Biomedical subjects

J P Ruurda

Publications and source records attributed to J P Ruurda.

8 recordsLinked to original sources

PubMed2004

Manual robot assisted endoscopic suturing: time-action analysis in an experimental model.

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.

Anastomosis, Surgical↗

PubMed2004

Robot-assisted versus standard videoscopic aortic replacement. A comparative study in pigs.

BACKGROUND: Reconstruction of the infrarenal aorta for aneurysms is routinely performed through laparotomy. A less invasive videoscopic approach has not gained wide acceptance due to technical difficulties. Robotic systems could potentially improve imaging of the operative field and surgeon's dexterity during videoscopic surgery and therefore might facilitate the performance of this procedure. The aim of this animal study was to compare the safety and efficacy of a robot-assisted videoscopic aortic replacement to the standard videoscopic approach. MATERIALS AND METHODS: In 10 female pigs, the infrarenal aorta was partially replaced by a 10 mm polytetrafluoroethylene (PTFE) interposition graft through a videoscopic retroperitoneal approach, using the da Vinci robot system (robot group). Ten other pigs were operated on in a similar fashion, using standard videoscopic instruments (control group). Relevant procedure times, blood loss and complications were registered. Efficacy of the anastomoses was evaluated by measuring patency and blood loss after removing the clamps. Furthermore, circumference and number of stitches were evaluated at autopsy. RESULTS: The procedure, suturing and clamping times were significantly shorter in the robot group and blood loss was less. In the control group, the inferior vena cava was injured in one pig. In two cases in the control group, haemostasis could not be established after clamp removal. At autopsy, all anastomoses in the robot group were adequate. In the control group, a stitch crossing the aortic lumen was found in two distal anastomoses and a large distance (>3 mm) between two stitches was encountered at least once in 12/20 suture lines. All 20 grafts were patent. No anastomotic narrowing was encountered. The number of stitches used for proximal and distal anastomosis was higher in the robot group. CONCLUSION: This study demonstrates the superiority of robot-assisted videoscopic aortic replacement over standard videoscopic techniques in an animal model.

Anastomosis, Surgical↗

PubMed2004

Early experience in robot-assisted laparoscopic Heller myotomy.

Heller myotomy for achalasia is routinely performed laparoscopically. This offers patients significant benefits compared to open surgery. Surgeons, however, are limited in their manipulation and visualization during laparoscopic interventions. Robotic telemanipulation systems were introduced with the objective of alleviating these limitations. The purpose of this study was to demonstrate the efficacy and safety of performing a Heller myotomy with the use of a robotic telemanipulation system. Fourteen patients were operated on with the da Vinci robot system. Robotic system set-up time, per- and postoperative complications, blood loss, operating time and hospital stay were recorded. Follow-up included manometry and symptom score. The robotic system set-up time was 15 min (10-15). Thirteen procedures (13/14: 93%) were completed by laparoscopic surgery. One procedure was converted because of inadequate exposure. One peroperative mucosal perforation was closed laparoscopically. The median blood loss was 10 mL (10-200). Median operating time was 90 min (75-150). Hospitalization ranged from 2 to 8 days (median 3). No complications occurred during a 30-day postoperative period. Dysphagia was relieved in 12/14 patients (86%). Heartburn was present postoperatively in 2/14 patients (14%). Manometry showed a significant decrease in median lower oesophageal sphincter (LOS) pressure from 2.9 preoperatively to 1 kPa postoperatively (P = 0.008). Robot-assisted laparoscopic Heller myotomy was demonstrated to be safe and effective in reducing basal LOS pressure and dysphagia. The results of this study clearly support the feasibility of the use of this system in performing a delicate laparoscopic surgical procedure. The use of a robotic system was experienced as being highly supportive in manipulation and visualization by the surgical team involved.

Adolescent↗

PubMed2003

Robot-assisted laparoscopic choledochojejunostomy.

