“Two-port Robot-assisted vs Standard Robot-assisted Laparoscopic Partial Nephrectomy: A Matched-pair Comparison.”
Arkoncel, F. R., J. W. Lee, et al. (2011).
OBJECTIVES: To compare the outcomes between 2-port robot-assisted partial nephrectomy (2-portRALPN) and standard robot-assisted laparoscopic partial nephrectomy (sRALPN). METHODS: From May 2009 to February 2010, 35 2-portRALPN were done by a single surgeon in a university-based tertiary referral center. A cohort of 35 patients who underwent sRALPN from September 2006 to July 2009 was selected for retrospective comparison and matched for tumor complexity. All patients underwent partial nephrectomy (PN) using the daVinci surgical robotic platform (Intuitive Surgical, Sunnyvale, CA). In the 2-portRALPN, a homemade umbilical port and an infraumbilical assistant port were used, whereas standard laparoscopic port placement was used for sRALPN. The clinical, operative, pathologic, and follow-up information were collected. RESULTS: The operative time (187.5 vs 171.7 minutes, P = .110), warm ischemia time (29.5 vs 28.8 minutes, P = .209), blood loss (257 vs 242.5 mL, P = .967), complication rate (17.1 vs 11.4%, P = .495), and transfusion rate (8.6 vs 2.9%, P = .303) were comparable in both groups. The pain scores on the first postoperative day (4.5 vs 3.9, P = .236) and on the day of discharge (2.3 vs 1.9, P = .433), in-hospital morphine requirement (130.5 vs 122.2 mg, P = .115), and length of hospital stay (4.2 vs 4.2 days, P = .875) were likewise similar in both groups. CONCLUSIONS: This matched-pair study design comparing 2-portRALPN with sRALPN shows that the outcomes of both techniques are comparable. The 2-portRALPN technique is a viable option until a more advanced robotic platform specifically designed for laparoendoscopic single-site surgery is developed and a pure robot-assisted laparoendoscopic single site surgery PN can be safely performed.
“Traditional versus single-site placement of adjustable gastric banding: A comparative study and cost analysis.”
Ayloo, S. M., N. C. Buchs, et al. (2011).
Obesity Surgery 21(7): 815-819.
In bariatric surgery, laparoscopic adjustable gastric banding (LAGB) has proven effective in reducing weight and improving obesity-associated comorbidities. Recently, however, laparoendoscopic single-site (LESS) surgery has been proposed to minimize the invasiveness of laparoscopic surgery. The aim of this study is to compare the operative cost and peri-operative outcomes of these two approaches. We undertook a retrospective review of a prospectively maintained database of patients undergoing either LAGB or LESS between March 2006 and October 2009. The outcomes and cost of 25 LESS gastric bandings were compared to 121 standard LAGB. Costs included operative time, consumables, and laparoscopic tower depreciation. Both groups had similar patient demographics, body mass index, and comorbidities; with the exception of age (37 year for single site vs. 44 years for standard; P=0.002). There were no statistical differences for operative time (78 vs. 76 min, P=0.69), blood loss (8.4 vs. 9 ml, P=0.76), pain score (0.81 vs. 0.84 at 1 week, P=0.95) or complication rates (12% vs. 14%, P=1). Length of stay was shorter for the LESS group (0.5 day vs. 1.5 days, P=0.02). The mean operative cost for the LESS banding was $20,502/case vs. $20,346/case for the standard LAGB, with no statistically significant difference between the approaches (P=0.73). Operative costs and peri-operative outcomes of LESS gastric banding are comparable with those of the standard LAGB procedure. As a result, single-site surgery can be proposed as a valid alternative to the standard procedure with cosmetic advantage and comparable complication rate. © 2010 Springer Science + Business Media, LLC.
“Postoperative pain after conventional laparoscopy and laparoendoscopic single site surgery (LESS) for benign adnexal disease: A randomized trial.”
Fagotti, A., C. Bottoni, et al. (2011).
Fertility and Sterility 96(1): 255-259.e252.
Objective: To compare postoperative pain after laparoendoscopic single-site surgery (LESS) approach with conventional multiaccess laparoscopy (LPS). Study Design: Prospective randomized trial. Setting: University hospital. Patient(s): Benign adnexal disease. Intervention(s): Postoperative pain was measured by using the visual analog scale (VAS) at 20 minutes, 2 hours, 4 hours, and 8 hours after surgery. The need for postoperative rescue doses of analgesia was also recorded. Main Outcome Measure(s): Pain after surgery. Result(s): A total of 60 patients were enrolled. Within 8 hours, patients who underwent conventional LPS complained of statistically significant greater postoperative pain at VAS evaluation than those undergoing LESS, both at rest and after Valsalva maneuver, with a higher need for rescue analgesia. Conclusion(s): LESS provides an advantage over conventional multiaccess LPS in terms of postoperative pain and need for rescue analgesia, with similar perioperative outcomes. © 2011 by American Society for Reproductive Medicine.
“Single-port laparoscopic-assisted vaginal hysterectomy: Safe and effective advance.”
Kalinoglou, N. (2011).
Gastric and Breast Cancer 10(3): 164-166.
Rapid technological developments and innovation enable a substantial progress of laparoscopic in surgery. Amounting evidence from randomized controlled trials (RCTs) in the fields of gynaecologic, gastrointestinal, urological surgery for the superiority of minimally invasive surgery progressively change clinical practice. Less pain, faster recovery and better aesthetic result have expanded the indications of laparoscopic surgery 1-8 so that one could predict that in the next decades come open surgery will dramatically be declined.
“Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: Results of a pilot randomized trial.”
Lirici, M. M., A. D. Califano, et al. (2011).
American Journal of Surgery 202(1): 45-52.
Background In recent years, new devices providing multiple channels have made the performance of laparoscopic cholecystectomy through a single access site not only feasible but much easier. The potential benefits of laparoendoscopic single-site (LESS) cholecystectomy may include scarless surgery, reduced postoperative pain, reduced postoperative length of stay, and improved postoperative quality of life. There are no comparative data between LESS cholecystectomy and standard laparoscopic cholecystectomy (LC) available at present with which to quantify these benefits. Methods This study was a prospective, randomized, dual-institutional pilot trial comparing LESS cholecystectomy with standard LC. The primary end point was postoperative quality of life, measured as length of hospital stay, postoperative pain, cosmetic results, and SF-36 questionnaire scores. Secondary end points included operative time, conversion to standard LC, difficulty of exposure, difficulty of dissection, and complication rate. Results No significant differences in postoperative lengths of stay were found in the two groups. Postoperative pain evaluation using a visual analogue scale showed significantly better outcomes in the standard LC arm on the same day of surgery (P =.041). No differences in postoperative pain were found at the next visual analogue scale evaluation or in the postoperative administration of pain-relieving medications. Cosmetic satisfaction was significantly higher in the LESS group at 1-month follow-up (mean, 94.5 ± 9.4% vs 86 ± 22.3%; median, 100% vs 90%; P =.025). Among the 8 scales of the SF-36 assessing patients’ physical and mental health, scores on the Role Emotional scale were significantly better in the LESS group (mean, 80.05 ± 29.42 vs 68.33 ± 25.31; median, 100 vs 66.67; P <.0001). Conclusions In this pilot trial, LESS cholecystectomy resulted in similar lengths of stay and improved cosmetic results and SF-36 Role Emotional scores but performed less well on pain immediately after surgery. A larger multicenter trial is needed to confirm and further investigate these results. © 2011 Elsevier Inc. All rights reserved.
“Lapabot: A compact telesurgical robot system for minimally invasive surgery: Part I. System description.”
Choi, J., J. W. Park, et al. (2011).
Minim Invasive Ther Allied Technol.
Abstract The applications of robotic minimally invasive surgery (MIS) have widened, providing new advantages such as augmented dexterity and telesurgery. However, current commercial robotic laparoscopic surgical systems still have aspects to be improved such as heavy and bulky systems not suitable for agile operations, large rotational radii of robot manipulator arms, limited remote control capacity, and absence of force feedback. We have developed a robotic laparoscopic surgical system that features compact slave manipulators. The system can simultaneously operate one laparoscope arm and up to four instrument arms. The slave robot is controlled remotely through an Ethernet network and is ready for telesurgery. The developed surgical robot has sufficient workspace to perform general MIS and has been shown to provide acceptable motion tracking control performance.
“Tactile communication systems. optimizing the display of information.”
Jones, L. A. (2011).
Book 192: 113-128.
Tactile communication systems based on vibrotactile signals have been developed as sensory substitution devices for those with visual, auditory, or vestibular impairments and to assist users in spatial orientation and navigation in unfamiliar environments. One of the main challenges in using tactile displays to compensate for sensory loss in other modalities or to overcome the limitations of visual and auditory information overload is in determining what type of information can be presented tactually and which parameters of stimulation can be used to convey these messages effectively. Psychophysical studies of vibrotactile perception provide a framework that assists in determining which stimulus dimensions and ranges of values can be used to create tactile patterns, known as tactons. A number of experiments have been conducted in which the ability of participants to identify tactons presented at different sites on the body has been measured. The results from this research indicate that tactons created by varying the spatial location, number, and temporal sequence of activation of motors in a tactile display can be accurately identified. They further demonstrate the potential of using two-dimensional tactile displays to present information, and the feasibility of creating tactile communication systems that are easily learned. © 2011 Elsevier B.V.
“Enhanced visualisation for minimally invasive surgery.”
Totz, J., K. Fujii, et al. (2011).
International Journal of Computer Assisted Radiology and Surgery: 1-10.
Purpose: Endoscopes used in minimally invasive surgery provide a limited field of view, thus requiring a high degree of spatial awareness and orientation. Attempts at expanding this small, restricted view with previously observed imagery have been made by researchers and is generally known as image mosaicing or dynamic view expansion. For minimally invasive endoscopy, SLAM-based methods have been shown to have potential values but have yet to address effective visualisation techniques. Methods: The live endoscopic video feed is expanded with previously observed footage. To this end, a method that highlights the difference between actual camera image and historic data observed earlier is proposed. Old video data is faded out to grey scale to mimic human peripheral vision. Specular highlights are removed with the help of texture synthesis to avoid distracting visual cues. The method is further evaluated on in vivo and phantom sequences by a detailed user study to examine the ability of the user in discerning temporal motion trajectories while visualising the expanded field of view, a feature that is of practical value for enhancing spatial awareness and orientation. Results: The difference between historic data and live video is integrated effectively. The use of a single texture domain generated by planar parameterisation is demonstrated for view expansion. Specular highlights can be removed through texture synthesis without introducing noticeable artefacts. The implicit encoding of motion trajectory of the endoscopic camera visualised by the proposed method facilitates both global awareness and temporal evolution of the scene. Conclusions: Dynamic view expansion provides more context for navigation and orientation by establishing reference points beyond the camera’s field of view. Effective integration of visual cues is paramount for concise visualisation. © 2011 CARS.