Clinical efficacy of da Vinci robotic and thoracoscopic transxiphoid approach in the treatment of anterior mediastinal tumors: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective To compare the safety and efficacy of the da Vinci robot and thoracoscopic subxiphoid approach for the treatment of anterior mediastinal tumors. Methods The clinical data of patients who underwent anterior mediastinal tumor resection through the subxiphoid approach admitted to the same medical group in the Department of Thoracic Surgery of the First Hospital of Lanzhou University between June 2020 and April 2022 were retrospectively analyzed. According to the surgery approach, the patients were divided into a robot-assisted thoracoscopic surgery (RATS) group and a video-assisted thoracoscopic surgery (VATS) group. The perioperative data and the incidence of postoperative complications were compared between the two groups. Results A total of 79 patients were enrolled. There were 41 patients in the RATS group, including 13 males and 28 females, with an average age of 45.61±14.99 years. There were 38 patients in the VATS group, including 14 males and 24 females, with an average age of 47.84±15.05 years. All patients completed the surgery successfully. Hospitalization cost and operative time were higher or longer in the RATS group than those in the VATS group, and the difference was statistically significant (P<0.05). Intraoperative bleeding, postoperative hospital stay, postoperative water and food intake time, postoperative off-bed activity time, white blood cell count, neutrophil percentage and visual analogue scale (VAS) score on the first postoperative day, white blood cell count and neutrophil percentage on the third postoperative day, duration of analgesic pump use, the number of voluntary compressions of the analgesic pump, and mediastinal drainage volume were all superior to those in the VATS group (P<0.05). The differences in VAS scores on the third postoperative day, duration of drainage tube retention and postoperative complication rates were not statistically different between the two groups (P>0.05). Conclusion RATS subxiphoid anterior mediastinum tumor resection is a safe and feasible surgical method with less injury and higher safety, which is conducive to rapid postoperative recovery and has wide clinical application prospects.

Câncer de reto: qual a melhor técnica para excisão total do mesorreto laparoscópica ou robótica? / Rectum cancer: which is the best technique for total excision of the mesorectum laparoscopic or robotic?

Introdução: As operações laparoscópicas, assistidas por robô e a abertas são técnicas cirúrgicas comumente utilizadas na vida diária. A viabilidade e os resultados em curto e longo prazos dos procedimentos laparoscópicos e robóticos têm sido amplamente relatados. Objetivos: Comparar os dados clínicos e oncológicos da cirurgia assistida por robô e laparoscópica no câncer retal. Métodos: Foram pesquisados o Pubmed/Medline, Embase, e Cochrane Library para artigos relevantes publicados até 2021. Estudos baseados na comparabilidade entre operação assistida por robô e laparoscópica para câncer retal foram designados. Os parâmetros analisados incluíram tempo operatório, conversão para procedimento aberto, perda estimada de sangue, tempo de recuperação da função intestinal, tempo de internação, vazamento da anastomose e complicações pós-operatórias. Resultados: Operação assistida por robô foi associada com maior tempo operatório (342 vs.192 min na cirurgia laparoscópica, p<0,001), menor conversão para procedimento aberto, menor tempo de internação hospitalar e recuperação mais rápida da função intestinal, menores complicações pós-operatórias de forma significativa (p=0,041). A perda estimada de sangue, a taxa de vazamento da anastomose e os resultados oncológicos, incluindo o número de linfonodos extraídos, não mostraram diferenças significativas entre os grupos. Conclusão: A cirurgia assistida por robô para câncer retal mostrou maior tempo operatório, menor conversão, taxas de recuperação da função intestinal mais rápidas e menor permanência no hospital. Seus resultados oncológicos forram semelhantes à cirurgia laparoscópica.

Introduction: Laparoscopic surgery, robot-assisted surgery and open surgery are the most commonly used surgical techniques in daily living. The feasibility and short- and long-term results of laparoscopic and robotic procedures have been widely reported. Objectives: To compare the clinical and oncological results of robot-assisted and laparoscopic surgery for rectal cancer. Methods: PubMed/Medline, Embase, The Cochrane Library were searched for relevant articles published until 2021. Studies based on comparability between robot-assisted and laparoscopic surgery for rectal cancer were designed. The parameters analyzed included operative time, conversion to open surgery, estimated blood loss, bowel function recovery time, length of hospital stay, anastomosis leak, and postoperative complications. Results: The robot-assisted surgery group was associated with longer operative time (342 vs. 192 min in laparoscopic surgery,p <0.001), lower conversion to open surgery, shorter length of hospital stay, faster bowel function recovery and lower postoperative complications significantly (p=0.041). Estimated blood loss, anastomosis leak rate, and oncological outcomes including the number of lymph nodes extracted showed no significant differences between groups. Conclusion: Robot-assisted surgery for rectal cancer showed longer operative time, lower conversion, faster bowel function recovery rates, shorter hospital stay, and similar oncological outcomes compared to laparoscopic surgery.

