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At least 1,135 records · Page 63Linked to original sources

PubMed2004

Feasibility of robot-assisted totally intracorporeal laparoscopic ileal conduit urinary diversion: initial results of a single institutional pilot study.

OBJECTIVES: To explore the use of the da Vinci Surgical Robotic System (DSRS) to assist in the completion of totally intracorporeal laparoscopic ileal conduit urinary diversion (TLIC). METHODS: Two patients with radiation cystitis underwent TLIC procedures and another patient with bladder cancer underwent TLIC along with laparoscopic radical cystoprostatectomy at our institution. The ileal conduit urinary diversion was done totally intracorporeally using conventional laparoscopic techniques, and the DSRS was used to assist in the Bricker-type ureteroileal anastomosis. RESULTS: The 3 patients in the study included 2 men and 1 woman (mean age 73 years, range 64 to 84). The TLIC was completed intracorporeally in all 3 patients without the need for open conversion. The operative time, estimated blood loss, intraoperative decrease in hemoglobin, and time to hospital discharge for the 2 patients undergoing TLIC and the patient undergoing TLIC along with radical cystoprostatectomy was 628, 616, and 828 minutes, 50, 200, and 500 mL, 1.7, 2.8, and 5.3 g, and 5, 7, and 10 days, respectively. The median follow-up was 4.5 months (range 3.5 to 5.5). Postoperative satisfactory drainage of both kidneys was confirmed in all 3 patients at 8 weeks or later by intravenous urography or renal nuclear imaging. The serum creatinine remained stable in all 3 patients after surgery at hospital discharge. The only complication noted was postoperative ileus in the patient undergoing radical cystoprostatectomy that resolved with conservative management. CONCLUSIONS: TLIC is technically feasible and safe and can be done intracorporeally without complications. The DSRS can be successfully used to assist in the completion of TLIC. However, that each case lasted for more than 600 minutes highlights the need for further refinement in the technique. The practical application of TLIC requires improved long-term outcomes compared with open surgery, as well as a reduction in the operative time to justify the costs of robotic surgery.

Aged↗

PubMed2005

Impact of obesity on clinical outcomes in robotic prostatectomy.

OBJECTIVES: To assess the preoperative parameters and clinical outcomes of patients undergoing robotic laparoscopic radical prostatectomy with specific attention to the body mass index (BMI). Little is known about the impact of obesity (BMI greater than 30) on the clinical outcomes of patients undergoing radical prostatectomy. METHODS: The data of 100 men undergoing robotic laparoscopic radical prostatectomy between June 2002 and October 2003 were prospectively entered into a database. The standard clinical characteristics (eg, prostate-specific antigen, Gleason score) and perioperative and postoperative parameters were evaluated. Additionally, all were assessed preoperatively and postoperatively for American Urological Association symptom and bother scores, uroflowmetry, postvoid residual urine volume, and sexual function. RESULTS: Nineteen men were obese (BMI greater than 30) and 81 were not (BMI less than 30). The two groups had a similar need for transfusion, length of stay, and pathologic outcome. However, the obese men had poorer baseline urinary function (peak flow rate 13.9 versus 18.3 mL/s; voided volume 306 versus 454 mL; P < or =0.05) and sexual function (Sexual Health Inventory of Men score 14.1 versus 18.2; P < or =0.05). Obese men had significantly more complications (26.3% versus 4.9%; P = 0.01) and required more time to return to baseline activities (7 versus 4.3 weeks; P = 0.09) and urinary function. Finally, at 6 months, only 47% of obese patients versus 91.4% of nonobese patients had achieved pad-free urinary continence (P < or =0.001). CONCLUSIONS: In this study, obese patients had significantly worse baseline urinary and sexual function, had complications, and did not recover urinary function as quickly or as well as nonobese patients. Obese patients also demonstrated a strong trend toward a delay in recovery time.

Adult↗

PubMed2005

Feasibility study for robotic radical prostatectomy cautery-free neurovascular bundle preservation.

