Abstrakt Technologie Květen 2010

“Laparo-endoscopic single site (LESS) versus standard laparoscopic left donor nephrectomy: matched-pair comparison.”

Canes, D., A. Berger, et al. (2010).

European Urology 57(1): 95-101.


BACKGROUND: Laparo-endoscopic single site (LESS) surgery is a recent development in minimally invasive surgery. Presented herein is the initial comparison of LESS donor nephrectomy (LESS-DN) and standard laparoscopic living donor nephrectomy (LLDN). OBJECTIVE: To determine whether LESS-DN provides any measurable benefit over LLDN during the perioperative period and subsequent convalescence. DESIGN, SETTING, AND PARTICIPANTS: Between November 2007 and November 2008, 18 consecutive patients underwent LESS-DN (17 left DN, 1 right DN). A contemporary matched-pair cohort of 17 patients undergoing standard LLDN was selected for retrospective comparison. INTERVENTIONS: LESS-DN was performed through an intraumbilical novel multichannel port. The kidney was extracted through a slightly extended umbilical incision. MEASUREMENTS: All data were prospectively accrued in an institutional review board-approved database. Convalescence data included visual analog pain scores and questionnaires containing patient-reported time to recovery end points. RESULTS AND LIMITATIONS: One right-sided donor was converted to standard laparoscopy and excluded from analysis. Baseline demographics, operating time, blood loss, and hospital stay were comparable between groups. Compared to LLDN, patients undergoing LESS-DN had similar in-hospital analgesic requirements and mean visual analog scores at discharge. After discharge, patient-reported convalescence was faster in the LESS-DN group, including days on oral pain medication (20 vs 6; p=0.01), days off work (46 vs 18; p=0.0009), and days to 100% physical recovery (83 vs 29; p=0.03). Mean warm ischemia time was longer in the LESS-DN group (3 vs 6.1 min; p<0.0001); however, allograft function was immediate and comparable between groups. One allograft in the LESS-DN group thrombosed postoperatively. Regardless of laparoscopic approach, patients’ global satisfaction with kidney donation and willingness to recommend their procedure to others were favorable and equivalent between groups. CONCLUSIONS: This retrospective matched-pair comparison between LESS-DN and LLDN suggests that the single-port approach may be associated with quicker convalescence. In this initial series, LESS-DN had longer ischemia time, yet early allograft outcomes were comparable.




“Optimized transumbilical endoscopic cholecystectomy: a randomized comparison of two procedures.”

Hu, H., J. Zhu, et al. (2009).

Surgical Endoscopy: 1-5.


Background: Natural orifice transluminal endoscopic surgery (NOTES) and transumbilical endoscopic surgery (TUES) are being developed to improve minimally invasive surgery further. In 2006, the authors developed TUES using a single triple-channel trocar or single-trocar (ST) technique. To minimize the risk and improve the surgical efficiency further, the procedure was optimized using a two-trocar (TT) technique, with both trocars in the umbilicus. This study compared the clinical results for the TT and ST techniques. Methods: For this study, 32 patients with chronic gallbladder disease and indications for cholecystectomy were randomly assigned to undergo surgery with either the TT technique (17 patients) or the ST technique (15 patients). With the TT procedure, two modified 5-mm trocars with small handles were inserted through the navel, one above and one below the umbilicus. Another 2-mm trocar was inserted for a grasper in the right upper abdomen. With the ST procedure, one 15-mm umbilical incision was made for insertion of a previously developed triple-channel trocar to apply the laparoscope, grasper, and dissector individually. Operation time, postoperative hospital stay, and postoperative pain were compared between the two procedures. Results: The mean operative time was significantly shorter with the TT technique (35.71 ± 9.74 min) than with the ST technique (125.25 ± 18.9 min (p < 0.001). Use of analgesics after surgery also was less in the TT group than in the ST group (0 vs. 7, respectively; p < 0.05). The postoperative hospital stay did not differ significantly between the two groups (p > 0.05). Conclusions: Although both procedures were based on the transumbilical approach, the TT approach was found to be faster and less painful than the ST approach. The difference in the cosmetic result was minimal. © 2009 Springer Science+Business Media, LLC.




