Robot-assisted endovascular treatment of hepatic artery aneurysm: A case report.

OBJECTIVE: Robot-assisted endovascular surgery has emerged as a new alternative to interventional procedures, with its application expanding to peripheral and visceral approaches. The objective of this paper is to describe a robot-assisted endovascular treatment in splanchnic arteries. METHODS: A case report of an asymptomatic male patient with an incidental finding of a saccular aneurysm of the proper hepatic artery measuring 3.7 × 2.7 cm and distant 0.6 cm from the origin of the gastroduodenal artery. RESULTS: Using a robot-assisted endovascular technique (CorPath GRX platform - Siemens), 2 guidewires were advanced in parallel: the first one was placed inside the aneurysm sac, while the second one was placed in the proper hepatic artery distal to the aneurysm; through the first guidewire, a balloon was advanced, positioned distally to the aneurysm, and through the second one, a microcatheter was advanced. Embolization of the aneurysm was performed with the use of coils and Onyx. Control exam performed 120 days after embolization revealed treated aneurysm and preserved distal arterial flow. CONCLUSION: Using a robotic platform for navigation in splanchnic territory is safe and effective.

Bridging the Gap: Enhancing Maritime Vessel Cyber Resilience through Security Operation Centers.

Increasingly disruptive cyber-attacks in the maritime domain have led to more efforts being focused on enhancing cyber resilience. From a regulatory perspective, there is a requirement that maritime stakeholders implement measures that would enable the timely detection of cyber events, leading to the adoption of Maritime Security Operation Centers (M-SOCs). At the same time, Remote Operation Centers (ROCs) are also being discussed to enable increased adoption of highly automated and autonomous technologies, which could further impact the attack surface of vessels. The main objective of this research was therefore to better understand both enabling factors and challenges impacting the effectiveness of M-SOC operations. Semi-structured interviews were conducted with nine M-SOC experts. Informed by grounded theory, incident management emerged as the core category. By focusing on the factors that make M-SOC operations a unique undertaking, the main contribution of this study is that it highlights how maritime connectivity challenges and domain knowledge impact the M-SOC incident management process. Additionally, we have related the findings to a future where M-SOC and ROC operations could be converged.

Establishment of a new practical telesurgical platform using the hinotori™ Surgical Robot System: a preclinical study.

AIM: The recent development of new surgical robots and network telecommunication technology has opened new avenues for robotic telesurgery. Although a few gastroenterological surgeries have been performed in the telesurgery setting, more technically demanding procedures including gastrectomy with D2 lymphadenectomy and intracorporeal anastomosis have never been reported. We examined the feasibility of telesurgical robotic gastrectomy using the hinotori™ Surgical Robot System in a preclinical setting. METHODS: First, the suturing time in the dry model was measured in the virtual telesurgery setting to determine the latency time threshold. Second, a surgeon cockpit and a patient unit were installed at Okazaki Medical Center and Fujita Health University, respectively (approximately 30 km apart), and connected using a 10-Gbps leased optic-fiber network. After evaluating the feasibility in the dry gastrectomy model, robotic distal gastrectomies with D2 lymphadenectomy and intracorporeal B-I anastomosis were performed in two porcine models. RESULTS: The virtual telesurgery study identified a latency time threshold of 125 ms. In the actual telesurgery setting, the latency time was 27 ms, including a 2-ms telecommunication network delay and a 25-ms local information process delay. After verifying the feasibility of the operative procedures using a gastrectomy model, two telesurgical gastrectomies were successfully completed without any unexpected events. No fluctuation was observed across the actual telesurgeries. CONCLUSION: Short-distance telesurgical robotic surgery for technically more demanding procedure may be safely conducted using the hinotori Surgical Robot System connected by high-speed optic-fiber communication.

Transoral robotic surgery in Ireland: the beginning.

BACKGROUND: Transoral robotic surgery (TORS) has shown promising results in the treatment of myriad head and neck pathologies but is now most commonly used in the investigation and management of oropharyngeal squamous cell carcinoma. AIMS: The aim of this study was to report our cases of the newly introduced TORS, particularly its role in identifying primary of unknown origin and the potential implications for patients. A literature review and our early experience should begin to debunk some of the criticisms of TORS including setup times and cost. METHODS: Prospective data was collected from all patients undergoing transoral robotic surgery including demographics, indication, histology results in primary of unknown origin and complications. RESULTS: We have performed 36 TORS procedures in total ranging from intermediate to major complex. Our complication rate is low, and this has improved with the passage of time. Haemorrhage rates remain at 5.6% (n = 2), and the average length of stay is 1 day. Successful identification of a primary tumour in cancer of unknown primary was 80% (n = 8). CONCLUSIONS: We anticipate the integration of TORS into routine practice in the investigation and management of a number of ENT pathologies following robust clinical trials.

