Technical Modifications Necessary to Implement the da Vinci Single-port Robotic System

Moschovas, Marcio Covas; Bhat, Seetharam; Rogers, Travis; Önol, Fikret Fatih; Roof, Shannon; Mazzone, Elio; Mottrie, Alexandre; Patel, Vipul

doi:10.1016/j.eururo.2020.01.005

Cited by 53 publications

(39 citation statements)

References 13 publications

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“…11 The procedure was then performed with our conventional technique by an experienced surgeon to optimize the operative time. 12,13 High-risk patients underwent bilateral pelvic lymphadenectomy. However, we modified the trocar removal step.…”

Section: Management Of Surgical Patientsmentioning

confidence: 99%

“…The patient was then sent to the hospital room with a surgical mask, where he stayed without any companion until discharge the next morning (median time of 16 hours after surgery). 12 Also, during this postoperative period, the patient received orientations about Coronavirus precautions and performed physical therapy in his room. On the morning following surgery, before discharge, our postoperative nurse provided all necessary orientation and educational material regarding the postoperative period to the patient.…”

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confidence: 99%

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Managing Patients with Prostate Cancer During COVID-19 Pandemic: The Experience of a High-Volume Robotic Surgery Center

Moschovas

Bhat

Rogers

et al. 2021

Journal of Endourology

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Objectives: To report our experience and lessons learned as high-volume center of robotic surgery managing patients with prostate cancer since the beginning of the COVID-19 pandemic in our center. Materials and Methods: We described some critical changes in our routine to minimize the COVID infection among patients and health care workers. From March 1 to May 25, 2020, we described our actions and surgical outcomes of patients treated in our center during the pandemic. Results: Preventing hospital visits, we implemented some modifications in our office routine in terms of patient appointment, follow-up, and management of nonsurgical candidates. In this period, 147 patients underwent robotassisted radical prostatectomy (RARP) without intraoperative complications. The median operative time and blood loss were 91 minutes (interquartile range [IQR] = 25) and 50 mL (IQR = 50), respectively. The median hospitalization time was 15.8 hours (IQR = 2.5). None of the patients of our study had COVID in the postoperative followup, and only two patients were rescheduled due to a positive rapid COVID test 1 day before surgery. The final pathology described 10 patients (6.8%) Grade Group (GrGp) 1, 34 (23.1%) GrGp 2, 31 (21%) GrGp 3, 16 (10.8%) GrGp 4, 37 (25.3%) GrGp 5, and 19 (13%) with deferred Gleason. Two patients, COVID negative, were readmitted due to infected lymphocele managed with antibiotic and Interventional Radiology drainage. Conclusion: Our experience managing patients with prostate cancer during the COVID-19 pandemic showed that changing the office routine, stratifying the patients according to the National Comprehensive Cancer Network (NCCN) risk, and adopting COVID-based criteria to select patients for surgery are necessary actions to maintain the best quality of treatment and minimize the viral infection among our oncological patients. In our routine, the RARP during the COVID pandemic is safe and feasible for patients and health care workers if the necessary precautions described in this article are taken.

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Section: Management Of Surgical Patientsmentioning

confidence: 99%

mentioning

confidence: 99%

Managing Patients with Prostate Cancer During COVID-19 Pandemic: The Experience of a High-Volume Robotic Surgery Center

Moschovas

Bhat

Rogers

et al. 2021

Journal of Endourology

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“…da Vinci SP robot implementation and technical modifications Recently, our group described the technical modifications necessary to implement the da Vinci SP system during the transition from the conventional multi-arm robot to the SP console [2]. One crucial factor described by the author during this initial period of implementation was the requirement of a new learning curve and adaption in terms of trocar placement, working distance, instrument configuration, and arms triangulation during the different steps.…”

Section: Discussionmentioning

confidence: 99%

“…We described the challenges during the transition from the Xi to the SP in terms of trocar placement, robot docking, camera settings, instrument movements, pedal functions, and instrument grip. These steps are different with the new robot and demand a new learning curve for the whole team [2]. Our initial experience with da Vinci SP aimed to establish feasibility and to establish outcomes data.…”

Section: Discussionmentioning

confidence: 99%

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Early outcomes of single‐port robot‐assisted radical prostatectomy: lessons learned from the learning‐curve experience

et al. 2020

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To describe the crucial factors related to the implementation of the da Vinci single-port (SP) system (Intuitive Surgical Inc., Sunnyvale, CA, USA), and the early outcomes after the introduction of this robot for robot-assisted radical prostatectomy (RARP). Patients and methods We prospectively collected data from 50 consecutive patients with prostate adenocarcinoma who underwent RARP using this robot. The median follow-up was 53 days. We performed a transperitoneal technique. The robotic (multiport) trocar was placed on the supra-umbilical midline 20 cm from the pubis and an assistant trocar placed in the right lower quadrant. We report our initial experience describing the intra-and postoperative outcomes associated with this new robot. Also, we report the early functional and oncological outcomes in the follow-up period considered. Continuous variables were described as medians and interquartile ranges, while categorical variables as frequencies and proportions. Results The median total operative time was 118 min, median console time was 80 min, and median estimated blood loss was 50 mL. There were no intraoperative complications or blood transfusions. The final pathology reported 18% Grade Group (GrGp)1, 58% GrGp2, 18% GrGp3, 2% GrGp4, and 4% GrGp5. In all, 40 patients (80%) were pT2 and 20% were ≥pT3a. The overall positive surgical margin rate was 14%. In all, 39 patients (78%) achieved full continence at median of 21 days after RARP. The median pain scale (0-10) score at 8, 12 and 16 h after RARP was 2, 2, and 0, respectively. Conclusion The use of the da Vinci SP robot with an additional assistant port for RARP is technically safe and feasible, with acceptable short-term functional and oncological outcomes. However, there is a technical learning curve for this new platform due to the smaller scope of the operative field and the decreased flexibility and strength of the surgical instruments.

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Design of a dexterous robotic surgical instrument with a novel bending mechanism

Yang

Kong

et al. 2021

Robotics Computer Surgery

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Background:The robot-assisted minimally invasive surgery (RMIS) has developed rapidly in recent years, requiring highly articulated instruments to enable surgeons to perform complicated and precise procedures.Methods: A novel wrist-type surgical instrument was proposed for RMIS. The wrist consists of superelastic-wire-driven snake-like joints and universal joints, which could perform two deflections and one distal rotation. The bending mechanism and the kinematics of universal joints were analysed. The forward and inverse kinematics of the wrist were derived. Results:The performances of the instrument were evaluated using a prototype by experiments. The average motion deviation of the wrist's deflection was 0.15 � 0.08 mm, and the maximum deviation was 0.52 mm. The maximum payload capability was 10 N. The suture task and ex vivo procedure verified the effectiveness of the instrument. Conclusions:The proposed instrument has high dexterity and payload capability, which contributes to improving the quality of the RMIS procedures.

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Technical Modifications Necessary to Implement the da Vinci Single-port Robotic System

Cited by 53 publications

References 13 publications

Managing Patients with Prostate Cancer During COVID-19 Pandemic: The Experience of a High-Volume Robotic Surgery Center

Managing Patients with Prostate Cancer During COVID-19 Pandemic: The Experience of a High-Volume Robotic Surgery Center

Early outcomes of single‐port robot‐assisted radical prostatectomy: lessons learned from the learning‐curve experience

Design of a dexterous robotic surgical instrument with a novel bending mechanism

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