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Background:
Single port (SP) robotic assisted laparoscopic surgery was approved by the FDA for urologic surgery and clinically available in 2018. This new robotic system enables a camera and 3 separate instruments, with fully wristed motions, to be placed through a single 25 mm port. This system was designed to perform complex surgery in narrow de...
Citations
... Intuitive surgical recently released a purpose-built, single-site robotic platform, the da Vinci SP system, which received FDA approval in 2018 and has already been successfully used in many urological procedures [5,6]. Studies have shown that the single-port (SP) system may allow for a shorter hospital stay, decreased postoperative pain, and improved scar cosmesis [7,8]. ...
The objective of this study was to compare the perioperative and short-term functional and oncological outcomes of single-port and multiport robotic-assisted laparoscopic partial nephrectomy using propensity-score analysis. We evaluated all patients who underwent robotic partial nephrectomy at our institution between January 2019 and October 2020. Patient demographics, intraoperative data, and postoperative outcomes were collected and analyzed. Propensity-score matching was performed on age, sex, body mass index, prior abdominal surgery, and nephrometry score using the optimal matching method. A post hoc sensitivity analysis was performed to examine the robustness of the results. In total, 48 and 238 patients underwent single-port and multiport robotic partial nephrectomy, respectively. Following propensity-score matching, 48 multiport cases were matched 1:1 to single-port cases. The single-port cohort had lower median opioid use at postoperative day 1 (4.6 vs 9.8 MME, p = 0.0209) and cumulative hospital stay (5.1 vs 9.3 MME, p = 0.0357). Single port also had a shorter median length of stay (1.4 vs 1.6 days, p = 0.0045), although the post hoc sensitivity analysis showed no difference between the groups [− 0.13 (95% CI; − 0.580, 0.315, p = 0.5607). There were no significant differences in operative time, estimated blood loss, ischemia time, transfusions received, or positive margin rates. In conclusion, based on our early experience, single-port robotic partial nephrectomy is a safe and acceptable alternative to multiport robotic partial nephrectomy, providing comparable perioperative and postoperative outcomes while reducing inpatient opioid use.
... The da Vinci Xi surgical system was successfully used for SILS [5], but it works with crossed instruments and is prone to collisions due to the arms' position. The use of articulated instruments that do not intersect is proposed by the da Vinci SP system [6] or Single Port Orifice Robotic Technology (SPORT) [7], but these configurations do not provide a large variety of distal heads for the instruments, and sometimes suffer for lack of tissue gripping force. ...
... Laparoendoscopic single-site surgery (LESS) is another feature of surgical robotic platforms that is an advancement from original laparoscopy. One disadvantage of LESS is the challenge of instruments interfering with one another, although early success has been reported [5][6][7]. No head-to-head comparison of any robotic platforms from different companies exists in the urologic literature. ...
... Intuitive has also made advances in the field of LESS, where in addition to the SP platform, they have developed software to allow for same-sided hand-eye control of the instruments that enables the surgeon's right hand to control the screen right instrument even though the instrument is in the left robotic arm and vice versa [13]. LESS using the da Vinci SP system allows a smaller incision with superior cosmesis and non-inferior oncologic and surgical outcomes, although there appears to be a great learning curve [6,7,[14][15][16][17]. Additionally, side docking for urologic procedures has been made possible with the da Vinci S and Si systems, allowing better access to the perineum and the urethra throughout the procedure [18]. ...
Objectives: Since the introduction of the first master–slave robotic platform for surgical procedures, there have been ongoing modifications and development of new platforms, but there is still a paucity of commercially available systems. Our study aims to identify all master–slave robotic surgical platforms currently commercially available or in development around the world with applications in urologic surgery.
Methods: A scoping literature search was performed using PRISMA methodology to identify all relevant publications in English in PubMed, PubMed Central, and Embase, with additional information being obtained from official company websites.
Results: Ten robotic platforms with either proven or potential application in urologic surgery were identified: the da Vinci surgical system (Intuitive), Senhance surgical system (Transentrix), Versius Surgical (CMR Ltd), Enos surgical system (Titan Medical), Revo –I (Meere Company), MiroSurge (DLR), Avatera System (Avatera Medical), Hugo Surgical Robot (Medtronic), Ottava (J&J, Ethicon, Areus), and Hinotori (Medicaroid Corporation).
Conclusions: This review highlights the distinct features of emerging master–slave robotic platforms with applications in urologic surgery. Research and development are now focused on finding wider applications, improving outcomes, increasing availability, and reducing cost. Additional research is required comparing newly developed master–slave robotic platforms with those already well established.
... Studies to date suggest that the learning curve for most procedures (albeit in expert hands) may be similar to that of multiport robotic surgery. 2,49 The cognitive burden of operating the SP platform has also been evaluated, with findings again comparable to more established approaches. With further dissemination of various techniques and approaches for robotic-assisted reconstruction, standardizing the training and grading of surgeons will become paramount -as well as the environment in which learning occurs. ...
With the widespread dissemination of robotic surgical platforms, pathology previously deemed insurmountable or challenging has been treated with reliable and replicable outcomes. The advantages of precise articulation for dissection and suturing, tremor reduction, three-dimensional magnified visualization, and minimally invasive trocar sites have allowed for the management of such diverse disease as recurrent or refractory bladder neck stenoses, and radiation-induced ureteral strictures, with excellent perioperative and functional outcomes. Intraoperative adjuncts such as near-infrared imaging aid in identification and preservation of healthy tissue. More recent developments include robotics via the single port platform, gender-affirming surgery, and multidisciplinary approaches to complex pelvic reconstruction. Here, we review the recent literature comprising developments in robotic-assisted genitourinary reconstruction, with a view towards emerging technologies and future trends in techniques.
