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@#Objective To compare the effects of anterior mediastinal tumor resection by the Da Vinci robot and video-assisted thoracoscopy via subxiphoid approach. Methods A retrospective cohort study was conducted to continuously enroll patients who underwent anterior mediastinal tumor resection between 2020 and 2021 in our department. They were divided into a robotic group and a subxiphoid thoracoscopic group. The differences of general indexes (intraoperative blood loss, postoperative drainage volume, postoperative catheterization time, postoperative hospital stay), postoperative pain visual analogue scale (VAS), perioperative declining levels of hemoglobin, hematocrit, serum prealbumin and serum albumin were compared and analyzed. Results A total of 113 patients were enrolled. There were 76 patients in the robotic group (46 males and 30 females, median age of 50 years) and 37 patients in the subxiphoid thoracoscopic group (21 males and 16 females, median age of 51 years). Intraoperative blood loss, postoperative drainage volume, postoperative catheterization time and postoperative hospital stay of the robotic group were better than those in the subxiphoid thoracoscopic group (P<0.05). The postoperative VAS scores in the robotic group were lower than those in the subxiphoid thoracoscopic group, but there was no statistical difference (P>0.05). Perioperative declining levels of hemoglobin, and hematocrit were not statistically different between the two groups (P>0.05). Declining levels of serum prealbumin, and serum albumin in the robotic group were lower than those in the subxiphoid thoracoscopic group (P<0.05). Conclusion Da Vinci robotic and subxiphoid video-assisted thoracoscopic surgeries for the treatment of anterior mediastinal tumors are both safe and reliable, with short postoperative hospital stay, mild postoperative pain and quick recovery. Da Vinci robot surgery has a slight advantage in the treatment outcome.
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In recent decade, pediatric liver transplantation has developed rapidly in China due to the improvement of surgical techniques and postoperative management, which has been applied from several domestic liver transplantation centers to more than 10 provinces, cities and autonomous regions. The annual quantity of pediatric liver transplantation has exceeded 1 000 for 3 consecutive years, ranking first across the world. The technique of pediatric liver transplantation has been gradually oriented to precision medicine. The development of pediatric liver transplantation mainly focuses on the "grafts". In this article, the development characteristics and trends of pediatric liver transplantation were elucidated from the perspectives of different types of liver transplantation that expanded the source of donor liver, including split liver transplantation, auxiliary liver transplantation, Domino liver transplantation and liver transplantation with hyper-reduced grafts, as well as the application of minimally invasive surgical and microsurgical anastomosis techniques in pediatric liver transplantation, which represented by laparoscopic surgery and Da Vinci surgical system, aiming to provide reference for further improving the long-term survival rate of grafts and the quality of life of the recipients.
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Objective:To investigate the safety and efficacy of da Vinci surgical system in surgical treatment of primary hyperparathyroidism.Methods:The clinical data of 19 patients with primary hyperparathyroidism who received the Da Vinci robot surgical system (the da Vinci surgery group) from Feb. 2016 to May. 2020 and 23 patients undergoing open parathyroid surgery (the open surgery group) were retrospectively analyzed and compared. The operation time, intraoperative blood loss, postoperative drainage volume, hospital stay, postoperative serum calcium and phosphorus, parathyroid hormone, postoperative pain visual analog score, and surgical complications rate and beauty effect of the two groups were statistically compared. The postoperative clinical symptoms and recurrence were followed up in a duration 3 to 84 months.Results:All patients completed the operation successfully, there was no conversion to open operation in the da Vinci surgery group. The operation time (65.5±9.9 vs 54.3±8.3) min ( t=6.231, P=0.015) and postoperative drainage volume (109.7±50.6 vs 97.2±45.2) ml ( t=3.132, P=0.016) in the da Vinci surgery group were more than those in the open surgery group, while the cosmetic effect (9.1±0.6 vs 8.3±0.7) ( t=3.628, P=0.031) was better in the da Vinci surgery group than in the open surgery group. There was no significant difference in intraoperative blood loss (44.3±19.4 vs 39.1±15.4) ml, hospital stay (7.4±1.4 vs 7.9±2.8) days, incidence of complications (15.8% vs 8.7%) , visual analogue scale of postoperative pain (6.9±0.6 vs 6.4±0.8) , clinical symptom relief during the follow-up (100.0% vs 100.0%) , postoperative serum calcium (2.48±0.30 vs 2.43±0.26) mmol/L, serum phosphorus (0.75±0.07 vs 1.37±0.31) mmol/L or parathyroid hormone (36.5±4.7 vs 40.4±5.3) ng/L between the da Vinci surgery group and the open surgery group ( P>0.05) . Conclusion:Leonardo da Vinci robot-assisted surgical treatment for primary hyperparathyroidism with strict surgical indications is similar to traditional open surgery in safety and efficacy, while its cosmetic effect is better.