Effects of Bowel Preparation and Fluid Restriction in Robot-Assisted Radical Prostatectomy Patients.

OBJECTIVE: In Robot-assisted radical prostatectomy (RARP) patients, preoperative bowel preparation and intraoperative fluid restriction may cause dehydration and electrolyte imbalance. In these patients, laboratory results that are considered "normal" in the pre-anaesthesia clinic may be misleading, and cardiac arrhythmia due to hypokalaemia and hypocalcaemia, as well as problems, such as prolonged non-depolarising blockade and delayed recovery from anaesthesia, may be observed during anaesthesia practice. In this study, we aimed to determine these disturbances by comparing the preoperative (T1) laboratory values with those at the beginning of the operation (T2) and at the 6(th) hour of the operation (T3) and values at discharge. METHODS: This prospective study comprised 49 American Society of Anesthesiologists (ASA) I-II patients. Bowel preparation was made with a rectal enema (NaP) twice in 12 hours and with one single dose of oral laxative soda (NaP). During surgery, 1 mL kg(-1) h(-1) 0.09% NaCl and 1 mL kg(-1) h(-1) 6% HES 200/05 infusions were applied. RESULTS: The potassium level at T2 was significantly lower than at T1 and T3. The calcium levels at T2 and T3 were significantly lower than at T1, and the level at T3 was significantly lower than at T2. The creatinine level at T3 was significantly higher than at T1 and T2. CONCLUSION: Although there were no severe increases or decreases in laboratory test values due to bowel preparation and fluid restriction in RARP operations, which reflected on the clinical outcome in this ASA I-II patient group, these changes may be important in critically ill or ASA III-IV patients.

Cirugía Robótica Transoral (TORS), en el manejo de lesiones neoplásicas de cabeza y cuello / Transoral Robotic Surgery (TORS), in the management of head and neck tumors

El cáncer de cabeza y cuello es una enfermedad muy complicada cuya incidencia ha venido incrementando en la última década y está relacionada con la infección del virus del papiloma humano. La base del tratamiento es la cirugía, que debe hacerse con intervenciones extensas y mutilantes a través del cuello, son acompañadas de quimioterapia y radioterapia, dejando secuelas funcionales difíciles de manejar. Desde 2009 se aprobó el uso del robot Da Vinci® para resecar tumores de la orofaringe y supraglotis, con la cirugía robótica transoral. Las bondades de esta técnica, que inciden en la pronta recuperación del paciente, y que están derivadas de la excelente visión tridimensional y la versatilidad de movimientos del instrumental articulado (EndoWrist®), han hecho que las recomendaciones de su uso estén redefiniéndose continuamente. Este artículo resume las ventajas, las desventajas, las indicaciones de manejo actual, el cuidado posoperatorio, la rehabilitación y la terapia adyuvante de este novedoso tratamiento.

Head and neck cancer is a complicated disease, with an increasing incidence in the last decade, and is associated with the human papilloma virus infection. The basic treatment is surgery, which should be done with interventions through the neck, which are extensive and crippling, supplemented by chemotherapy and radiotherapy, leaving hard-to-manage functional sequels. The use of the Da Vinci® robot was approved in 2009 for the resection of tumors of the oropharynx and supraglotis, using transoral robotic surgery. The benefits of this technique, leading to an early recovery of the patient, arise from the excellent three-dimensional views and exceptional movements of the automated instrument (EndoWrist®). This has led to the recommendations for its use being continuously redefined. This article summarizes the indications, advantages, disadvantages, postoperative care, management, rehabilitation, and adjuvant therapy of this new treatment.

Unexpected cardiac tamponade during robot-assisted permanent pacemaker insertion: A case report / 대한마취과학회지

Cardiac tamponade can result in severe hemodymanic instability, including cardiac arrest. We experienced one case of unexpected cardiac tamponade during permanent pacemaker insertion using da Vinci(TM) Surgical System (Intuitive Surgical Inc., Mountain View, USA) in 76-year-old male patient with complete atrioventricular block. Soon after the port insertion for robotic arm, sudden-onset electromechanical dissociation was developed. Prompt cardiopulmonary resuscitation was performed. Rapid left thoracotomy revealed the cardiac tamponade caused by the injury of right ventricle. Hemodynamic parameter was immediately improved after pericardiocentesis and primary repair of right ventricle. Permanent pacemaker was inserted uneventfully through the left thoracotomy. The patient was discharged 10 days after operation without any other complication.