“Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer.”
Cooperberg, M. R., A. J. Vickers, et al. (2010).
BACKGROUND:: Because no adequate randomized trials have compared active treatment modalities for localized prostate cancer, the authors analyzed risk-adjusted, cancer-specific mortality outcomes among men who underwent radical prostatectomy, men who received external-beam radiation therapy, and men who received primary androgen-deprivation therapy. METHODS:: The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry comprises men from 40 urologic practice sites who are followed prospectively under uniform protocols, regardless of treatment. In the current study, 7538 men with localized disease were analyzed. Prostate cancer risk was assessed using the Kattan preoperative nomogram and the Cancer of the Prostate Risk Assessment (CAPRA) score, both well validated instruments that are calculated from clinical data at the time of diagnosis. A parametric survival model was constructed to compare outcomes across treatments adjusting for risk and age. RESULTS:: In total, 266 men died of prostate cancer during follow-up. Adjusting for age and risk, the hazard ratio for cancer-specific mortality relative to prostatectomy was 2.21 (95% confidence interval [CI], 1.50-3.24) for radiation therapy and 3.22 (95% CI, 2.16-4.81) for androgen deprivation. Absolute differences between prostatectomy and radiation therapy were small for men at low risk but increased substantially for men at intermediate and high risk. These results were robust to a variety of different analytic techniques, including competing risks regression analysis, adjustment by CAPRA score rather than Kattan score, and examination of overall survival as the endpoint. CONCLUSIONS:: Prostatectomy for localized prostate cancer was associated with a significant and substantial reduction in mortality relative to radiation therapy and androgen-deprivation monotherapy. Although this was not a randomized study, given the multiple adjustments and sensitivity analyses, it is unlikely that unmeasured confounding would account for the large observed differences in survival. Cancer 2010. (c) 2010 American Cancer Society.
“Surgeon’s volume and number of lymph nodes in assessing colorectal cancer surgery and multimodal treatment quality.”
Hottenrott, C. (2010).
Surgical Endoscopy and Other Interventional Techniques 24(8): 2068-2069.
“Live Transference of Surgical Subspecialty Skills Using Telerobotic Proctoring to Remote General Surgeons.”
Ereso, A. Q., P. Garcia, et al. (2010).
Journal of the American College of Surgeons 211(3): 400-411.
BACKGROUND: Certain clinical environments, including military field hospitals or rural medical centers, lack readily available surgical subspecialists. We hypothesized that telementoring by a surgical subspecialist using a robotic platform is feasible and can convey subspecialty knowledge and skill to a remotely located general surgeon. STUDY DESIGN: Eight general surgery residents evaluated the effect of remote surgical telementoring by performing 3 operative procedures, first unproctored and then again when teleproctored by a surgical subspecialist. The clinical scenarios consisted of a penetrating right ventricular injury requiring suture repair, an open tibial fracture requiring external fixation, and a traumatic subdural hematoma requiring craniectomy. A robotic platform consisting of a pan-and-tilt camera with laser pointer attached to an overhead surgical light with integrated audio allowed surgical subspecialists the ability to remotely teleproctor residents. Performance was evaluated using an Operative Performance Scale. Satisfaction surveys were given after performing the scenario unproctored and again after proctoring. RESULTS: Overall mean performance scores were superior in all scenarios when residents were proctored than when they were not (4.30 +/- 0.25 versus 2.43 +/- 0.20; p < 0.001). Mean performance scores for individual metrics, including tissue handling, instrument handling, speed of completion, and knowledge of anatomy, were all superior when residents were proctored (p < 0.001). Satisfaction surveys showed greater satisfaction and comfort among residents when proctored. Proctored residents believed the robotic platform facilitated learning and would be feasible if used clinically. CONCLUSIONS: This study supports the use of surgical teleproctoring in guiding remote general surgeons by a surgical subspecialist in the care of a wounded patient in need of an emergency subspecialty operation.
“Robotic surgery or master-slave device?”
Galata, G. and M. Hannan (2010).
“Life without robots: What is left for the urologist?”
Hakenberg, O. (2010).
Ein leben ohne roboter: Was bleibt dem urologen? 49(8): 922-924.
The triumphal march of robots in urology seems to be unstoppable. In the meantime, a broadening of the scope for indications in urology can be observed: this applies to pyeloplasty and to a lesser degree also to partial nephrectomy and radical cystectomy. As yet no evidence has been provided that robot-assisted radical prostatectomy (RP) is superior to open surgery. Furthermore, data are available which suggest that the midterm functional results are possibly even worse than those achieved with open RP. © 2010 Springer-Verlag.
“Robotic-assisted minimally invasive surgery; a useful tool in resident training-the Peoria experience, 2002-2009.”
Huettner, F., D. Dynda, et al. (2010).
Int J Med Robot.
