This document provides an overview of the current status of robotics in GI surgery. It discusses the history and evolution of surgical robots including early systems like AESOP and da Vinci. The da Vinci system is described in detail, including its design and components. Clinical applications are summarized for various GI procedures like foregut, gastric, hepatic, pancreatic and colorectal surgery. While robotic surgery is shown to be feasible and safe for many GI procedures, the document notes that large comparative studies are still needed to establish clear benefits over laparoscopic approaches.
Robotic surgery :-
Definition
limitations
History
Types
Applications
Advantages and disadvantages
Reference
,robotic surgery ,applications of robotic surgery ,advantages of robotic surgery ,disadvantages of robotic surgery ,uses of robotic surgery ,cardiac surgery ,gynecology ,neurosurgery ,radio surgery ,shared control robotic surgery ,da vinci robotic surgical system ,tele surgery system ,types of robotic surgery ,history of robotic surgery
This document presents the robot Da Vinci the revolutionary endoscopic surgical device to assist remote control surgeries. Integrated Surgical Systems (now Intuitive Surgery, Inc.) redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist. It was approved by FDA in July 2000 for general laparoscopic surgery, in November 2002 for mitral valve repair surgery. The da Vinci robot is currently being used in various fields such as urology, general surgery, gynecology, cardio-thoracic, pediatric and ENT surgery. It provides several advantages to conventional laparoscopy such as 3D vision, motion scaling, intuitive movements, visual immersion and tremor filtration
Robotic surgery :-
Definition
limitations
History
Types
Applications
Advantages and disadvantages
Reference
,robotic surgery ,applications of robotic surgery ,advantages of robotic surgery ,disadvantages of robotic surgery ,uses of robotic surgery ,cardiac surgery ,gynecology ,neurosurgery ,radio surgery ,shared control robotic surgery ,da vinci robotic surgical system ,tele surgery system ,types of robotic surgery ,history of robotic surgery
This document presents the robot Da Vinci the revolutionary endoscopic surgical device to assist remote control surgeries. Integrated Surgical Systems (now Intuitive Surgery, Inc.) redesigned the SRI Green Telepresence Surgery system and created the daVinci Surgical System classified as a master-slave surgical system. It uses true 3-D visualization and EndoWrist. It was approved by FDA in July 2000 for general laparoscopic surgery, in November 2002 for mitral valve repair surgery. The da Vinci robot is currently being used in various fields such as urology, general surgery, gynecology, cardio-thoracic, pediatric and ENT surgery. It provides several advantages to conventional laparoscopy such as 3D vision, motion scaling, intuitive movements, visual immersion and tremor filtration
We live in an age of a new unpreceded wonders. The wonders of the world are not seven any more. The inanimate talk to us. We are flying in the air. More than 65,000-Ton can float over the water in an iron vessel. The Robotic Doctor is already a reality. Reviewing the history of mankind's cumulative experience starting with the ancient very primitive trials and ending with the presence of Robotic and Telesurgery
Clearly show that the major and rapid advances in the whole mankind's life occur only in the last few decades especially the last 10 years ? .
It is a presentation of Robotic Surgery. Medical Science is using so many techniques for performing surgeries. Robotic Surgery is one of them. For detail document please send me mail...abhilashpillai13@gmail.com
Robotic Surgery by muthugomathy and meenakshi shetti.Qualcomm
Here is the very animatedly designed Presentation that explains briefly about Robotic Surgery , Uses of Robobic Surgery, Robotic Surgery Advantages and Disadvantages and about its future scope.
Robotic Surgery(minimally invasive surgery)Sgtm Saha
robotic surgery,minimally invasive surgery,MIS,the vinci surgical process,leproscopy surgey, 5 mins representation,BCDA College of pharmacy, SGTM, Swagatam Saha,WBUT Board,6th sem.
Robotic surgery is a type of minimally invasive surgery. “Minimally invasive” means that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fit through a series of quarter-inch incisions.
