ObjectiveTo explore the application of 5G remote robotic surgery in distal gastrectomy for gastric cancer and evaluate the feasibility and advantages of the “3+2” model “seven-step method”. MethodsThe situations at preoperative, intraoperative and postoperative follow-up of a patient who underwent 5G remote robotic distal gastrectomy for gastric cancer with “3+2” model “seven-step method” in Gansu Provincial People’s Hospital were summarized, and based on our experience of robotic surgery, the application advantages of “3+2” model “seven-step method” in 5G remote robotic distal gastrectomy for gastric cancer was explored. ResultsThe operative time of this case was 190 min, the intraoperative blood loss was 50 mL, the network delay was 43.554 ms, and no intraoperative adverse events occurred. After a one-year follow-up, the patient recovered well, with no complications, good diet and good quality of life. ConclusionsThe “3+2” model “seven-step method” is feasible for 5G remote robotic distal gastrectomy. Further research requires an increased sample size and extended follow-up period.
Objective To investigate the clinical application of da Vinci surgical system in nipple sparing mastectomy (NSM) and immediate one-stage implant-based breast reconstruction. Methods Five cases of breast cancer who underwent NSM and immediate implant-based breast reconstruction were analyzed from March 2022 to April 2022. Evaluation endpoints included the key points of operation, duration of surgery, postoperative complications, and patient-reported outcomes. Results Two patients underwent implant-based postpectoral breast reconstruction without mesh. Three patients received prepectoral reconstruction with biological mesh, 2 of which underwent bilateral breast reconstruction. Operating duration of 5 patients was 240–320 min, with an average of 291 min. The blood loss was 10–30 mL, with an average of 18 mL. No patient switched to open surgery due to the uncontrolled bleeding. The average drainage volume was 78 mL/d (60–100 mL/d) in the first 3 days and 38 mL/d (30–50 mL/d) in the 3 to 7 days after operation. The drainage tube was removed 10–18 days after operation, with an average of 13.2 days. No postoperative infections or nipple-areolar complex necrosis were observed. The inpatient stay was 1–3 days, with an average of 1.8 days. One month after operation, the BREAST-Q satisfaction score was 64–82, with an average of 76.20. The average cost for operation was 45 072 RMB (43 420–47 524 RMB). Conclusions The robotic NSM and immediate one-stage implant-based breast reconstruction is a safe procedure with better clinical outcomes and favorable patients’ satisfaction. However, the robotic system has longer operation time and higher cost. It still needs to be personalized in the clinical practice.
Thymectomy is an important treatment for thymoma and myasthenia gravis. The application of minimally invasive surgery to complete thymectomy and rapid recovery of patients after surgery is a developmental goal in thoracic surgery technology. Surgical robots have many technical advantages and are applied for many years in mediastinal tumor resections, a process that has led to its recognition. We published this consensus with the aim of examining how to ensure surgical safety based on the premise that better use of surgical robots achieving rapid recovery after surgery. We invited multiple experts in thoracic surgery to discuss the safety and technical issues of thymectomy under nonintubated anesthesia, and the consensus was made after several explorations and modifications.
ObjectiveTo summarize the application status and related progress of robot-assisted technology in general surgery.MethodThe related researches about robot-assisted technology in general surgery in recent year were searched and reviewed.ResultsRobot-assisted techniques had similar safety and effectiveness to endoscopic surgery in general surgery. In addition, in rectal cancer, thyroid and pancreatic surgery, due to the narrow operation space, the advantages of robot-assisted surgery was more obvious.ConclusionsThe application of robot-assisted techniques in general surgery is safe and effective. With the decrease of the cost of robotic surgery, which has wide application value in general surgery.
Nowadays, thoracoscopic laparoscopic esophagectomy (TLE) has been widely used in the treatment of esophageal cancer. In recent years, robot assisted minimally invasive esophagectomy (RAMIE) has been developing vigorously. According to the research progress and practical experience in the world, RAMIE has the same safety and effectiveness as TLE. In this paper, several aspects on this novel operation were demonstrated, including the safety evaluation, lymph node dissection, prognosis of RAMIE, comparison of RAMIE and TLE, and the role of RAMIE in multidisciplinary treatment of esophageal cancer, in order to promote the rational application of RAMIE in esophagectomy.
Robotic gastric cancer surgery had developed rapidly in recent years, and its clinical application had come a long way. More and more studies had demonstrated that the robotic gastric cancer surgery was a safe and feasible procedure, and showed the technical advantages in the lymph node dissection, bleeding control, precise surgery, and postoperative recovery over laparoscopic surgery. However, some limitations such as the high surgical costs, lack of high-quality evidence, insufficient intelligence limited the development of robotic gastric cancer surgery. In the future, with more high-quality evidence-based medicine research and the development of intelligent surgical robots, the robotic gastric cancer surgery will be further standardized and promoted. We believe that robotic gastric cancer surgery will become the mainstream of minimally invasive surgery for the treatment of gastric cancer.
