Objective?To approach feasibility, safety, and the application range of pure laparoscopic resection （PLR）, hand-assisted laparoscopic resection （HALR）, and robotic liver resection （RLR） in the minimally invasive liver resection （MILR）. Methods?The clinical data of 128 patients underwent MILR in the Surgical Department of the Shanghai Ruijin Hospital from September 2004 to January 2012 were analyzed retrospectively. According to the different methods, the patients were divided into PLR group, HALR group, and RLR group. The intraoperative findings and postoperative recovery of patients in three groups were compared.?Results?There were 82 cases in PLR group, 3 cases of which were transferred to open surgery；the mean operating time was （145.4±54.4） minutes （range：40-290 minutes）；the mean blood loss was （249.3±255.7） ml （range：30-1 500 ml）；abdominal infection was found in 3 cases and biliary fistula in 5 cases after operation, but all recovered after conservative treatment；the mean length of hospital stay was （7.1±3.8） days （range：2-34 days）. There were 35 cases in HALR group, 3 cases of which were transferred to open surgery；the mean operating time was （182.7±59.2） minutes （range：60-300 minutes）；the mean blood loss was （754.3±785.2） ml （range：50-3 000 ml）；abdominal infection was found in 1 case, biliary fistula in 2 cases, and operative incision infection in 2 cases after operation, but all recovered after conservative treatment；the mean length of hospital stay was （15.4±3.7） days （range：12-30 days）. There were 11 cases in RLR group, 2 cases of which were transferred to open surgery； the mean operating time was （129.5±33.5） minutes （range：120-200 minutes）； the mean blood loss was （424.5±657.5） ml （range：50-5 000 ml）； abdominal infection was found in 1 case and biliary fistula in 1 case after operation, but all recovered after conservative treatment； the mean length of hospital stay was （6.4±1.6） days （range：5-9 days）. The operating time （P=0.001） and length of hospital stay （P=0.000） of the RLR group were shortest and the blood loss （P=0.000） of the PLR group was least among three groups. Conclusions?Minimally invasive resection is a safe and feasible. Different surgical procedures should be chosen according to different cases. The robotic liver resection provides new development for treatment of liver tumor.
ObjectiveTo evaluate the efficacy and safety of robot-assisted thoracoscopic esophagectomy in the treatment of esophageal carcinoma. MethodsWe retrospectively analyzed the clinical data of 79 patients with robotassisted thoracoscopic esophagectomy in our hospital from August 2010 to June 2015. There were 43 males and 36 females at average age of 62 years. The clinical effect was analyzed. ResultsThe mean operation time was 245 min (range 170 min to 330 min). The mean blood loss was 75 ml (range 20 ml to 310 ml). The mean hospital stay was 10.2 days (range 7 days to 26 days). Two perioperative deaths occurred. A total of 14 (17.7%) patients with complication were reported. Mean lymph node harvest was 20.7 nodes with 10.9 in chest, 9.6 in abdomen. ConclusionRobot-assisted thoracoscopic esophagectomy is technically feasible and safe. It is expected to reduce surgical trauma and reduce the incidence of pulmonary complications.
ObjectiveTo evaluate the curative and economic effect of da Vinci robotic lung segmentectomy. MethodWe retrospectively analyzed clinical data of 13 patients who underwent robotic lung segmentectomy (as a robotic group) and 35 patients who underwent thoracoscopic lung segmentectomy (as a thoracoscopic group) in our hospital between September 2014 and April 2015. There were 4 males and 9 females at age of 43-73 (59.1±8.9) years in the robot group and 17 males and 18 females in the thoracoscopic group at age of 30-79 (59.1+12.0) years. Effects of the two groups were compared. ResultsPostoperative hospitalization time in the robotic group was shorter than that in the thoracoscopic group (4.4±0.8 d vs. 6.3±2.5 d, P<0.05). But the cost of hospitalization in the robotic group was higher than that in the thoracoscopic group (P<0.05). The surgery indwelling catheter time and incidence of complications in the robotic group were lower than those in the thoracoscopic group with no statistical difference (P=0.053, 0.081). ConclusionRobotic lung segmentectomy is a safe and feasible operation method. With the further accumulation of clinical experience and decrease of the cost of materials, the robot will play a more important role in the future of minimally invasive thoracic surgery.
