Robot-assisted surgery in gynaecology

Lawrie, Theresa A; Liu, Hongqian; Lü, Donghao; Dowswell, Therese; Song, Huan; Wang, Lei; Su, Gang

doi:10.1002/14651858.cd011422.pub2

Cited by 76 publications

(80 citation statements)

References 132 publications

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“…Over the last 25 years, minimal access surgery (MAS) has become an essential component of modern gynecology surgery, with many laparoscopic techniques now considered routine [1]. Gynecologic MAS is associated with a number of advantages over open surgery, including reduced blood loss, fewer perioperative complications, reduced post-operative pain, earlier recovery, shortened hospital stay, and improved cosmesis [1][2][3]. However, MAS for complex surgery is technically demanding and associated with a steep learning curve [1,[4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…However, MAS for complex surgery is technically demanding and associated with a steep learning curve [1,[4][5][6][7]. This is due to certain limitations of conventional laparoscopy such as restricted movement, difficulty performing accurate suturing, uncomfortable positions for the surgeon and assistant, and twodimensional vision [1][2][3]8]. These limitations may contribute to the relatively low adoption of MAS for commonly performed gynecologic procedures, such as hysterectomy and sacrocolpopexy [4,[9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…Robot-assisted laparoscopy has made progress in overcoming some of the important shortcomings of conventional laparoscopy by providing an ergonomic operating position, a stable magnified three-dimensional view, tremor filtering, motion scaling, and articulated or wristed instruments, allowing for precise tissue dissection and suturing [12,13]. By shortening the learning curve, these advantages may enable more surgeons to perform complex MAS procedures, and could extend the feasibility of MAS to a greater body of surgeons [2]. In addition, robot-assisted MAS could be feasible in a wider range of patients, such as those with a higher body mass index (BMI) [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Preclinical evaluation of a new robot-assisted surgical system for use in gynecology minimal access surgery

et al. 2020

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Robot-assisted laparoscopy has been developed to overcome some of the important limitations of conventional laparoscopy. In particular, the provision of stable magnified three-dimensional vision, tremor filtering, motion scaling, and articulated instruments with robot-assisted surgery has the potential to enable more surgeons to perform more complex surgery compared with conventional laparoscopy. The aim of this study was to evaluate the utility of a new robot-assisted surgical system (Versius, CMR Surgical, Cambridge, UK) for gynecologic procedures in a preclinical setting. Cadaveric sessions were conducted to evaluate the ability of the system to complete all surgical steps required for a robot-assisted total laparoscopy hysterectomy. A live animal (porcine) model was used to assess the system in performing oviduct removal as a surrogate for robot-assisted total laparoscopy hysterectomy. Procedures were performed by experienced gynecologic surgeons, supported by a surgical team. The precise surgical steps conducted to conclude that the procedures could be fully completed were systematically recorded, as well as instruments used and endoscope angle. In total, six gynecologic procedures were performed in cadavers by four surgeons; 16/17 procedures were completed successfully. Positioning of the ports and bedside units reflected the surgeons' preferred laparoscopic setup and enabled good surgical access and reach, as exemplified by the high procedure completion rate. Oviduct removal procedures performed in pigs were all completed successfully by a single surgeon. This preclinical study of a new robot-assisted surgical system for gynecologic procedures demonstrated the safety and effectiveness of the system in cadaver and porcine models. Further studies are required to assess its clinical utility.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preclinical evaluation of a new robot-assisted surgical system for use in gynecology minimal access surgery

et al. 2020

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“…Over the last 20 years, several robot-assisted surgical devices have been developed that overcome some of the challenges associated with performing MAS. Robot-assisted devices are now available to support many procedures, including laparoscopic, cardiovascular, orthopedic, and brain and spine surgery 10–13. Robotic-assisted MAS has the potential to bring the benefits of MAS to a wider population of patients, and research suggests it may provide benefits over standard laparoscopic surgery 14–17.…”

Section: Introductionmentioning

confidence: 99%

Using end-user feedback to optimize the design of the Versius Surgical System, a new robot-assisted device for use in minimal access surgery

