Current status and pondering of minimally-invasive surgical techniques in radical resection of hilar cholangiocarcinoma / 中华消化外科杂志

Hilar cholangiocarcinoma is one difficultly-treated biliary malignancy with poor prognosis, and radical resection offers the only hope of cure for the disease. In recent years, with development and maturation of minimally-invasive techniques, laparoscopic or robotic-assisted radical resection of hilar cholangiocarcinoma has been attempted in some major medical centers. Laparoscopic and robotic-assisted radical resection of hilar cholangiocarcinoma is technically safe and feasible at present, but there is still a lack of large number of case report and evaluation of long-term survival of patients. Based on previous literatures and combined with clinical experiences, the author elaborates on the application status of laparoscopic and robot surgical system in the radical resection of hilar cholangiocarcinoma, and discusses the key issues that should be paid attention to in carrying out this technology, such as the operator′s prerequisite requirement and patients′ selec-tion, how to ensure the radicality of surgical resection and improve the long-term outcomes.

Robot-assisted laparoscopic enucleation in the treatment of leiomyosarcoma of urinary bladder: A case report / 中南大学学报(医学版)

Leiomyosarcoma of urinary bladder (LMS-UB) is a highly malignant mesenchymal tumor, accounting for less than 0.5% of all bladder malignancies, with a predominant clinical presentation of hematuria. Here we report a case of low-grade LMS-UB. A 44-year-old male patient was admitted to the hospital with urodynia for 2 weeks. The patient's pelvis CT showed a mass on the right part of the bladder. For this reason, he was initially diagnosed with bladder cancer. We performed a robot-assisted laparoscopic enucleation of the bladder tumor and low-grade LMS-UB was diagnosed with the histopathological examination. He underwent 5 cycles of adjuvant chemotherapy after surgery. At 19months postoperative follow-up, the patient had no symptoms, recurrence, or distant metastasis. There is no report on the treatment of LMS-UB with minimally invasive enucleation worldwide. This case provides a new comprehensive treatment method of enucleation combined with adjuvant chemotherapy for early low-grade LMS-UB to reduce complications and improve patients' quality of life after surgery.

Training status of operating room nurses of robotic-assisted surgery system in China: a cross-sectional survey / 中国实用护理杂志

Objective:To investigate the training status of robotic-assisted surgery nurses in hospitals with robotic-assisted surgery system in China, and to provide reference for the training and management of robotic-assisted surgery nurses.Methods:From August to December in 2021, hospitals with robotic-assisted surgery system in China were surveyed by a self-designed questionnaire distributed online.Results:The participants in the survey of 111 hospitals in 30 provinces, cities, autonomous regions and municipalities directly under the central government, nurses cooperated with robotic-assisted surgery exist the phenomenon of their own training was up to 96.40% (107/111) of hospital, 47.75% (53/111) of the hospital said the current training content also need to add other aspects of the course. Training duration of theoretical courses was 0-13 (2.86 ± 3.03) periods arranged by hospitals, and the training duration of practical courses was 1-60 (8.38 ± 9.91) d. 35.14% (39/111) of hospitals set up regular assessment after training, and the assessment cycle of them was 1-12 (4.08 ± 3.31) months. Many hospitals put forward suggestions on strengthening English training and attaching importance to team cooperation and so on.Conclusions:In our country, Robotic-assisted surgery nurses′ training has turned to that training themselves in operating rooms, the training time, form, content and other aspects have no uniform standard, strict admittance, standardization of specialist training , these are questions need to solve.

Extraperitoneal approach robotic-assisted urethra-sparing simple prostatectomy for large-gland benign prostatic hyperplasia: initial experience / 中华泌尿外科杂志