This presentation of introduction of laparoscopic surgery made by Dr. R.K. Mishra Director and chief surgeon World Laparoscopy Hospital. Dr. Mishra in this presentation has explained present pas and future of laparoscopic surgery. Laparoscopy is a surgical procedure which uses a special surgical instrument called a laparoscope to look inside the body, or to perform certain operations. World Laparoscopy Hospital is the center of excellence for laparoscopic and da vinci robotic surgery training and considered as one of the best institute in the world. For more detail about laparoscopic surgery please visit: http://www.laparoscopyhospital.com
Minimally invasive liver surgery has recently acquired the surgical robot among the available weapons. In particular, the “Da Vinci” Robot currently represents the operative standard. Liver resections are now increasingly performed robotically. The increased experience has made these robotic procedures ever simpler and safer to perform. In this presentation, we review the basic steps for dealing with a robotic liver resection. The tools available to perform a robotic hepatectomy also occur. However, at the present time, the robotic surgical instruments completely studied and realized for their application on the liver are very few.
We live in an age of a new unpreceded wonders. The wonders of the world are not seven any more. The inanimate talk to us. We are flying in the air. More than 65,000-Ton can float over the water in an iron vessel. The Robotic Doctor is already a reality. Reviewing the history of mankind's cumulative experience starting with the ancient very primitive trials and ending with the presence of Robotic and Telesurgery
Clearly show that the major and rapid advances in the whole mankind's life occur only in the last few decades especially the last 10 years ? .
It is a presentation of Robotic Surgery. Medical Science is using so many techniques for performing surgeries. Robotic Surgery is one of them. For detail document please send me mail...abhilashpillai13@gmail.com
Robotic Surgery by muthugomathy and meenakshi shetti.Qualcomm
Here is the very animatedly designed Presentation that explains briefly about Robotic Surgery , Uses of Robobic Surgery, Robotic Surgery Advantages and Disadvantages and about its future scope.
Robotic Surgery(minimally invasive surgery)Sgtm Saha
robotic surgery,minimally invasive surgery,MIS,the vinci surgical process,leproscopy surgey, 5 mins representation,BCDA College of pharmacy, SGTM, Swagatam Saha,WBUT Board,6th sem.
Robotic surgery is a type of minimally invasive surgery. “Minimally invasive” means that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fit through a series of quarter-inch incisions.
This presentation of introduction of laparoscopic surgery made by Dr. R.K. Mishra Director and chief surgeon World Laparoscopy Hospital. Dr. Mishra in this presentation has explained present pas and future of laparoscopic surgery. Laparoscopy is a surgical procedure which uses a special surgical instrument called a laparoscope to look inside the body, or to perform certain operations. World Laparoscopy Hospital is the center of excellence for laparoscopic and da vinci robotic surgery training and considered as one of the best institute in the world. For more detail about laparoscopic surgery please visit: http://www.laparoscopyhospital.com
Minimally invasive liver surgery has recently acquired the surgical robot among the available weapons. In particular, the “Da Vinci” Robot currently represents the operative standard. Liver resections are now increasingly performed robotically. The increased experience has made these robotic procedures ever simpler and safer to perform. In this presentation, we review the basic steps for dealing with a robotic liver resection. The tools available to perform a robotic hepatectomy also occur. However, at the present time, the robotic surgical instruments completely studied and realized for their application on the liver are very few.
Robot-assisted laparoscopic surgery: Just another toy?Apollo Hospitals
One of the most significant developments in medical technology in the past decade is the advent of Robot-assisted laparoscopic surgery. Laparoscopic surgery has distinct advantages over conventional open surgery, and most gynecological procedures can now be performed by the laparoscopic route. However, the popularity and acceptance of laparoscopic surgery is far from universal, mainly due to the technical difficulties in the procedure. Laparoscopic surgery requires training and skill, and has a long learning curve. Robot-assisted surgery may help overcome some of these problems.
Robotic colorectal surgery technique, advantages, disadvantages and its impac...Apollo Hospitals
The use of robotics in colorectal surgery is gaining momentum of late. Technical advances, such as three-dimensional imaging, a stable camera platform, excellent ergonomics, tremor elimination, ambidextrous capability, motion scaling and instruments with multiple degrees of freedom, have helped many surgeons adapt to it easily. There is a shorter learning curve compared to the standard laparoscopic surgery. This article helps to give an outline as to how robotic colorectal surgery can go a long way in the future of colorectal surgery.