“Initial experience with 50 laparoendoscopic single site surgeries using a homemade, single port device at a single center.”

Jeon, H. G., W. Jeong, et al. (2010).

Journal of Urology 183(5): 1866-1871.


PURPOSE: We report our technique of and initial experience with 50 patients who underwent laparoendoscopic single site surgery using a homemade single port device at a single institution. MATERIALS AND METHODS: Between December 2008 and August 2009 we performed 50 laparoendoscopic single site surgeries using the Alexis wound retractor, which was inserted at the umbilical incision. A homemade single port device was made by fixing a size 7 1/2 surgical glove to the retractor outer ring and securing the glove fingers to the end of 3 or 4 trocars with a tie and a rubber band. A prospective study was performed in 50 patients to evaluate outcomes. RESULTS: Of 50 patients 34 underwent conventional laparoendoscopic single site surgery, including radical and simple nephrectomy, and cyst decortication in 8 each, nephroureterectomy in 3, partial nephrectomy and adrenalectomy in 2 each, and partial cystectomy, ureterectomy and ureterolithotomy in 1 each, while 16 underwent robotic laparoendoscopic single site surgery, including partial nephrectomy in 11, nephroureterectomy in 3, and simple and radical nephrectomy in 1 each. Mean patient age was 52 years, mean body mass index was 23.4 kg/m(2), mean operative time was 201 minutes and mean estimated blood loss was 201 ml. Four intraoperative complications occurred, including 2 bowel serosal tears, diaphragm partial tearing and conversion to open radical nephrectomy. One case of postoperative bleeding was managed by transfusion. Surgical margins were negative in the 13 patients who underwent partial nephrectomy. Mean hospital stay was 4.5 days (range 1 to 16). CONCLUSIONS: Our homemade single port device is cost-effective, provides adequate range of motion and is more flexible in port placement for laparoendoscopic single site surgery than the current multichannel port.




“Single-port-access laparoscopic-assisted vaginal hysterectomy versus conventional laparoscopic-assisted vaginal hysterectomy: a comparison of perioperative outcomes.”

Kim, T. J., Y. Y. Lee, et al. (2010).

Surgical Endoscopy: 1-5.


Background: The objective of the study was to compare the perioperative outcomes, including the operative time, length of hospital stay, and postoperative pain, of a single-port-access laparoscopic-assisted vaginal hysterectomy (SPA-LAVH) and conventional LAVH. Methods: This is a retrospective case-control study. A single surgeon performed 43 SPA-LAVH (cases) between May 2008 and February 2009, and 43 conventional LAVH between September 2005 and April 2008 (controls). Data of the SPA-LAVH cases were collected prospectively into our data registry and we reviewed the data of controls on chart. Results: The demographic parameters, except a history of vaginal delivery, were comparable between the two groups. The SPA group was associated with a history of fewer vaginal deliveries (SPA, 63%; conventional, 84%; p = 0.03). The two groups were comparable with respect to indications for surgery, failed cases from planned procedures, cases requiring additional procedures, and cases needing transfusion. The operative time, estimated blood loss (EBL), drop in hemoglobin preoperatively to postoperative day 1, and postoperative hospital stay were comparable between both groups. SPA-LAVH was associated with reduced postoperative pain. The VAS-based pain scores 24 h (SPA, 2.5 ± 0.7; conventional, 3.5 ± 0.8; p < 0.01) and 36 h after surgery (SPA, 1.7 ± 1.2; conventional, 2.9 ± 1.1; p < 0.01) were lower in the SPA group. There were no complications, including reoperation, adjacent organ damage, and any postoperative morbidity, in both groups. In addition, we have encountered no umbilical complications to date using SPA. Conclusions: Our study demonstrated that SPA-LAVH has comparable operative outcomes to conventional LAVH and the postoperative pain was decreased significantly in the SPA group 24 and 36 h after surgery. © 2010 Springer Science+Business Media, LLC.