The technical combination of artificial intelligence (AI) and thoracic surgery is increasingly close, especially in the field of image recognition and pathology diagnosis. Additionally, robotic surgery, as a representative of high-end technology in minimally invasive surgery is flourishing. What progress has been or will be made in robotic surgery in the era of AI? This article aims to summarize the application status of AI in thoracic surgery and progress in robotic surgery, and looks ahead the future.
Surgery is the preferred treatment for early esophageal cancer. Minimally invasive esophagectomy (MIE) can significantly reduce the incidence of postoperative complications and mortality, but due to the complex esophageal anatomy, intraoperative esophageal exposure, separation, anastomosis and lymph node dissection are difficult. The da Vinci surgical system provides a 3D vision and a more flexible as well as stable robotic arm, which is very helpful in completing fine surgical procedures. Robot-assisted minimally invasive esophagectomy(RAMIE) has been carried out in a number of countries, including China. Robot-assisted Ivor-Lewis esophagectomy (RAILE) is a transthoracic approach of robots developed in recent years. This paper summarizes the current researches on RAILE.
Objective To compare three surgical treatments for mediastinal mass with myasthenia gravis. Methods Retrospective analysis was performed on the clinical data of 53 patients who underwent extended thymectomy between January 2010 and December 2017 in our hospital. There were 29 males and 24 females, aged 17-73 years. Patients were divided into three groups according to the surgical methods: a group A (video-assisted thoracoscopic surgery with the da Vinci robotic system, n=22), a group B (video-assisted thoracoscopic surgery, n=12) and a group C (median sternotomy, n=19). The gender distribution, age, intraoperative blood loss, operation time, postoperative extubation time, postoperative hospital stay, Osserman classification of myasthenia gravis, postoperative myasthenic remission rate, etc were compared in three groups. Results No perioperative death was observed in 53 patients. One patient in the group C suffered from postoperative myasthenic crisis and improved after active treatment. One patient with video-assisted thoracoscopic surgery was converted to median sternotomy due to the intraoperative injury of the left brachiocephalic vein. Compared with the group B and group C, the group A had shorter operation time, less intraoperative blood loss and drainage on the first postoperative day and fewer days of extubation. Postoperative hospital stay was less in the group A than that in the group C (P<0.05). The postoperative myasthenic remission rate was higher in the group A than that in the other two groups, but there was no statistical difference. Conclusion Because of the robot’s unique minimally invasive advantage, in this study, the outcome of patients with myasthenia gravis treated with Da Vinci robots and thymectomy is better than that of the remaining two groups in terms of perioperative outcomes and myasthenic remission rate. But long-term results and a large of number matching experiments are needed to confirm. However, it is undeniable that robotic surgery must be the future of the minimally invasive surgery.
ObjectiveTo evaluate the short-term effectiveness of robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP) by meta-analysis.MethodsWe searched for manuscripts about RDP versus LDP form PubMed, The Cochrane Library, EMbase, CKNI, CBM, and WanFang Databases. The parallel quality assessment was selected according to the literature inclusion and exclusion criteria. Relevant data were extracted and meta-analysis was performed by using Revman 5.3 software.ResultsA total of 23 articles were included, and a total of3 487 patients enrolled who underwent pancreatic body resection. Meta-analysis results showed that compared with the LDP group, the RDP group had a longer operation time [MD=15.52, 95%CI was (0.60, 30.45), P=0.04], but the intraoperative blood loss was less [MD=–59.18, 95%CI was (–111.62, –6.73), P=0.03], the intraoperative spleen preservation rate was higher [OR=1.74, 95%CI was (1.02, 2.96), P=0.04], the intraoperative conversion to open rate was lower [ OR=0.45, 95%CI was (0.34, 0.60), P<0.000 01], and postoperative hospital stay was shorter [MD=–0.90, 95%CI was (–1.70, –0.10), P=0.03], while there were no significant differences in intraoperative blood transfusion rate [OR=0.88, 95%CI was (0.60, 1.30), P=0.52], incidence of postoperative overall complication [OR=0.88, 95%CI was (0.68, 1.13), P=0.32] and pancreatic leakage [OR=0.91, 95%CI was (0.72, 1.14), P=0.41], 90-day readmission rate [OR=1.32, 95%CI was (0.95, 1.83), P=0.10], and 90-day reoperation rate [OR=0.73, 95%CI was (0.40, 1.33), P=0.30].ConclusionsRDP has the advantages of less bleeding, low turnover rate, and short postoperative hospital stay. However, due to the quality limitations of the included studies, the above conclusions still need to be verified by more high-quality studies.