Objective To summarize the current research progress of endoscopic/robotic surgery for breast cancer, so as to provide theoretical basis for surgeons and patients to choose surgical methods. Method The relevant literatures on breast cancer endoscopic/robotic surgery at home and abroad in recent years were summarized and reviewed. Results Endoscopic/robotic surgery for breast cancer had the advantages of low intraoperative bleeding, fewer postoperative complications, fast postoperative recovery, good cosmetic results and high patient satisfaction. Conclusions Endoscopic/robotic surgery is a safe and feasible surgical modality and a complement to traditional open breast surgery.
ObjectiveTo compare the short-term outcomes of surgical repair for atrial septal defect (ASD) with a robotic (da Vinci Si) approach versus a conventional open procedure.MethodsClinical data of 140 patients undergoing ASD closure in the First Affiliated Hospital of Anhui Medical University from January 2016 to May 2020 were retrospectively analyzed. The patients were divided into a robotic group and a sternotomy group according to different surgical methods. In the robotic group, there were 67 patients including 20 males and 47 females at a median age of 40.0 (25.0) years, and in the sternotomy group there were 73 patients including 23 males and 50 females at a median age of 41.0 (29.0) years. Multivariate linear regressions were used to produce risk-adjusted analysis of pertinent clinical characteristics. Kaplan-Meier analysis was performed to compare the speed of sternotomy versus robotic group returning to exercise or daily life.ResultsRobotic-assisted surgery was associated with significantly shorter 24 h postoperative drainage volume [220.0 (210.0) mL vs. 345.0 (265.0) mL, P<0.001], mechanical ventilation [6.0 (11.0) h vs. 8.0 (11.0) h, P=0.024], intensive care unit length of stay (LOS) [19.0 (19.0) h vs. 22.0 (25.0) h, P=0.005], postoperative hospital LOS [9.0 (5.0) d vs. 10.0(6.0) d, P=0.003], and a lower rate of perioperative blood transfusion (28.36% vs. 84.93%, P<0.001). After controlling for patient comorbidity in the multiple regression model, there remained a trend toward decreased 24 h postoperative drainage volume (β=–115.30, 95%CI–170.78 to –59.82, P<0.001), mechanical ventilation (β=–4.96, 95%CI –8.33 to –1.59, P=0.004) and postoperative hospital LOS (β=–2.31, 95%CI –3.98 to –0.63, P=0.007) in the robotic group. Kaplan-Meier analysis revealed that patients returned to exercise or daily life earlier in the robotic group [35.0 (32.0) d vs. 90.0 (75.0) d, P<0.001].ConclusionClosure of ASD can be performed safely and effectively via robotic approach. And the minimally invasive technique is beneficial to postoperative recovery.
Objective To evaluate the safety and feasibility of remote robot-assisted thoracoscopic surgery utilizing 5G technology. Methods Clinical data from five patients who underwent 5G remote robot-assisted thoracoscopic surgery at the Thoracic Surgery Center of Gansu Provincial People's Hospital from May to October 2024 were retrospectively analyzed. Results Finally, five patients were included. There were 2 males and 3 females at median age of 50 (42-63) years. All five surgeries (including 1 patient of lobectomy, 3 patients of partial lung resection and 1 patient of mediastinal lesion resection) were successfully completed without conversion to thoracotomy, complications, or mortality. The median intraoperative signal delay across the patients was 39 (37-42) ms. The median psychological load score for the surgeons was 9 (3-13). The median operation time was 100 (80-122) minutes with a median intraoperative blood loss of 100 (30-200) mL. Catheter drainage lasted a median of 4 (3-5) days, and the median drainage volumes on the first, second, and third postoperative day were 200 (100-300) mL, 150 (60-220) mL, and 80 (30-180) mL, respectively. The median postoperative hospital stay was 4 (3-7) days, and the median pain scores on the third postoperative day were 3 (1-4), 3 (0-3), and 1 (0-3), respectively. Conclusion 5G remote robot-assisted thoracoscopic surgery is safe and effective, with good surgical experience, smooth operation and small intraoperative delay.
Nowadays, thoracoscopic laparoscopic esophagectomy (TLE) has been widely used in the treatment of esophageal cancer. In recent years, robot assisted minimally invasive esophagectomy (RAMIE) has been developing vigorously. According to the research progress and practical experience in the world, RAMIE has the same safety and effectiveness as TLE. In this paper, several aspects on this novel operation were demonstrated, including the safety evaluation, lymph node dissection, prognosis of RAMIE, comparison of RAMIE and TLE, and the role of RAMIE in multidisciplinary treatment of esophageal cancer, in order to promote the rational application of RAMIE in esophagectomy.