Objective@#To report our initial experience with extraperitoneal approach Robotic-Assisted Urethra-sparing simple prostatectomy(US-RASP)on large-gland (>100 ml) benign prostatic hyperplasia(BPH).@*Methods@#From August 2015 to April 2018, 32 patients with large volume prostate underwent US-RASP performed by single surgical team were retrospectively reviewed. The patient's median age was 73 (range 59-80) years, and median BMI was 24.9 (19.3-34.8 ) kg/m2, The estimated prostate volume(V), postvoid residual volume(PV) by transrectal ultrasonography and PSA were 152.0(119.0-223.1)ml, 145(0-280)ml and 13.7(5.2-27.3)ng/ml, respectively. Four of 32 patients underwent preoperative urinary catheterization. The perioperative functional parameters including international prostate symptom score (IPSS) questionnaire, maximum flow rate (Qmax), maximum voided volume(Vmax), quality of life questionnaires (QOL) and International Index of erectile function-erectile function (IIEF-EF) were 27(23-33), 5.9 (2.5-7.8) ml/s, 110 (80-210)ml, 5(3-6), and 27(26-29), respectively. Functional parameters including IPSS, QOL, Qmax, Vmax, PV and IIEF-EF were compared and analyzed at 3 and 12 months postoperatively during the following-up.@*Results@#The US-RASP was completed in all 32 patients and no open conversion. Median operation time was 180 (115-240) min, the estimated blood loss was 300(range 100 to 400)ml, Hemoglobin loss was 17(5-38)g/L. The median Foley catheterization time was 7 (5-12) days and drainage was removed after a median of 5 (4-7) days with median hospital stay of 8(6-14)days. Median specimen weight on pathological examination was 107.7 (79.8-147.4)g with median of 64.2% (49.4%-86.2%) resection ratio. At 3-mo follow-up, median IPSS score, Qmax, Vmax, PV and QOL were 6(4-18), 17.3 (13.8-21.1)ml/s, 167(140-310)ml, 50(0-61)ml, 1(0-3) , respectively. At 12-mo follow-up, median IPSS score, Qmax, Vmax, PV and QOL were 4(1-9), 20.1 (17.9-24.1)ml/s, 205(176-305)ml, 24(0-35)ml and 1(0-2) , respectively. All patients showed great improvement of IPSS, Qmax, Vmax, PV and QOL after median 17 (12-44) months follow-up compared with preoperative parameters (P<0.05). Erectile function was not impaired in 17 patients who have normal erectile function pre-operatively and 14 cases (82.4%) preserved satisfactory anterograde ejaculation. No significant complication occurred during the procedure. No patient developed permanent urinary incontinence.@*Conclusions@#US-RASP is a safe and effective treatment option for selected patients with large-gland obstructive BPH(>100 ml). Our data showed significant improvement in voiding function and maintaining satisfactory anterograde ejaculation following urethral-sparing technique. It may be a new alternative method in the future for large-volume symptomatic BPH.

Extraperitoneal approach robotic-assisted urethra-sparing simple prostatectomy for large-gland benign prostatic hyperplasia: initial experience / 中华泌尿外科杂志

Objective To report our initial experience with extraperitoneal approach RoboticAssisted Urethra-sparing simple prostatectomy (US-RASP)on large-gland (＞ 100 ml) benign prostatic hyperplasia(BPH).Methods From August 2015 to April 2018,32 patients with large volume prostate underwent US-RASP performed by single surgical team were retrospectively reviewed.The patient's median age was 73 (range 59-80) years,and median BMI was 24.9 (19.3-34.8) kg/m2,The estimated prostate volume(V),postvoid residual volume(PV) by transrectal ultrasonography and PSA were 152.0 (119.0-223.1) ml,145 (0-280) ml and 13.7 (5.2-27.3) ng/ml,respectively.Four of 32 patients underwent preoperative urinary catheterization.The perioperative functional parameters including international prostate symptom score (IPSS) questionnaire,maximum flow rate (Qmax),maximum voided volume(Vmax),quality of life questionnaires (QOL) and International Index of erectile function-erectile function (IIEF-EF) were 27(23-33),5.9 (2.5-7.8) ml/s,110 (80-210)ml,5(3-6),and 27(26-29),respectively.Functional parameters including IPSS,QOL,Qmax,Vmax,PV and IIEF-EF were compared and analyzed at 3 and 12 months postoperatively during the following-up.Results The US-RASP was completed in all 32 patients and no open conversion.Median operation time was 180 (115-240) min,the estimated blood loss was 300(range 100 to 400)ml,Hemoglobin loss was 17 (5-38)g/L.The median Foley catheterization time was 7 (5-12) days and drainage was removed after a median of 5 (4-7) days with median hospital stay of 8(6-14)days.Median specimen weight on pathological examination was 107.7(79.8-147.4) g with median of 64.2％ (49.4％-86.2％) resection ratio.At 3-mo follow-up,median IPSS score,Qmax,Vmax,PV and QOL were6(4-18),17.3 (13.8-21.1)ml/s,167(140-310)ml,50 (0-61)ml,1(0-3),respectively.At 12-mo follow-up,median IPSS score,Qmax,V PV and QOL were 4(1-9),20.1 (17.9-24.1)ml/s,205(176-305)ml,24(0-35)ml and 1(0-2),respectively.All patients showed great improvement of IPSS,Q V PV and QOL after median 17 (12-44) months follow-up compared with preoperative parameters (P ＜ 0.05).Erectile function was not impaired in 17 patients who have normal erectile function pre-operatively and 14 cases (82.4％) preserved satisfactory anterograde ejaculation.No significant complication occurred during the procedure.No patient developed permanent urinary incontinence.Conclusions US-RASP is a safe and effective treatment option for selected patients with large-gland obstructive BPH(＞ 100 ml).Our data showed significant improvement in voiding function and maintaining satisfactory anterograde ejaculation following urethral-sparing technique.It may be a new alternative method in the future for large-volume symptomatic BPH.

