ABSTRACT
Objective: We present the applications and experiences of robot-assisted laparoscopic and thoracoscopic surgery (RALTS) in pediatric surgery. Materials and Methods: A prospective, observational, and longitudinal study was conducted from March 2015 to March 2018 that involved a non-random sample of a pediatric population that was treated with RALTS. The parameters examined were: gender, age, weight, height, diagnoses, surgical technique, elapsed time of console surgery, estimated bleeding, need for hemotransfusion, complications, surgical conversions, postoperative hospital stay, and follow-up. The Clavien-Dindo classification of complications was used. The surgical system used was the da Vinci model, Si version (Intuitive Surgical, Inc., Sunnyvale, CA. U.S.A), with measures of central tendency. Results: In a 36-months period, 186 RALTS cases were performed, in 147 pediatric patients and an adult; 53.23% were male, and the remaining were female. The average age was 83 months, ranging from 3.5 to 204 months, plus one adult patient of 63 years. The stature was an average of 116.6 cm, with a range of 55-185 cm; the average weight was 26.9 kg, with a range of 5-102 kg; the smallest patient at 3.5 months was 55 cm in stature and weighed 5.5 kg. We performed 41 different surgical techniques, grouped in 4 areas: urological 91, gastrointestinal and hepatobiliary (GI-HB) 84, thoracic 6, and oncological 5. The console surgery time was 137.2 min on average, ranging from 10 to 780 min. Surgeon 1 performed 154 operations (82.8%), and the remainder were performed by Surgeon 2, with a conversion rate of 3.76%. The most commonly performed surgeries were: pyeloplasty, fundoplication, diaphragmatic plication, and removal of benign tumors, by area. Hemotransfusion was performed for 4.83%, and complications occurred in 2.68%. The average postoperative stay was 2.58 days, and the average follow-up was 23.5 months. The results of the 4 areas were analyzed in detail. Conclusion: RALTS is safe and effective in children. An enormous variety of surgeries can be safely performed, including complex hepatobiliary, and thoracic surgery in small children. There are few published prospective series describing RALTS in the pediatric population, and most only describe urological surgery. It is important to offer children the advantages and safety of minimal invasion with robotic assistance; however, this procedure has only been slowly accepted and utilized for children. It is possible to implement a robust program of pediatric robotic surgery where multiple procedures are performed.
ABSTRACT
INTRODUCTION: Robot-assisted laparoscopic surgery (RALS) has become a widely used technology in urology. Urological procedures that are now being routinely performed robotically are: radical prostatectomy (RP), radical cystectomy (RC), renal procedures - mainly partial nephrectomy (PN), and pyeloplasty, as well as ureteric re-implantation and adrenalectomy. METHODS: This non-systematic review of the literature examines the effectiveness of RALS compared with conventional laparoscopic surgery for the most relevant urological procedures. RESULTS: For robot-assisted RP there seems to be an advantage in terms of continence and potency over laparoscopy. Robot-assisted RC seems equal in terms of oncological outcome but with lower complication rates; however, the effect of intracorporeal urinary diversion has hardly been examined. Robotic PN has proven safe and is most likely superior to conventional laparoscopy, whereas there does not seem to be a real advantage for the robot in radical nephrectomy. For reconstructive procedures, e.g. pyeloplasty and ureteric re-implantation, there seems to be advantages in terms of operating time. CONCLUSIONS: We found substantial, albeit mostly low-quality evidence, that robotic operations can have better outcomes than procedures performed laparoscopically. However, in light of the significant costs and because high-quality data from prospective randomised trials are still missing, conventional urological laparoscopy is certainly not 'dead' yet.
ABSTRACT
Objective To evaluate the clinical value of three-dimensiomal (3D) image reconstruction in the urologic robot-assisted laparoscopic surgery.Methods From Sept.2017 to Jun.2018,7 patients (3 male cases,4 female cases) diagnosed with genitourinary tumors in Beijing United Family Hospital were involved in this study.The median age was 55 years(IQR 36-64 years).There were 1 case of renal tumor,1 case of adrenal gland tumor,1 case of retroperitoneal tumor,1 case of metastatic tumor post-nephrectomy,1 case of bladder neuroendocrine tumor and 1 case of urachal tumor.All the patients underwent four-phase enhanced CT scan and the CT images were imported into 3D visualization system for 3D image reconstruction,aiming to assist surgery planning and tumor locating.The main parameters of 3D image reconstruction included tumor size,location and the relationships among tumor,organs and blood vessels.All the 7 patients underwent robot-assisted laparoscopic surgeries,including 2 cases of partial nephrectomy (1 case with no blockage of renal artery),1 case of excision of right adrenal gland tumor,1 case of transperitoneal excision of left renal hilus chromaffinoma,1 case of transperitoneal excision of right adrenal gland and postcaval metastatic tumors,1 case of transperitoneal radical cystectomy + orthotopic bladder substitution + extended pelvic lymph node dissection,1 case of transperitoneal excision of urachal tumor + partial cystectomy + pelvic lymph node dissection.Results 3D image reconstruction svstem allows accurate evaluation of tumors,related vessels,surrounding tissue and organs before operation.All the 7 cases surgeries were uneventful,no case was converted to open or conventional laparoscopic surgery,the median operation time was 225 min (IQR 135-280 min),the median blood loss was 50 ml (IQR 20-600 ml).One patient had fever post-operation and there was no over Clavien Dindo Ⅱ perioperative complication.Conclusions 3D image reconstruction shows the great clinical value in approach selection,reduction of tissue and organ damage,reduction of surgery related complication and improving the success rate in robot-assisted laparoscopic surgery.
