A technical feasibility study on adaptation of a microsurgical robotic system to an intraoperative complication management in dental implantology: perforated Schneiderian membrane repair using Symani® Surgical System

Journal of Robotic Surgery - Tập 17 Số 6 - Trang 2861-2867
Henning Wieker1, Cedric Hinrichs1, Merle Retzlaff1, Johannes Spille1, Martin Laudien2, Yahya Açil1, Jens Wiltfang1, Aydın Gülses1
1Department of Oral and Maxillofacial Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany
2Department of ENT Surgery, Christian Albrechts University, UKSH Campus Kiel, 24105, Kiel, Germany

Tóm tắt

Abstract

The aim of the current study was to test the technical and clinical feasibility of a robotic system and investigate its potential in the surgical repair of perforated Schneiderian membranes using an ex-vivo porcine model. Eight pig heads were operated conventionally via a surgical loop and eight pig heads with the surgical robot “Symani® Surgical System” (Medical Microinstruments, Inc., Pisa, Italy). On each specimen, the Schneiderian membrane was incised over a length of 0.7 mm resembling a perforation. Operation time, the maximum sinusoidal pressure, the course of the pressure and the filling volume were measured. Additionally, adaptation of the wound edges has been detected via scanning electron microscopy. There were no significant differences for the pressure maximum (p = 0.528), for the time until the pressure maximum was reached (p = 0.528), or for the maximum filling volume (p = 0.674). The time needed for the suturing of the membrane via robotic surgery was significantly longer (p < 0.001). However, the scanning electron microscope revealed a better adaptation of the wound edges with robotic surgery. The technical feasibility of robot-assisted suturing of Schneiderian membrane laceration using the robotic system has been confirmed for the first time. No differences considering the pressure resistance compared to the conventional repair could be observed, but advantages in wound adaptation could be found with an electron microscope. Regarding the material and training costs and limited indications spectrum, robotic surgery systems still might not present financially feasible options in the daily dental practice yet.

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Tài liệu tham khảo

Emmert M, Spille J, Behrens E, Ayna M, Karayurek F, Wiltfang J et al (2022) comparative assessment of the primary stability of straumann BLX implant design using an in vitro sinus lift-simultaneous implant insertion model. J Oral Implantol 48(4):269–275. https://doi.org/10.1563/aaid-joi-D-20-00411

Kim YK, Ku JK (2020) Sinus membrane elevation and implant placement. J Korean Assoc Oral Maxillofac Surg 46(4):292–298. https://doi.org/10.5125/jkaoms.2020.46.4.292

Hernandez-Alfaro F, Torradeflot MM, Marti C (2008) Prevalence and management of Schneiderian membrane perforations during sinus-lift procedures. Clin Oral Implants Res 19(1):91–98. https://doi.org/10.1111/j.1600-0501.2007.01372.x

Oncu E, Kaymaz E (2017) Assessment of the effectiveness of platelet rich fibrin in the treatment of Schneiderian membrane perforation. Clin Implant Dent Relat Res 19(6):1009–1014. https://doi.org/10.1111/cid.12528

Nolan PJ, Freeman K, Kraut RA (2014) Correlation between Schneiderian membrane perforation and sinus lift graft outcome: a retrospective evaluation of 359 augmented sinus. J Oral Maxillofac Surg 72(1):47–52. https://doi.org/10.1016/j.joms.2013.07.020

Beck-Broichsitter BE, Westhoff D, Behrens E, Wiltfang J, Becker ST (2018) Impact of surgical management in cases of intraoperative membrane perforation during a sinus lift procedure: a follow-up on bone graft stability and implant success. Int J Implant Dent 4(1):6. https://doi.org/10.1186/s40729-018-0116-8

Koleilat A, Mansour A, Alkassimi FM, Aguirre A, Almaghrabi B (2023) A combination of platelet-rich fibrin and collagen membranes for sinus membrane repair: a case report (repair of sinus membrane perforation). Dent J (Basel). 11(3):84. https://doi.org/10.3390/dj11030084

Diaz-Olivares LA, Cortes-Breton Brinkmann J, Martinez-Rodriguez N, Martinez-Gonzalez JM, Lopez-Quiles J, Leco-Berrocal I et al (2021) Management of Schneiderian membrane perforations during maxillary sinus floor augmentation with lateral approach in relation to subsequent implant survival rates: a systematic review and meta-analysis. Int J Implant Dent 7(1):91. https://doi.org/10.1186/s40729-021-00346-7

Savastano A, Rizzo S (2022) A novel microsurgical robot: preliminary feasibility test in ophthalmic field. Transl Vis Sci Technol 11(8):13. https://doi.org/10.1167/tvst.11.8.13

Tatum H Jr (1986) Maxillary and sinus implant reconstructions. Dent Clin North Am 30(2):207–229

Ozkan O, Ozkan O, Cinpolat A, Arici C, Bektas G, Can UM (2019) Robotic harvesting of the omental flap: a case report and mini-review of the use of robots in reconstructive surgery. J Robot Surg 13(4):539–543. https://doi.org/10.1007/s11701-019-00949-8

Park YM, Choi EC, Kim SH, Koh YW (2022) Recent progress of robotic head and neck surgery using a flexible single port robotic system. J Robot Surg 16(2):353–360. https://doi.org/10.1007/s11701-021-01221-8