ObjectiveTo summarize the clinical experience of 180 general surgeries under da Vinci surgical system. MethodsFrom January 2009 to October 2010, 180 patients with hepatopancreaticobiliary and gastrointestinal disease underwent robotic surgeries by using da Vinci surgical system. The case distribution, intra-and post-operative data were analyzed. ResultsA total of 171 patients had underwent total robotic surgeries and nine patients converted to hand-assisted procedure (5.0%, 9/180). The surgery for hepatic portal was performed in 63 cases of patients, including surgery for hilar cholangiocarcinoma in 36 cases, gallbladder carcinoma in 10 cases, complex calculus of intrahepatic duct in 12 cases, and iatrogenic biliary duct injury in 5 cases. The pancreatic surgery was performed in 44 cases of patients, including pancreatoduodenectomy in 16 cases, distal pancreatectomy in 6 cases, medial pancreatectomy in 1 case, pancreatic cyst-jejunum anastomosis in 1 case, and palliative surgery in 20 cases. Hepatic surgery was in 19 cases and gastrointestinal surgery in 12 cases of patients. Other procedures were in 42 cases of patients, including common bile duct exploration and removing the stone, retroperitoneal lymph nodes dissection, and splenectomy, etc. All of ten cases of patients with obstructive suppurative cholangitis received emergency surgery by the robot and postoperative infection symptoms were controlled, and shock was corrected quickly. No death occurred during the perioperative period. Postoperative complications occurred in 12 cases (6.7%, 12/180) and 2 cases died (1.1%, 2/180). Conclusionsda Vinci surgical system can carry out all kinds of general surgery, especially complicated and difficult hepatobiliary and pancreatic surgery, which improves the development of minimally invasive surgery.
ObjectiveTo determine postoperative pain of the robotic technique for the patients with lobectomy. MethodsWe retrospectively analyzed the clinical data of 120 patients with lobectomy between October 2014 and May 2015 in our hospital. The patients are divided into two groups:a robotic group, including 40 patients with 16 males and 24 females at age of 59.7±7.2 years, undergoing robotic lobectomy, and a video-assisted thoraciscopic surgery (VATS) lobectomy group (a VATS group) including 80 patients with 29 males and 51 females at age of 61.2±8.9 years, undergoing VATS lobectomy. We used the numerical rating scale (NRS) and verbal rating scale (VRS) to assess the pain level on the first day, the 7th day and the 30th day after the surgery. The pain level of the two groups was compared. ResultsThe patients in the two groups both felt pain. There were no statistical differences in the scores of VRS and NRS on the first day, the 7th day and the 30th day after the surgery between the two group (P>0.05). The pain score of the patients in the two groups decreased with no statistical difference from the first day to the 30th day after the surgery (P>0.05). ConclusionThe patients with robotic lobectomy have similar pain level after surgery compared with the patients with VATS lobectomy.
ObjectivesTo investigate the safety and efficacy of robot-assisted surgery for mediastinal tumor. MethodsWe respectively analyzed the clinical data of 47 patients with clinical diagnosis of mediastinal tumor undergoing robot-assisted surgery in our hospital from May 2009 to March 2015. There were 29 males and 18 females at age of 48 (20-78) years. Robotic instruments were used through two 8 mm thoracoscopic ports and camera placed through a 12 mm observation port, without any additional utility incision. ResultsAll 47 surgeries were accomplished successfully. The operative time was 73±36 minutes. The blood loss was 48±15 ml. There was only one conversion due to bleeding during the operation. No perioperative mortality or morbidity occurred. There was no perioperative transfusion. Learning curve showed operative time shortened sharply as the procedures increased. After 20 cases of procedure, operative time was stabilized as the learning curve established. The equation is y(min)=-20.41ln(x)+119.43, R2=0.312, P<0.01. ConclusionRobot-assisted surgery for mediastinal tumor are initially proved safe and feasible with great perspective in the new age of minimally invasive thoracic surgery.
Spanning two decades since the 1st generation spinal robotics inception, the robot-assisted spine surgery (RSS) technology has evolved through generations, culminating in the 4th generation characterized by real-time visual navigation and wire-free screw placement. The fundamental principles of RSS technology include surgical planning, tracking, image registration, and robotic arm control technologies. Currently, RSS technology is maturely employed in thoracolumbar procedures and is progressively being applied in cervical surgeries, spinal tumor resections, and percutaneous operations, offering advantages in reducing tissue trauma and exposure to radiation, thereby improving patient outcomes. Emerging research also focuses on the cost-effectiveness of clinical applications and robot-specific complications. With the integration of artificial intelligence into surgical planning, RSS technology is poised to further incorporate emerging technologies and expand its application across a broader clinical spectrum.
