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@#Objective To explore the training mode of robotic surgical system for thoracic surgeons. Methods Thirteen surgeons enrolled in the Department of Thoracic Surgery, Ruijin Hospital from May 2015 to December 2019 were targeted for training. Training methods included learning basic knowledge of Da-Vinci robotic system, simulation platform training, physical simulation training, training on animal models, practice of thoracic surgery and video analysis. Results The robotic operation skills of the surgeons were improved. Currently 4 surgeons were qualified for using robotic system to do thoracic surgery, and 9 surgeons had assistant qualification. Conclusion Multiple modes of training can help surgeons learn and master the techniques of robotic surgery, and will provide the basis for robotic training standard.
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@#Objective To investigate the short-term postoperative pain between robot-assisted and thoracolaparoscopic McKeown esophagectomy for esophageal carcinoma. Methods We prospectively analyzed clinical data of 77 patients with esophageal carcinoma in our hospital between September 2016 and February 2017. The patients were allocated into two groups including a robot group and a thoracolaparoscopic group. The patients underwent robot assisted McKeown esophagectomy in the robot group and thoracolaparoscopic McKeown esophagectomy in the thoracolaparoscopic group. There were 38 patients with 30 males and 8 females at average age of 60.80±6.20 years in the thoracolaparoscopic group, and 39 patients with 35 males and 4 females at average age of 60.90±7.20 years in the robot group. Results There was no statistical difference between the two groups in terms of the postoperative usage of analgesic drugs. The patients in the robot group experienced less postoperative pain on postoperative day 1, 3, 5, 6 and 7 than the patients in the thoracolaparoscopic group. The mean value of visual analogue scale (VAS) on postoperative day 1, 3, 5, 6 and 7 for the robot group and the thoracolaparoscopic group was 3.20±1.10 versus 2.70±0.90 (P=0.002), 2.75±0.96 versus 2.40±0.98 (P=0.030), 2.68±1.08 versus 2.02±0.8 (P=0.005); 2.49±0.99 versus 1.81±0.88 (P=0.003), 2.27±0.83 versus 1.51±0.61 (P<0.001), respectively. Conclusion Compared with the thoracolaparoscopic group, patients receiving robot assisted McKeown esophagectomy experience less postoperative short-term pain. However, the long-term postoperative pain for these patients needs to be further studied.
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Objective: To explore the clinical application value of the spinal robot-assisted surgical system in mild to moderate lumbar spondylolisthesis and evaluate the accuracy of its implantation. Methods: The clinical data of 56 patients with Meyerding grade Ⅰ or Ⅱ lumbar spondylolisthesis who underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) between January 2017 and December 2017 were retrospectively analysed. Among them, 28 cases were preoperatively planned with robotic arm and percutaneous pedicle screw placement according to preoperative planning (group A); the other 28 cases underwent fluoroscopy-guided percutaneous pedicle screw placement (group B). There was no significant difference in gender, age, body mass index, slippage type, Meyerding grade, and surgical segmental distribution between the two groups ( P>0.05). The screw insertion angle was measured by CT, the accuracy of screw implantation was evaluated by Neo's criteria, and the invasion of superior articular process was evaluated by Babu's method. Results: One hundred and twelve screws were implanted in the two groups respectively, 5 screws (4.5%) in group A and 26 screws (23.2%) in group B penetrated the lateral wall of pedicle, and the difference was significant ( χ2=9.157, P=0.002); the accuracy of nail implantation was assessed according to Neo's criteria, the results were 107 screws of degree 0, 3 of degree 1, 2 of degree 2 in group A, and 86 screws of degree 0, 16 of degree 1, 6 of degree 2, 4 of degree 3 in group B, showing significant difference between the two groups ( Z=4.915, P=0.031). In group B, 20 (17.9%) screws penetrated the superior articular process, while in group A, 80 screws were removed from the decompression side, and only 3 (3.8%) screws penetrated the superior articular process. According to Babu's method, the degree of screw penetration into the facet joint was assessed. The results were 77 screws of grade 0, 2 of grade 1, 1 of grade 2 in group A, and 92 screws of grade 0, 13 of grade 1, 4 of grade 2, 3 of grade 3 in group B, showing significant difference between the two groups ( Z=7.814, P=0.029). The screw insertion angles of groups A and B were (23.5±6.6)° and (18.1±7.5)° respectively, showing significant difference ( t=3.100, P=0.003). Conclusion: Compared to fluoroscopy-guided percutaneous pedicle screw placement, robot-assisted percutaneous pedicle screw placement has the advantages such as greater accuracy, lower incidence of screw penetration of the pedicle wall and invasion of the facet joints, and has a better screw insertion angle. Combined with MIS-TLIF, robot-assisted percutaneous pedicle screw placement is an effective minimally invasive treatment for lumbar spondylolisthesis.
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The esophageal cancer is a commmon maligant tumor.The main treatment for esophageal cancer is surgery.Robotic surgery,a new rising surgery,offers an option for esophageal cancer,besides the traditional open surgery and minimally invasive esophagectomy.The robotic surgical system with the advantages like magnifying 3-dimensional view,accuracy and stability,has been increasingly applied in the field of esophageal cancer recent years.Robotic surgery for esophageal cancer has a wide range of indication,and its trauma is small.Long-term and short-term outcone is good.So robotic surgery for esophageal concer is a safe and feasible surgical approach.
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Minimally invasive has surgery become the target of the surgeons,Da Vinci robot assisted surgical system has been used generally for colorectal cancer,with the advantages of three-dimensional high-definition imaging,flexible and high degree of freedom robotic arms,functions of action correction and shake filtration compared with laparoscopic surgery.However,advantages and disadvantages between Da Vinci robot assisted surgical system and traditional laparoscopic surgery are still controversial.In this paper,the present situation and prospect of Da Vinci robot assisted surgical system for colorectal cancer surgery are explored.
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With the initiation of laparoscopic techniques in general surgery and a significant expansion of minimally invasive techniques in the last 20 years.However,some of the shortcomings of laparoscopic technology has limited it's surgical application.More recently,the da Vinci robotic surgical system further defined the ability of a roboticassist device to address limitations in laparoscopy.This in cludes a significant improvement in instrument dexterity,dampening of natural hand tremors,three dimensional visualization,ergonomics,and camera stability.As experiencewith robotic technology increased and its applications to advanced laparoscopic procedures have become more understood,more procedures have been performed with robotic assistance.We review the current status of da Vinci robotic technology and its applications in general surgical procedures.
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Robotic assisted surgery system as an advanced technique gains particular attention over the world.We hereby introduce the history of Robotic assisted surgery system, and induce the advantage or existing problems of this technique. We also compared the new technique with traditional surgery and laparoscopic surgery. The future of this novel technique is assessed with the recent development application at home and abroad.