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@#Objective To compare the perioperative results of hybrid coronary revascularization (HCR), off-pump coronary artery bypass (OPCAB) and percutaneous coronary intervention (PCI) in elderly patients with three-vessel coronary artery disease involving left anterior descending (LAD) branch and explores the safety of surgery. Methods We prospectively enrolled patients with coronary heart disease over 65 years who were admitted to General Hospital of People’s Liberation Army from January 2018 to September 2019. Coronary angiography results were all three-vessel lesions involving the anterior descending artery. After preoperative examination and assessment by the cardiovascular team, all patients were suitable for OPCAB or PCI treatment. According to the patient’s preference, HCR, OPCAB or PCI were performed. The preoperative baseline data and perioperative results were collected, and SPSS 22.0 was used for statistical analysis. Results A total of 110 patients met the criteria and were included in the study, 28 in the HCR group, 45 in the OPCAB group, and 37 in the PCI group, with an average age of 71.4±5.6 years. There was no statistical difference in the preoperative baseline data of patients among the three groups. The intubation time (P=0.039), perioperative drainage volume (P<0.001), blood transfusion (P=0.021) in the HCR group were lower than those in the OPCAB group. There was no statistical difference in the main organ adverse events (MOAE, P=0.096) and in-hospital mortality (P=0.784) among the three groups of patients. The use of antibiotics in the PCI group was significantly lower than the other two groups (P<0.001). Conclusion HCR combines the advantage of CABG and PCI including proved long-term patency rate with left internal mammary artery-LAD grafting, less trauma and superior long-term patency with PCI in non-LAD territory. Compared with OPCAB and PCI, there is no increase in perioperative major organ adverse events and in-hospital mortality. It is a safe and reliable minimally invasive myocardial revascularization technique for elderly patients with three-vessel coronary artery disease involving the anterior descending artery.
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Robots are man-made machines; created to increase the performance of an action. They are either autonomous or semi-autonomous in the hands of the user. The medical field has evolved and revolutionized over the decades. It is the hour of the robot-assisted medical care to successfully change the clinical scenario of patient care. Employment of robotics in diverse fields of medical care has increased the effectiveness of the treatment and in return the effectiveness of the healthcare professionals. Our aim is to emphasize the advances in robot-assisted procedures over their comparable facets and highlight the unresolved challenges of robotics in medical care for the near future.
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@#Objective To compare the perioperative outcomes of subxiphoid robot-assisted extended thymectomy (SRAET) and video-assisted thoracoscopic extended thymectomy (VATET) for myasthenia gravis complicated with thymoma. Methods Retrospective analysis of 61 patients with myasthenia gravis combined with thymoma who were admitted to the Department of Thoracic Surgery, West China Hospital, Sichuan University from January 2017 to June 2019 was performed. All patients underwent extended thymectomy, and the patients were divided into a SRAET group and a VATET group. There were 26 patients in the SRAET group, including 11 males and 15 females, with an average age of 42.20±13.20 years. There were 35 patients in the VATET group, including 14 males and 21 females, with an average age of 45.00±13.00 years. The perioperative outcomes of the two groups including gender, age, operation time, intraoperative blood loss, conversion rate, postoperative drainage, tube removal time, drainage volume, visual analogue scale, hospital stay and postoperative complications were compared. Results There was no conversion to thoracotomy, death or myasthenia crisis in both groups. The operation time (111.42±28.60 min vs. 103.71±26.20 min, P=0.845), intraoperative blood loss (32.31±23.84 mL vs. 63.57±132.22 mL, P=0.239), visual analogue scale at postoperative 24 h (2.46±0.76 vs. 2.40±0.74, P=0.751) and postoperative 48 h (2.12±0.77 vs. 2.26±0.56, P=0.407), complication rate (3.8%vs. 2.9%, P=0.675), drainage volume (206.85±130.09 mL vs. 276.86±173.46 mL, P=0.089) and hospital stay (5.81±2.52 d vs. 5.29±2.17 d, P=0.642) were not significantly different between the two groups. The visual analogue scale of the SRAET group at postoperative 72 h (1.12±0.65 vs. 1.86±0.91, P=0.001) was significantly lower than that of the VATET group. Conclusion SRAET is a safe and feasible method with less postoperative short-term pain, which is an alternative surgical treatment for myasthenia gravis complicated with thymoma.
