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Objective:To investigate the clinical efficacy of da Vinci Xi surgical system assisted programmed six-hole method anterior resection of rectal cancer.Methods:The retrospec-tive cohort study was conducted. The clinicopathological data of 102 patients with middle and low rectal cancer who were admitted to the Affiliated Hospital of Xuzhou Medical University from August 2020 to June 2021 were collected. There were 62 males and 40 females, aged (53±12)years. Of the 102 patients, 51 cases undergoing da Vinci Xi surgical system assisted programmed six-hole method anterior resection of rectal cancer were divided into the robotic group and 51 cases undergoing laparoscopic anterior resection of rectal cancer were divided into the laparoscopic group. Observa-tion indicators: (1) treatment; (2) postoperative pathological examination; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Repeated measurement data were analyzed using the repeated ANOVA. Results:(1) Treatment. All patients of the two groups under-went radical resection of rectal cancer successfully, and none of patient with intraoperative blood transfusion, conversion to open surgery, and death within 30 days after surgery. The operation time, volume of intraoperative blood loss, number of lymph nodes dissected, time to postoperative first flatus, time to postoperative first liquid food intake, time to postoperative catheter removal, cases with postoperative pain grading as grade 1, grade 2, grade 3, grade 4, cost of treatment were (170±12)minutes, (73±50)mL, 23±6, (35.1±9.4)hours, (2.1±0.8)days, (2.9±2.7)days, 13, 15, 17, 6, (7.1±4.5) ten thousand yuan in patients of the robotic group, versus (153±22)minutes, (119±66) mL, 15±4, (40.7±1.9)hours, (2.9±0.4)days, (5.3±2.1)days, 6, 7, 26, 12, (6.7±1.6) ten thousand yuan in patients of the laparoscopic group, showing significant differences in the above indicators between the two groups ( t=6.79, -4.46,20.09, -3.01, -5.54, -16.69, Z=-2.87, t=4.22, P<0.05). (2) Postoperative patho-logical examination. The tumor diameter, length of specimen resected, distance of upper resection margin to tumor, distance of lower resection margin to tumor, cases with mesorectal specimens as integrity and mostly integrity, cases with tumor differentiation as high differentiation, moderate differentiation, low differentiation, cases with postoperative TNM staging as stage Ⅰ, stage Ⅱ, stage Ⅲ were (3.8±1.1)cm, (18.7±3.2)cm, (11.8±3.6)cm, (2.7±0.8)cm, 48, 3, 4, 41, 6, 6, 17, 28 in patients of the robotic group, versus (3.7±1.0)cm, (18.3±2.8)cm, (10.2±2.7)cm, (2.5±0.6)cm, 46, 5, 6, 39, 6, 5,20, 26 in patients of the laparoscopic group, showing no significant difference in the above indicators between the two groups ( t=1.72, 1.29, 1.64, 1.11, χ2=0.14, Z=-0.42, -0.26, P>0.05). Cases with positive circumferential margin and cases with destruction of mesentery was 0 and 0 in patients of the robotic group, versus 1 and 1 in patients of the laparoscopic group, showing no significant difference in the above indicators between the two groups ( P>0.05). (3) Follow-up. All patients in the two groups were followed up for 12 months after surgery and none of patient had postoperative local recurrence and distant metastasis of tumors. The anal incontinence score, low anterior resection syndrome score, international prostate symptom score, night urination score, international index of erectile score, female sexual function index score in patients of the robotic group were 0, 12.25±1.08, 4.43±0.33, 0.49±0.09, 24.07±2.75, 65.84±1.79 before surgery and 1.34±0.11, 18.11±3.54, 4.03±0.26, 1.08±0.28, 22.63±2.03, 38.57±6.13 at postoperative 12 months, respectively. The above indicators in patients of the laparoscopic group were 0, 12.60±1.11, 4.56±0.36, 0.46±0.07, 23.11±2.77, 66.31±1.73 before surgery and 1.99±1.33,20.85±6.19, 6.43±1.78, 2.27±0.23, 21.00±2.73, 27.62±8.20 at postoperative 12 months, respectively. There were significant differences in the above indicators between the two groups ( P<0.05). Conclusions:The oncological effects of da Vinci Xi surgical system assisted programmed six-hole method anterior resection of rectal cancer and lapa-roscopic anterior resection of rectal cancer are comparable. However, robotic surgery is superior to laparoscopic surgery in terms of intraoperative bleeding, lymph node dissection, gastrointestinal function recovery, and pelvic autonomic nerve protection.