Effect of intraoperative alveolar recruitment maneuver on intraoperative oxygenation and postoperative pulmonary function tests in patients undergoing robotic-assisted hysterectomy: a single-blind randomized study

Abstract Background Robotic-Assisted Hysterectomies (RAH) require Trendelenburg positioning and pneumoperitoneum, which further accentuate alteration in respiratory mechanics induced by general anesthesia. The role of Recruitment Maneuver (RM) as a lung-protective strategy during intraoperative surgical settings has not been much studied. We planned this study to evaluate the effect of RM on perioperative oxygenation and postoperative spirometry using PaO2/FiO2 and FEV1/FVC, respectively in patients undergoing RAH. Methods Sixty-six ASA I‒II female patients scheduled for elective RAH were randomized into group R (recruitment maneuver, n = 33) or group C (control, n = 33). Portable spirometry was done one day before surgery. Patients were induced with general anesthesia, and mechanical ventilation started with volume control mode, with Tidal Volume (TV) of 6-8 mL.kg−1, Respiratory Rate (RR) of 12 min, inspiratory-expiratory ratio (I: E ratio) of 1:2, FiO2 of 0.4, and Positive End-Expiratory Pressure (PEEP) of 5 cmH2O. Patients in group R received recruitment maneuvers of 30 cmH2O every 30 minutes following tracheal intubation. The primary objectives were comparison of oxygenation and ventilation between two groups intraoperatively and portable spirometry postoperatively. Postoperative pulmonary complications, like desaturation, pulmonary edema, pneumonia, were monitored. Results Patients who received RM had significantly higher PaO2 (mmHg) (203.2+-24.3 vs. 167.8+-27.3, p < 0.001) at T2 (30 min after the pneumoperitoneum). However, there was no significant difference in portable spirometry between the groups in the postoperative period (FVC, 1.40 ± 0.5 L vs. 1.32 ± 0.46 L, p= 0.55). Conclusion This study concluded that intraoperative recruitment did not prevent deterioration of postoperative spirometry values; however, it led to improved oxygenation intraoperatively.

Short-Term Efficacy and Postoperative Inflammatory Cytokine Changes in Lung Cancer Treated with Da Vinci Robot-assisted Versus Video-assisted Thoracoscopic Surgery / 肿瘤防治研究

Objective To evaluate the short-term outcomes and postoperative inflammatory cytokine changes in patients with lung cancer treated with robot-assisted thoracoscopic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS). Methods A total of 270 patients with lung cancer treated by minimally invasive surgery were selected for the study, and the surgical procedures were selected according to the patients' economic conditions and preferences. Among them, 132 patients completed the operation through RATS, and 138 patients completed the operation through VATS. The clinical data of the two groups were compared. Results All patients successfully completed radical lung cancer surgery, and no perioperative deaths were reported. Intraoperative bleeding, postoperative drainage time, postoperative hospital stay, number of lymph nodes dissected, and number of lymph nodes dissected groups were more advantageous in the RATS group compared with the VATS group (P < 0.05). In terms of operative time, total postoperative chest drainage, and hospitalization cost, the VATS group had an advantage (P < 0.05). The postoperative levels of CRP, PCT, IL-6, IL-8, IL-10, and TNF-α increased in both groups, compared with preoperative levels, and the increases in the RATS group were lower than those in the VATS group. Conclusion RATS offers technical and short-term efficacy advantages for the treatment of lung cancer but comes with the disadvantage of high cost. Post-operative inflammatory cytokine elevation is lower in the RATS group, and inflammatory response to the organism is less severe.

Clinical Efficacy of Da Vinci Robot-assisted Subxiphoid Versus Lateral Thoracic Approach for Treatment of Anterior Mediastinal Tumors / 肿瘤防治研究

Objective To compare the perioperative efficacy and safety of da Vinci robot-assisted thoracoscopic surgery (RATS) for treatment of anterior mediastinal tumors through subxiphoid versus lateral thoracic approaches under the laryngeal mask anesthesia. Methods We retrospectively analyzed the clinical data of 102 patients with anterior-mediastinal tumors treated by RATS under laryngeal mask anesthesia completed by the same operator. Forty-five patients underwent the subxiphoid approach (subxiphoid group), and 57 patients were treated with the lateral thoracic approach (lateral thoracic group). The operating time, intraoperative bleeding, and total postoperative drainage volume in the two groups were compared and analyzed. Results All patients successfully completed resection of the anterior mediastinal tumor without the occurrence of perioperative death. In terms of total postoperative drainage volume, postoperative drainage time, postoperative hospital stay, and VAS pain on postoperative days 2 and 3, the subxiphoid group was more advantages (P < 0.05). No statistically significant difference was found between the two groups in terms of operative time, docking time, total operative time, intraoperative bleeding volume, postoperative day 1 VAS pain score, or postoperative complications (P > 0.05). Conclusion The subxiphoid approach of RATS is safe and feasible for resection of anterior mediastinal tumors. Compared with the lateral thoracic approach, the subxiphoid approach has advantages in terms of rapid postoperative recovery and postoperative pain.