ObjectiveTo summarize our initial experience in robot-assisted left upper lobectomy for non-small cell lung cancer. MethodsFour patients with non-small cell lung cancer underwent robot-assisted left upper lobectomy with da Vinci S surgical system (Intuitive Surgical, California) in General Hospital of Shenyang Military Area Command between March and August 2013. There were 3 male and 1 female patients, and their age was 58.8 years (range:49-67 years). We used general anesthesia with double lumens trachea cannula. The patients set in right lateral decubitus position with jackknife. We used 3 arms of the robot system. A single direction lobectomy procedure or an anatomic lobectomy procedure was used according to the differentiation of fissure. Systemic lymph node dissection was performed for all patients. ResultsFour patients with left upper lobectomy were completed with total robotic procedure without conversion. Postoperative pathological examination showed all the patients were of all adenocarcinoma with 2 patients inⅠA stage and 2 patients inⅢA stage. The range of operating time was 100-150 min, intraoperative blood loss was 30-80 ml and no blood transfusion was needed for the patients. The drainage time was 6-20 days. All of the 4 patients were discharged smoothly. The patients were followed up for 10-15 months without recurrence or metastasis. ConclusionRobot-assisted left upper lobectomy is safe and feasible for non-small cell lung cancer.
ObjectiveTo investigate the safety and efficacy of robot-assisted pulmonary lobectomy using da Vinci S System, and explore its advantages in minimally invasive surgery. MethodsFrom May 2009 to May 2013, 12 patients with suspected non-small cell lung cancer (NSCLC) underwent robot-assisted lobectomy using da Vinci S System in Shanghai Chest Hospital. There were 6 male and 6 female patients with their age of 40-61 (52±8) years. Robotic instruments were used through a 12-mm observation port, two 8-mm thoracoscopic ports and a 12 to 40 mm utility incision without rib spreading. Perioperative data of the patients were collected and analyzed. ResultsAll the 12 patients successfully received surgical resection. All types of lobectomy were performed, and all the procedures were radical resection. Each patient received 4 to 9 (5±1) stations of lymph node dissection. None of the patients underwent conversion to thoracotomy. There was no perioperative mortality or morbidity in this group. Chest drainage duration was 3-11 (8±7) days. Length of hospital stay was 6 to 18 (14±8) days. Operation time was 60 to 280 (185±78) minutes. Intraoperative blood loss was 20 to 200 (108±71) ml. There was no perioperative blood transfusion. ConclusionsRobot-assisted lobectomy is initially proven a safe and effective procedure with enhanced visualization and better dexterity and stability than video-assisted thoracopscopic surgery. Thus surgical indications for robot-assisted lobectomy can be widened. Robot-assisted lobectomy is an important choice in the new age of minimally invasive thoracic surgery.
Objective To investigate the risk factors for arrhythmia after robotic cardiac surgery. Methods The data of the patients who underwent robotic cardiac surgery under cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed. According to whether arrhythmia occurred after operation, the patients were divided into an arrhythmia group and a non-arrhythmia group. Univariate analysis and multivariate logistic analysis were used to screen the risk factors for arrhythmia after robotic cardiac surgery. ResultsA total of 146 patients were enrolled, including 55 males and 91 females, with an average age of 43.03±13.11 years. There were 23 patients in the arrhythmia group and 123 patients in the non-arrhythmia group. One (0.49%) patient died in the hospital. Univariate analysis suggested that age, body weight, body mass index (BMI), diabetes, New York Heart Association (NYHA) classification, left atrial anteroposterior diameter, left ventricular anteroposterior diameter, right ventricular anteroposterior diameter, total bilirubin, direct bilirubin, uric acid, red blood cell width, operation time, CPB time, aortic cross-clamping time, and operation type were associated with postoperative arrhythmia (P<0.05). Multivariate binary logistic regression analysis suggested that direct bilirubin (OR=1.334, 95%CI 1.003-1.774, P=0.048) and aortic cross-clamping time (OR=1.018, 95%CI 1.005-1.031, P=0.008) were independent risk factors for arrhythmia after robotic cardiac surgery. In the arrhythmia group, postoperative tracheal intubation time (P<0.001), intensive care unit stay (P<0.001) and postoperative hospital stay (P<0.001) were significantly prolonged, and postoperative high-dose blood transfusion events were significantly increased (P=0.002). Conclusion Preoperative direct bilirubin level and aortic cross-clamping time are independent risk factors for arrhythmia after robotic cardiac surgery. Postoperative tracheal intubation time, intensive care unit stay, and postoperative hospital stay are significantly prolonged in patients with postoperative arrhythmia, and postoperative high-dose blood transfusion events are significantly increased.