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Objective:To investigate the short-term outcomes of totally robotic surgical system and robotic surgical system assisted radical gastrectomy for gastric cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 290 patients who under-went robotic surgical system radical gastrectomy for gastric cancer in the First Affiliated Hospital of Army Medical University from January 2018 to November 2021 were collected. There were 208 males and 82 females, aged 58 (range, 24?84)years. Of the 290 patients, 125 patients undergoing totally robotic surgical system radical gastrectomy combined with reconstruction of digestive tract were divided into the totally robot group, and 165 patients undergoing robotic surgical system radical gastrectomy combined with a small midline incision-assisted reconstruction of digestive tract were divided into the robotic-assisted group. Observation indicators: (1) surgical and postoperative situations; (2) postoperative complications. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Comparison of ordinal data was conducted using the non-parameter rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Surgical and postoperative situations. The operation time, volume of intraoperative blood loss, length of incision, duration of postoperative analgesic using, time to postoperative gastric tube removal, time to postoperative initial water intake, time to postoperative first anal flatus, duration of post-operative hospital stay were (246±43)minutes, (104±51)mL, 4(range, 3?6)cm, (2.2±0.5)days, 36(range, 10?112)hours, 62(range, 32?205)hours, 63(range, 18?138)hours, 8(range, 6?50)days in patients of the totally robot group, versus (296±59)minutes, (143±87)mL, 6(range, 3?13)cm, (3.6±0.7)days, 42(range, 12?262)hours, 90(range, 18?262)hours, 80(range, 16?295)hours, 9(range, 6?63)days in patients of the robotic-assisted group, showing significant differences in the above indicators between the two groups ( t=8.04, 4.42, Z=?13.98, t=18.46, Z=?5.47, ?5.87, ?6.14, ?4.04, P<0.05). (2) Post-operative complications. Cases with systemic related complications and cases with pulmonary infection were 7 and 4 in patients of the totally robot group, versus 31 and 16 in patients of the robotic-assisted group, showing significant differences in the above indicators between the two groups ( χ2=10.86, 4.68, P<0.05). Further analysis showed that there were significant differences in age ≥60 years, body mass index ≥25 kg/m 2, tumor diameter ≥3 cm, TNM staging as stage Ⅲ of cases with postoperative complications between the totally robot group and the robotic-assisted group ( odds ratio=0.44, 0.17, 0.40, 0.31, 95 confidence interval as 0.20?1.00, 0.03?0.88, 0.18?0.89, 0.11?0.84, P<0.05). Conclusion:Totally robotic surgical system radical gastrectomy for gastric cancer is safe and feasible with advantages of minimal trauma and quick recovery, especially for patients as age ≥60 years, body mass index ≥25 kg/cm 2, tumor diameter ≥3 cm and TNM stage Ⅲ in complication controlling.
