Robotic single‐port surgery: Preliminary experience in general surgery

Bianco, Francesco M.; Dreifuss, Nicolás H; Chang, Betty; Schlottmann, Francisco; Cubisino, Antonio; Mangano, Alberto; Pavelko, Yevhen; Masrur, Mario; Giulianotti, Pier Cristoforo

doi:10.1002/rcs.2453

Cited by 10 publications

(18 citation statements)

References 66 publications

(150 reference statements)

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“…Further, the surgeon can perform multi‐quadrant surgery without repositioning the operating room table and almost no clashing of the instruments. Similar favourable ergonomics, positioning and outcomes have been reported using SP robotics in thoracic, hernia, gynaecological and urological surgery [38–41].…”

Section: Discussionsupporting

confidence: 65%

“…Further, the surgeon can perform multi-quadrant surgery without repositioning the operating room table and almost no clashing of the instruments. Similar favourable ergonomics, positioning and outcomes have been reported using SP robotics in thoracic, hernia, gynaecological and urological surgery[38][39][40][41].This work adds to the literature as there are few reports of SP robotic CRS. All published work has very small numbers with no follow-up, showing only initial safety and feasibility.…”

supporting

confidence: 72%

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A prospective phase II clinical trial/IDEAL Stage 2a series of single‐port robotic colorectal surgery for abdominal and transanal cases

Marks,

Yang,

Spitz

et al. 2023

Colorectal Disease

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AimSlow laparoscopy adoption accelerated the uptake of robotic surgery. However, the current robotic platforms have limitations in transanal applications and multiple port sites. The da Vinci single‐port (SP) robot is currently used on trial for colorectal surgery, and broad assessment of outcomes is needed. We aimed to report findings of a phase II clinical trial of SP robotic colorectal surgery.MethodsA sequentially reported prospective case series was performed on patients using SP robotics at a tertiary referral centre from 1 October 2018 to 31 August 2021. Cases were stratified into abdominal and transanal cohorts. Demographics, intra‐operative variables and 30‐day postoperative outcomes were evaluated. Univariate analysis was performed, with statistical process control for the docking process. Main outcomes were conversion rates, morbidity, mortality and point of standardization of docking.ResultsIn all, 133 patients were included: 93 (69.92%) abdominal and 40 (30.08%) transanal. The main diagnosis was rectal cancer (n = 59) and the procedure performed a robotic transanal abdominal transanal radical proctosigmoidectomy (n = 30). There were no conversions to open surgery. Two abdominal (2.15%) and three transanal cases (7.50%) were converted to laparoscopy. All colorectal adenocarcinomas had negative margins, proper lymph node harvest and complete mesorectal excision, as appropriate. Docking became a standardized process at cases 34 (abdominal) and 23 (anorectal). After surgery, bowel function returned on mean day 2 (abdominal) and 1 (transanal). The morbidity rate was 15.05% (abdominal) and 27.50% (transanal). There were two major morbidities in each cohort. Overall, there were three (2.65%) readmissions, one reoperation and no mortality.ConclusionsSingle‐port robotics is feasible for all types of colorectal procedures, with good clinical and oncological outcomes. With this development in colorectal surgery, further studies can develop best practices with this novel technology.

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Section: Discussionsupporting

confidence: 65%

supporting

confidence: 72%

A prospective phase II clinical trial/IDEAL Stage 2a series of single‐port robotic colorectal surgery for abdominal and transanal cases

Marks,

Yang,

Spitz

et al. 2023

Colorectal Disease

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“…The reported cases belonged to several specialties: hepatopancreatobiliary surgery [13,[37][38][39][50][51][52][53][54][55]78,79,[87][88][89][90][91][92][93][94][95][96][97][100][101][102][103] (Tables S1 and S2), colorectal surgery [14-36,56- The authors belonged to institutions located in: South Korea (n = 27), China (n = 16), North America (n = 13), Lithuania (n = 11), Japan (n = 8), Germany (n = 6), Italy (n = 6), United Kingdom (n = 6), India (n = 4), United Arab Emirates (n = 2), Taiwan (n = 1), France (n = 1), Croatia (n = 1), Australia (n = 1).…”

Section: Resultsmentioning

confidence: 99%

New Robotic Platforms in General Surgery: What’s the Current Clinical Scenario?

et al. 2023

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Background and Objectives: Robotic surgery has been widely adopted in general surgery worldwide but access to this technology is still limited to a few hospitals. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures. The aim of this systematic review is to highlight the current clinical practice with the new robotic platforms in general surgery. Materials and Methods: A grey literature search was performed on the Internet to identify the available robotic systems. A PRISMA compliant systematic review was conducted for all English articles up to 10 February 2023 searching the following databases: MEDLINE, EMBASE, and Cochrane Library. Clinical outcomes, training process, operating surgeon background, cost-analysis, and specific registries were evaluated. Results: A total of 103 studies were included for qualitative synthesis after the full-text screening. Of the fifteen robotic platforms identified, only seven were adopted in a clinical environment. Out of 4053 patients, 2819 were operated on with a new robotic device. Hepatopancreatobiliary surgery specialty performed the majority of procedures, and the most performed procedure was cholecystectomy. Globally, 109 emergency surgeries were reported. Concerning the training process, only 45 papers reported the background of the operating surgeon, and only 28 papers described the training process on the surgical platform. Only one cost-analysis compared a new robot to the existing reference. Two manufacturers promoted a specific registry to collect clinical outcomes. Conclusions: This systematic review highlights the feasibility of most surgical procedures in general surgery using the new robotic platforms. Adoption of these new devices in general surgery is constantly growing with the extension of regulatory approvals. Standardization of the training process and the assessment of skills’ transferability is still lacking. Further studies are required to better understand the real clinical and economical benefit.

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“…After the da Vinci SP robotic platform from Intuitive company was approved in 2014, SP robotic surgery has shown feasibility in cholecystectomy and colectomy. [6][7][8][9] However, although the TAPP approach has been reported with a robotic system, TEP using the da Vinci SP platform has not been applied to inguinal hernia, the most common disease among surgical areas. 7 The reason for this is that in order to optimize the wrist ergonomics of the da Vinci SP platform, a certain distance from the target must be maintained.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9] However, although the TAPP approach has been reported with a robotic system, TEP using the da Vinci SP platform has not been applied to inguinal hernia, the most common disease among surgical areas. 7 The reason for this is that in order to optimize the wrist ergonomics of the da Vinci SP platform, a certain distance from the target must be maintained. A study that performed a da Vinci SP robotic cholecystectomy suggested need for a 10 cm distance.…”

Section: Discussionmentioning

confidence: 99%