Robotic hysterectomy: A review of indications, technique, outcome, and compli...Apollo Hospitals
Hysterectomy is the second most common surgery performed on women after cesarean section. The advantages of minimally invasive hysterectomy such as reduced hospitalization, quick recovery with more rapid return to normal activities, and less postoperative morbidity are well known. Although most guidelines recommend that minimally invasive hysterectomy should be the standard of care, the gynecologists have been slow in adopting minimally invasive laparoscopic techniques to perform this operation. Since its approval in 2005 for gynecological surgeries, robot-assisted hysterectomy has been found to be feasible and safe both in benign and malignant indications. This significant difference is mainly due to ergonomics, endowrist movements of instruments, and stereoscopic three-dimensional magnified vision. The specific indications for hysterectomy where the robotic technology can benefit women are the ones with adhesions such as severe endometriosis, large uterus with large or multiple fibroids, early carcinoma cervix, and/or endometrial carcinoma. However the main benefit of this procedure was seen in the reduction of open surgery including conversions during laparoscopic hysterectomies. In the long run, we need to critically examine the long-term benefits and appropriate indications for robot-assisted hysterectomy especially in benign conditions, thus reducing the incidence of open surgery in gynecology. This review describes the operative procedure of robotic hysterectomy in eight steps.
On July 11, 2000, the Food and Drug Administration (FDA) approved the first completely robotic surgery device, the da Vinci surgical system from Intuitive Surgical (Mountain View, CA).
Chemotherapy for liver metastases from colorectal cancer now makes it possible to reduce their size. Sometimes these metastases can even disappear. This does not mean that the metastases are cured and surgical removal is always advisable. The main problem is how to identify these "vanishing" metastases during liver resection and how to perform truly effective interventions from an oncological point of view.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
3. History
Derived from the Czech word robota, meaning “forced labor.”
Word robot first used by Capek in play Rossum's Universal Robots in 1921
First developed by NASA for use in space exploration.
Satava RM. Surg Laparosc Endosc Percutan Tech 2002
Murphy D et al. Postgrad Med J 2006
Mid-1990s –
Automated Endoscopic System for Optimal Positioning (AESOP) for
voice-controlled optimal camera positioning, and
Laparoscopic Assisted Robotic Systems (LARS) for organ retraction.
1997 - DaVinci system (Intuitive Surgical)
US FDA approval in 2000
Bought Zeus system
Schurr MO et al. Surg Endosc 2000
4. 1997 – first robotic cholecystectomy
1998 – first robotically assisted heart bypass by Dr Friedrich Wilhelm Mohr
using Da Vinci
2007 – first robotic pancreatectomy by Prof Pier Giulianotti at Chicago
2008 – first minimally invasive liver resection for LDLT
Surge in no. of cases
1500 cases in 2000 to 20000 in 2004
Majority : Urology procedures (prostatectomy)
Marescaux and colleagues - first robot-assisted laparoscopic cholecystectomy
between New York and Strausbourg, France, 2001
Marescaux J et al. Nature 2001
Marescaux J et al. Ann Surg 2002
5. Definitions
Robotic surgery –
autonomous, reprogrammable manipulator designed to move and articulate
instruments through programmed motions to achieve specific task.
Robotically assisted surgery –
mechanical devices under partially programmed control by surgeon's
intervention.
Telesurgery – ability to perform surgery using computer-assisted
instruments from remote location.
Telemanipulation – ability to produce electronically precise instrument
movements at distance from remote location.
Telepresence – virtual projection of images from remote sites. Allows
surgeon to visualize intended robotic movements at distant locations.
Telementoring – supervision and instruction from distant location
6. 7 degrees of freedom -
1. three arm movements (in out, up down, side
to side),
2. three wrist movements (side to side, up and
down, roll) and
3. grasping or cutting.