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Objective:To investigate the perioperative efficacy of robot surgical system assisted anatomic and non-anatomic hepatectomy.Methods:The propensity score matching and retrospective cohort study was conducted. The clinical data of 103 patients who underwent robot surgical system assisted hepatectomy in Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine from March 2016 to December 2021 were collected. There were 54 males and 49 females, aged 56(range, 44?64)years. Of the 103 patients, 55 cases undergoing robot surgical system assisted anatomic hepatectomy were divided into the anatomic group, and 48 cases undergoing robot surgical system assisted non-anatomic hepatectomy were divided into the non-anatomic group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative conditions; (3) perioperative complications. Propensity score matching was done by the 1:1 nearest neighbor matching method. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were expressed as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the rank sum test. Results:(1) Propensity score matching and compari-son of general data of patients between the two groups after matching. Of the 103 patients, 94 cases were successfully matched, including 47 cases in the anatomic group and 47 cases in the non-anatomic group. The elimination of preoperative body mass index, preoperative platelet and preoperative albumin confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative conditions. After propensity score matching, the operation time and volume of intraoperative blood loss were 175(range, 120?240)minutes and 50(range, 50?100)mL in patients of the anatomic group, versus 155(range, 105?190)minutes and 100(range, 50?200)mL in patients of the non-anatomic group, showing significant differences in the above indicators between the two groups ( Z=1.97, 2.49, P<0.05). (3) Perioperative complications. After propensity score matching, cases with pleural fluid and/or ascites, case with biliary fistula, case with thrombosis, case with peritoneal infection, case with incision infection were 11, 1, 2, 4, 1 in patients of the anatomic group, versus 12, 0, 4, 1, 0 in patients of the non-anatomic group, showing no significant difference in the above indicators between the two groups ( P>0.05). Cases with complications classified as grade Ⅰ, grade Ⅱ, grade Ⅲ, grade Ⅳ of the Clavien-Dindo classification were 33, 14, 0, 0 in patients of the anatomic group, versus 28, 14, 3, 2 in patients of the non-anatomic group, showing no significant difference in the above indicators between the two groups ( Z=?1.38, P>0.05). Conclusions:Robotic surgical system assisted anatomic and non-anatomic hepatectomy are safe and feasible for clinical application. Compared with robot surgical system assisted non-anatomic hepatectomy, patients under-going robot surgical system assisted anatomic hepatectomy have long operation time and less volume of intraoperative blood loss.
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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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OBJECTIVE@#To investigate the clinical effect of unilateral interlaminar approach 270° circular spinal canal decompression under the Interlaminar Endoscopic Surgical System(iLESSYS) Delta for the treatment of lumbar spinal stenosis (LSS) in the elderly.@*METHODS@#Total of 29 patients with LSS treated with the iLESSYS Delta from December 2018 to January 2021 were retrospectively analyzed, including 12 males and 17 females with an average age of (71.52±10.82) years old ranging from 63 to 83 years old. All patients had definite intermittent claudication, mainly neurogenic symptoms of both lower limbs. All patients had single-level spinal stenosis, including L3,4 5 cases, L4,5 21 cases, and L5S1 3 cases. Visual analogue scale (VAS), Oswestry Disability Index (ODI) and modified Macnab assessment criteria were used to evaluate pain, low back pain dysfunction index and clinical efficacy, respectively.@*RESULTS@#All 29 cases were successfully completed. The operation time was (73.45±5.89) min, the intraoperative blood loss was (9.93±0.83) ml, the hospital stay was (4.03±0.41) days, and the follow-up was more than 12 months. The VAS scores of low back pain before surgery and 1 day, 1 month, 3 months, 1 year after surgery were 2.31±0.88, 1.45±0.62, 1.21±0.61, 1.10±0.55, 1.03±0.49;VAS of leg pain were 6.48±0.49 0.56, 1.97±0.61, 1.31±0.59, 1.17±0.59, 1.10±0.55;ODI scores were 38.41±2.74, 18.14±1.17, 5.17±0.53, 5.07±0.45, 4.90±0.48;low back and leg pain VAS score and ODI score have statistically significant differences between preoperative and postoperative follow-up time points (P<0.05). The MacNab efficacy evaluation at 1-year follow-up:excellent in 22 cases, good in 5 cases and fair in 2 cases.@*CONCLUSION@#The clinical effect of unilateral interlaminar approach 270° circular spinal canal decompression under the iLESSYS Delta for the treatment of lumbar spinal stenosis in the elderly is satisfactory, with the advantages of less trauma and less bleeding, large microscopic operation space, sufficient decompression, and ideal post-operative recovery, and at the same time, it can minimize the damage to the stable structure of the lumbar spine, which is an ideal surgical method for the treatment of elderly lumbar spinal stenosis.