Kupferman ME, Demonte F, Levine N, Hanna E (2011) Feasibility of a robotic surgical approach to reconstruct the skull base. Skull Base 21(2):79–82. https://doi.org/10.1055/s-0030-1261258

Veleur M, Lahlou G, Torres R, Daoudi H, Mosnier I, Ferrary E et al (2021) Robot-assisted middle ear endoscopic surgery: preliminary results on 37 patients. Front Surg 8:740935. https://doi.org/10.3389/fsurg.2021.740935

Barbu HM, Iancu SA, Jarjour Mirea I, Mignogna MD, Samet N, Calvo-Guirado JL (2019) Management of Schneiderian membrane perforations during sinus augmentation procedures: a preliminary comparison of two different approaches. J Clin Med 8(9):1491. https://doi.org/10.3390/jcm8091491

Beck-Broichsitter BE, Gerle M, Wiltfang J, Becker ST (2020) Perforation of the Schneiderian membrane during sinus floor elevation: a risk factor for long-term success of dental implants? Oral Maxillofac Surg 24(2):151–156. https://doi.org/10.1007/s10006-020-00829-8

Schwartz-Arad D, Herzberg R, Dolev E (2004) The prevalence of surgical complications of the sinus graft procedure and their impact on implant survival. J Periodontol 75(4):511–516. https://doi.org/10.1902/jop.2004.75.4.511

van den Bergh JP, ten Bruggenkate CM, Disch FJ, Tuinzing DB (2000) Anatomical aspects of sinus floor elevations. Clin Oral Implants Res 11(3):256–265. https://doi.org/10.1034/j.1600-0501.2000.011003256.x

van den Bergh JP, ten Bruggenkate CM, Krekeler G, Tuinzing DB (2000) Maxillary sinusfloor elevation and grafting with human demineralized freeze dried bone. Clin Oral Implants Res 11(5):487–493. https://doi.org/10.1034/j.1600-0501.2000.011005487.x

Brasileiro BF, Cortez AL, Asprino L, Passeri LA, De Moraes M, Mazzonetto R et al (2005) Traumatic subcutaneous emphysema of the face associated with paranasal sinus fractures: a prospective study. J Oral Maxillofac Surg 63(8):1080–1087. https://doi.org/10.1016/j.joms.2005.04.007

Sakakibara A, Suzuki H, Yamashita A, Hasegawa T, Minamikawa T, Furudoi S et al (2015) Facial emphysema after sinus lift. J Surg Case Rep 2015(6):067. https://doi.org/10.1093/jscr/rjv067

Wu Z, Craig JR, Maza G, Li C, Otto BA, Farag AA et al (2020) Peak sinus pressures during sneezing in healthy controls and post-skull base surgery patients. Laryngoscope 130(9):2138–2143. https://doi.org/10.1002/lary.28400

Yun JE, Lee NR, Kwak C, Rha KH, Seo SI, Hong SH et al (2019) Clinical outcomes and costs of robotic surgery in prostate cancer: a multiinstitutional study in Korea. Prostate Int 7(1):19–24. https://doi.org/10.1016/j.prnil.2018.04.004

Market Analysis Report. (978-1-68038-811-4):118. https://www.grandviewresearch.com/industry-analysis/surgical-robot-market. Accessed 30 May 2023

https://www.mmimicrocom/symani-system-overview. Accessed 30 May 2023

Soomro NA, Hashimoto DA, Porteous AJ, Ridley CJA, Marsh WJ, Ditto R et al (2020) Systematic review of learning curves in robot-assisted surgery. BJS Open 4(1):27–44. https://doi.org/10.1002/bjs5.50235

Pennington Z, Judy BF, Zakaria HM, Lakomkin N, Mikula AL, Elder BD et al (2022) Learning curves in robot-assisted spine surgery: a systematic review and proposal of application to residency curricula. Neurosurg Focus 52(1):E3. https://doi.org/10.3171/2021.10.FOCUS21496

Barbon C, Grunherz L, Uyulmaz S, Giovanoli P, Lindenblatt N (2022) Exploring the learning curve of a new robotic microsurgical system for microsurgery. JPRAS Open 34:126–133. https://doi.org/10.1016/j.jpra.2022.09.002

Plessas A, Nasser M, Hanoch Y, O’Brien T, Bernardes Delgado M, Moles D (2019) Impact of time pressure on dentists’ diagnostic performance. J Dent 82:38–44. https://doi.org/10.1016/j.jdent.2019.01.011

Ayna M, Karayurek F, Jepsen S, Emmert M, Acil Y, Wiltfang J et al (2021) Six-year clinical outcomes of implant-supported acrylic vs ceramic superstructures according to the all-on-4 treatment concept for the rehabilitation of the edentulous maxilla. Odontology 109(4):930–940. https://doi.org/10.1007/s10266-021-00605-4

Ballestin A, Malzone G, Menichini G, Lucattelli E, Innocenti M (2022) New robotic system with wristed microinstruments allows precise reconstructive microsurgery: preclinical study. Ann Surg Oncol 29(12):7859–7867. https://doi.org/10.1245/s10434-022-12033-x