INTRODUCTION: Efforts continue to develop techniques that maintain the neurovascular bundles and minimize trauma for robotic laparoscopic radical prostatectomy. We evaluated the feasibility of preserving the nerve bundles without cautery or surgical clips. TECHNICAL CONSIDERATIONS: The seminal vesicles were dissected using scissors and bipolar cautery. After the rectum was mobilized, the vascular pedicles (VPs) were delineated. Laparoscopic bulldog clamps (30 mm) were placed at least 1 cm from the prostate. Using scissors, the VPs were divided right at the prostate. The neurovascular bundle was gently dissected off the prostatic capsule. After mobilizing the bundle, FloSeal was applied along its entire length. The FloSeal was then covered with a dry 1 x 4-cm sheet of Gelfoam. Once the prostate was removed, the bulldog clamps were sequentially withdrawn. The VPs were observed, and, if pulsatile bleeding was encountered, a 3-0 figure-of-eight suture was precisely placed for hemostasis. When hemostasis was complete, the anastomosis was performed. RESULTS: In 17 men, temporary vascular occlusion was applied to 27 VPs and FloSeal and Gelfoam was applied each time. In 4 cases (15%), hemostasis was inadequate because of continued arterial bleeding that was easily controlled with a superficial figure-of-eight ligature of 3.0 absorbable suture. The average estimated blood loss was 91 mL (range 75 to 150). CONCLUSIONS: Cautery-free, clip-free, nerve-sparing robotic laparoscopic radical prostatectomy is feasible using a combination of temporary occlusion of the thick posterior prostatic pedicles with bulldog clamps followed by application of FloSeal. The effect on potency needs further follow-up.

Adult↗

PubMed2005

Feasibility of robotic radical nephrectomy--initial results of single-institution pilot study.

OBJECTIVES: To report our initial experience and the utility of the da Vinci surgical robotic system (DSRS) for performing robotic radical nephrectomy (RRN). The DSRS has been increasingly evaluated to determine its feasibility for assisting surgeons in major urologic procedures. METHODS: The perioperative outcomes of the first five RRNs performed at our institution were analyzed to establish the safety and utility of the DSRS in performing RRN. RESULTS: Five male patients with a median age of 72 years (range 45 to 78) underwent RRN. The median body mass index, operative time, intraoperative blood loss, postoperative decrease in hemoglobin, postoperative rise in serum creatinine, postoperative morphine use, hospital stay, kidney size, and tumor size was 28 (range 20.9 to 32.9), 321 minutes (range 246 to 437), 150 mL (range 25 to 1500), 1.4 g/dL (range 0.2 to 3.5), 0.6 mg/dL (range 0.5 to 0.7), 28 mg (range 10 to 212), 3 days (range 1 to 5), 430 cm3 (range 158 to 1387), and 66 cm3 (range 29 to 120), respectively. One RRN was converted to hand-assisted laparoscopy because of bleeding from the left renal vein. No perioperative morbidities or mortalities occurred. The final pathologic examination revealed conventional clear cell carcinoma in 4 patients (1 with pT1a, 2 with pT1b, and 1 with T3a) and a benign cyst in 1 patient. CONCLUSIONS: The results of our study have confirmed that RRN is a feasible and viable alternative for performing radical nephrectomy. A larger randomized study incorporating cost and outcome comparisons with laparoscopic and open radical nephrectomy is needed before wider application of RRN.

Aged↗

PubMed2005

Robotic-assisted laparoscopic prostatectomy: what is the learning curve?

Although equipment for performance of robotic-assisted laparoscopic prostatectomy (RALP) is becoming more widely available, few surgeons have acquired the skill and experience necessary to master RALP. A significant issue has been the requisite training and experience (ie, the "learning curve") necessary for a qualified surgeon to become an expert at RALP. The senior author (J.A.S.) has experience with > 2500 radical retropubic prostatectomy (RRP) and > 350 RALP procedures. He assessed his learning curve in achieving expertise with RALP. Because there are no objective measures to define expertise with RALP, achievement of expert status depends on the surgeon's comfort, experience, and results with alternative approaches. Surgeons with extensive experience with open approaches may "set the bar" higher for the learning curve because of expectations. RALP results comparable to those obtained routinely with RRP were not achieved until after > or = 150 procedures. Surgeon comfort and confidence comparable to that with RRP did not occur until after 250 RALP procedures. Defining the learning curve for RALP as the point at which a surgeon could provide outcomes comparable to those obtainable with alternative surgical approaches means that the point varies, depending on the experience and expertise of the surgeon. Surgeons whose sole or dominant experience is with laparoscopic or robotic approaches may have a different perception of the learning curve compared with an experienced open surgeon.

Clinical Competence↗

PubMed2006

Robotic-assisted laparoscopic retroperitoneal lymph node dissection.