Clinical application of robotic-assistant living donor left lateral segmentectomy / 中华器官移植杂志

Objective:To explore the feasibility and safety of robotic-assisted living donor left lateral segmentectomy (LDLLS) in a large pediatric liver transplant program.Methods:Retrospective analysis was performed for clinical data of 45 LDLLS donors and recipients from June 2021 to September 2022.Traditional open donor liver resection (n=30) and robotic-assisted segmentectomy (n=15) were performed.Two groups were compared with regards to operative duration, intraoperative hemorrhage, postoperative healing and postoperative complications.SPSS 21.0 was utilized for statistical analysis.Independent sample T, paired sample T, Wilcoxon rank sum and Chi-square tests were performed for examining the inter-group differences.Results:Operative duration of robot-assisted surgery group was substantially longer than that of traditional open surgery group ( P<0.001). Intraoperative blood loss was less in robot-assisted surgery group was less than that in traditional open surgery group[(106.0±39.8) vs.(251.0±144.8) ml, P=0.001]. Postoperative hospital stay of robot-assisted surgery group was shorter than that of traditional open surgery group[6.0(6.0, 6.0) vs.7.0(6.0, 9.0), P<0.05]. Two cases of postoperative biliary leakage were observed in donor of traditional open surgery group.Among 2 cases of abdominal infection, one was due to biliary leakage from liver section and secondary surgery was then performed.One case of incisional infection and another case of thrombosis occurred in donor of traditional open surgery group.In robot-assisted surgery group, only one donor had amylase elevation.In traditional open surgery group, there were one case of local thrombosis in middle hepatic vein and one case of bile duct stricture.No long-term complications occurred in robot-assisted surgery group during a follow-up period of over 6 months.Finally recipient data analysis indicated that no significant inter-group differences existed in operative duration, intraoperative blood loss, postoperative hospital stay or postoperative abdominal infection ( P=0.634, P=0.180, P=0.86 and P=0.153). Conclusions:Robotic-assisted LDLLS proves to be be a safe and reliable option for living donor segmentectomy.It is superior to conventional LDLLS in terms of shorter hospital stay, less intraoperative blood loss and fewer postoperative complications.

Impact of body mass index on perioperative efficacy and complications of robot-assisted radical cystectomy with intracorporeal urinary diversion / 中华泌尿外科杂志

