Journal of Robotic Surgery

To compare the clinical efficacy and safety of robot-assisted adrenalectomy (RA) and laparoscopic adrenalectomy (LA) for pheochromocytoma (PHEO). We conducted a comprehensive search of PubMed, the Cochrane Library, and Embase databases for studies comparing RA and LA treatment for PHEO, covering the period from database inception to January 1, 2024. Two researchers will independently screen literature and extract data, followed by meta-analysis using Review Manager 5.3 software. Six studies with 658 patients were included in the analysis. There were no significant differences in operation time [MD = −8.03, 95% CI (−25.68,9.62), P > 0.05], transfusion rate [OR = 1.10, 95% CI (0.55, 2.19) , P > 0.05], conversion rate [OR = 0.31, 95% CI (0.08, 1.12), P > 0.05], complication rate [OR = 0.93, 95% CI (0.52, 1.70), P > 0.05], Intraoperative max SBP [MD = −4.08, 95% CI (−10.13,1.97), P > 0.05], Intraoperative min SBP [MD = −2.71, 95% CI (−9.60,4.18), P > 0.05] among patients undergoing RA and LA. However, compared with patients who underwent LA, patients who underwent RA had less estimated blood loss [MD = −37.72, 95% CI (−64.11,−11.33), P < 0.05], a shorter length of hospital stay [MD = −0.43, 95% CI (−0.65,−0.21) P < 0.05]. RA has higher advantages in some aspects compared to LA. RA is a feasible, safe, and comparable treatment option for PHEO.

Total mesorectal excision (TME) is currently recognised as the standard of care for patients with rectal cancer. Complete TME is known to be associated with lower rates of recurrence. Robotic and endoscopic TaTME approaches are reported to offer excellent proximal and distal rectal dissection into the TME plane, however, combining both approaches in a hybrid procedure could potentially optimise visualisation of the dissection plane and confer improved circumferential and distal margin rates. The aim of this study was to analyse the feasibility of a hybrid robotic abdominal approach with conventional TaTME for rectal cancer. Furthermore, pathological and patient outcomes were assessed. A review of prospectively maintained databases was undertaken to assess all patients undergoing robotic TME surgery for rectal tumours from August 2016 to October 2017. Patient demographics, tumour characteristics and outcomes were collated from patient charts and hospital databases. All patients underwent a modified Cecil approach after multidisciplinary team discussion. Eight patients (7 male, 1 female) underwent a combined hybrid approach with a median age of 60 years (range 47–73) and BMI of 29.5 (range 20–39.1) kg/m2. Median distance from the anorectal junction (ARJ) was 7.5 (range 4–13) cm. Six patients underwent neoadjuvant treatment with chemoradiotherapy. Patients had a median length of stay (LOS) of 9 (range 4–33) days. There were no intra-operative complications encountered and no patients required a conversion to an open procedure. Complications included one anastomotic leak and one presacral collection. All patients had a complete TME with RO resection with a median number of lymph nodes harvested was 22 (range 6–37) lymph nodes. This hybrid technique is a feasible, practical and operatively favourable approach to rectal cancer surgery with initial pathological outcomes and complication profile equivalent to other approaches.

Uterus transplantation (UTx) is the first treatment for absolute uterine factor infertility. The first birth after human UTx in Sweden occurred in 2014 and very favourable results of the Swedish trial performed with laparotomy raised great hope. Several teams are leading their own trial among the world, but UTx is still in its experimental phase. Surgical intervention needs to be optimized. The long surgical duration (> 10 h), vascular dissection and risks of ureteral damages for live donors are major drawbacks. Minimal invasive surgery by means of robotic-assisted laparoscopy for live donors could become an improved option. Our collaborative Swedish-French team has initiated efforts to introduce minimal invasive surgery in one trial in Sweden and one in France. UTx is somewhat similar to a radical colpohysterectomy for arterial dissection. We describe a robotic-assisted radical colpohysterectomy and its transposition to uterus retrieval in a living donor. We report our experience on nine cases that were completed prior to our French UTx robot-assisted trial.