Minimally invasive laparoscopic techniques have been applied to the staging and treatment of testicular cancer during the performance of retroperitoneal lymph node dissection. The da Vinci Surgical System potentially improves the safety and accuracy of this approach. We present what we believe to be the first published description of robotic-assisted retroperitoneal lymph node dissection, which was performed in an 18-year-old man with a mixed germ cell tumor. This case demonstrates the technical feasibility, safety, and accuracy of robotic-assisted retroperitoneal lymph node dissection and expands the role of minimally invasive techniques in urologic oncology.

Adolescent↗

PubMed2006

Robotic laparoscopic radical prostatectomy: setup and procedural techniques after 150 cases.

OBJECTIVES: To report our current methods of patient positioning, establishing the pneumoperitoneum, port placement, and helpful maneuvers during the procedure that have been refined over the course of our initial experience with robotic laparoscopic radical prostatectomy (RLRP). RLRP is gaining popularity as a minimally invasive technique for treating patients with organ-confined prostate cancer. Because this is a new procedure, strategies to optimize the surgical technique are constantly evolving. METHODS: Two genitourinary surgeons experienced in open surgery with no laparoscopic experience began performing RLRP in December 2003 after appropriate training and mentoring. During the course of the ensuing 150 cases, new techniques were developed in an attempt to simplify the operation and improve its outcome. RESULTS: We documented and illustrated techniques for patient positioning, safe and rapid placement of the initial camera trocar, use of the third working arm of the da Vinci Surgical System, trocar positioning, and prostatic retraction to assist with posterior dissection. CONCLUSIONS: We have described setup techniques and principles we developed during our experience with the da Vinci robotic system. These points of technique may be helpful for simplifying a procedure that is still in evolution.

Aged↗

PubMed2006

Robotic-assisted laparoscopic prostatectomy in overweight and obese patients.

OBJECTIVES: To assess outcomes of robotic laparoscopic radical prostatectomy (RLRP) in overweight and obese patients, defined as those with a body mass index (BMI) of 25 to 30 kg/m2 and greater than 30 kg/m2, respectively. METHODS: This was a nonrandomized study evaluating all of our RLRP patients. Patients were divided into three groups: BMI of 25 kg/m2 or less (group 1), BMI greater than 25 kg/m2 and less than 30 kg/m2 (group 2), and BMI of 30 kg/m2 or more (group 3). Patients were evaluated prospectively with the validated Rand 36-Item Health Survey (version 2) and with the University of California, Los Angeles Prostate Cancer Index questionnaire. RESULTS: Between February 2003 and November 2004, 150 RLRPs were performed at our center. Average follow-up was 8 months. Groups 1, 2, and 3 had 39, 65, and 46 patients, respectively. Average BMIs for all three groups were statistically different (P < 0.01). When compared with group 1, open conversion rates, hospital stay, positive margin, and complication rates were not statistically different for groups 2 or 3. Operative time (P < 0.004) and estimated blood loss (P < 0.03), however, were statistically greater for group 3 compared with group 1. Transfusion rate was highest in group 2 (P = 0.04 compared with group 1). Prostate weights were also statistically greater in groups 2 (P = 0.003) and 3 (P = 0.02) compared with group 1. Overall, BMI did not increase perioperative and postoperative morbidity. CONCLUSIONS: Robotic laparoscopic radical prostatectomy is safe in overweight and obese patients and might be the surgical management of choice in this subset of patients. Further long-term follow-up with more patients is required to verify this initial observation.

Adult↗

PubMed2001

Perioperative nurse training in cardiothoracic surgical robotics.

The exponential growth of OR technology during the past 10 years has placed increased demands on perioperative nurses. Proficiency is required not only in patient care but also in the understanding, operating, and troubleshooting of video systems, computers, and cutting edge medical devices. The formation of a surgical team dedicated to robotically assisted cardiac surgery requires careful selection, education, and hands-on practice. This article details the six-week training process undertaken at Sarasota Memorial Hospital, Sarasota, Fla, which enabled staff members to deliver excellent patient care with a high degree of confidence in themselves and the robotic technology.

Coronary Artery Bypass↗

PubMed1998

Is the robotic arm a cost-effective surgical tool?

With the advancement of technology, OR managers must properly appraise new tools and blend their resources to achieve optimal cost benefits. This article examines and compares five research studies to determine if the robotic arm can effectively provide the surgeon complete control of the surgical field and alleviate the need for a human camera holder assistant. The study results indicates the robotic arm not only outperforms human camera holders, but also reduces laparoscopic surgical operating time, resulting in improved efficiency and cost savings to the institution.

Cost-Benefit Analysis↗

PubMed2006

Robotic-assisted laparoscopic radical prostatectomy.