Thymectomy is an important treatment for thymoma and myasthenia gravis. The application of minimally invasive surgery to complete thymectomy and rapid recovery of patients after surgery is a developmental goal in thoracic surgery technology. Surgical robots have many technical advantages and are applied for many years in mediastinal tumor resections, a process that has led to its recognition. We published this consensus with the aim of examining how to ensure surgical safety based on the premise that better use of surgical robots achieving rapid recovery after surgery. We invited multiple experts in thoracic surgery to discuss the safety and technical issues of thymectomy under nonintubated anesthesia, and the consensus was made after several explorations and modifications.
The kinematic model parameter deviation is the main factor affecting the positioning accuracy of neurosurgical robots. To obtain more realistic kinematic model parameters, this paper proposes an automatic parameters identification and accuracy evaluation method. First, an identification equation contains all robot kinematics parameter was established. Second, a multiple-pivot strategy was proposed to find the relationship between end-effector and tracking marker. Then, the relative distance error and the inverse kinematic coincidence error were designed to evaluate the identification accuracy. Finally, an automatic robot parameter identification and accuracy evaluation system were developed. We tested our method on both laboratory prototypes and real neurosurgical robots. The results show that this method can realize the neurosurgical robot kinematics model parameters identification and evaluation stably and quickly. Using the identified parameters to control the robot can reduce the robot relative distance error by 33.96% and the inverse kinematics consistency error by 67.30%.
In conventional open breast surgery, the surgical trauma is significant and the postoperative scar is often noticeable. Endoscopic and robot-assisted breast surgery is increasingly attracting attention due to the advantages such as smaller incisions, lower complication rate, and improved aesthetic outcomes. However, the lack of natural cavities in the breast has become a primary challenge in establishing and maintaining the necessary surgical space for endoscopic breast surgery. We reviewed the research progress of endoscopic and robot-assisted breast surgery, summarized the the innovations and challenges of existing techniques, and focused on introducing the application value of physical and biological properties of gas and liquid in endoscopic breast surgery.
Objective To present the preliminary clinical experience of robot assisted trans-subxiphoid (extended) thymectomy in patients with thymic neoplasms or myasthenia gravis. Methods A total of 62 patients (34 males and 28 females at an average age of 38±11 years) suffering from thymic neoplasms or myasthenia gravis who underwent robotic (extended) thymectomy via subxiphoid approach were included in our department between August 2016 and August 2017. All of the operation were completed through 4 ports. In details, the observation hole was created just below the xiphoid process, two ports for arm 1 and arm 2 were created below bilateral subcostal arch at the midclavicular line, and trocar for arm 3 was placed in the 5th or 6th intercostal space at the anterior axillary line, respectively. Patients with thymic neoplasms received thymectomy. Patients with myasthenia gravis received extended thymectomy. Results All the patients experienced uneventful operations. The mean operative time was 116.0±34.0 min. The mean intraoperative blood loss was 5.6±4.3 ml. The mean postoperative hospital stay was 4.0±2.2 days. There was no intra-operational massive hemorrhage, mortality, conversion or postoperative complication during the postoperative and follow-up period. Conclusion Robotic trans-subxiphoid thymectomy is safe and feasible, which is a promising technique for extensive application.
ObjectiveThe aim of this study was to evaluate the safety and feasibility of robot-assisted surgery in pancreatic cancer.MethodRecent literatures related to robot-assisted surgery in treatment of pancreatic cancer compared with traditional open surgery or traditional laparoscopic surgery were collected to make an review.ResultsCompared with the traditional laparoscopic surgery, the robot-assisted surgery was expensive, with the obvious advantages in terms of anastomosis and reconstruction. Compared with the open operation, both robot-assisted pancreaticoduodenectomy and robot-assisted distal pancreatectomy had longer operation time, but the length of hospital stay and intraoperative blood loss were obviously shortened, robot-assisted distal pancreatectomy also had higher spleen preservation rate. Compared with the traditional laparoscopic distal pancreatectomy, the number of lymph node retrieved, R0 resection rate, and splenic preservation rate were also higher in the robot-assisted group. Simultaneously, robot-assisted total pancreatectomy and midsection pancreatectomy were deemed as safe in some high-volume centers.ConclusionsRobot-assisted pancreatic cancer surgery is safe and feasible, but many surgeries are restricted to a small number of high-volume medical centers, and most cases selected to undergo robot-assisted surgery are often early stage patients with small tumor size. A lot of efforts should be made and problems should be solved.
The technical combination of artificial intelligence (AI) and thoracic surgery is increasingly close, especially in the field of image recognition and pathology diagnosis. Additionally, robotic surgery, as a representative of high-end technology in minimally invasive surgery is flourishing. What progress has been or will be made in robotic surgery in the era of AI? This article aims to summarize the application status of AI in thoracic surgery and progress in robotic surgery, and looks ahead the future.