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@#Objective To summarize the clinical experience of Da Vinci robotic-assisted left upper lobectomy for treating lung cancer. Methods We retrospectively analyzed the perioperative data of 33 patients with primary lung cancer who underwent Da Vinci robotic-assisted left upper lobectomy between December 2016 and December 2018 in our hospital. Meanwhile, the perioperative data of 41 patients with lung cancer who underwent video-assisted thoracoscopic left upper lobectomy during the same period by the same surgeon were studied as a control group. The resection was followed by the principle of "from back down to front up" way. Systemic lymph node dissection including No.4-9 was performed for all patients. Results All patients received successful surgery with no case of conversion to thoracotomy and perioperative death. Comparing to video-assisted thoracoscopic surgery, the Da Vinci robotic-assisted left upper lobectomy had longer operating time (191.21±61.77 min vs. 154.51±38.81 min, P=0.003), more cost (82 307.75±11 859.03 yuan vs. 58 966.57±5 640.07 yuan, P=0.000), shorter chest tube duration (4.58±1.77 d vs. 5.41±1.52 d, P=0.031) and postoperative hospital stay (6.48±1.82 d vs. 7.66±2.12 d, P=0.014). However, there was no significant difference between the two groups regarding to blood loss, lymph node dissection, postoperative pain score, total chest drainage volume, chest drainage volume per day and the rate of pulmonary complications. Conclusion The Da Vinci robotic-assisted left upper lobectomy for treating lung cancer is safe and more minimally invasive, but more expensive.
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@#Objective To investigate the preoperative localization of pulmonary glabrous nodules. Methods A total of 192 patients admitted to General Hospital of Northern Theater Command from April 2012 to September 2019 were selected for the study. There were 95 males and 97 females at an age of 56.47±11.79 years. All patients completed preoperative examination, and were divided into a positioning group (n=97) and a non-positioning group (n=95) according to whether the preoperative positioning was performed. And the surgical indicators between the two groups were compared. According to the substance of ground-glass opacity, they were divided into a pure ground-glass nodules group (n=23) and a mixed ground-glass nodules group (n=74) in the positioning group and a pure ground-glass nodules group (n=14) and a mixed ground-glass nodules group (n=81) in the non-positioning group . According to the size and distance of the nodules from the pleura and whether the nodules could be detected, the corresponding linear function was obtained. Results The operative time of methylene blue localization group was shorter than that of the no localization group. In the scatter plot, the corresponding diameter and depth of the nodules and the corresponding coordinate points which can be explored were described. And linear regression was performed on all the coordinate points to obtain the linear function: depth=0.648×diameter–1.446 (mm). It can be used as an indication for the preoperative localization of pure ground-glass nodules in Da Vinci robotic surgery. Linear function: depth=0.559 5×diameter+0.56 (mm). It can be used as an indication of preoperative localization of mixed ground-glass nodules in Da Vinci robotic surgery. Conclusion This equation can be used as a preoperative indication for clinical peripheral pulmonary ground-glass nodules.