Objective:To determine the impact of body mass index (BMI) on perioperative and oncological outcomes after robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion.Methods:Clinical data of bladder cancer patients undergoing robot-assisted radical cystectomy with intracorporeal urinary diversion in Zhejiang Provincial People's Hospital from January 2017 to January 2020 were retrospectively analyzed. Patients were divided into three groups according to BMI, including 61 cases in normal group (<25.0 kg/m2), 52 cases in overweight group (25.0-29.9 kg/m2) and 33 cases in obese group (≥30.0 kg/m2). In the normal group, the median age was 73.6(59, 79), including 45 male(73.8%), with 51 cases(83.6%) of ASA score 0-2, 10 cases (16.4%)of 3 or higher, and 10 cases (16.4%) undergoing neoadjuvant chemotherapy. Past medical history included smoking in 34 cases (55.7%), hypertension in 19 cases (31.1%), diabetes in 10 cases (16.4%), heart disease in 12 cases (19.7%), and abdominal surgery in 6 cases (9.8%). In the overweight group, the median age was 69.7(60, 78), including 38 male (73.1%), with 25 cases (48.1%)of ASA score 0-2, 27 cases (51.9%) of 3 or higher, and 9 cases (17.3%) undergoing received neoadjuvant chemotherapy. Past medical history included smoking in 30 cases (57.7%), hypertension in 20 cases (38.5%), diabetes in 10 cases (19.2%), heart disease in 9 cases (17.3%), and abdominal surgery in 5 cases (9.6%). In the obses group, the median age was 69.9(61, 78), including 21 male(63.7%), with 20 cases (60.6%)of ASA score 0-2, 13 cases(39.4%) of 3 or higher, 9 cases (27.3%) undergoing neoadjuvant chemotherapy. Past medical history included smoking in 18 cases (54.5%), hypertension in 17 cases (51.5%), diabetes in 19 cases (57.6%), heart disease in 7 cases (21.2%), and abdominal surgery in 4 cases (12.1%). After statistical comparison among the three groups, it was found that the proportion of patients with hypertension and diabetes in the obesity group and overweight group was higher than that in the normal group (all P<0.05), but there was no significant difference in other factors (all P>0.05). During the surgical process, robot-assisted radical cystectomy and bilateral pelvic lymph node dissection were performed firstly. The scope of lymph node dissection was divided into standard range and expanded range, and the diversion was divided into orthotopic neobladder and ileal bladder. During the orthotopic neobladder process, 40-50 cm ileum at the distance of 15 cm away from ileocecum was obtained by stapler, and then the U-shaped neobladder was made, and the new bladder was anastomosed with urethra and bilateral ureter. For ileal bladder, the ileum was cut off 15cm away from the ileocecum with stapler to obtain the 15 cm ileum to prepare the ileal conduit and restore the continuity of the ileum. The bilateral ureteral spacing 3cm was implanted on the ileal conduit. In the normal group, standard range lymphatic dissection was performed in 20 cases (32.8%), enlarged dissection in 41 cases (67.2%), orthotopic neobladder in 22 cases(36.1%), and ileal conduit in 39 cases (63.9%). In the overweight group, standard range lymphatic dissection was performed in 12 cases (23.1%), enlarged dissection in 40 cases (76.9%), orthotopic neobladder in 26 cases (49.1%), and ileal conduit in 26 cases (50.9%). In the obesity group, the standard range of lymphatic dissection was performed in 7 cases (21.2%), enlarged dissection in 26 cases (78.7%), orthotopic neobladder in 7 cases (21.2%), and ileal conduit in 26 cases (78.8%). There was no significant difference among the three groups (all P>0.05). Compared the operation time, intraoperative blood loss, postoperative exhaust time, postoperative time of taking solid food, postoperative hospital stay, postoperative complications (according to the Clavien-Dindo grading system, postoperative complications are reported inⅠ-Ⅱ grade as mild complications and above Ⅲ grade as serious complications) and pathology results in three groups. Results:All cases successfully underwent robotically without conversion or major intraoperative complications. The operation time in overweight and obsess group were longer than that of normal group with RARC or orthotopic neobladder [310(250, 350) min, 370(310, 420) min, 250(230, 310) min, ( P<0.05)], but there was no significant difference in RARC and ileal conduit[270(220, 300) min, 280(230, 300) min, 240(220, 290)min, P>0.05]. The estimated blood loss in overweight and obsess group was more than that in normal group [230(150, 450)ml, 310(250, 600)ml, 190(100, 350)ml, P<0.05], but there was no difference in blood transfusion rate [4(7.7%), 2(6.1%), 5(8.2%), P>0.05]. The exhaust time [2(1, 3) days, 2(1, 4)days, 2(1, 4)days], postoperative solid food intake time [4(3, 5)days, 4(3, 6)days, 4(3, 6)days] and the hospital stay[10(5, 16)days, 10(6, 17)days, 12(6, 20)days] were not different in three groups(all P>0.05). The mild complication rates in 90 days were significant higher in overweight and obsess groups[28 (53.8%), 16(48.5%), 20(32.8%), P<0.05], but the total and severe complication rates were not significantly different. The incidences of urinary system complications and incision complications in obese and overweight patients were significantly higher than those in normal group ( P<0.05). There was no significant difference in the incidence of gastrointestinal complications and ureteral anastomosis-related complications (stricture or urinary leakage)( P>0.05). There was no significant difference in the number of dissected lymph node, positive lymph node, positive rate of incisional margin and postoperative pathological stage among three different BMI groups(all P>0.05). Conclusion:Robot-assisted radical cystectomy combined with intracorporeal urinary diversion is a safe and effective method for the treatment of overweight, obese and even morbidly obese patients with bladder cancer. The recovery of intestinal function and the oncological results are not affected by body mass index. However, laparoscopic radical cystectomy for overweight and obese patients, especially for orthotopic neobladder, has the risk of long operation time, large amount of intraoperative bleeding and increased risk of minor postoperative complications.