Experiencia inicial con cirugía revisional bariátrica asistida por robot / Initial experience with robotic assisted revisional bariatric surgery

Resumen Introducción La cirugía bariátrica robótica es una técnica novedosa y en desarrollo en Chile. Los procedimientos bariátricos revisionales han aumentado durante los últimos años. No existen publicaciones en nuestro país relacionadas con experiencias en cirugía bariátrica revisional robótica. El objetivo de este estudio es describir la experiencia inicial y los resultados a corto plazo con el uso de la cirugía robótica en estos procedimientos. Material y Métodos Realizamos una revisión retrospectiva de todos los pacientes sometidos a cirugía bariátrica revisional asistida por robot, en Clínica Santa María, de Santiago de Chile. Analizamos las características demográficas, resultados quirúrgicos, morbilidad, mortalidad y tiempo de estadía hospitalaria. Resultados Se realizaron un total de 59 cirugías bariátricas revisionales asistidas por robot, 11 remodelamientos de gastrectomía en manga, 34 bypass gástrico en Y-Roux, 1 remodelamiento del pouch gástrico en un bypass gástrico en Y-Roux, 3 extracciones de banda gástrica ajustable, 1 de ellas con gastrectomía en manga simultánea, 5 instalaciones de banda gástrica ajustable en pacientes con bypass gástrico en Y-Roux, 3 gastrectomías totales, 1 resección de fístula gastro-gástrica y una anastomosis gastroyeyunal. La edad promedio fue de 47,8 años. El Índice de Masa Corporal promedio preoperatorio fue de 33,86 kg/m2. El tiempo quirúrgico promedio fue de 101,63 min. Se observaron complicaciones postoperatorias en 3 pacientes (5,08%). En 2 (3,39%) de ellos, se requirió una reoperación. No hubo fallecidos. El tiempo promedio de estadía hospitalaria fue de 3,6 días. conclusión La cirugía bariátrica revisional asistida por robot es una técnica novedosa, que parece ser segura y efectiva.

Background Robotics in bariatric surgery is a novel development in medical institutions in Chile. Revisional bariatric procedures have increased during the last years. There are no publications in our country related to the initial experience and results in robotic revisional bariatric surgery. The aim of this study is to describe the initial experience and short term outcomes with robotic revisional bariatric surgery. Study Design We conducted a retrospective study of all consecutive robotic revisional bariatric surgeries performed by a single surgeon in Clínica Santa María in Santiago, Chile. We analyzed demographic characteristics and surgical outcomes, morbidity, mortality and length of hospital stay. Results 59 revisional bariatric surgeries were performed, 11 reshaping of sleeve gastrectomy, 34 Roux in Y gastric bypass, 1 pouch reshaping of Roux in Y gastric bypass, 3 extractions of laparoscopic adjustable gastric banding, 1 of them with simultaneous sleeve gastrectomy, 5 laparoscopic adjustable gastric banding to patients with previous Roux in Y gastric bypass, 3 total gastrectomy, 1 resection of gastro-gastric fistula and 1 gastro enteral anastomosis. Mean age was 47.8 years. Average preoperative body mass index was 33.86 kg/m2. Mean surgical time was 101.63 minutes. Postoperative complications were observed in 3 patients (5.08%). In 2 (3.39%) of this patient, reoperation was required. There were no deaths in this group. Average length of hospital stay was 3.6 days. Conclusion Robotic revisional bariatric surgery is a novel technique that appears to be safe and effective.

