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Instrumentation and Operating Theater Set up in Minimally Invasive Cardiac Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Robotic cardiac surgery is done through various incisions in the chest. With the use of minimally invasive robotic instruments and robot-controlled tools, surgeons are able to execute more precise movements within smaller operating fields, and ultimately perform heart surgery in a way that is much less invasive than open heart surgery. The da Vinci surgical system, created by Intuitive Surgical, is one such robotic surgical system that is designed for performing complex surgeries through a minimally invasive approach. It has been successfully used in robotically assisted mitral valve repair, demonstrating excellent mid-term outcomes [10]. The technique has also been determined to be safe and effective for use in a multitude of other cardiac surgery procedures, including minimally invasive CABG, cardiac myxoma treatment and atrial septal defects [11] (detailed description in Chapter 9.3) (Figure 4.55).
Robotic Hysterectomy in Fibroid Uterus
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
The first total laparoscopic hysterectomy was performed in 1989 in a patient where vaginal approach was not feasible; since then, laparoscopic hysterectomy has gained popularity with patients and surgeons alike [3]. In 2005, the US Food and Drug Administration approved the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) for gynecological surgeries. Since then, minimally invasive surgery has won a great deal of enthusiasm, and greater numbers of patients prefer the robotic route and surgeons prefer to operate robotically for both complex and malignant gynecological conditions [4]. The spectrum of diseases of benign uterine conditions includes myomectomy, hysterectomy, endometriosis, cystectomy, tubal recanalization, vesico-vaginal fistulas, and sacrocolpopexy.
Resection for Colorectal Liver Metastasis
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Palanisamy Senthilnathan, Srivatsan Gurumurthy Sivakumar, Srinivasan Muthukrishnan, C Palanivelu
The da Vinci surgical system, also known as robot-assisted LR, is believed to overcome the disadvantages of a laparoscopy [37]. Robot-assisted LR is performed through a series of flexible mechanical arms, allowing more degrees of freedom, which can effectively avoid the ‘fulcrum effect’ caused by rigid laparoscopic instruments. What's more, the robotic approach makes the surgical procedure more precise by providing 3D vision and avoiding hand tremors. Therefore, robot-assisted LR can be used in narrow spaces or curved transections, and it is particularly suitable for the handling of metastases located in the posterior-superior segments [38]. Standard laparoscopy or robot-assisted LR for minor LRs can be performed with favorable perioperative and long-term outcomes. Nevertheless, the robotic approach offers more benefits for a major hepatectomy and challenging cases [39].
Eye-Tracking Indicators of Workload in Surgery: A Systematic Review
Published in Journal of Investigative Surgery, 2022
Otto Tolvanen, Antti-Pekka Elomaa, Matti Itkonen, Hana Vrzakova, Roman Bednarik, Antti Huotarinen
Wu et al. conducted the exploratory study in the robotic environment (The da Vinci Surgical System) to examine the relationship between the normalized pupil diameter and the perceived workload (NASA-TLX) in the robotic surgical tasks with variable complexity levels. They recorded 15 robotic skills simulation sessions over four months period and participants performed up to 12 simulated exercises in each session. Wu et al. observed that the increasing task difficulty was correlated with the increase in pupil diameter, indicating that the change in pupil responses are sensitive to task difficulty.[35] However, in contrast to other studies a linear relationship was not observed between the pupil diameter and the NASA-TLX scores.[35]
Comparison of uterine scarring between robot-assisted laparoscopic myomectomy and conventional laparoscopic myomectomy
Published in Journal of Obstetrics and Gynaecology, 2020
Bor-Ching Sheu, Kuan-Ju Huang, Su-Cheng Huang, Wen-Chun Chang
The decision to perform LM must be made based on the size, number, and location of the myomas (Segars et al. 2014; Parazzini et al. 2016). It is also determined by the expertise of the surgeon (Malzoni et al. 2010). Selection criteria for LM have been suggested; they include no myoma near the uterine artery or near the tubal ostia if fertility is desired, and at least 50% of the myoma subserosal, permitting adequate repair through the laparoscope (Glasser 2005). Contraindications to LM usually include the presence of an intramural myoma >10–12 cm in size or multiple myomas (≥4) in different sites of the uterus, requiring numerous incisions. RM using the da Vinci Surgical System (Advincula et al. 2004) is poised to become an ethical alternative to abdominal myomectomy for surgeons who do not master advanced LM (Nezhat et al. 2009).
Transoral robotic surgery: a 4-year learning experience in a single Danish Cancer Centre
Published in Acta Oto-Laryngologica, 2020
Asher Lou Isenberg, Hani Ibrahim Channir, Christian von Buchwald, Niclas Rubek, Jeppe Friborg, Katalin Kiss, Birgitte Wittenborg Charabi
Initially, it did not seem clear which patients could benefit most from TORS. During our 4-year learning experience with the da Vinci surgical system, we have observed a change in indications: fewer cases of salvage surgery and advanced cancer stages that tend to be more complicated, have longer hospitalization and have higher complication rates. Treatment of benign tumours using TORS has decreased, while TORS treatment of sleep-apnoea due to hypertrophic lingual tonsils may see a rise in the future. Lower mean rates of failure were shown compared to coblation tonsillectomies although there was a higher rate of minor complications [15]. There has been an increase in the number of primary treatments of cancer and this is likely to continue to rise as HPV-positive tumours become more prevalent, and as access and awareness of TORS as an option becomes more widespread. In the treatment of early-stage oropharyngeal cancer, the survival rates of TORS are comparable to the standard chemo-irradiation therapy [16] where complication rates and long-term quality-of-life outcomes seem favourable when comparing TORS and chemo-irradiation therapy [17]. Newer reports on functional outcomes like dysphagia show that TORS may have a short term worsening of dysphagia (<3 months) while comparable to radiotherapy at 3–6 months [18]. The current ongoing randomized trials will be crucial in the future for selecting the optimal treatment. In Denmark, an ongoing national randomized clinical trial (The QoLATI Study, DAHANCA 34 protocol) is now aiming at comparing TORS and IMRT with a focus on long-term functional outcomes.