... surgeons and institutions have described their initial experience with the da Vinci SP in various procedures and have reported their series. These numerous clinical publications include descriptions for radical prostatectomy, radical cystectomy, radical and partial nephrectomy, pyeloplasty, and other reconstructive procedures [11][12][13][14][15][16][17]. ...
... However, this approach was not widely adopted by the urological community, as the robotic system used was not specially designed for R-LESS, and issues related to loss of triangulation, instrument clashing, and limited assistant workspace were noted [49]. The da Vinci SP was specially designed to overcome these challenges and has already been used in several demanding urologic procedures [11][12][13][14][15][16][17]. ...
Robotic assistance in laparoscopic surgery was introduced at the turn of this millennium, marking a milestone in the history of surgery. Urologists were early adopters of robotic technology and the indications of robot-assisted surgery in urology are expanding. Over the last 20 years, the da Vinci surgical system was the dominant system in the robotic surgical market. However, the recent expiration of Intuitive patents has allowed new systems to enter the market more freely. We performed a nonsystematic literature review using the PubMed/MEDLINE search engines. The aim of this review was to briefly summarize the currently available robotic surgical systems for laparoscopic urologic surgery. New surgical devices have already been launched in the robotic market and the da Vinci systems have some competition. The innovation of robotic technology is continuing, and new features such as an open-console design, haptic feedback, smaller instruments, and separately mounted robotic arms have been introduced. A new robotic era is rising, and new systems and technologies enhancing patient care are welcomed.
Vesicovaginal fistula is an abnormal connection between the bladder and the vagina that can lead to continuous leakage of urine. The condition can be associated with significant psychosocial stress for women. This chapter focuses on the pre-operative, perioperative, and postoperative considerations surrounding laparoscopic and robot-assisted laparoscopic repairs of vesicovaginal fistula. The evaluation of vesicovaginal fistula, conservative management, and timing of repair are all discussed. Particular attention is paid to examining various surgical techniques that can be performed in a minimally -invasive fashion, as well as the challenges and advantages of each approach. Crucial perioperative components of a minimally -invasive fistula repair, including patient positioning, fistula identification and dissection, bladder closure, use of interposing tissue, and bladder drainage, are all addressed within the context of basic principles of fistula repair. Furthermore, the use of robotic assistance in vesicovaginal fistula repair is also considered given the increasing availability and proficiency in robotic surgery. Current literature surrounding surgical outcomes, lower urinary tract symptoms, and sexual function following these repairs is also reviewed. This chapter serves as a tool for surgeons considering a minimally -invasive approach to vesicovaginal fistula repair
Background:
This meta-analysis was conducted to evaluate the effectiveness and safety of robot-assisted hepatectomy (RAH) versus open hepatectomy (OH) for liver tumors (LT).
Methods:
A computer-based literature search was conducted to identify all randomized or nonrandomized controlled trials of RAH and OH in the treatment of LT from January 2000 to July 2022. Study-specific effect sizes and their 95% confidence intervals (CIs) were combined to calculate the pooled values, using a fixed-effects or random-effects model.
Results:
Eight studies were included, with a combined total of 1079 patients. Compared with the OH group, the RAH group was found to involve less blood loss (standardized mean difference [SMD] = -152.52 mL; 95% CI = -266.85 - 38.18; p = 0.009), shorter hospital stay (SMD = -2.79; 95% CI = -4.19 - -1.40; p < 0.001), a lower rate of postoperative complications (odds ratio [OR] =0.67; 95% CI = 0.47 - 0.95; p = 0.02), and a lower recurrence rate (OR = 0.42; 95% CI = 0.23 - 0.77; p = 0.005). However, operative time was longer in the RAH group than in the OH group (SMD = 70.55; 95% CI = 37.58 - 103.53; p < 0.001).
Conclusion:
This systematic review shows that RAH is safe and feasible in the treatment of LT.
Robotic surgery was initially developed to perform telesurgery at distant locations and to overcome problems of conventional laparoscopic surgeries. It has now established itself as the epitome of minimally invasive surgery (MIS) and robot-assisted radical prostatectomy has gained remarkable worldwide distribution and has become a standard procedure for localized prostate cancer, indeed the new “gold standard”.In this chapter we will review the milestones that robot-assisted radical prostatectomy (RARP) has taken over the last two decades to become a standard of care.KeywordsProstate cancerProstatectomyRoboticsSurgeryTechniqueRobotic trainingTechnology
Multiple medical conditions require urinary diversion including radical cystectomy due to bladder cancer, refractory hematuria, radiation cystitis, or chronic pelvic pain. John Simon performed the first urinary diversion in 1851. Sixty years later in 1911, Zaayer described the first ileal conduit. Since then, urinary diversion has become a widely known procedure and despite multiple techniques described in the literature, ileal conduit is the most used technique to this day. The robotic approach to ileal conduit urinary diversion has evolved overtime with progression of the robotic systems. With the introduction of the Single Port Robot, we have transitioned from multiple small incisions to a single port.
