied with their outcome. The robot-assisted laparoscopic sacrocolpopexy
is a minimally invasive technique for vaginal vault prolapse repair, combining the advantages of open sacrocolpopexy with
the reduced morbidity of laparoscopy. We observed reduced hospital stay, low occurrence of complications, and high patient
satisfaction, with a minimum of 1-year follow-up. Most importantly, the long-term results of the robotic repair are similar
to those of open repair, but with significantly less morbidity. 相似文献
6.
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
7.
V. Kyriazis 《Journal of orthopaedics and traumatology》2006,7(1):1-5
Abstract Robotics has been applied to the rehabilitation of patients suffering from upper limb-related diseases such as stroke, upper
spinal cord injuries and neuromuscular diseases (e. g. muscular dystrophy) alone, or combined with appropriate orthotic devices.
In all cases, expensive industrial manipulators, as much as relatively low-cost commercial systems with specific modifications
have been used. However, no reference has been made in the literature on the technology of such devices. This article presents
the development of a joystick-computer system for the control of a step motor. Further research can lead to the development
of an extremely low-cost robotic arm which uses residual finger movement input and can be used by research centers with restricted
funding. Reference is made to the technology on which the circuitry is based, as well as to the design concept of it. 相似文献
8.
Yukihisa Fukuda Savio L-Y Woo John C Loh Eiichi Tsuda Peter Tang Patrick J McMahon Richard E Debski 《Journal of orthopaedic research》2003,21(6):1107-1112
The loads needed to elicit a positive pivot shift test in a knee with an anterior cruciate ligament (ACL) rupture have not been quantified. The coupled anterior tibial translation (ATT), coupled internal tibial rotation (ITR), and the in situ force in the ACL in response to a valgus torque, an inherent component of the pivot shift test, were measured in 10 human cadaveric knee specimens. Using a robotic/universal force-moment sensor testing system, valgus torques ranging from 0.0 to 10.0 Nm were applied in nine increments on the intact and ACL-deficient knee in flexion ranging from 0 degrees to 90 degrees. At 15 degrees of knee flexion, the coupled ATT and ITR were significantly increased in the ACL-deficient knee when compared to the intact knee. Coupled ATT increased a maximum of 291% (6.7 mm, p<0.05), while coupled ITR increased a maximum of 85% (5.1 degrees, p<0.05). At 30 degrees, the increases in coupled ATT and ITR were significant at valgus loads of 3.3 Nm and greater with a maximum increase in coupled ATT of 137% (6.3 mm, p<0.05) and a maximum increase in coupled ITR of 38% (3.6 degrees, p<0.05). At 45 degrees, coupled ATT increased significantly (maximum of 69%, 4.4 mm, p<0.05), but only at torques > or =6.7 Nm. The in situ force in the ACL was less than 20 N for all flexion angles when a torque between 3.3 and 5.0 Nm was applied. Low valgus torque elicited tibial subluxation in the ACL-deficient knee with low in situ ACL forces, similar to a positive pivot shift test. Thus, application of a valgus torque may be suitable to evaluate ACL-deficient and ACL-reconstructed knees, since subluxation can be achieved with minimal harm to the ACL graft. This work is important in understanding one load component needed for the pivot shift examination; further studies quantifying other load components are essential for better comprehension of the in vivo pivot shift examination. 相似文献
9.
Salvage robot-assisted radical prostatectomy with pelvic lymph node dissection after cryotherapy failure 总被引:1,自引:1,他引:0
Esequiel Rodriguez Jr Douglas W. Skarecky Thomas E. Ahlering 《Journal of robotic surgery》2007,1(1):89-90
We report the first case of post-cryotherapy salvage radical prostatectomy for local recurrence performed laparoscopically
with the da Vinci robot. Total operative time was 210 minutes and blood loss was 50ml. There were no intraoperative or postoperative
complications. The hospital stay was 24 hours and the Foley catheter was removed on postoperative day 7. The patient achieved
a pad free status 4 weeks postoperatively. Pathology showed extensive disease, pT3bN0, Gleason score of 5+3 and positive margins.
The patient continued on complete androgen deprivation therapy and his follow up PSA at 10 months was <0.1. Further studies
are needed to evaluate both functional and oncological results with this approach. 相似文献
10.
Juan Carlos Sebasti n-Tom s Aleix Mart nez-P rez El as Mart nez-L pez Nicola de Angelis Marcos G mez Ruiz Eduardo Garc a-Granero 《World journal of gastrointestinal surgery》2021,13(8):834-847
Total mesorectal excision (TME) is the standard surgical treatment for the curative radical resection of rectal cancers. Minimally invasive TME has been gaining ground favored by the continuous technological advancements. New procedures, such as transanal TME (TaTME), have been introduced to overcome some technical limitations, especially in low rectal tumors, obese patients, and/or narrow pelvis. The earliest TaTME reports showed promising results when compared with the conventional laparoscopic TME. However, recent publications raised concerns regarding the high rates of anastomotic leaks or local recurrences observed in national series. Robotic TaTME (R-TaTME) has been proposed as a novel technique incorporating the potential benefits of a perineal dissection together with precise control of the distal margins, and also offers all those advantages provided by the robotic technology in terms of improved precision and dexterity. Encouraging short-term results have been reported for R-TaTME, but further studies are needed to assess the real role of the new technique in the long-term oncological or functional outcomes. The present review aims to provide a general overview of R-TaTME by analyzing the body of the available literature, with a special focus on the potential benefits, harms, and future perspectives for this novel approach. 相似文献