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@#Objective To compare the the effectiveness of robot-assisted thoracic surgery (RATS) with video-assisted thoracic surgery (VATS), in stageⅠ lung adenocarcinoma. Methods From January 2012 to December 2018, 291 patients were included. The patients were allocated into two groups including a RATS group with 125 patients and a VATS group with 166 patients. Two cohorts (RATS, VATS ) of clinical stageⅠ lung adenocarcinoma patients were matched by propensity score. Then there were 114 patients in each group (228 patients in total). There were 45 males and 69 females at age of 62±9 years in the RATS group; 44 males, 70 females at age of 62±8 years in the VATS group. Overall survival (OS) and disease-free survival (DFS) were assessed. Univariate and multivariate analyses were performed to identify factors associated with the outcomes. Results Compared with the VATS group, the RATS group got less blood loss (P<0.05) and postoperative drainage (P<0.05) with a statistical difference. There was no statistical difference in drainage time (P>0.05) or postoperative hospital stay (P>0.05) between the two groups. The RATS group harvested more stations and number of the lymph nodes with a statistical difference (P<0.05). There was no statistical difference in 1-year, 3-year and 5-year OS and mean survival time (P>0.05). While there was a statistical difference in DFS between the two groups (1-year DFS: 94.1% vs. 95.6%; 3-year DFS: 92.6% vs. 75.2%; 5-year DFS: 92.6% vs. 68.4%, P<0.05; mean DFS time: 78 months vs. 63 months, P<0.05) between the two groups. The univariate analysis found that the number of the lymph nodes dissection was the prognostic factor for OS, and tumor diameter, surgical approach, stations and number of the lymph nodes dissection were the prognostic factors for DFS. However, multivariate analysis found that there was no independent risk factor for OS, but the tumor diameter and surgical approach were independently associated with DFS. Conclusion There is no statistical difference in OS between the two groups, but the RATS group gets better DFS.
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Objective@#To apply the Da Vinci Surgical System in laparoscopic splenectomy and pericardial devascularization using " the tunnel-building technique" .@*Methods@#The clinical data of 31 patients who underwent robotic assisted laparoscopic splenectomy from Oct 2017 to Oct 2018 were analyzed. The operative time, intraoperative blood loss, postoperative hospital stay and conversion rate were studied.@*Results@#All patients underwent robotic-assisted laparoscopic splenectomy without conversion to open surgery. The operation time was (216.0±33.5) min, intraoperative blood loss (137.6±53.8) ml, and postoperative stay (9.4±1.9) days. There were no early postoperative complications.@*Conclusion@#" The tunnel-building technique" using the Da Vinci Surgical System is feasible and has its unique advantages in laparoscopic splenectomy and pericardial devascularization.
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Objective To apply the Da Vinci Surgical System in laparoscopic splenectomy and pericardial devascularization using "the tunnel-building technique". Methods The clinical data of 31 pa-tients who underwent robotic assisted laparoscopic splenectomy from Oct 2017 to Oct 2018 were analyzed. The operative time, intraoperative blood loss, postoperative hospital stay and conversion rate were studied. Results All patients underwent robotic-assisted laparoscopic splenectomy without conversion to open surgery. The operation time was ( 216. 0 ± 33. 5 ) min, intraoperative blood loss ( 137. 6 ± 53. 8 ) ml, and postoperative stay (9. 4 ± 1. 9) days. There were no early postoperative complications. Conclusion "The tunnel-building technique" using the Da Vinci Surgical System is feasible and has its unique advantages in laparoscopic splenectomy and pericardial devascularization.
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@#Objective To present the initial clinical experience of robot-assisted thoracoscopic esophagectomy for patients with esophageal cancer and to analyze the short-term outcomes of these patients. Methods Between February 2016 and December 2017, 148 patients with esophageal carcinoma underwent robotic esophagectomy and two-fields lymph node dissection. There were 126 males and 22 females at average age of 62.0±8.0 years. Demographic data, intraoperative characteristics and short-term surgical outcomes were collected and analyzed. Results 106 patients underwent McKeown esophagectomy and 42 patients underwent Ivor-Lewis esophagectomy. The mean operation time was 336.0±76.0 min, the mean intraoperative blood loss was 130.0±89.0 ml, the mean number of lymph nodes removed was 21.0±8.0 and the mean length of postoperative hospital-stay was 12.0±7.2 days. Postoperative complications included anastomotic fistula (n=8, 5.4%), pulmonary infection (n=13, 8.7%), hoarseness (n=23, 15.5%), tracheoesophageal fistula (n=1, 0.7%), chylothorax (n=4, 2.7%) and incision infection (n=2, 1.4%). There was no intra-operational massive hemorrhage or in-hospital mortality. Conclusion Both robot-assisted McKeown and Ivor-Lewis esophagectomy are safe and feasible with good early outcomes.