Hares

Roberts

Marshall

et al. 2019

BMJ Surg Interv Health Technologies

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BackgroundRobot-assisted minimal access surgery (MAS) reduces blood loss, recovery time, intraoperative and postoperative complications and pain. However, uptake of robotic MAS remains low, suggesting there are barriers to its use. To overcome these barriers, a new surgical robot system, Versius, was developed based on the needs and feedback of surgeons and surgical teams.MethodsThe surgical robot prototype was designed based on observations in the operating room (OR) and previous interviews with surgeons. Formative studies with surgeons and surgical teams were used to refine the prototype design, resulting in modifications to all components, including the arms, instruments, handgrips and surgeon console. Proof-of-concept cadaver studies were used to further optimize its design by assessing its usability during surgical procedures.ResultsFeedback led to the development of a novel, mobile design with independent arm carts and surgical console, linked by supported serial or parallel connections, providing maximum flexibility in the OR. Instrument tips were developed based on surgeons’ preferred designs and wristed at the tip providing seven degrees of freedom within the patient. Multiple handgrip designs were assessed by surgeons; of these, a ‘game controller’ design was rated most popular and usable. An open surgical console design allowing multiple working positions was rated highest by surgeons and the surgical teams.ConclusionsThis surgical robot system has been developed using feedback from end users throughout the design process and aims to minimize barriers to robotic MAS uptake. Additionally, these studies demonstrate system success in the surgical procedures it was designed for. The studies reported here, and further studies of the Versius Surgical System, are intended to align with IDEAL (Idea, Development, Exploration, Assessment, Long-term study) Framework guidance.

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“…However in surgery of early cervical cancer there is RCT evidence showing a higher recurrence rate and worse overall survival after using the minimally invasive technique, mostly laparoscopically but also robotically, compared with open surgery (Ramirez, et al 2018, Printz 2019. Another aspect of robotic surgery is the currently ongoing debate about the benefit of the technique versus the markedly increased costs of acquisition and maintenance of the robot (Kristensen, et al 2017, Nevis, et al 2017, Lawrie, et al 2019.…”

Section: Robotic Surgerymentioning

confidence: 99%

On Quality Improvement in Gynaecological Cancer Surgery

Lundin

2020

Linköping University Medical Dissertations

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Objectives: The overall purpose of this thesis was to find medical and surgical treatment methods of improving the perioperative care of gynaecological cancer patients. The specific objectives were to determine whether a single dose tranexamic acid given immediately before surgery for presumed advanced ovarian cancer reduces perioperative blood loss and the need for blood transfusions, and to determine whether postoperative recovery, tissue damage, and inflammatory response markers differ between women operated with robotic and abdominal hysterectomy for low-risk endometrial cancer in an enhanced recovery after surgery (ERAS) programme, and to evaluate costs for hospital stay and postoperative recovery in relation to health impact. Material and Methods: The thesis was based on two randomised trials. The first trial was a randomised double-blind placebo-controlled multicentre study conducted in four hospitals in the southeast and central of Sweden between March 2008 and May 2012. One hundred women with presumed advanced ovarian cancer who had been scheduled for radical debulking surgery were included; 50 received tranexamic acid and 50 received a placebo. The main outcomes were blood loss and red blood cell transfusions. The second trial was a randomised open single centre trial at a Swedish university hospital, which included 50 women with low-risk endometrial cancer scheduled for radical surgery between February 2012 and May 2016; 25 women underwent robotic hysterectomy and 25 had abdominal hysterectomy. Anaesthesia and perioperative care followed an ERAS protocol in both groups. The EuroQol Group form EQ-5D-3L and the Short Form-36 evaluated the health-related quality of life. The Swedish Postoperative Symptoms Questionnaire assessed symptoms perioperatively until six weeks postoperatively. Venous blood samples were collected on several occasions until six weeks postoperatively and were analysed for markers reflecting inflammatory response and tissue damage. In addition, a health-economy analysis was conducted comparing total costs, quality-adjusted life years (QALYs) and cost per QALY between the surgical methods. Results: Total blood loss volume and transfusion rate following surgery in advanced ovarian cancer were significantly lower in the tranexamic group compared with the placebo group. Women with early endometrial cancer treated by robotic hysterectomy recovered significantly faster in the EQ-5D health index, and reached their preoperative level nearly two weeks earlier than the abdominal group. Differences regarding improvement in health-related quality of life (Short Form-36) comprising general health and social functioning were more favourable in the robotic hysterectomy group. Consumption of analgesics, pain intensity, postoperative symptom sum score and length of hospital stay were equal between the groups. The occurrence of complications was an independent risk factor and influenced most of the outcome measures adversely. Postoperative inflammatory response and tissue damage were lower after roboti...

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Robot-assisted surgery in gynaecology

Cited by 76 publications

References 132 publications

Preclinical evaluation of a new robot-assisted surgical system for use in gynecology minimal access surgery

Preclinical evaluation of a new robot-assisted surgical system for use in gynecology minimal access surgery

Using end-user feedback to optimize the design of the Versius Surgical System, a new robot-assisted device for use in minimal access surgery

On Quality Improvement in Gynaecological Cancer Surgery

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