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Masculino , Femenino , Humanos , Anciano , Persona de Mediana Edad , Anciano de 80 o más Años , Estenosis Espinal/cirugía , Dolor de la Región Lumbar , Estudios Retrospectivos , Canal Medular/cirugía , Descompresión Quirúrgica/métodos , Resultado del Tratamiento , Endoscopía/métodos , Vértebras Lumbares/cirugíaRESUMEN
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 clinical outcome and influencing factor of one-anastomosis duodenal switch (OADS) for obesity.Methods:The retrospective cohort study was conducted. The clinical data of 104 obesity patients who underwent OADS in the China-Japan Union Hospital of Jilin University from October 2018 to June 2021 were collected. There were 42 males and 62 females, aged 33(range, 18?66)years. The clinical outcome of each patient was evaluated using Textbook Outcome (TO). Observation indicators: (1) treatment situations for patients; (2) TO situa-tions; (3) analysis of factors affecting postoperative TO. Follow-up was conducted using outpatient examination or telephone interview to detect postoperative complication of patients up to November 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was conducted using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using chi-square test. Multivariate analysis was conducted using the binary Logistic regression model. Results:(1) Treatment situations for patients. All 104 patients under-went OADS without conversion to laparotomy or death of patient. The operation time and duration of postoperative hospital stay of the 104 patients were (187±39)minutes and 6(range, 4?55)days, respectively. Two of the 104 patients were readmitted. The experiences of surgeons on OADS was (53±30)cases. There were 82 patients underwent OADS using the Da Vinci robotic surgical system, while there were 22 patients underwent OADS using laparoscopic surgery system. The complication rate of 104 patients was 7.69%(8/104). Cases with stage Ⅱ, stage Ⅲb and stage Ⅳ complications of the Clavien Dindo classification were 5, 2 and 1, respectively. (2) TO situation. Of the 104 patients, 62 cases achieved TO, while 42 cases did not achieve TO. The operation time, retention time of abdominal drainage tube, duration of postoperative hospital stay, experiences of surgeons on OADS, number of OADS for surgeons using Da Vinci robotic surgical system were (166±26)minutes, 0(range, 0?7)days, 6(range, 4?7)days, 62±28, 54 in patients achieved TO, versus (218±34)minutes, 3 (range, 0?11)days, 8(range, 5?55)days, 38±27, 28 in patients not achieved TO, showing significant differences in the above indicators between them ( t=?8.81, Z=?3.63, ?5.33, t=4.27, χ2=6.27, P<0.05). Cases with complications were 0 in patients achieved TO, versus 8 in patients not achieved TO, showing a significant difference between them ( P<0.05). (3) Analysis of factors affecting postoperative TO. Results of multivariate analysis showed that the experiences of surgeons on OADS was an independent influencing factor for postoperative TO in patients undergoing OADS ( odds ratio=1.04, 95% confidence interval as 1.01?1.06, P<0.05). Conclusions:OADS is safe and feasible for obesity patients with low postoperative complication incidence and satisfactory clinical outcome. The experiences of surgeons on OADS is an independent influencing factor for postoperative TO in patients undergoing OADS.
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Since the first report of robotic surgical system in gastric cancer by Hashizume in 2002, the new generation of minimally invasive technology represented by robotic surgical system has developed rapidly in gastric cancer. The new generation of minimally invasive technology is cha-racterized by faster recovery of patients, better of clinical outcomes and long-term efficacy. In the past 20 years, robotic surgical system has made great progress in clinical application, which is expected to solve the disadvantages and problems of laparoscopic surgery. Experienced surgeon teams have accumulated lots of research experiences in clinical application of robotic surgical system. Robotic surgical system can provide a technologically superior surgical environment for minimally invasive surgery, which could be an effective and feasible alternative to conventional radical gastrectomy. The author investigates the hot issues of robotic radical gastrectomy including the feasibility, safety, short- and long-term outcome and current research status.