Effects of transcutaneous electrical acupoint stimulation on recovery of patients undergoing robotic gynecologic surgery / 临床麻醉学杂志

Objective To observe whether transcutaneous electrical acupoint stimulation (TEAS) could improve the emergence and recovery of patients undergoing robotic gynecologic surgery,and to explore the mechanism behind it.Methods Patients (aged 18-65 years,BMI 18-30 kg/m2,ASA grade Ⅰ or Ⅱ) scheduled for elective robotic gynecologic surgery were screened and randomized into three groups:group TEAS (groups T),no acupoint group (group N) and control group (group C),receiving TEAS (ST-36,SP6,BL59,BL60),stimulation at bilateral hips and no-stimulation respectively.Stimulations were given from 30 min before anesthesia induction to the end of surgery.Recovery measurements during emergence,PACU stay and 24 h after surgery were recorded.Levels of serum AQP4,MMP9 and S100β were analyzed.Results Time to response to verbal command and time to extubation in group T [(18.3± 6.7) min and (19.4 ± 6.6) min respectively] were significantly shorter than those in group C [(21.9±7.3) min and (23.1±7.3) min respectively] (P ＜0.05).Maximum VAS scores during PACU stay were significantly lower in group T than that in groups C and N (P＜0.05).Postoperative AQP4 level in group T significantly decreased compared with baseline (P＜0.05).However,postoperative MMP9 and S100β level in group C significantly in creased compared with the baseline (P＜0.05 or P＜0.01).Conclusion TEAS could fasten emergence of patients after robotic gynecologic surgery and improve postoperative analgesia.Mechanisms involving AQP4,MMP9 and S100β may be involved.

Effects of hyperventilation on jugular bulb pressure and optic nerve sheath diameter during robotic laparoscopic radical prostatectomy / 实用医学杂志

Objective To observe the effects of hyperventilation on jugular bulb pressure and optic nerve sheath diameter during RALRP. Methods Twenty patients undergoing elective RALRP were enrolled in this study. After hyperventilation of General anesthesia,we monitored and recorded changes of Heart rate(HR),mean arterial pressure (MAP),end-tidal carbon dioxide (ETCO2),arterial oxygen tension (PaO2),arterial carbon dioxide tension(PaCO2),peak airway pressure(PIP),JBP and ONSD in 5 minutes after intubation(T0),Trendelenberg posture in 15 minutes (T1),the established pneumoperitoneum in 30,60,90 minutes (T2,T3,T4) and termination of pneumoperitoneum in 15 minutes in supine position(T5)respectively. Results Compared with T0, JBP increased at T1 ~ T5(P < 0.05). ETCO2 and PaCO2 of T1 ~ T5 were lower than those of T0(P < 0.05)during hyperventilation. After establishment of Trendelenburg posture and pneumoperitoneum,PIP values increased at T1~T4 than that at T0 (P < 0.05),However,ONSD increased from T3 to T5 compared with T1 to T2 (P < 0.05). Conclusion Through over-ventilation,pneumoperitoneum and Trendelenburg posture,JBP and PIP can increase, and ONSD becomes wider evendually.

The technique and effectiveness of potency preservation in robotic-assisted laparoscopic radical prostatectomy / 中华泌尿外科杂志