BACKGROUND: Endoscopic stenting is the treatment of choice for palliative relief of biliary obstruction by a periampullary tumor. If treated surgically, a choledochojejunostomy and Roux-en-Y diversion is still performed by laparotomy in a large number of cases due to technical challenges of the biliodigestive anastomosis in the laparoscopic approach. Robotic systems may enhance dexterity and vision and might therefore support surgeons in delicate laparoscopic interventions. The purpose of this study is to assess the efficacy and safety of performing a laparoscopic choledochojejunostomy and Roux-en-Y reconstruction with the aid of a robotic system. METHODS: Ten laparoscopic procedures were performed in pigs with the da Vinci robotic system and compared to 10 procedures performed by laparotomy (controls). Operation room time, anastomoses time, blood loss, and complications were recorded. The effectiveness of the anastomoses was evaluated by postoperative observation for 14 days and by measuring passage, circumference, and number of stitches. RESULTS: Operating room time was significantly longer for the robot-assisted group than for controls (140 vs 82 min, p < 0.05). The anastomoses times were longer in the robot-assisted cases but not statistically significant (biliodigestive anastomosis, 29 vs 20 min; intestinal anastomosis, 30 vs 15 min), Blood loss was less than 10 cc in all robot-assisted cases and 30 cc (10-50 cc) in the controls. In both groups, there were no intraoperative complications. In the control group, one pig died of gastroparesis on postoperative day 6. In the robot-assisted group, one pig died on postoperative day 7 due to a volvulus of the jejunum. At autopsy, a bilioma was found in one pig in the robot-assisted group. In all pigs, the biliodigestive and intestinal anastomoses were macroscopically patent with an adequate passage. Circumference and number of stitches were similar. CONCLUSION: The safety and efficacy of robot-assisted laparoscopic choledochojejunostomy was proven in this study. The procedure can be performed within an acceptable time frame.

Anastomosis, Roux-en-Y↗

PubMed2002

Robot-assisted laparoscopic intestinal anastomosis.

INTRODUCTION: Robotic telemanipulation systems have been introduced recently to enhance the surgeon's dexterity and visualization in videoscopic surgery in order to facilitate refined dissection, suturing, and knot tying. The aim of this study was to demonstrate the technical feasibility of performing a safe and efficient robot-assisted handsewn laparoscopic intestinal anastomosis in a pig model. METHODS: Thirty intestinal anastomoses were performed in pigs. Twenty anastomoses were performed laparoscopically with the da Vinci robotic system (robot-assisted group), the remaining 10 anastomoses by laparotomy (control group). OR time, anastomosis time and complications were recorded. Effectiveness of the laparoscopic anastomoses was evaluated by postoperative observation of 10/20 pigs of the robot-assisted group for 14 days and by testing mechanical integrity in all pigs by measuring passage, circumference, number of stitches, and bursting pressure. These parameters and anastomosis time were compared to the anastomoses performed in the control group. RESULTS: In all cases of the robot-assisted group the procedure was completed laparoscopically. The only perioperative complication was an intestinal perforation, caused by an assisting instrument. The median procedure time was 77 min. Anastomosis time was longer in the laparoscopic cases than in the controls (25 vs 10 min; p <0.001). Postoperatively, one pig developed an ileus, based on a herniation of the spiral colon through a trocar-port. For this reason it was terminated on the sixth postoperative day. All anastomoses of the robot-assisted group were mechanically intact and all parameters were comparable to those of the control group. CONCLUSION: Technical feasibility of performing a safe and efficient robot-assisted laparoscopic intestinal anastomosis in a pig model was repeatedly demonstrated in this study, with a reasonable time required for the anastomosis.

Anastomosis, Surgical↗

PubMed2002

Robotics in laparoscopic surgery: current status and future perspectives.

BACKGROUND: Laparoscopic surgery has been introduced to limit the burden of surgical damage to the abdominal wall and peritoneum. METHODS: Description of procedure and results of robotic laparoscopic surgery. RESULTS: Laparoscopic surgery has resulted in reduction of postoperative pain, surgery-related complications and scarring. Laparoscopic techniques, however, are challenging for the surgeon owing to the disadvantages of inverted and restricted manipulation and the indirect two-dimensional view. In order to solve these problems, robotic telemanipulation systems were developed and introduced to the market at the end of the past decade. This article describes and discusses the current status and future perspectives of robotic systems in endoscopic surgery. CONCLUSION: Robotic laparoscopic surgery overcomes some of the disadvantages of conventional laparoscopic surgery.

Humans↗

PubMed2002

Robot-assisted surgical systems: a new era in laparoscopic surgery.

The introduction of laparoscopic surgery offers clear advantages to patients; to surgeons, it presents the challenge of learning new remote operating techniques quite different from traditional operating. Telemanipulation, introduced in the late 1990s, was a major advance in overcoming the reduced dexterity introduced by laparoscopic techniques. This paper reviews the development of robotic systems in surgery and their role in the operating room of the future.

Forecasting↗

PubMed2001

Continuing expansion of internal iliac artery aneurysms after surgical exclusion of the inflow. A report of two cases.

Two patients with continuing expansion of an internal iliac artery aneurysm following earlier repair of an aortoiliac aneurysm are described. At the primary operation, inflow to small internal iliac aneurysms had been interrupted by simple proximal ligation only. During follow-up, however, increasing diameter of the by CT-angiography completely thrombosed internal iliac aneurysms required re-operation. The observation of continuing growth of thrombosed internal iliac artery aneurysms following proximal ligation emphasises the danger of persistent collateral circulation and supports the concept of endotension in the absence of endoleak following endovascular AAA repair.

Aged↗