7. Types of robots
Industrial robots –
preprogrammed highly precise, repetitive tasks
tasks invoked on command
used in orthopedic surgery and neurosurgery
Assist device –
control instrument location under guidance
not autonomous, need input cues
AESOP
Telemanipulator –
under constant control
da Vinci
8. daVinci Surgical System (dVSS)
Developed by Intuitive Surgical (Sunny Valley, California) designed to enable and
enhance Minimally invasive surgery.
First surgical robotics system cleared in 2000 by US FDA
Initially for laparoscopic surgery, later for thoracoscopic, urologic, gynecologic
surgeries, and some cardiac procedures
Computer enhances interaction between surgeon and bedside robotic device by
1) Eliminating tremors
2) Scaling all motions to a selected degree.
Evolution- S version in 2006 to Si (2009) and finally da Vinci Xi cleared in 2014.
By 2014, 2585 systems installed worldwide ( 1878 USA, 416 Europe and 291 rest of
the world)
10. Surgical Console
Viewing space similar to double-
eyepiece microscope – 3D Vision
Manipulation with two masters –
levers attached to index fingers and
thumbs of each hand.
Wrist movements replicate movements
of instruments at end of robotic arms.
Foot pedals for
Disengaging robotic motions
Allowing adjustment of endoscopic
camera, and
Controlling energy of electric
cauterization.
Allows more precise surgical
procedures and intuitive orientation
makes tasks easier.
11. Optical tower
Computer equipment
1. Integrate left and right
optical channels for
stereoscopic vision
2. Run software for controlling
kinematics of robotic arms.
Interfaces translated motion of
surgeon's hands to digital code
that moves mechanical levers,
motors, and cables
Four arms for real time manipulation
by surgeon
First two arms represent surgeon's
right and left arms,
Third arm positions endoscope.
Optional fourth arm to hold another
instrument or additional tasks
Bulky and very heavy- wheeled to
vicinity of patient and locked
Patient must be guarded against
inadvertent contact from motions of
robotic arms.
After instruments are engaged and
inside patient, patient's body position
cannot be modified unless
instruments are disengaged and
removed
Patient cart
12.
13. Improved ergonomics
Stabilisation of instruments with mechanical advantage over traditional
laparoscopy
14. daVinci Clinical Applications
Although great promise across broad range of
surgical disciplines, no Level 1 data to strongly
support RS.
15. Robotics in GI Surgery
FOREGUT SURGERY
Some of the largest data sets for Robotic GI surgery, mainly
Nissen fundoplication and Heller Myotomy.
Robotic assisted Laparoscopic Heller Myotomy ( RALHM)
was reported in 2001 followed by a small case series.
Universities across the US prospectively collected data of
104 cases of RALHM and found
1. Both lap and robotic safe and low complication rates.
2. However no clear benefit seen in robotic group.
16. Horgan et al (2016) reported an esophageal perforation
rate of 16% in their LHM group compared with 0% for
the RALHM group.
Several RCTs compared robotic vs lap Nissen
fundoplication
1. No distinct advantage offered by robot aside from
increased operative time.
2. Owen et al (2013) at University of Nebraska reported
similar outcomes except increased cost.
17. General GI procedures –
Tomulescu V, Romania
129 procedures in 1 yr
Cholecystectomy, fundoplication, gastrectomy, gastro- enterostomies and
bowel anastomosis, splenectomy, adrenalectomy, liver cyst fenestration
Best indications: 1) procedures that require small operating field,
2) fine precise dissection and
3) safe intracorporeal sutures.
Tomulescu V. Chirurgia. 2009
18. ROBOTIC GASTRECTOMY
Guilianotti in 2003 first reported robotics in management of
gastric cancer.
Limited comparison series exist between robotic and lap
gastrectomy.
Kim et al (2017) compared robotic vs lap vs open looking
specifically at oncologic outcomes
1. LN harvest did not differ significantly.
2. Robotic surgery associated with less blood loss.
3. Shorter hospital stay with robotic surgery.
Morbidity 9-30% and mortaliy 0-9% in literature.
19. GI luminal malignancies –
Anderson C, CA
73 procedures in 3 yrs
Esophagectomy, gastrectomy, proctectomy
Leak rate : 16, 9 and 11% resp.