Robotic-assisted radical prostatectomy uses the newest technology for surgical treatment of men with prostate cancer. Cancer of the prostate is the most common cancer in men and the second leading cause of death in American men. The Benefits of robotic-assisted prostate surgery over open radical prostatectomy include small portal incisions, decreased blood loss, and shorter hospital stays. Magnification of the surgeon's field of vision and jointed laparoscopic instruments that mimic the human wrist allow precision of movement and the ability to spare nerves, which result in improved postoperative urinary continence and sexual function.

Humans↗

PubMed2003

Application of robotics to steady state enzyme kinetics: analysis of tight-binding inhibitors of dipeptidyl peptidase IV.

Using available commercial robotics and instrumentation, we developed a fully automated and rigorous steady state enzyme kinetic assay for dipeptidyl peptidase IV (DPP IV; E.C. 3.4.14.5). The automated assay was validated with isoleucyl thiazolidide, a potent inhibitor of DPP IV with K(is)=110nM. Signal window analysis indicated that the assay had a 98% probability of detecting an inhibitor yielding 15% inhibition, with a predicted false positive rate of 0.13%. A mechanistic inhibition version of the automated assay was validated with isoleucyl 4-cyanothiazolidide, a very potent inhibitor of DPP IV. Isoleucyl 4-cyanothiazolidide was a competitive inhibitor of purified porcine DPP IV with K(is)=1 nM. Similar K(is) values were obtained for purified rat DPP IV and for DPP IV activity in human plasma from normal and diabetic donors. The pH dependence of K(is) for isoleucyl 4-cyanothiazolidide yielded a bell-shaped profile, with pK(a)=5.0 and pK(b)=7.6. To date, over 100,000 data points have been generated in profiling targeted compound libraries and in the analysis of tight-binding inhibitors of DPP IV. The data also show that robotic analysis is capable of producing full mechanistic inhibition analysis in a timely fashion to support drug discovery.

Animals↗

PubMed2000

A comparison of robot-assisted versus manually constructed endoscopic coronary anastomosis.

BACKGROUND: New technology has enabled surgeons to attempt totally endoscopic coronary artery bypass grafting. Our purpose was to compare three different techniques of totally endoscopic anastomosis using a porcine animal model. METHODS: Porcine hearts were excised and the right coronary artery was dissected free for use as an arterial graft. The hearts were placed in a human thoracic model and an endoscopic arterial anastomosis between the free right coronary artery and the left anterior descending coronary artery was performed using one of the following: (1) two-dimensional visualization with straight endoscopic instruments (n = 8); (2) three-dimensional head-mounted visualization with curved endoscopic instruments (n = 7); or (3) three-dimensional visualization with robotic telemanipulation (n = 8). Pathologic analysis of suture placement, vessel trauma, and patency was performed. Anastomoses were graded according to quality, ease, and patency using a seven-point Likert scale (1 = excellent, 7 = very poor). RESULTS: Endoscopic anastomotic ease and quality were significantly improved when three-dimensional visualization and curved endoscopic instruments were employed. Telemanipulation enhanced the process and provided the best operative results with regard to time required to construct the anastomosis, as well as ease and quality. CONCLUSIONS: Totally endoscopic anastomosis is feasible using currently available technology. Three-dimensional visualization and robotic telemanipulation significantly facilitate anastomosis construction and will likely benefit clinical operative outcome.

Anastomosis, Surgical↗

PubMed2000

Robotic-enhanced arterial revascularization for multivessel coronary artery disease.

BACKGROUND: A tendency to reduce operative trauma is determining the evolution of cardiac surgical techniques lately. The introduction of robotic-enhanced endoscopic systems enables surgeons to perform arterial revascularization for multivessel disease without sternotomy. METHODS: From May 1999,17 (4 women, 13 men; median age 63+/-7.4 years) patients with multivessel coronary artery disease were treated surgically using arterial revascularization by means of bilateral internal mammary arteries. Both arteries were harvested endoscopically using the da Vinci system (Intuitive Surgical, Mountain View, CA). These vessels were anastomosed using the "Dresden technique." RESULTS: Survival was 100%. Mean duration of the operation was 255+/-40.4 minutes. Bilateral internal mammary artery harvesting took 88.5+/-15.9 minutes; cross-clamp time was 36+/-8.7 minutes. An average of 2.06 anastomoses were performed per operation. Postoperatively, patients remained in the intensive care unit for 21+/-13 hours. One patient (5.8%) needed reexploration due to bleeding. CONCLUSIONS: The robotic surgical system introduces a new treatment of coronary artery disease to surgical practice, and enables arterial revascularization with distinctly reduced surgical trauma.