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@#Objective To present the preliminary clinical experience of robot assisted trans-subxiphoid (extended) thymectomy in patients with thymic neoplasms or myasthenia gravis. Methods A total of 62 patients (34 males and 28 females at an average age of 38±11 years) suffering from thymic neoplasms or myasthenia gravis who underwent robotic (extended) thymectomy via subxiphoid approach were included in our department between August 2016 and August 2017. All of the operation were completed through 4 ports. In details, the observation hole was created just below the xiphoid process, two ports for arm 1 and arm 2 were created below bilateral subcostal arch at the midclavicular line, and trocar for arm 3 was placed in the 5th or 6th intercostal space at the anterior axillary line, respectively. Patients with thymic neoplasms received thymectomy. Patients with myasthenia gravis received extended thymectomy. Results All the patients experienced uneventful operations. The mean operative time was 116.0±34.0 min. The mean intraoperative blood loss was 5.6±4.3 ml. The mean postoperative hospital stay was 4.0±2.2 days. There was no intra-operational massive hemorrhage, mortality, conversion or postoperative complication during the postoperative and follow-up period. Conclusion Robotic trans-subxiphoid thymectomy is safe and feasible, which is a promising technique for extensive application.
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The da Vinci Surgical System has developed and great progress has been made recently in surgery. Despite lack of applications in tumors of head and neck, its advantages, such as minimally invasive procedure and rapid recovery, show great prospects. In this article, we reviewed the surgical method, indication, advantages and prospects of its application in tumors of head and neck.
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Objective To explore the effect of pedicled omental flap with Da Vinci surgical system for breast reconstruction,so as to facilitate the application of robot-assisted surgery in the breast reconstruction after breast cancer(BC) surgery.Methods A luminal BC patient,administrated in March 2017,received Da Vinci robot-assisted filling with pedicled omental flap after extensive lumpectomy and sentinel lymph node biopsy.Blood supply,wound healing,cosmetic outcome,complications and satisfaction of the patient were evaluated.Results The wound healed well,with no obvious scar.The reconstructed breast had desirable volume and looked symmetrical against the other side.The cosmetic outcome was excellent and the patient was satisfied with the surgery.No recurrence or metastasis was found during the twomonth post-operational follow-up.Conclusion Da Vinci robot-assisted breast reconstruction with pedicled omental flap has the advantages of clear vision,precise movement and flexible machinery joint.Breast conservation and autologous reconstruction with this technique substantially improves the psychological and social well-being of the patient.
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Objective To analyze the safety of atrial septal defect closure using Da Vinci surgical system. Methods Totally 23 atrial septal defect patients hospitalized from July to December 2016 underwent atrioseptopexy by using Da Vinci surgical system. The effect of atrioseptopexy was observed under cardiopulmonary bypass conditions. Results All the patients had the operation completed successfully, with the operating time being (2.8 ±0.5)h, the intraoperative cardiopulmonary bypass time being (35.4±18.4)min, aortic clamping time being (25.9±8.4)min, postoperative mechanical ventilation time being (5.7±1.5)h, amount of thoracic drainage fluid from 50 to 300 ml and postoperative hospital stay being (7 ±5.1)d. The follow-up 1 and 3 months after discharge showed there were no complications and death occurred, and the examinations by chest X-ray film and heart color ultrasound found no abnormality. Conclusion Da Vinci surgical system gains advantages in safety, reliability, patient satisfaction, operative incision and surgical trauma, and thus is worthy promoting clinically.