LN harvested : 22, 26 and 13 resp.
One recurrence at 9m & 30 day mortality zero
Safe and feasible for variety of radical oncological procedures
Anderson C. Int J Med Robot. 2007
20. BARIATRIC SURGERY
Only operative procedure studied in any volume is the Roux en
Y Gastric Bypass (RYGB).
Totally robotic RYGB has beein described in 5 systemic
reviewsas a safe and effective alternative to open and lap
techniques.
All published reviews report non inferiority and fail to
demonstrate superiority of robotic approach over std.
laparosopy due to lack of high quality data.
An RCT by Sanchez et al in 2005 showed equivalent outcomes.
21. Data from case control studies show some benefit in
reducing GJ Leaks, strictures and length of stay, non being
statistically significant.
However facilitates hand sewn GJ offering several
advantages compared to laparoscopy
1. Added degrees of freedom
2. Ambidextrous suture placement
However paucity of data comparing the two approaches.
22. Described for both benign and malignant hepatic resections.
No RCT however exists to compare robotic assistance with conventional lap for
hepatic resections
Giulianotti PC, University of Illinois, Chicago
70 resections by single surgeon
60% malignant; 40% benign
Median duration for major resection : 313 min
minor resection : 198 min
Median blood loss : 150 ml
Mortality nil and morbidity 21%
Conversion rate : 5.7%
Safe, with min conversion, blood loss, morbidity
Giulianotti PC. Surgery. 2011
ROBOTIC LIVER SURGERY
23. A systematic review of literature by Berber et al in 2010
-19 case series reviewed
-236 robotic provedures in 219 patients
-Both benign and malignant tumors included.
-Tumor size up to 6.4 cm.
-Wedge resection was most common procedure f/b Right
hepatectomy, left lateral sectionectomy, left hepatectomy
and
bisegmentectomy.
-Conversion to open in 10 cases (4.6%)
-Morbidity rates 20.3% cited with MC being Intra abdominal
biloma or abscess in 6-7% each.
-No mortality reported.
Robotic hepatectomy feasible but comparisons to evaluate
oncologic outcomes, cost effectiveness and morbidity cannot be
determined with existing data.
24. ROBOT ASSISTED PANCREATIC SURGERY
Procedures described include Whipple, Distal pancreatectomy, central
pancreatectomy, enucleation, appleby procedure and Frey procedure.
Similar to hepatic resections, no RCTs exist to compare open vs lap vs
robotic pancreatic resections.
Giulianotti PC, University of Illinois, Chicago
134 patients over 9 yrs
Mean operating time : 331 min
Conversion : 10.4%
Mortality 2.23% and morbidity 26%
Safe & feasible, with morbidity and mortality same as open surgery
Giulianotti PC. Surg Endosc. 2010
25. ROBOTIC COLORECTAL SURGERY
Weber et al reported the first adaptation of the da Vinci system
for colorectal procedures in 2002.
Delaney et al evaluated the perioperative outcomes for 6
matched robotic vs lap colorectal procedures.
1. Length of hospitalization, blood loss and incision length were
the same.
2. Robotic procedures were associated with increased operative
time.
Potential benefits in cases involving rectal pelvic dissection.
Some studies have shown positive outcomes for Total
mesorectal excision (TME) and cylindrical excision for low
26. Greatest utilization of robotic advancements currently is centered
on TME.
3D visualization and wristed instruments afford advantages for
nerve sparing over conventional techniques.
Short term outcomes similar, costs higher, trends towards
improved sexual and bladder function present but without
significance.
No clear advantage over lap for benign diseases like rectal
prolapse and complicated diverticulitis.
Rationalized on a case to case basis ( especially narrow pelvic
anatomy, low rectal tumors or morbid obesity)
27. Mesorectal excision for rectal cancer –
deSouza AL, Illinois, USA.
44 patients in 4 yrs
88.7% in mid/ lower rectum
36 LAR & 8 APR
LNs : median 14 (5-45)
Circumferential margin negative in all, distal margin positive in 2.7%,
leak in 5.6%, death 2.7%
Conversion 4.5%
deSouza AL. Dis Colon Rectum. 2010
28.