Robot-assisted percutaneous vertebroplasty combined with pediculoplasty in treating symptomatic chronic thoracolumbar osteoporotic vertebral fracture without neurological impairment / 中华创伤杂志

Objective:To compare the efficacy of robot-assisted and conventional fluoroscopy-guided percutaneous vertebroplasty (PVP) combined with pediculoplasty in treating symptomatic chronic thoracolumbar osteoporotic vertebral fracture (SCOVF) without neurological symptoms.Methods:A retrospective cohort study was used to analyze the clinical data of 120 patients with thoracolumbar SCOVF without neurological symptoms, who were admitted to Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2015 to January 2020. The patients included 34 males and 86 females, aged 63-85 years [(72.9±5.7)years]. All patients were treated with PVP combined with pediculoplasty. A total of 87 patients were treated with robot-assisted and C-arm X-ray machine guided puncture (robot group) and 33 patients with C-arm X-ray machine fluoroscopic-guided puncture (conventional group). The operation time, amount of bone cement injection and puncture accuracy were compared between the two groups. The results of vertebral body index, Cobb angle, visual analogue scale (VAS), and Oswestry disability index (ODI) were also compared before operation, at 1 day and 1 year after operation and at the final follow-up. Complications such as bone cement leakage and displacement were observed.Results:All patients were followed up for 24-36 months [(29.4±3.4)months]. The operation time was (85.2±10.5)minutes in the robot group, significantly longer than (37.2±3.7)minutes in the conventional group ( P<0.01). The amount of bone cement injection was (5.0±0.7)ml in the robot group, significantly less than (5.3±0.8)ml in the conventional group ( P<0.05). The puncture accuracy in the robot group was 95.4% (83/87), significantly higher than 81.8% (27/33) in the conventional group ( P<0.01). There were no significant differences in vertebral body index, Cobb angle, VAS or ODI between the two groups before operation (all P>0.05). The values of vertebral body index were 87.1±4.5, 86.9±4.3, 86.8±4.3 in the robot group at 1 day after operation, 1 year after operation and the final follow up, respectively, which were significantly higher than 83.6±4.4, 84.1±3.8, 84.4±3.9 in the conventional group (all P<0.01). There were no significant differences in Cobb angle or ODI between the two groups at 1 day after operation, 1 year after operation or the final follow-up (all P>0.05). The values of VAS were (2.9±1.0)points, (1.8±0.7)points, (1.8±0.7)points in the robot group at 1 day after operation, 1 year after operation and the final follow-up, respectively, which were significantly lower than (4.4±1.1)points, (3.1±0.8)points, (3.0±0.9)points in the conventional group (all P<0.01). The bone cement leakage occurred in 7 patients in the robot group [8.0%(7/87)] and in 10 in the conventional group [30.3%(10/33)] ( P<0.01). No delayed bone cement displacement [0.0%(0/87)] occurred in the robot group from 1 day after operation to the final follow-up, but 3 patients [9.1%(3/33)] were noted in the conventional group ( P<0.05). Conclusion:Both robot-assisted and conventional fluoroscopy-guided PVP combined with pediculoplasty have satisfactory effect for SCOVF patients without neurological impairment, but the robot-assisted one has the advantages of higher puncture accuracy, more satisfactory vertebral height recovery, more rapid pain relief, lower incidence of bone cement leakage and effective avoidance of cement displacement.

Robot assisted radical nephrectomy with lymph node dissection for metastasis around inferior vena cava / 现代泌尿外科杂志

【Objective】 To summarize the key points of robot assisted radical nephrectomy combined with resection of metastatic lymph nodes around inferior vena cava. 【Methods】 The patients undergoing the operation during Jan.2019 and Dec.2021 were analyzed and followed up. The surgical procedures and key points for right renal cancer with huge lymph node metastasis around inferior vena cava were illustrated. 【Results】 A total of 5 patients completed operation successfully, including 4 cases of clear cell carcinoma and 1 case of papillary carcinoma. The average operation time and estimated blood loss were 135 min and 300 mL, respectively, with no major complications. 【Conclusion】 It is feasible to perform robot assisted radical nephrectomy with resection of metastatic lymph nodes for selected patients of renal cancer especially with large lymph node metastasis around vena cava. The value of minimally invasive surgery in the comprehensive treatment of renal cancer deserves further attention and research.

Comparison between robot-assisted and open radical nephrectomy in the treatment of complex kidney neoplasm >8 cm in diameter / 现代泌尿外科杂志

【Objective】 To compare the feasibility, safety, and efficacy of robot-assisted and open radical nephrectomy for complex kidney neoplasm >8 cm in diameter. 【Methods】 Clinical data of 24 patients with large kidney neoplasm undergoing robot-assisted radical nephrectomy (9 cases, 37.5%) and open radical nephrectomy (15 cases, 62.5%) during Nov.2015 and Aug.2019 were retrospectively analyzed. The surgical parameters, perioperative complications and follow-up outcomes were compared between the two groups. 【Results】 All operations were successful. Compared with the robot group, the open group had a higher incidence of clinical symptoms (93.3% vs.44.4%, P=0.015) and larger maximum tumor diameter (124 mm vs.95 mm, P=0.021). There were no significant differences in other preoperative characteristics between the two groups. The robot group had less intraoperative blood loss (100 mL vs.800 mL, P=0.006) and lower blood transfusion rate (0% vs. 60.0%, P=0.007) than the open group. During the median follow-up of 50 (range: 25-67) months, 4 patients in the open group and 1 in the robot group developed new metastases, and 4 patients in the open group died due to advanced tumor stage. 【Conclusion】 Robot-assisted radical nephrectomy is safe in the treatment of complex and large renal tumors, and causes less intraoperative blood loss than open surgery.