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Objective:To investigate the application value of Da Vinci robotic surgical system in radical resection of perihilar cholangiocarcinoma (pCCA).Methods:The retrospective and descrip-tive study was conducted. The clinicopathological data of 10 patients undergoing Da Vinci robotic radical resetion of pCCA in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from September 2018 to March 2021 were collected. There were 6 males and 4 females, aged (58±7)years. Observtaion indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. The patients were followed up by telephone interview and outpatient service to detect survival of patients and tumor recurrence up to June 2021. Measurement data with normal distribution were expressed as Mean± SD, and measurement data with skewed distribu-tion were represented as M(range). Count data were represented as absolute numbers. Results:(1) Surgical situations: 10 patients underwent Da Vinci robotic radical resection of pCCA succe-ssfully, without conversion to laparotomy or intraoperative blood transfusion. The operation time of 10 patients was (465±87)minutes, and the volume of intraoperative blood loss was (167±81)mL. Of the 10 patients, 1 case of Bismuth type Ⅲb had a positive surgical margin and the remaining 9 cases had R 0 resection. (2) Postoperative situations: the time to gastric tube extraction was (2.3±1.9)days, and the duration of postoperative hospital stay of the 10 patients was (19.9±9.0)days. Among the 10 patients, there was no second operation or perioperative death. Of the 10 patients, 6 cases had perioperative complications, including 5 cases wth pleural effusion, 3 cases with peritoneal effusion, and 1 case with intestinal obstruction, some patients had multiple complications. After symptomatic conservative treatment, pleural effusion and peritoneal effusion disappeared and intestinal obstruction was improved. None of the 10 patients had serious complica-tions such as bleeding, biliary fistula or intestinal fistula. (3) Follow-up: 10 patients were followed up for 3-20 months, with a median follow-up time of 11 months. During the follow-up, 3 of 10 patients had tumor recurrence which occurred in intrahepatic bile duct of residual liver, and no implantation metastasis was found in the rest of abdominal cavity. Of the 7 unrecurrent patients, 1 case died of gastrointestinal bleeding and multiple organ failure. Nine of 10 patients survived well. Conclusion:The Da Vinci robotic surgical system used for radical operation of pCCA is feasible.
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In recent years, along with the unremitting efforts of clinical practitioners and the innovation of science and technology, minimally invasive technique has developed rapidly, and robot assisted surgical system has been invented. As a minimally invasive and precise technique, robot assisted surgical system can also be used by remote operation, which is the important development direction of surgical technique in modern era. Robot assisted surgical system has been applied extensively in the field of kidney transplantation, which is one of the research hot spots in this field. At present, da Vinci surgical system is more commonly adopted. In this article, the development history and current status of robot assisted surgical system in the field of kidney transplantation were introduced. The main advantages and disadvantages were summarized and the technical key points were discussed. The evaluation scheme and prospect of robot assisted kidney transplantation were predicted, which may promote the application of robot assisted surgical system in kidney transplantation and provide reference for improving clinical prognosis of kidney transplant recipients.
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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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The robotic surgical system applied to gastrectomy is regarded as a safe technique which has similar short- and long-term outcomes compared to laparoscopic and open gastrectomy. With the iteration of anastomotic staplers and improvement of anastomotic skills, coupled with the flexible robot's rotatable device making the manual intracorporal anastomosis easier, gastrointestinal reconstruction after robotic gastrectomy has also started to move toward the era of complete intracorporal anastomosis. In order to further standardize the indications and operating points, the Upper Gastrointestinal Surgery Group of Surgical Branch of Chinese Medical Doctor Association, the Gastrointestinal Surgery Group of Surgery Branch of Chinese Medical Association, the Digestive Tract Cancer Committee of Chinese Research Hospital Association, and Cancer Gastroenterology Society of Chinese Anticancer Association jointly organized domestic experts in general surgery field to formulate the Chinese expert consensus on intracorporal digestive reconstruction after robotic gastrectomy (2021 edition). The definition of intracorporeal digestive reconstruction after robotic gastrectomy is that all surgical steps of digestive reconstruction are done totally in the abdominal cavity by robotic system or all steps mentioned above except jejunojejunal extracorporeal anastomosis. The digestive reconstructions mainly include Billroth I anastomosis, Billroth II anastomosis, Billroth II+ Braun anastomosis, Roux-en-Y anastomosis, Uncut Roux-en-Y anastomosis after distal gastrectomy; double-tract anastomosis, esophagogastric anastomosis by stapler or hand-sewn technique (double flap gastroesophagostomy) after proximal gastrectomy; FEEA method, π-type anastomosis, overlap method and modified procedures, Uncut Roux-en-Y anastomosis, Parisi's double-loop reconstruction after total gastrectomy. Compared with extracorporeal digestive reconstruction, intracorporeal digestive reconstruction operated by robotic system can minimize the surgical incision, reduce the risk of abdominal exposure and accelerate postoperative recovery, etc. Previous studies have demonstrated promising results. We believe that the publication of the consensus will guide surgeons to break through the technical barriers of intracorporeal digestive reconstruction after robotic gastrectomy, which will be more and more widespread with the gradual maturity of domestic robotic systems by bringing less medical costs.