BACKGROUND: The purpose of this study was to review the use of robotic-assisted general surgery at our institution. We evaluated the 8 year experience of one minimally invasive surgery (MIS) fellowship-trained surgeon in Peoria, IL, performing 240 cases of foregut, colon, solid organ and biliary surgery using the da Vinci system, with resident assistance. Foregut and colon procedures are the fifth and sixth most commonly performed procedures of the senior author annually. METHODS: An IRB-approved retrospective review of prospectively collected data representing 124 foregut and 102 colon operations was performed. Data analysed were procedure performed and indications for surgery, gender, age, body mass index (BMI), estimated blood loss (EBL), port set-up time (PST), robot operating time (ROT), total case time (TCT), length of stay (LOS), complications, conversions and resident involvement were recorded. Fourteen cases were excluded from the data review. Statistical analysis using the ANOVA test was applied. A specific review of resident participation was performed. RESULTS: Times for 226 foregut and colon cases were: PST 31.2 +/- 9.4 (range 10-64) min, ROT 119.3 +/- 41.5 (range 12-306) min, and TCT 194.8 +/- 50.3 (range 50-380) min. The EBL was 48.6 +/- 55.0 (range 5-500) ml, BMI 28.5 +/- 4.7 (range 15.4-46.8) kg/m(2), and median LOS 2.0 (range 0-27) days. The overall complication rate was 13.3%. No deaths occurred. Over the 8 year study period the number of cases participated in by residents was 0, 16, 22, 15, 29, 26, 28 and 10 (as of June 2009), respectively. CONCLUSION: This series demonstrates the technical feasibility and safety of robotic surgery for the foregut and colon in a clinical setting where the surgeon does far more of other types of MIS. This series compares favorably with the literature. Incorporation of robotic training in the curriculum has allowed residents to learn robotic techniques in an effective manner. Copyright (c) 2010 John Wiley & Sons, Ltd.
“Technical communication: robot-assisted regional anesthesia: a simulated demonstration.”
Tighe, P. J., S. J. Badiyan, et al. (2010).
Anesthesia and Analgesia 111(3): 813-816.
Recent advances in robotically assisted telesurgery offer expert surgical care for the geographically remote patient. Similar advances in teleanesthesia will be necessary to bring comparable perioperative care to the geographically remote patient. Although many preliminary investigations into teleanesthesia are underway, none involve remote performance of anesthesia-related procedures. Herein, we describe the placement of ultrasound-guided nerve blocks into an ultrasound phantom using the da Vinci multipurpose surgical robotic system (Intuitive Surgical, Sunnyvale, CA). Both single-injection and perineural catheter techniques were successfully performed by an operator who was not physically present at the bedside.
“The Developments and Achievements of Endoscopic Surgery, Robotic Surgery and Function-preserving Surgery.”
Yoshida, M., T. Furukawa, et al. (2010).
Japanese Journal of Clinical Oncology 40(9): 863-869.
The breakthrough in laparoscopic surgery has been the development of a charge-coupled device camera system and Mouret performing cholecystectomy in 1987. The short-term benefits of laparoscopic surgery are widely accepted and the long-term benefit of less incidence of bowel obstruction can be expected. The important developments have been the articulating instrumentation via new laparoscopic access ports. Since 2007, single-incision laparoscopic surgery has spread all over the world. Not only single-scar but also no-scar operation is a current topic. In 2004, Kalloo reported the flexible transgastric peritoneoscopy as a novel approach to therapeutic interventions. In 2007, Marescaux reported transvaginal cholecystectomy in a patient. The breakthrough in robotic surgery was the development of the da Vinci Surgical System. It was introduced to Keio University Hospital in March 2000. Precision in the surgery will reach a higher level with the use of robotics. In collaboration with the faculty of technology and science, Keio University, the combined master-slave manipulator has been developed. The haptic forceps, which measure the elasticity of organs, have also been developed. The first possible sites of lymphatic metastasis are known as sentinel nodes. Otani reported vagus-sparing segmental gastrectomy under sentinel node navigation. This kind of function-preserving surgery will be performed frequently if the results of the multicenter prospective trial of the dual tracer method are favorable. Indocyanine green fluorescence-guided method using the HyperEye charge-coupled device camera system can be a highly sensitive method without using the radioactive colloid. ‘Minimally invasive, function-preserving and precise surgery under sentinel node navigation in community hospital’ may be a goal for us.
“Clinical applications of robotic technology in vascular and endovascular surgery.”
Antoniou, G. A., C. V. Riga, et al. (2010).
Journal of Vascular Surgery.
BACKGROUND:: Emerging robotic technologies are increasingly being used by surgical disciplines to facilitate and improve performance of minimally invasive surgery. Robot-assisted intervention has recently been introduced into the field of vascular surgery to potentially enhance laparoscopic vascular and endovascular capabilities. The objective of this study was to review the current status of clinical robotic applications in vascular surgery. METHODS:: A systematic literature search was performed in order to identify all published clinical studies related to robotic implementation in vascular intervention. Web-based search engines were searched using the keywords “surgical robotics,” “robotic surgery,” “robotics,” “computer assisted surgery,” and “vascular surgery” or “endovascular” for articles published between January 1990 and November 2009. An evaluation and critical overview of these studies is reported. In addition, an analysis and discussion of supporting evidence for robotic computer-enhanced telemanipulation systems in relation to their applications in laparoscopic vascular and endovascular surgery was undertaken. RESULTS:: Seventeen articles reporting on clinical applications of robotics in laparoscopic vascular and endovascular surgery were detected. They were either case reports or retrospective patient series and prospective studies reporting laparoscopic vascular and endovascular treatments for patients using robotic technology. Minimal comparative clinical evidence to evaluate the advantages of robot-assisted vascular procedures was identified. Robot-assisted laparoscopic aortic procedures have been reported by several studies with satisfactory results. Furthermore, the use of robotic technology as a sole modality for abdominal aortic aneurysm repair and expansion of its applications to splenic and renal artery aneurysm reconstruction have been described. Robotically steerable endovascular catheter systems have potential advantages over conventional catheterization systems. Promising results from applications in cardiac interventions and preclinical studies have urged their use in vascular surgery. Although successful applications in endovascular repair of abdominal aortic aneurysm and lower extremity arterial disease have been reported, published clinical experience with the endovascular robot is limited. CONCLUSIONS:: Robotic technology may enhance vascular surgical techniques given preclinical evidence and early clinical reports. Further clinical studies are required to quantify its advantages over conventional treatments and define its role in vascular and endovascular surgery.