29. Robotic vs Laparoscopic resection for rectal cancer-
ROLARR Study
(University of California, Irvine)
CONCLUSIONS AND RELEVANCE:
Among patients with rectal adenocarcinoma suitable for curative resection, robotic-assisted laparoscopic
surgery, as compared with conventional laparoscopic surgery, did not significantly reduce the risk of
conversion to open laparotomy. These findings suggest that robotic-assisted laparoscopic surgery, when
performed by surgeons with varying experience with robotic surgery, does not confer an advantage in
rectal cancer resection.
30. ROBOTIC HERNIA REPAIR
Inguinal hernia
Provides surgeon with more comfortable, ergonomic position than
laparoscopic approach.
Feasible immediately following robotic prostatectomy.
Ito F. J Laparoendosc Adv Surg Tech A. 2008
31. With the advent of robotics, larger and more complex hernia repairs are
being approached in a minimally invasive fashion.
Benefits of fascial closure, retrorectus placement of the mesh, rectus muscle
release, and intraperitoneal suturing of the mesh are facilitated by the
minimally invasive robotic platform.
33. daVinci Clinical Limitations
1. No advantage over laparoscopy for cholecystectomy, splenectomy,
colectomy
2. Increased operative time
3. Open space: limitations with broad sweeping motions
4. Lack of haptic feedback while operating
5. Inability to switch instruments as well as operating field during
procedure ( problem with multi quadrant surgery)
6. Large size of the robot with bulky arms
34. Limitations/Complications
Mechanical failure/ malfunction (0.4-4.6%)
On/off failure
Console malfunctions
Robotic arm malfunctions
Malfunctions of optic system, and
System (software) errors
Instrument malfunction (1.1%)
Conversion to laparoscopy/ open (0.17%)
Won Tae Kim. Urology. December 2009
35. Recent Developments
Decreasing size of robot – RAVEN
Ward rounds – RP-7
Telesurgery - Increasing distance between surgeon and
patient
NOTES
36. RAVEN : Washington University
Can be mounted on patient and controlled remotely
38. Telesurgery along with telementoring
Trans Atlantic Cholecystectomy by Marescaux and
colleagues
Mentoring surgeons of Canada
Marescaux J et al. Nature 2001
Sebajang H et al. Surg Endosc 2006
39. NOTES
Avoids wound infections, reduces pain, and improves
cosmetics and recovery times
First transvaginal assisted cholecystectomy in US - March
2007
First transgastric cholecystectomy in US - June 2007
Limitations with conventional endoscope
limited two dimensional image
Lack of triangulation
4 degrees of freedom
Gastrointest Endosc 2006
40. ONGOING TRIALS
Robotic vs Laparoscopic Cholecystectomy- Outcomes and
cost analyses at University of Zurich.
Robotic vs Laparoscopic surgery for right colon cancer-
RCT at Kyongpook National University
Clinical and health economic impact of robot assisted
surgery vs conventional laparoscopy- A case for GBP from
IHU, Strasbourg.
Robotic vs Laparoscopic abdominal wall hernia repair-
Assistance publique ( Hospitaux de Paris)
41. Problems to be addressed
The pricing especially in developing countries is a
major concern.
Training system fro surgeons.
Following systems should be developed further
1. Image guided surgical assistant system
2. Smaller sized forceps for robots
3. Capsule endoscopic surgery
4. Training centres to be established across the world.
42. Summary
dVSS remains the only commercially available therapeutic robotic
system .
Telesurgery, telementoring & telepresence.
Robotic surgery has already proven to be of great value, particularly
in areas inaccessible to conventional laparoscopy.
Doubtful if conventional laparoscopy is replaceable in less
technically demanding procedures.
Whether or not benefit of its usage overcomes cost remains to be
seen.
Although feasibility shown, more prospective randomized trials
evaluating efficacy and safety must be undertaken.
43. “It is well to remember that, in the 19th century, surgery
was thought to have reached its apogee – but the best is
yet to come.”
Fortner JG, Blumgart LH. J Am Coll Surg 2001