“Laparo-endoscopic single site (LESS) robotic radical prostatectomy in an Asian man with prostate cancer: An initial case report.”

Leewansangtong, S., P. Vorrakitkatorn, et al. (2010).

Journal of the Medical Association of Thailand 93(3): 383-387.


Objective: To report the feasibility of laparo-endoscopic single site (LESS) robotic radical prostatectomy performed in Asian man. Material and Method: A 71 year-old man with adenocarcinoma of prostate presented at Faculty of Medicine Siriraj Hospital, Bangkok. Prostate-specific antigen level was 16.5 ng/ml and digital rectal examination approximately showed 30 gram prostate with nodule in both lobes. No clinical metastasis was found. Leuprorelin acetate and 50 mg of bicalutamide were used for 3 months. The patient’s body mass index was 22 and healthy. With the consent form signed, laparo-endoscopic single site (LESS) robotic radical prostatectomy was performed with the robot daVinci S system. Results: The total operative time was 335 minutes; docking time was 12 minutes; console time was 275 minutes. The estimate blood loss was 250 ml and no blood transfusion required. No intraoperative or post-operative complication was found. Jackson drain was removed within 60 hours after surgery. The patient was discharged from the hospital within 84 hours after surgery. The urethral catheter was removed within 14 days after surgery Conclusion: Laparo-endoscopic single site (LESS) robotic radical prostatectomy is feasible to be performed. In the initial experience, patient selection is required.




“Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial.”

Tsimoyiannis, E. C., K. E. Tsimogiannis, et al. (2010).

Surgical Endoscopy.


BACKGROUND: The attempt to further reduce operative trauma in laparoscopic cholecystectomy has led to new techniques such as natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS). These new techniques are considered to be painless procedures, but no published studies investigate the possibility of different pain scores in these new techniques versus classic laparoscopic cholecystectomy. In this randomized control study, we investigated pain scores in SILS cholecystectomy versus classic laparoscopic cholecystectomy. PATIENTS AND METHODS: Forty patients (34 women and 6 men) were randomly assigned to two groups. In group A (n = 20) four-port classic laparoscopic cholecystectomy was performed. Patients in group B (n = 20) underwent SILS cholecystectomy. In all patients, preincisional local infiltration of ropivacaine around the trocar wounds was performed. Infusion of ropivacaine solution in the right subdiaphragmatic area at the beginning of the procedure plus normal saline infusion in the same area at the end of the procedure was performed in all patients as well. Shoulder tip and abdominal pain were registered at 2, 6, 12, 24, 48, and 72 h postoperatively using visual analog scale (VAS). RESULTS: Significantly lower pain scores were observed in the SILS group versus the classic laparoscopic cholecystectomy group after the first 12 h for abdominal pain, and after the first 6 h for shoulder pain. Total pain after the first 24 h was nonexistent in the SILS group. Also, requests for analgesics were significantly less in the SILS group, while no difference was observed in incidence of nausea and vomiting between the two groups. CONCLUSION: SILS cholecystectomy, as well as the invisible scar, has significantly lower abdominal and shoulder pain scores, especially after the first 24 h postoperatively, when this pain is nonexistent. (Registration Clinical Trial number: NTC00872287, www.clinicaltrials.gov ).




“Transumbilical single-port access versus conventional total laparoscopic hysterectomy: surgical outcomes.”

Yim, G. W., Y. W. Jung, et al. (2010).

American Journal of Obstetrics and Gynecology.