The objective of this study was to evaluate the incidence of perioperative complications in robotic-assisted hysterectomies performed by high-volume robotic surgeons compared to conventional laparoscopic hysterectomies performed by all gynecologic surgeons. This retrospective cohort study was performed at a single-center community based hospital and medical center. A total of 332 patients who underwent hysterectomy for benign indications were included in this study. Half of these patients (n = 166) underwent conventional laparoscopic hysterectomy and the other half underwent a robotic-assisted laparoscopic hysterectomy. The main outcome measures included composite complication rate, estimated blood loss (EBL), and hospital length of stay (LOS). Median (IQR) EBL was significantly lower for robotic hysterectomy [22.5 (30) mL] compared to laparoscopic hysterectomy [100 (150) mL, p < 0.0001]. LOS was significantly shorter for robotic hysterectomy (1.0 ± 0.2 day) compared to laparoscopic hysterectomy (1.2 ± 0.7 days, p = 0.04). Despite averaging 3.0 (IQR 1.0) concomitant procedures compared to 0 (IQR 1.0) for the conventional laparoscopic hysterectomies, the incidence of any type of complication was lower in the robotic hysterectomy group (2 vs. 6%, p = 0.05). Finally, in a logistic regression model controlling for multiple confounders, robotic-assisted hysterectomy was less likely to result in a perioperative complication compared to traditional laparoscopic hysterectomy [odds ratio (95% CI) = 0.2 (0.1, 0.90), p = 0.04]. In conclusion, robotic-assisted hysterectomy may reduce complications compared with conventional laparoscopic hysterectomy when performed by high volume surgeons, especially in the setting of other concomitant gynecologic surgeries.

Improvements in outcomes after primary hepatectomy have increased the eligibility of patients for reoperative hepatectomies, but this can be fraught with technical difficulties, particularly via a minimally invasive approach. The robotic approach provides superior visualization, articulated instrumentation, platform stability, and increased dexterity when compared to conventional laparoscopy. We sought to investigate the effect brought by the robotic system in the outcome of these operations. We followed 234 patients who underwent robotic liver resection from 2012 to 2021 for retrospective analysis. Patients were classified as: no prior abdominal operation, prior abdominal operation(s), and prior liver resection. Cohorts were compared by one-way ANOVA and 2 × 3 contingency table analyses. For illustrative purposes, data are presented as median (mean ± SD). Significance was accepted at p < 0.05. Of the 234 patients studied, 114 underwent primary hepatectomy, 105 had a prior laparoscopic or open abdominal operation (cholecystectomy, herniorrhaphy, colectomy, and appendectomy), and 15 had a redo hepatectomy. Demographic and preoperative ASA, MELD, neoplasm size, and extent of liver resection were similar among the cohorts. There were no statistically significant differences between the three cohorts for all outcome variables including blood loss, operative duration, intensive care unit length of stay, overall length of stay, morbidity, mortality, and readmission rate. There were no differences in morbidity nor mortality between patients undergoing primary nor reoperative robotic hepatectomy. The advantages afforded by the robotic platform may have contributed to the equalization of outcomes.

Mannitol is routinely used during partial nephrectomies due to its renoprotective properties. With minimally invasive techniques, the need for mannitol has been questioned. Robotic-assisted laparoscopic partial nephrectomy (RALPN) has been shown to decrease warm ischemia time, which may potentially minimize the benefit of mannitol. To date, no prospective, randomized, controlled trials have investigated the use of mannitol in only robotic procedures. We hypothesize that the intraoperative mannitol use during RALPN provides no statistically significant benefit for post-operative renal function outcomes. We conducted a randomized, controlled, double-blinded, single surgeon, prospective study to assess renal function after RALPN. Patients were randomized into a control group with intravenous normal saline infusion prior to clamping of the vessels or to an experimental group with an infusion of mannitol. Estimated glomerular filtration rate (eGFR) were obtained prior to the surgery as well as post operatively at 24 h, 1 week, and 30 days. Preoperative eGFR showed no statistical differences between the groups and evaluation of median percent change in eGFR after surgery did not indicate a statistical difference between the groups after RALPN. After prospective analysis of the change in post-operative renal function of randomized groups who received 12 g of mannitol following RALPN, we determined that infusion of mannitol does not provide significant improvement of maintenance of renal functions after RALPN. Based on our results, we recommend discontinuing routine use of mannitol during RALPN.