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Humanos , China , Consenso , Gastrectomía , Procedimientos Quirúrgicos Robotizados , Robótica , Neoplasias Gástricas/cirugíaRESUMEN
Objective:To investigate the advantages of Da Vinci robotic thyroidectomy in treatment of the unilateral papillary thyroid microcarcinoma (PTMC).Methods:The clinical data of 49 patients with unilateral thyroid cancer admitted to the First Hospital of Shanxi Medical University from June 2018 to March 2020 were retrospectively analyzed, and they were divided into Da Vinci robotic group (the experimental group, 18 cases) and conventional surgery group (the control group, 31 cases) according to the surgical method. The clinicopathological characteristics, perioperative and postoperative related indexes changes, length of hospital stay, incidence of surgical complications, and operation cost of both groups of patients were analyzed. Visual analogue scale (VAS) was used to evaluate postoperative pain.Results:There were statistically significant differences in age, marriage and education background of both groups (all P < 0.05). There were statistically significant differences in the number of central lymph node dissection [(4.3±2.0) vs. (6.5±3.9)], operation time [198.5 min (166.3 min, 228.5 min) vs. 82.0 min (60.0 min, 102.0 min)], pain score of 24 h after surgery [3 scores (3 scores, 4 scores) vs. 2 scores (2 scores, 3 scores)], postoperative total drainage volume [49.0 ml (40.8 ml, 56.5 ml) vs. 37.0 ml, (29.0 ml, 44.0 ml)], operation cost [33,200 yuan (33,100 yuan, 34,000 yuan) vs. 5,200 yuan (4,200 yuan, 5,900 yuan)], and differences were statistically significant (all P < 0.05). No postoperative complications such as hemorrhage, fat liquefaction and subcutaneous ecchymosis occurred in all patients of the two groups. Conclusion:Da Vinci robotic thyroidectomy is safe and reliable in treatment of the unilateral PTMC, and it has good therapeutic effects.
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Objective:To investigate the predictive value of postoperative C-reactive protein for serious complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 298 patients with advanced gastric cancer who underwent Da Vinci robotic surgical system radical gastrectomy in the 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from January 2017 to June 2019 were collected. There were 253 males and 45 females, aged from 24 to 86 years, with a median age of 60 years. Of the 298 patients, 275 cases underwent no serious postoperative complications and 23 cases underwent serious postoperative complications. Observation indicators: (1) serious postoperative complications; (2) analysis of risk factors for serious postoperative complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer; (3) performance evaluation of the predictive indicators. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the rank sum test. Univariate analysis was conducted using the chi-square test. Multivariate analysis was conducted using Logistic regression model. The receiver operating characteristic curve was drawn and the area under curve (AUC) was used to compare and estimate the efficiency of diagnostic criteria. The value of Youden index was used to determine the optimal cut-off point. Results:(1) Serious postoperative complications: of the 298 patients, 23 cases underwent complications classified ≥grade Ⅲa of Clavien-Dindo classifica-tion, including 10 cases with grade Ⅲa complications, 7 cases with grade Ⅲb complications, 4 cases with grade Ⅳa complications, 1 case with grade Ⅳb complications and 1 case with grade Ⅴ complications. (2) Analysis of risk factors for serious postoperative complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer. Results of univariate analysis showed that operation time, indicators of C-reactive protein concentration and neutrophil count at post-operative day 1, and indicators of C-reactive protein concentration, white blood cells count, neutrophil count and platelet count at postoperative day 3 and pathological stage were related factors affecting serious complications for advanced gastric cancer after Da Vinci robotic surgical system radical gastrectomy ( χ2=7.671, 4.504, 5.045, 48.293, 9.575, 15.436, 13.731, 9.537, P<0.05). Results of multivariate analysis showed that the operation time ≥250 minutes, the concentration of C-reactive protein at postoperative day 3 ≥16.65 mg/dL, the neutrophil