Transvesical robot-assisted radical prostatectomy: a report of 13 cases / 现代泌尿外科杂志

【Objective】 To share the technical key points and experience of transvesical robot-assisted radical prostatectomy (TvRARP). 【Methods】 The clinical data of 13 patients with prostate cancer (PCa) receiving TvRARP during Nov.2021 and May 2022 were collected. The operation time, estimated blood loss, blood transfusion rate, catheter removal time, postoperative length of hospital stay, immediate urinary continence rate, postoperative IIEF-5 score and perioperative complications were evaluated. 【Results】 The operation time was (142±39) min, estimated intraoperative blood loss was (76±40) mL, and no transfusion was needed. The median postoperative IIEF-5 score was 16 (12-22), hospital stay 3 (2-5)days, and catheter removal time 7(5-14)days. Of all 13 patients, 12(92.3%) achieved immediate urinary continence at the removal of catheter. There were no postoperative complications of Clavien Ⅲ and above. Clavien Ⅰ-Ⅱ complications were observed in 4 patients (30.8%). 【Conclusion】 TvRARP is feasible and safe for selected patients with clinically localized PCa, which can ensure promising postoperative urinary continence and preserve erectile functional.

Efficacy of robot-assisted single-port laparoscopic transvaginal surgery in the treatment of vesicovaginal fistula / 现代泌尿外科杂志

【Objective】 To investigate the efficacy of robot-assisted single-port laparoscopic transvaginal vesicovaginal fistula repair. 【Methods】 The clinical data of 3 patients with high vesicovaginal fistula treated during Jun.2020 and Jun.2021 were retrospectively analyzed. 【Results】 All operations were completed successfully, with no conversion to other surgical methods. Operation time: 98 min, 104 min and 115 min; Intraoperative bleeding volume: 15 mL, 20 mL and 22 mL; Postoperative hospital stay was 2 days. The catheter was removed after 1-month follow-up, and the patients had no bleeding, urine leakage, infection or other complications. There was no recurrence of urine leakage at the end of 12-month follow-up. 【Conclusion】 Robot-assisted single-port laparoscopic transvaginal vesicovaginal fistula repair has the advantages of fine suture and minor damage, which can be an effective treatment of vesicovaginal fistula.

Adjustable "paper clip" techniques suturing the dorsal vein complex in radical prostatectomy / 现代泌尿外科杂志

【Objective】 To investigate the efficacy of the adjustable "paper clip" techniques in the suture of dorsal vein complex (DVC) and retention of urethral function in robot-assisted laparoscopic radical prostatectomy (RALRP). 【Methods】 A total of 30 cases of prostate cancer treated with RALRP were enrolled, all of which used the adjustable "paper clip" techniques. During operation, the DVC was sewed with barbed suture, and then a reverse suture was made through two sides of the prostatic ligaments. A Hem-o-lock was used to fasten the suture, which would be flexible to control the degree of tightness for the ligature. Perioperative and follow-up data of urinary continence and symptoms were collected and analyzed. 【Results】 All operations were successful. The estimated blood loss was (123.3±80.7) mL, 53.6% patients recovered continence in 1 month, and the continence rate increased to 92.9% and 96.3% at month 3 and 6. 92.9 of patients had no risk of incontinence 3 months after surgery. 【Conclusion】 The adjustable "paper clip" techniques have advantages in reducing blood loss, maintaining clear surgical field, preserving urethral function, and improving urinary continence.

Management of vena cava tumor thrombus dislodgement in robot-assisted laparoscopic surgery / 现代泌尿外科杂志

Renal cancer complicated with inferior vena cava tumor thrombus has been difficult to manage in urological surgery, because it has a complex anatomical relationship and involves vascular blockage of vital organs such as kidney, liver and heart, as well as the blockage and reconstruction of inferior vena cava. In addition, tumor thrombus dislodgement may occur intraoperatively, leading to acute pulmonary embolism, which makes the surgery extremely difficult and risky. In this paper, we report the successful treatment of thrombus dislodgement in a case of right kidney tumor with inferior vena cava thrombus during robot-assisted laparoscopic surgery and explore the treatment methods, aiming to avoid lethal pulmonary embolism caused by tumor thrombus dislodgement.