Objective To evaluate the key technique and effectiveness of potency preservation in robotic-assisted laparoscopic radical prostatectomy (RALP).Methods The complete clinical and follow-up data of 30 cases underwent RALP between February and May of 2016 were reviewed retrospectively.The average age of the patients was 67.3 years (48-82 years).The peak PSA level before surgery ranged from 7.6 to 53.4 ng/ml with the average level of 21.1 ng/ml.There were 7,16,6 and 1 case with the Gleason score of 6,7,8,and 9 point,respectively.Preoperative erectile score (IIEF-5) of the 30 patients were list as below:3 cases (0-10 points),4 cases(11-15 points),17 cases(16-20 points),and 6 cases(21-25 points).The key techniques of potency preservation during RALRP includes deep dorsal vein ligation techniques,neurovascular bundles preservation techniques and drain tube placement techniques.Results All 30 cases underwent operation successfully with no transfer to open surgery.Average operative time was 150.7 min (98-240 min) with an estimated blood loss of 165.7ml (50-550 ml).The average drainage removal time was 5.1 d postoperatively.The average bowel recovery time was 2.7 d and average hospitalization time was 8.2 d,respectively.There were two cases with one positive margin on the bladder neck and one on the tip of prostate,respectively.Seventeen cases gained potency preservation six months after surgery.Conclusion It was safe and beneficial for the potency preservation in RALP,which could be considered as one of the best options for the prostate cancer surgery.

Application of robotic-assisted surgery in urology / 医疗卫生装备

Objective To elaborate the application of robotic-assisted surgery in urology. Methods The application of robotic-assisted surgery was described to the prostate, bladder, kidney, adrenal gland and pyeloplasty in the urology department. Results The robotic-assisted surgery was compared with the traditional open surgery and laparoscopic operation, and then had its prospect explored. Conclusion The robotic-assisted surgery provides 3D visual system and flexible operation, decreases the complications and hospital stay, improves the prognosis of the patient, and takes the place of the traditional operation mode.

Net present value as an instrument to simplificate the decision making process in health technologies economic evaluation / O Valor Presente Líquido como instrumento de simplificação do processo de tomada de decisão nas análises econômicas de tecnologias em saúde

Objectives: The study aims to highlight the Present Value (PV) as a financial analysis tool which could simplify the decision making process of introducing health technologies. The financial evaluation can be extended as necessary, including outcomes and utility. As a model, the instrument was applied to the economic analysis of a robotic-assisted surgery equipment acquisition at José de Alencar Gomes da Silva National Cancer Institute (INCA ? Ministry of Health ? Brazil). Methods: The economic analysis of a robotic-assisted surgery equipment acquisition in an institute for oncology using the PV. Quantitative data was simulated to allow the development of an economic model, considering prostatectomy as a basis. The PV was calculated using MS EXCEL®. The results allowed us to formulate the goals of a Budget Impact Analysis (BIA) or other health economics evaluation within the process of public choice in a Beveridge model health care system. Results: The PV in this model was positive. Data collection and processing was simple and extrinsic macroeconomics variables, such as inflation and change, were important to reflect their impact to the budget. Cost information reflected the local market. A negative PV provided information on the financial resourceamount to introduce technology by justified use. Conclusions: The PV has proved to be a useful and robust instrument to evaluate financial risks, especially those related to the introduction of a recent technology. This financial perspective as performed helped to set the goals of a societal perspective in a unified health care system through the health economics evaluation.

Objetivos: O trabalho procura oferecer uma visão sobre a aplicação do valor presente (VP) como um instrumento de análise financeira que poderia simplificar o processo de tomada de decisão para a introdução de tecnologias de saúde. A partir do resultado da análise financeira, o processo de tomada de decisão poderá ser ampliado de acordo com a necessidade, incluindo as análises sobre desfecho e utilidade. O modelo descrito foi utilizado como instrumento de avaliação econômica da aquisição do equipamento de cirurgia robótica no Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA ? Ministério da Saúde ? Brasil). Métodos: Análise econômica da introdução de equipamento de cirurgia robótica em um instituto de atenção oncológica, utilizando o valor presente. As informações quantitativas foram simuladas para permitir o desenvolvimento do modelo econômico, considerando o procedimento de prostatectomia. O valor presente foi calculado com o auxílio do programa MS EXCEL®. O resultado possibilita a formulação dos objetivos de uma análise de impacto orçamentário (AIO) ou a de outra avaliação de econômica em saúde dentro do processo de escolha pública em um sistema de saúde do tipo Beveridge. Resultados: No modelo apresentado, o valor presente foi positivo. Foifácil levantar e manusear as informações e as variáveis econômicasextrínsecas como inflação e taxa de câmbio se deixam refletir nadeterminação das necessidades orçamentárias. Informações sobre custo refletem o mercado onde estará sendo utilizada a tecnologia. Um valor presente negativo irá oferecer informação sobre a necessidade orçamentária para introdução da tecnologia no caso de utilidade relevante para a sociedade. Conclusões: O valor presente comprovou ser uma ferramenta robusta e útil para avaliar o risco financeiro, principalmente na introdução de tecnologias pioneiras. Da maneira como é analisada a perspectiva financeira, facilita a determinação de objetivos relacionados à perspectiva social dentro de um sistema universal de saúde e que poderão ser acoplados a avaliação econômica de saúde.

