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Futuristic Approaches in Vitreoretinal Surgery
Published in Pradeep Venkatesh, Handbook of Vitreoretinal Surgery, 2023
The word robot is derived from the Slavic robota, which translates to servant or slave and was first introduced in a play almost a century ago. With advancements in technology and computing, robotics has evolved into an area of specialization within the field of engineering. Robotics involves the conceptualization, design, and applications of machinery that can emulate and reproduce mechanical tasks that are performed by human beings. These machines have been in use for several decades in areas that are beyond human capability such as space exploration and repair and deep-sea exploration. More recently, they are being used to replace human labour in homes and workplaces. In combination with the exponential improvements in deep learning and machine learning, robot-assisted surgery is expected to achieve a quantum leap in terms of precision and clinical applicability. It is also expected to improve the quality and standardization of surgical training. Limitations of robotic surgery include the technical complexity, cost, and questions on responsibility assignment, consent, ethics, and liability. Although robotic platforms provide 3D visualization, access to tissues and better dexterity to the surgeon, surgical aspects like traction, applied force, suture tying strength, dissection, and tissue response are based largely on visual cues. To overcome some of these limitations, approaches like the haptic feedback systems and tactile feedback systems have been studied.
Robotic Rectal Cancer Surgery
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
SP Somashekhar, K Rajagopal Ashwin
Robotic surgery is expensive, due to the cost of robot purchase, maintenance, and instruments. Therefore, a careful analysis of costs and of cost-effectiveness is mandatory, even if it is difficult to perform because of the lack of available data about the potential benefits of robotic surgery. A recent cost analysis demonstrates that robotic surgery is more expensive than laparoscopic surgery, but said the cost-effectiveness of robotic rectal cancer surgery should be assessed based on oncologic outcomes and functional results especially in lower rectal cancer surgery [37]. The average reduction in total direct cost is difficult to define due to the increasing cost over time, making the comparisons between studies conducted over a time range of more than 10 years challenging.
Laparoscopic and Robotic-Assisted Myomectomy
Published in Botros R.M.B. Rizk, Yakoub Khalaf, Mostafa A. Borahay, Fibroids and Reproduction, 2020
Harold Wu, Anja Frost, Mostafa A. Borahay
Though LSC tactile feedback is lost, robotically assisted surgery has several advantages over that of conventional LSC. It allows for three-dimensional stereoscopic view, greater dexterity with seven degrees of freedom in each of the jointed instruments, and mitigation of hand tremor, which can facilitate fibroid dissection and multilayer suturing. As such, the robotically assisted approach should be considered in more technically challenging cases, such as those with particularly large bulky fibroids, tumors involving the cervix and lower uterine segment or extending into the pelvic sidewall, or extensive pelvic adhesive disease. Overall, RALM confers similar patient care benefits as those of LM when compared to traditional open myomectomy, including lower blood loss and less need for blood transfusions, shorter hospital stays, and lower perioperative complication rates [46]. Figure 11.3 shows the sequential steps of robotic-assisted myomectomy. The common disadvantage for robotic surgery is the financial cost, including higher hospital/professional charges, and hospital reimbursement rates.
Synchronous colorectal cancer and abdominal aortic aneurysm treated simultaneously. Is a one-stage surgery a feasible treatment?
Published in Acta Chirurgica Belgica, 2023
Sara Alonso-Batanero, Carlos R. Díaz-Maag, María Parra-Rina, Jesús García-Alonso, Francisco S. Lozano Sanchez
There is still much uncertainty but the introduction of Endovascular Abdominal Aortic Aneurysm Repair (EVAR) marked a milestone that improved the management of AAA. EVAR is recommended if anatomically suitable in large or symptomatic AAA with concomitant colorectal cancer followed by staged cancer surgery, to allow treatment of the malignancy with minimal delay [7]. Although it has been associated with a considerable risk of thrombotic events [8]. The single-stage approach prolongs surgical time and could result in an aortic graft infection, especially when open aneurysm repair is applied. However, with EVAR this probability of graft infection could be lower. Additionally, laparoscopic and robotic surgery shortens recovery times and involves small incisions and less pain for the patient than open surgery. Minimally invasive surgery such as EVAR and laparoscopic or robotic resection of CCR, have changed the therapeutic strategy by allowing the simultaneous treatment of both pathologies to be safer. The patient of the clinical case was offered both options (surgery in two stages or surgery in one stage), and the possible advantages and disadvantages of both options were explained in detail as in the discussion. Finally, he chose the one-time surgery to avoid the stress of undergoing two surgeries and their corresponding recovery.
Oncologic outcomes in older women with endometrial carcinoma (≥70 years)
Published in Journal of Obstetrics and Gynaecology, 2022
Massoud Shoraka, Shu Wang, Semiramis L. Carbajal-Mamani, Haoting Han, Bernie Amaro, Joel Cardenas-Goicoechea
Performing major surgeries on older women with cancer has long been considered challenging due to the presence of serious chronic diseases. However, emerging data suggest it is safe and effective. Guy et al. (2016) compared the perioperative outcomes of robotic versus laparotomy approaches and included 7142 patients ≥65 years with endometrial cancer. They found that robotic surgery for endometrial cancer appeared to be safe given the current selection criteria utilised in the United States (Guy et al. 2016). Other studies (Walker et al. 2009, 2012; Janda et al. 2017; Gallotta et al. 2018) found similar results. In our study, robotic surgery appears to be safe, with reduced complications compared to open approach and significantly shorter hospital stay (Table 1). At our institution, there has been a steady trend towards robotic surgery. Based on our current data, in 2015, 27.27% of patients underwent robotic surgery, while in 2016, that rate rose to 84.62%. Older women with endometrial cancer should be encouraged to undergo a minimally invasive approach for a potentially curable disease, and medical optimisation is critical.
Technical aspects and standardization of the totally robotic Roux-en-Y gastric bypass. Results of a single surgeon experience with a 5-year follow-up
Published in Acta Chirurgica Belgica, 2022
Emmelie Reynvoet, Veerle Van Vlodrop, Kurt Hendrick, Dries Vandeweyer, Carlos Vaz
For the individual patient, the benefit of using of a robotic system reflects in the enhanced recovery and less postoperative discomfort. During robotic surgery the patient is in a stable position and the robotic arms are fixed. The puncture point through the abdominal wall is stable, and the arms rotate around this point, not applying any force on the abdominal wall. In the morbid obese patient, a thick abdominal wall can cause enormous leverages when performing laparoscopy in the upper abdomen, which is eliminated with robotics [5, 6]. Moreover, because of better vision, we are able to work on a lower intra-abdominal pressure, which reduces stretching of the peritoneum. Due to less trauma to the abdominal wall, the patient experiences less postoperative pain, has a faster recovery and mobilization and a shorter convalescence period. The temperature of the room can be set higher because surgeons are not below the warm operation lights or wearing thick surgical gowns, which reduces hypothermia on the recovery ward.