Safety of robot-assisted laparoscopic and laparoscopic heminephrectomy: a meta analysis / 现代泌尿外科杂志

【Objective】 To analyze the differences in efficacy of heminephrectomy with robot-assisted laparoscopy (RARN) and laparoscopic radical nephrectomy (LRN). 【Methods】 The published references in national and international databases on the comparison of clinical outcomes between heminephrectomy RARN and LRN for kidney neoplasms were searched. References were screened strictly according to PICOS criteria, and data including estimated amount of blood loss, operation time, length of hospital stay and complications were extracted from those that met the requirements. Sensitivity analysis was used to eliminate the included articles one by one to confirm the robustness of the results, and funnel plot and Eggers test were used to explore publication bias. 【Results】 A total of 16 studies involving 2 063 patients (1 097 in RARN group and 966 in LRN group) were included. The RARN group had less intraoperative blood loss and shorter hospital stay, but there were no significant differences between the two methods (P>0.05). The incidence of postoperative complications in RARN group was lower than that in LRN group (OR: 0.643, 95%CI: 0.467-0.886, P=0.007). 【Conclusion】 Compared with LRN, RARN has better control of complications in the treatment of renal tumor, but the overall effects of intraoperative bleeding, operation time, and hospital stay are comparable.

Robot-assisted transperitoneal and retroperitoneal adrenalectomy for huge adrenal tumors in 45 cases / 现代泌尿外科杂志

【Objective】 To compare the outcomes of robot-assisted laparoscopic transperitoneal and retroperitoneal operation for huge (>6 cm) adrenal tumors. 【Methods】 The clinical data of 45 patients with huge adrenal tumors who underwent robotic surgery during Jan.2017 and Dec.2021 were retrospectively analyzed, including 28 cases via the transperitoneal approach and 17 cases via the retroperitoneal approach. 【Results】 No patients were converted to open operations. There were no significant differences in postoperative drainage time (2.24±0.44 vs. 2.36±0.49) d, operation time (130.88±5.96 vs. 136.61±8.39) min, blood loss (189.41±13.91 vs. 192.5±12.36) mL and postoperative hospital stay (7.06±0.56 vs. 7.46±0.69) d between the retroperitoneal and transperitoneal approaches. Retroperitoneal approach was better than transperitoneal approach in early postoperative feeding [(38.82±6.75 vs. 74.14±6.57) h, P<0.01] . 【Conclusion】 Robotic surgery is safe and effective in the treatment of large adrenal tumors. The choice of surgical approach should be based on patients’ condition, tumor volume and location.

Application of robot-assisted lung basal segmentectomy: A retrospective study / 中国胸心血管外科临床杂志

@#Objective    To summarize the experience of robot-assisted lung basal segmentectomy, and analyze the clinical application value of intersegmental tunneling and pulmonary ligament approach for S9 and/or S10 segmentectomy. Methods    The clinical data of 78 patients who underwent robotic lung basal segmentectomy in our hospital between January 2020 to May 2022 were retrospectively reviewed. There were 32 males and 46 females with a median age of 50 (33-72) years. The patients who underwent S9 and/or S10 segmentectomy were divided into a single-direction group (pulmonary ligament approach, n=19) and a bi-direction group (intersegmental tunneling, n=19) according to different approaches, and the perioperative outcomes between the two groups were compared. Results    All patients successfully completed the operation, without conversion to thoracotomy and lobectomy, serious complications, or perioperative death. The median operation time was 100 (40-185) min, the blood loss was 50 (10-210) mL, and the median number of dissected lymph nodes was 3 (1-14). There were 4 (5.1%) patients with postoperative air leakage, and 4 (5.1%) patients with hydropneumothorax. No patient showed localized atelectasis or lung congestion at 6 months after the operation. Further analysis showed that there was no significant difference in the operation time, blood loss, thoracic drainage time, complications or postoperative hospital stay between the single-direction and bi-direction groups (P>0.05). However, the number of dissected lymph nodes of the bi-direction group was more than that of the single-direction group [6 (1-13) vs. 5 (1-9), P=0.040]. Conclusion    The robotic lung basal segmentectomy for pulmonary nodules is safe and effective. The  perioperative results of robotic S9 and/or S10 complex segmentectomy using intersegmental tunneling and pulmonary ligament approach are similar.