Stress urinary incontinence (SUI) is a risk of robotic-assisted radical prostatectomy (RP) which can be a frustrating problem for both surgeons and patients. We aim to compare short-term continence outcomes between patients undergoing Retzius Sparing RP (RS-RP) and those undergoing standard RP with the inclusion of a PUS suture technique and suprapubic tube (PUS-RP). A retrospective review of 105 consecutive patients who underwent RP was performed, comparing patients who underwent RS-RP and PUS-RP. Our main outcome was pad usage as a surrogate for SUI. Patients were evaluated 4 weeks following RP and again at approximately 3 months. Continence was defined as no pad usage or up to one safety pad per day. Risk factors associated with not being continent were identified using univariate and multivariate analyses. In our cohort, 52 patients underwent RS-RP and 53 patients underwent PUS-RP. The two groups had similar patient demographics. Although not statistically significant, there was a higher rate of a positive surgical margin in the RS-RP compared to PUS-RP (25% vs 15%, p = 0.204). At one month follow-up for PUS-RP and RS-RP, there was no significant difference in the frequency of continent men (69.2% vs. 76.9%, p = 0.302). At 3-month follow-up for the two groups of patients, again, there was no significant difference in the frequency of continence for PUS-RP and RS-RP (86.2% vs 88%, p = 0.824). Patients who underwent RS-RP had similar rates of continence to those patients undergoing PUS-RP in the short-term post-operative period.

Transoral robotic surgery, performed with the da Vinci surgical system (da Vinci), is a surgical approach for benign and malignant lesions of the oral cavity and laryngopharynx. It provides several unique advantages, which include a 3-dimensional magnified view and ability to see and work around curves or angles. However, the current da Vinci surgical system does not provide haptic feedback. This is problematic because the potential risks specific to the transoral use of the da Vinci include tooth injury, mucosal laceration, ocular injury and mandibular fracture. To assess the potential for intraoperative injuries, we measured the load of the endoscope and the instrument of the da Vinci Si surgical system. We pressed the endoscope and instrument of the da Vinci Si against Load cell six times each and measured the dynamic load and the time-to-maximum load. We also struck the da Vinci Si endoscope and instrument against the Load cell six times each and measured the impact load. The maximum dynamic load was 7.27 ± 1.31 kg for the endoscope and 1.90 ± 0.72 for the instrument. The corresponding time-to-maximum loads were 1.72 ± 0.22 and 1.29 ± 0.34 s, but the impact loads were significantly lower than the dynamic load. It remains possible that a major load is exerted on adjacent structures by continuous contact with the endoscope and instrument of da Vinci Si. However, there is a minor delay in reaching the maximum load. Careful monitoring by an on-site assistant may, therefore, help prevent contiguous injury.

The use of robot-assisted laparoscopic radical prostatectomy (RALP) continues to increase in the management of prostate cancer by minimally invasive approach, with shorter convalescence, reduced blood transfusion and improving oncological outcomes when compared to open surgery. There is a growing evidence base that RALP is significantly associated with incisional hernia (IH) at the specimen extraction site compared to open surgery. A series of 186 RALP patients between August 2012 and August 2018 was reviewed, where 1–7 years follow-up had been observed. The study endpoint was IH rate at the supraumbilical specimen extraction site utilized by the surgeon. Incisional hernia rate at specimen extraction site was 8.6% and incidental 1.1% IH rate at a lateral port site (not associated with specimen removal). Average age at operation was 60.9 years old and hernias were diagnosed at a mean of 11.8 months post-surgery. Common demographics in the population suffering from IH were previous abdominal surgery, adhesiolysis, history of smoking and obesity. Supraumbilical extraction site hernias are an underreported complication of RALP which may impact on quality of life and prompt further surgical correction. Patients should be asked for consent regarding the possibility of this complication ensuing.