Robotic endoscopy: a review of the literature

Purpose To present new endoscopic robotic devices in the context of minimally invasive procedures with high precision and automation. Methods Review of the literature by December 2018 on robotic endoscopy. Results We present the studies and investments for robotic implementation and flexible endoscopy evolution. We divided them into forceps manipulation platforms, active endoscopy and endoscopic capsule. They try to improve forceps handling and stability and to promote active movement. Conclusion The implementation and propagation of robotic models depend on doing what the endoscopist is unable to. The new devices are moving forward in this direction.(AU)

New trends in translational microsurgery

Technological advances such as optical instruments and surgical tools have enabled the considerable contributions of microsurgery to surgical therapies. Accordingly, surgical therapeutics has provided the latest information across a wide range of medical specialties, including immunology and pharmacology, despite specialization according to organs and organ systems. The International Society for Experimental Microsurgery, an academic organization, has utilized experimental microsurgery technology in the identification of curative concepts for diseases that remain difficult to treat. For this publication to mark the 32nd anniversary of the Brazilian Surgical Society, I introduced the following types of technology related to the further development of microsurgical technological innovations in the future: high-resolution three-dimensional (3D) video and touch-sensitive microsurgery robots.(AU)

Is previous experience in laparoscopic necessary to perform robotic radical prostatectomy? A comparative study with robotic and the classic open procedure in patients with prostate cancer

PURPOSE: To assess comparative results of robot-assisted radical laparoscopic prostatectomy (RARP) performed by surgeons without any experience in laparoscopic prostatectomy and the open procedure performed by surgeons with large experience. METHODS: We analyzed 84 patients (50 subjected to robotic surgery) from June 2012 to September 2013. Data were prospectively collected in a customized database. Two surgeons carried out all the RARP cases. These two surgeons and six more performed the open cases. The perioperative outcomes between the two groups were analyzed with a minimum followup of 12 months. RESULTS: The corporal mass index (BMI) was higher in the open group (p=0.001). There was more operatve time, less hospitalization and blood loss, better trifecta and pentafecta and earlier continence (p=0.045) in the robotic group (p=0.001). There was no difference in positive surgical margins but with greater extraprostatic extension in the open group (p=0.002). CONCLUSIONS: Robot-assisted radical prostatectomy is a safe procedure even in the hands of surgeons with no previous experience. Besides this, better operative outcomes can be reached with this modern approach.(AU)

Cirurgia robótica em medicina veterinária / Robotic Surgery in veterinary medicine

A cirurgia robótica tem sido vista como um avanço tecnológico para a videocirurgia. Bem como uma nova categoria de cirurgia minimamente invasiva. Este trabalho objetiva realizar uma revisão sobre a cirurgia robótica, considerando sua futura aplicabilidade na medicina veterinária. O desenvolvimento da Cirurgia Robótica representa uma tentativa para minimizar alguns obstáculos técnicos da laparoscopia, tornando a prática cirúrgica mais precisa, e mais fácil o aprendizado cirúrgico, enquanto diminui ainda mais o trauma. No entanto, é necessário um treinamento específico e possui alto custo. Apesar desses fatores, a cirurgia robótica poderá ser um importante instrumento no futuro da videocirurgia veterinária(AU)

Robotic surgery has been seen as a breakthrough laparoscopy surgical technologic and a new category of minimally invasive surgery. This paper aims to perform a robotic surgery review, considering its future applicability in veterinary medicine. Development of Robotic Surgery represents an endeavours to minimize some of technical laparoscopic hindrances, enhance more precise surgical practice, making na easier learning surgery, while still minimizing surgical trauma. However, a very specific training is required and represents a high cost. Despite these facts, robotic surgery may be an important instrument in veterinary videosurgery future(AU)

Cirurgia robótica em medicina veterinária / Robotic Surgery in veterinary medicine