OBJECTIVE: The objective of the study was to compare surgical outcomes and postoperative pain between transumbilical single-port access total laparoscopic hysterectomy (SPA-TLH) and conventional 4-port total laparoscopic hysterectomy (TLH). STUDY DESIGN: We retrospectively reviewed 157 patients who underwent SPA-TLH (n = 52) or conventional TLH (n = 105). A single-port access system consisted of a wound retractor, surgical glove, 2 5 mm trocars, and 1 10/11 mm trocar. RESULTS: The SPA-TLH group had less intraoperative blood loss (P < .001), shorter hospital stay (P = .001), and earlier diet intake (P < .001) compared with the conventional TLH group. There was no difference in perioperative complications. Immediate postoperative pain score was lower in the SPA-TLH group (P < .001). Postoperative pain after 6 and 24 hours was lower in SPA-TLH with marginal statistical significance. CONCLUSION: SPA-TLH is a feasible method for hysterectomy with lower immediate postoperative pain and better surgical outcomes with respect to recovery time compared with conventional TLH.




A mental workload study on the 2d and 3d viewing conditions of the da Vinci surgical robot

Klein, M. I., C. H. Lio, et al. (2009).


Fifteen medical students performed a standard training task using the da Vinci Surgical robot’s 2d and 3d viewing conditions. Measures of mental workload associated with both viewing conditions were assessed using a secondary interval production task as well as the NASA Task Load Index (NASA-TLX) and the Multiple Resources Questionnaire (MRQ). The Results of the NASA-TLX indicated that the 3d viewing condition results in lower scores of mental workload when compared to the 2d condition. The MRQ data provided diagnostic information regarding which information processing pools were stressed in both the 2d and 3d viewing conditions.




Investigating the relationship between visual spatial abilities and robot operation during direct line of sight and teleoperation

Long, L. O., J. A. Gomer, et al. (2009)..


Objective: To determine how scores on standard spatial measures correlate with the ability to operate a robot under different teleoperation conditions. Background: Past work has demonstrated that there is a relationship between visual spatial ability and teleoperation performance. Method: In this experiment participants completed a spatial visualization (VZ-2) and spatial relation (S-2) measure, and teleoperated a robot through both low and high difficulty courses under direct line of sight (DLS) and teleoperation (TO) conditions. Performance was determined by course completion time and the total number of collisions made during navigation. Results and Conclusion: Aggregate visual spatial ability was inversely correlated with operator performance under each of the experimental conditions. Analyzed independently, only spatial relations ability correlated with TO performance, while both measures correlated with DLS operation. Application: Better understanding of the relationship between spatial abilities and teleoperation performance can assist in the selection and training of future operators, as well as the design of superior interfaces.




“Estimation of environmental force for the haptic interface of robotic surgery.”

Son, H. I., T. Bhattacharjee, et al. (2010).

Int J Med Robot 6(2): 221-230.


BACKGROUND: The success of a telerobotic surgery system with haptic feedback requires accurate force-tracking and position-tracking capacity of the slave robot. The two-channel force-position control architecture is widely used in teleoperation systems with haptic feedback for its better force-tracking characteristics and superior position-tracking capacity for the maximum stability margin. This control architecture, however, requires force sensors at the end-effector of the slave robot to measure the environment force. However, it is difficult to attach force sensors to slave robots, mainly due to their large size, insulation issues and also large currents often flowing through the end-effector for incision or cautery of tissues. METHODS: This paper provides a method to estimate the environment force, using a function parameter matrix and a recursive least-squares method. The estimated force is used to feed back the force information to the surgeon through the control architecture without involving the force sensors. RESULTS: The simulation and experimental results verify the efficacy of the proposed method. The force estimation error is negligible and the slave device successfully tracks the position of the master device while the stability of the teleoperation system is maintained. CONCLUSIONS: The developed method allows practical haptic feedback for telerobotic surgery systems in the two-channel force-position control scheme without the direct employment of force sensors at the end-effector of the slave robot. Copyright (c) 2010 John Wiley & Sons, Ltd.