Effect of Da Vinci robot-assisted laparoscopic radical prostatectomy on the respiratory system of elderly patients in intensive care units / 中国综合临床

Objective To explore the effect of Da Vinci robot?assisted laparoscopic radical prostatecto?my on the respiratory function of elderly in Intensive Care Units( ICU) . Methods Thirty?nine elderly patients received Da Vinci robot?assisted laparoscopic radical prostatectomy ( RARP ) from January 2015 to April 2016 and 25 cases received conventional laparoscopic radical prostatectomy from January 2014 to December 2014 ad?mitted into ICU were retrospectively analyzed. Their comorbidities,blood loss and transfusion during surgery,ate?rial blood gas(ABG) analysis and respiratory complications after operation,clinical outcomes between the two groups were compared. Results Compared with conventional laparoscopic radical prostatectomy,RARP group spent more time in surgery((4. 23±1. 44) h vs. (3. 25±1. 31) h,t=2. 783,P<0. 05),more patients need venti?lation(11 vs. 1,χ2=4. 378,P<0. 05) . ABG analysis showed respiratory and metabolic acidosis with lower pH (7. 29±0. 09 vs. 7. 35±0. 05,t=3. 886,P<0. 05),HCO3?((20. 05±2. 50) mmol/L vs. (22. 86±2. 53) mmol/L,t=3. 473,P<0. 05),BE(-5. 11±3. 94 vs.-3. 64±1. 17,t=5. 018,P<0. 05) and higher pCO2(46. 15±8. 31 vs. 40. 25±6. 57,t=2. 475,P<0. 05),Lac((3. 54±1. 99) mmol/L vs. (2. 91±1. 39) mmol/L,t=2. 254,P<0. 05) . Conclusion RARP may cause carbon dioxide retention and respiratory complications on elderly pa?tients. It may reduce postoperative respiratory complications by shortening surgery time,lowering pneumoperitone?um pressure,hyperventilation,recruitment maneuvers and chest physical therapy.

Rupture of endotracheal tube cuff during robot-assisted endoscopic thyroidectomy: A case report / 대한마취과학회지

We encountered a case of a rupture of an endotracheal tube cuff during robot-assisted thyroid surgery in a 35-year-old male patient. Two hours after commencing surgery, the bellows of the ventilator were not filled and a rupture of the endotracheal tube cuff was suspected. Once the robot-manipulator is engaged, the position of the operating table cannot be altered without removing it from the patient. Reintubation with direct laryngoscopy was performed with difficulty in the narrow space between the patient's head and robot-manipulator without moving the robot away from the patient. The rupture of the endotracheal tube cuff was confirmed by observing air bubbles exiting from the balloon in water. The patient was discharged 3 days after surgery without complications. In robot-assisted thyroid surgery, a preoperative arrangement of the robot away from the patient's head to obtain easy access to the patient is essential for safe anesthetic care.

Common peroneal nerve palsy after robotic assisted laparoscopic colectomy: A case report / 대한마취과학회지

Common peroneal nerve palsy after surgery with lithotomy position has been widely reported, but it is an unexpected complication after surgery with supine position. We report a patient who developed common peroneal nerve palsy after surgery with supine position. A 55-year old man is planed for robotic assisted laparoscopic right hemicolectomy because of colon cancer. The patient was placed supine with Trendelenburg position at an angle about 5 degrees and tilted left about 15 degrees. The operation is uneventful, but he developed common peroneal nerve palsy on the first postoperative day. The patient was fully recovered with conservative treatment after 2 months. We consider that nerve palsy as a result of compression of common peroneal nerve related to patient positioning. So we should be careful not to develop common peroneal nerve palsy even if the patient was placed in the supine position during robotic assisted surgery.