count at postoperative day 3 ≥8.167×10 9/L, the platelet count at postoperative day 3 ≥218×10 9/L and the pathological stage of tumor as stage Ⅱ and stage Ⅲ were independent risk factors affecting serious complications for advanced gastric cancer after Da Vinci robotic surgical system radical gastrectomy ( odds ratio=3.721, 16.084, 6.056, 6.893, 12.455, 95% confidence interval: 1.032-13.421, 4.657-55.547, 1.073-34.163, 1.798-26.423, 1.338-115.930, P<0.05). (3) Performance evaluation of the predictive indicators: the C-reactive protein concentration at postoperative day 3 was a high-performance predictor with the AUC as 0.851 (95% c onfidence interval: 0.780-0.921, P<0.05) and neutrophil count and platelet count at postoperative day 3 were low-performance predictors with the AUC as 0.659 and 0.666 (95% confidence interval: 0.570-0.748 and 0.581-0.750, P<0.05). Conclusion:The C-reactive protein concentration ≥16.65 mg/dL at postoperative day 3 is a high performance predictive indicator for serious complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer.
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Objective:To investigate the application value of 'N' shaped Trocar placement in Da Vinci robotic bariatric and metabolic surgery.Methods:The retrospective and descriptive study was conducted. The clinical data of 69 patients who underwent Da Vinci robotic bariatric and metabolic surgery in the China-Japan Union Hospital of Jilin University from March to October 2020 were collected. There were 18 males and 51 females, aged from 12 to 67 years, with a median age of 34 years. The surgery was performed with the 'N' shaped Trocar placement by the same team of surgeons. The Da Vinci robotic sleeve gastrectomy, Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy or Da Vinci robotic biliopancreatic diversion with duodenal switch was selected according to the patient's condition. Observation indicators: (1) surgical and post-operative conditions; (2) follow-up. Follow-up using the outpatient examination, telephone interview and WeChat to detect the body weight, body mass index, fasting blood glucose, glycosylated hemoglobin, total cholesterol, Trocar-related complications of patients at postoperative 3 months. The follow-up was up to November 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison of general data before and after surgery was analyzed using the paired t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) Surgical and postoperative conditions: of the 69 patients, 34 cases received Da Vinci robotic sleeve gastrectomy, 34 cases received Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy, and 1 case received Da Vinci robotic biliopancreatic diversion with duodenal switch. There was no conversion to open surgery or laparoscopic surgery. The operation time of 69 patients was (161±52)minutes, and the volume of intraoperative blood loss was 30 mL(range, 10-100 mL). Two of 69 patients had post-operative complications. One of them with postoperative abdominal hemorrhage was cured after symptomatic treatment and discharged on the 10th day after surgery. The other one patient with postoperative peritoneal effusion was cured and discharged from hospital after puncture drainage and symptomatic treatment. No Trocar-related complication such as Trocar foramen bleeding and Trocar foramen hernia occurred in the 69 patients. The duration of postoperative hospital stay of 69 patients was (6±3)days. (2) Follow-up: 47 of 69 patients were followed up for 3 months. The body mass, body mass index, fasting blood glucose, glycosylated hemoglobin, and total cholesterol were (86±19)kg, (30±5)kg/m 2, (5.2±0.7)mmol/L, 5.3%±0.6%, (4.3±1.3)mmol/L at postoperative 3 months, which had significant differences compared with the preoperative indicators ( t=6.101, 8.261, 2.973, 2.567, 2.098, P<0.05). All the 47 patients had no Trocar-related complications during the follow-up. Conclusion:The 'N' shaped Trocar placement method is safe and feasible in the Da Vinci robotic bariatric and metabolic surgery, with good efficacy.
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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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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 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 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 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.