A cirurgia robótica tem sido vista como um avanço tecnológico para a videocirurgia. Bem como uma nova categoria de cirurgia minimamente invasiva. Este trabalho objetiva realizar uma revisão sobre a cirurgia robótica, considerando sua futura aplicabilidade na medicina veterinária. O desenvolvimento da Cirurgia Robótica representa uma tentativa para minimizar alguns obstáculos técnicos da laparoscopia, tornando a prática cirúrgica mais precisa, e mais fácil o aprendizado cirúrgico, enquanto diminui ainda mais o trauma. No entanto, é necessário um treinamento específico e possui alto custo. Apesar desses fatores, a cirurgia robótica poderá ser um importante instrumento no futuro da videocirurgia veterinária

Robotic surgery has been seen as a breakthrough laparoscopy surgical technologic and a new category of minimally invasive surgery. This paper aims to perform a robotic surgery review, considering its future applicability in veterinary medicine. Development of Robotic Surgery represents an endeavours to minimize some of technical laparoscopic hindrances, enhance more precise surgical practice, making na easier learning surgery, while still minimizing surgical trauma. However, a very specific training is required and represents a high cost. Despite these facts, robotic surgery may be an important instrument in veterinary videosurgery future

Telerobotic-assisted laparoscopic operation performed at a remote site: initial experience

Robotic surgery is an option to laparoscopy that may offer some benefits including the possibility of performing surgery when the surgeon is geographically away from the patient and faster tireless repetitive movements with greater precision. At present, robot-assisted surgery has been done routinely in several institutions around the world, however, to the best of our knowledge, it is the first time such procedure is performed in our academic environment and herein is reported the first telerobotic-assisted laparoscopic cystectomy performed in a domestic pig at our institution using the Zeus®robotic system (Computer Motion, EUA). The procedure was performed using two different operating rooms geographically apart from each other. The assistant was in an operating room that was set with the operating table and the pig as well as with the Zeus® robotic arms. In the other operating room, the surgeon was seated in the control console with a three-dimensional imaging five meters away from the operating table connected with electric cables. The assistant surgeon established the pneumoperitoneum and five trocars were placed in a fan configuration. The surgeon started performing the surgery using three out of the five ports taking control of the laparoscope (voice control) and manual control of laparoscopic instruments connected to the robotic arms using the joysticks. The other two ports were used by the assistant for traction and clips placement that was also necessary for exchanging the many laparoscopic instruments connected to the robot. The laparoscopic total cystectomy was successfully performed in 25 minutes with no complications. The truly benefits as well as the cost-effectiveness of the robotic surgery in our environment is yet to be determined after experience acquisition with telerobotic before start performing such procedures routinely in humans. The present report shows the technical feasibility of telerobotic surgery in a developing country.

A cirurgia totalmente robotizada é uma opção à laparoscopia que pode proporcionar alguns benefícios, entre os quais a realização dos incansáveis movimentos de repetição com maior precisão e rapidez e com o cirurgião localizado em ambiente geograficamente diferente do paciente. Relatamos, em nossa instituição, a primeira cistectomia totalmente robotizada à distância em um porco (raça Landrace) doméstico com o sistema robótico Zeus® (Computer Motion, EUA). A cirurgia foi realizada em duas salas geograficamente separadas, sendo que em uma delas, o porco foi posicionado na mesa cirúrgica bem como os braços do sistema Zeus® fixados de forma segura. Na seqüência, o assistente introduziu os cinco trocateres em forma de leque pela via transperitoneal após obtenção do pneumoperitônio pelo método fechado. Em outra sala, o cirurgião principal comandava os braços do robô através de controles manuais sentado dentro do console de comando do sistema Zeus ®, auxiliado por imagem de vídeo em três dimensões transmitida pelo laparoscópio, que era comandado por sistema de voz, pelo cirurgião. A distância do console de comando e da mesa cirúrgica era de 5 metros e estes estavam conectados por cabos elétricos. A cistectomia total foi realizada em 25 minutos sem intercorrências. O assistente auxiliou apenas nas manobras de troca de instrumento do sistema Zeus ®, apresentação dos tecidos e introdução do clipador, utilizando apenas dois trocartes. Os reais benefícios do sistema robótico em nosso meio ainda será determinado através da aquisição de maior experiência com o sistema e pelo início da realização deste procedimento em humanos.