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Our hospital has started laparoscopic cholecystectomy in 1991, and thereafter many surgeons have been trained in the era of laparoscopic and minimally invasive surgery. Since then numerous procedures have been applied for laparoscopic surgery, and many patients have benefited as a result. We have performed the first automated surgery in Korea using the Automated Endoscopic System for Optimal Positioning (AESOP) in June, 1996 [1]. With the help of Inbae Yoon's inspiration [2] and donation, our hospital has started the “I.B. Yoon Multi-Specialty Endoscopic Research & Training Center” in 1998. We then started the “Severance Robot and Minimally Invasive Surgery Center” in March 2005. These infrastructures enables us the expansion of laparoscopic surgery and inspires many surgeons to understand the principles and equipments of laparoscopic and robotic surgery. We performed the first robotic surgery using the da Vinci system in July, 2005. During a 10 years period after introducing the da Vinci surgical system in 2005 we have performed more than 15000 cases of robotic surgery successfully. With collaboration between medicine and robotic engineering, we are now developing our own version of Korean robotic system.
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Humans , Cholecystectomy, Laparoscopic , Cooperative Behavior , Korea , Laparoscopy , Minimally Invasive Surgical Procedures , SurgeonsABSTRACT
Objective To explore the clinical safety and validity of Da Vinci surgical system in distal pancreatic tumor resection.Methods The clinical data of 14 patients with distal pancreatic tumor underwent robotic surgeries by using Da Vinci surgical system from January 2009 to June 2012 were retrospectively analyzed.Results The average operation time was 343.93 (170-575) min,average blood loss was 192.5 (10-700) ml,without blood trahsfusion.Pathologic examination showed:pancreatic ductal adenocarcinoma in 7 patients,pancreatic cystadenoma in 1 patient,mucous cystadenoma in 1 patient,cystadenocarcinoma in 1 patient,high levels of pancreatic ductal intraepithelial neoplasia in 1 patient,insulinoma in 1 patient,solid pseudo-papillary tumor in 2 patients.Two patients with pancreatic leaks after operation and then relieved after conservative medical therapy.Others were discharged from hospital without complications.The average hospital stay was 10.64 d.Conclusions Da Vinci surgical system is safe and effective in treatment for patients with distal pancreatic rumor with minimally invasive advantage.Because lack of surgical experience and small sample,a large sample with long term follow-up of high-quality clinical research is required and then update the system to evaluate the efficacy and safety.
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Objective To summarize the clinical experience in Da Vinci surgical system-assisted hepatopancreatobiliary surgery.Methods From January to December in 2009,94 patients with hepatopancreatobiliary diseases were treated at General Hospital of Second Artillery of PLA.The surgical procedure and postoperative recovery of patients were analysed.Results A total of 90 patients had successfully undergone robotic surgery,and 4 patients were converted to open surgery with the conversion rate of 4%(4/94).Sixteen patients received surgeries for hepatic diseases,and 1 patient with a giant hemangioma in the right posterior hepatic lobe was converted to open surgery,because a very close relationship between the hemangioma and inferior vena cava was observed;27 patients received surgeries for hilar diseases;19 patients underwent surgeries for pancreatic diseases,and 3 patients were converted to open surgery,including 2 with poor exposure of the giant pancreatic head carcinoma and 1 with tumors in the distal common bile duct:32 patients received other surgeries,including 6 with choledochojejunostomy and 11 with laparoscopic common bile duct exploration.Conclusions Almost all kinds of operations for hepatopanereatobiliary diseases could be performed by Da Vinci surgical system.Da Vinci surgical system expands the indications for laparoscopic surgery.
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Objective To evaluate the effect of Da Vinci surgical system for the treatment of hepatopancreatobiliary diseases.Methods The clinical data of 29 patients with hepatopancreatobiliary diseases who had undergone operations with Da Vinci surgical system from March to November 2009 at the General Hospital of PLA were retrospectively analyzed.Results The operations were successfully done on 28 patients,except 1 patient was converted to open pancreaticoenterostomy.The total operation time was(339±149)minutes,and the time for operations done with Da Vinci surgical system was(285±117)minutes.The postoperative bowl movement recovery time was(33±21)hours,and the length of postoperative hospital stay was(8±6)days.No blood transfusion was needed.Three patients had postoperative complications and were cured by conservative treatment.Conclusion Laparoscopic operations for hepatopancreatobiliary diseases can be applied with the help of the threedimensional imaging system and flexible surgical instruments of the Da Vinci surgical system,and its superiority is more obvious when applied for intractable hepatopancreatobiliary diseases.