Da-Vinci robot-assisted thoracic surgery versus video-assisted thoracic surgery for non-small cell lung cancer: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To compare the surgical efficacy of Da-Vinci robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for non-small cell lung cancer (NSCLC). Methods    Online databases including PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP and CBM from inception to 18 February, 2022 were searched by two researchers independently. The references of related studies were also searched to re-enroll the potential studies. The quality of the studies was evaluated with Newcastle-Ottawa Scale (NOS). The meta-analysis was performed by RevMan 5.3. Results     A total of 43 studies including 33 089 patients were enrolled in the final study. The NOS scores of the included studies were ≥6 points. The results of meta-analysis showed that the operation time was longer [MD=8.50, 95%CI (1.59, 15.41), P=0.020], the blood loss was less [MD=−46.58, 95%CI (−62.86, −30.29), P<0.001], the dissected lymph nodes stations were more [MD=0.67, 95%CI (0.40, 0.93), P<0.001], the dissected lymph nodes were more [MD=2.39, 95%CI (1.43, 3.36), P<0.001], the conversion rate was lower [OR=0.52, 95%CI (0.46, 0.59), P<0.001], the time of chest tube drainage was shorter [MD=−0.35, 95%CI (−0.58, −0.11), P=0.004], the length of hospital stay was shorter [MD=−0.32, 95%CI (−0.45, −0.19), P<0.001], and the recurrence rate was lower [OR=0.51, 95%CI (0.36, 0.72), P<0.001] in the RATS group than those in the VATS group. The rate of overall postoperative complications [OR=0.95, 95%CI (0.89, 1.01), P=0.110] and postoperative mortality rate [OR=0.85, 95%CI (0.62, 1.16), P=0.300] were not significantly different between the two groups. Conclusion    Compared with VATS, although RATS prolongs the operation time, it does not increase the incidence of postoperative complications and mortality rates. Moreover, RATS can dissect more lymph nodes, effectively control intraoperative bleeding, shorten the duration of chest drainage tube indwelling and shorten the postoperative hospital stay to a certain extent.

Effect of robot-assisted training on upper limb motor in patients with stroke: a meta-analysis / 中国康复理论与实践

ObjectiveTo systematically review the efficacy of robot-assisted training on upper limb motor dysfunction in stroke patients. MethodsRelated literatures were searched in PubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, SinoMed, VIP data from July 1, 2019 to July 1, 2022. Two researchers screened the studies and extracted the data independently, and evaluated the methodological quality. Rev Man 5.4 was used for meta-analysis. ResultsA total of 19 randomised controlled trials with 1 258 subjects were finally included. The scores of Fugl-Meyer Assessment-Upper Extremity (SMD = 0.55, 95%CI 0.40 to 0.71, P < 0.001), modified Bathel Index (MD = 7.55, 95%CI 6.55 to 8.54, P < 0.001) and Motor Activity Log (SMD = -0.84, 95%CI -1.38 to -0.31, P = 0.002) were better in the experimental group than in the control group. However, no significant difference was found in the scores of Brunnstrom stages (upper extremity) (SMD = 0.61, 95%CI -0.08 to 1.30, P = 0.08) and modified Ashworth Scale (MD = -0.51, 95%CI -1.18 to 0.17, P = 0.14) between two groups. ConclusionRobot-assisted training could significantly improve the motor function of upper limbs in stroke patients.

Early clinical application of Mako robot-assisted total knee arthroplasty in knee osteoarthritis / 中国骨伤

OBJECTIVE@#To investigate the early efficacy of Mako robot-assisted total knee arthroplasty (TKA) in the treatment of knee osteoarthritis (KOA) and summarize the initial application experience.@*METHODS@#Retrospective analysis of 73 patients with KOA treated with Mako robot-assisted TKA from June 2021 to December 2021. There were 16 males and 57 females, aged from 54 to 81 years old with an average of (67.8±6.6) years old. The hip knee and ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), lateral femoral component angle (LFCA) and lateral tibial component angle (LTCA) were recorded and analyzed. WOMAC score and KSS were used to compare the functional recovery of patients preoperatively, 3 and 6 months postoperatively.@*RESULTS@#All the 73 patients were successfully treated without serious complications such as vascular and nerve injury, and all the incisions healed well at stageⅠwithout infection. The patients were followed up from 4 to 11 months with an average of (7.0±2.7) months, and the satisfaction rate of the last follow-up was 90.41% (66/73). WOMAC scores were (23.1±5.4) at 3 months and (14.8±4.1) at 6 months postoperatively. KSS clinical scores were ( 76.1±4.0) at 3 months and (82.1±3.7) at 6 months postoperatively;KSS functional scores were (74.3±3.1) at 3 months and (78.6±2.1) at 6 months after operation. Postoperative imaging showed good position of the prosthesis, HKA angle was (178.5±2.1)°, LDFA was (91.2±1.8)°, MPTA was(89.9±1.5) °, LFCA was (7.6±3.1)°, LTCA was (88.2±1.1)°. The mechanical axis within ±3° in sixty cases(82.2%), and the mechanical axis within ±6° in all the patients.@*CONCLUSION@#Mako robot-assisted TKA is a safe and effective surgery in the treatment of knee osteoarthritis, which exhibited good efficacy in the correction of lower limb alignment, soft tissue balance and improvement of knee function. The long-term efficacy needs further follow-up observation.