Anastomosis, Surgical↗

PubMed1998

Robotic automation of coagulation analysis.

Laboratory automation systems (LAS) have been installed in over 22 sites across North America providing automation of many preanalytical and analytical tasks in clinical laboratories. Only a few laboratories have automated the analysis of citrated whole blood for the diagnosis of hemostasis disorders. The analysis of coagulation factors in citrated blood requires a large amount of labor in order to provide rapid turnaround; thus automation of this analytical process is attractive. Therefore, we have created an automated coagulation workstation using a systematic approach to automation design and engineering. First, we used discrete event simulation to calculate potential throughput and to identify possible bottlenecks for the proposed coagulation workcell. We then created a three-dimensional animated computer model of the workstation to simplify workstation design. Finally, we constructed a prototype workcell using a mobile robot, an articulated robotic arm, and a coagulation analytical system.

Blood Coagulation Disorders↗

PubMed2002

A walking robot called human: lessons to be learned from neural control of locomotion.

From what we know at present with respect to the neural control of walking, it can be concluded that an optimal biologically inspired robot could have the following features. The limbs should include several joints in which position changes can be obtained by actuators across the joints. The control of mono- and biarticular actuators should occur at least at three levels: one at direct control of the actuators (equivalent to motoneuron level), the second at indirect control acting at a level which controls whole limb movement (flexion or extension) and the third at a still higher level controlling the interlimb coordination. The limb level circuits should be able to produce alternating flexion and extension movements in the limb by means of coupled oscillator flexor and extensor parts which are mutually inhibitory. The interlimb control level should be able to command the various limb control centers. All three control levels should have some basic feedback circuits but the most essential one is needed at the limb control level and concerns the decision to either flex or extend a given limb. The decision to activate the extensor part of the limb oscillator has to be based on feedback signalling the onset of loading of the limb involved. This should be signalled by means of load sensors in the limb. The decision to activate the flexor part of the limb oscillator has to depend on various types of feedback. The most important requirement is that flexion should only occur when the limb concerned is no longer loaded above a given threshold. The rule for the initiation of limb flexion can be made more robust by adding the requirement that position at the base of the limb ("hip") should be within a normal end of stance phase range. Hence, human locomotion is thought to use a number of principles which simplify control, just as in other species such as the cat. It is suggested that cat and human locomotion are good models to learn from when designing efficient walking robots.

Animals↗

PubMed1999

Robotic computer-assisted telemanipulation enhances coronary artery bypass.

OBJECTIVES: Totally endoscopic coronary artery bypass grafting depends greatly on perfecting the anastomosis. We tested a new computer-assisted telemanipulation robot (Intuitive Surgical Inc, Mountain View, Calif) in performing endoscopic coronary bypass. METHODS: On-bench anastomoses of the porcine arterial graft to the left anterior descending coronary artery were performed with both direct visualization and conventional surgical instruments (group I), endoscopic 3-dimensional visualization and current endoscopic surgical instruments (group II), direct visualization and endoscopic instruments (group III), 3-dimensional endoscopic visualization and conventional surgical instruments (group IV), and telemanipulation robotic with 3-dimensional endoscopic visualization (group V). Anastomoses (n = 6 in each group) were assessed for time (minutes), quality (good = 3, fair = 2, poor = 1), technical difficulty (easy-difficult: 1-4), and patency (100% = 1, >50% = 2, <50% = 3). RESULTS: Anastomotic time was significantly longer in groups II and III than in groups IV and V (P </=.02). Patency was comparable in all groups. CONCLUSION: Telemanipulation technology may enhance the performance of totally endoscopic coronary artery anastomosis. The facility and time of an Intuitive telemanipulation anastomosis is comparable with that of a conventional anastomosis created under direct vision.

Anastomosis, Surgical↗

PubMed2003

Robot-assisted laparoscopic colorectal surgery.

Colorectal surgery can be difficult at open and laparoscopic surgery. This is particularly the case for rectal surgery deep in the pelvis. In obese males distal rectal dissection can be challenging because of instrument and visual limitations. Robot-assisted laparoscopic colorectal operations do not differ significantly from the standard laparoscopic approach but it has certainly been shown that it is feasible to perform the same operation using robotic assistance for the dissection. This allows the surgeon to benefit from vastly enhanced vision and dexterity, which may ultimately translate into benefit for the patient in terms of reduced operating time, and better preservation of pelvic nerves and other structures.

Colonic Diseases↗