RESUMEN
BACKGROUND: Robot-assisted microsurgery (RAMS) is gradually becoming the preferred method for some delicate surgical procedures. However, the lack of haptic feedback reduces the safety of the surgery. Surgeons are unable to feel the grasping force between surgical instruments and the patient's tissues, which can easily lead to grasping failure or tissue damage. METHODS: This paper proposes a tendon-driven grasping force feedback mechanism, consisting of a follower hand and a leader hand, to address the lack of grasping force feedback in flexible surgical robots. Considering the friction in the tendon transmission process, a grasping force estimation model is established for the follower hand. The admittance control model is designed for force/position control of the leader hand. RESULTS: Through experimental validation, it has been confirmed that the grasping force sensing range of the follower hand is 0.5-5 N, with a sensing accuracy of 0.3 N. The leader hand is capable of providing feedback forces in the range of 0-5 N, with a static force accuracy of 0.1 N. CONCLUSIONS: The designed mechanism and control strategy can provide the grasping force feedback function. Future work will focus on improving force feedback performance. TRIAL REGISTRATION: This research has no clinical trials.
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Diseño de Equipo , Retroalimentación , Fuerza de la Mano , Procedimientos Quirúrgicos Robotizados , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/instrumentación , Fuerza de la Mano/fisiología , Microcirugia/métodos , Microcirugia/instrumentación , Tendones/cirugía , Tendones/fisiología , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Multicompartmental lesions within the central nervous system are challenging due to their complex anatomy. This study evaluates the efficacy, safety, and utility of hybrid endoscopic and microsurgery versus endoscope-assisted microsurgery(EAM) for excising these lesions. METHODS: A retrospective comparative analysis was conducted on patients who underwent multicompartmental brain tumor surgery, utilizing either hybrid endoscopic and microsurgical techniques with the Endocameleon Hopkins telescope featuring a rotating lens system and knob (Karl Storz GmbH & Co., Tuttlingen, Germany), alternately used with a microscope (ZEISS PENTERO 800 S) (Group 1, n = 69), or endoscope-assisted microsurgery employing a fully high-definition, 45° angled endoscopic tool, QEVO®, integrated into the digital surgical microscope KINEVO 900 (Carl Zeiss Meditec, Oberkochen, Germany) as a plug-in feature (Group 2, n = 63), from July 2018 to March 2024. Data on demographics, clinical presentation, lesion characteristics, surgical details, and outcomes were meticulously collected and analyzed using rigorous statistical methods, including t-tests and chi-square tests. RESULTS: Compared to Group 2, Group 1 had better ease of dissection and visualization of bleeders (p = 0.01) and fewer postoperative hematomas (p = 0.04). Surgical times were similar (p = 0.134). Postoperative follow-up revealed fewer recurrences in Group 1, though not statistically significant (p = 0.33). Group 1 patients reported higher cosmetic satisfaction and shorter hospital stays (p = 0.002). Logistic regression identified tumor vascularity(p = 0.001) and ease of dissection(p = 0.008) as significant factors for recurrence. CONCLUSIONS: Hybrid endoscopic and microsurgery demonstrated superior intraoperative visualization, ease of dissection, and postoperative outcomes compared to endoscope-assisted microsurgery with the Quevo device. These findings suggest that the integrated approach may offer better outcomes for multicompartmental lesion excision regarding safety, efficacy, and patient satisfaction.
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Neoplasias Encefálicas , Microcirugia , Neuroendoscopía , Humanos , Microcirugia/métodos , Microcirugia/instrumentación , Masculino , Femenino , Persona de Mediana Edad , Neoplasias Encefálicas/cirugía , Estudios Retrospectivos , Adulto , Neuroendoscopía/métodos , Neuroendoscopía/instrumentación , Anciano , Resultado del Tratamiento , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/instrumentación , Adulto JovenRESUMEN
Minimally invasive spinal surgery has shown benefits not only from a clinical standpoint but also in some cost-effectiveness metrics. Microendoscopic procedures combine optical advantages of endoscopy with the preservation of bimanual surgical maneuvers that are not feasible with full percutaneous endoscopic procedures. TELIGEN is a new endoscopic platform designed to optimize these operations. Our aim was to present a retrospective review of surgical data from the first consecutive cases applying this device in our institution and describe some of its technical details. 25 patients have underwent procedures using this device at our institution to the date, with a mean follow-up of 341.7 ± 45.1 days. 17 decompression-only procedures, including microendoscopic discectomies (MED) and decompression of stenosis (MEDS), with or without foraminotomies (± MEF) and 8 microendoscopic transforaminal lumbar interbody fusions (ME-TLIF) were performed. Mean age and body mass index (BMI) were respectively 58.8 ± 17.4 years and 27.6 ± 5.3 kg/m2. Estimated blood loss (13 ± 4.8, 12.8 ± 6.98 and 76.3 ± 35.02 mL), postoperative length of hospital stay (11.2 ± 21.74, 22.1 ± 26.85 and 80.7 ± 44.60 h), operative time (130.3 ± 58.53, 121 ± 33.90 and 241.5 ± 45.27 min) and cumulative intraprocedural radiation dose (14.2 ± 6.36, 15.4 ± 12.17 and 72.8 ± 12.26 mGy) are reported in this paper for MED ± MEF, MEDS ± MEF and ME-TLIF, respectively. TELIGEN affords an expanded surgical field of view with unique engineered benefits that provide a promissing platform to enhance minimally invasive spine surgery.
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Vértebras Lumbares , Humanos , Persona de Mediana Edad , Masculino , Femenino , Anciano , Vértebras Lumbares/cirugía , Adulto , Estudios Retrospectivos , Endoscopía/métodos , Descompresión Quirúrgica/métodos , Descompresión Quirúrgica/instrumentación , Fusión Vertebral/métodos , Fusión Vertebral/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Microcirugia/métodos , Microcirugia/instrumentación , Resultado del Tratamiento , Estenosis Espinal/cirugía , Neuroendoscopía/métodos , Neuroendoscopía/instrumentaciónRESUMEN
The anterior communicating artery (AcoA) aneurysms represent the most complex aneurysms of the anterior circulation. For years, surgical challenges including the intricate anatomy and narrow surgical corridor have been overcome using supplementary techniques including extended craniotomies, wide opening of the cisterns, gyrus rectus resection and special clips like fenestrated clips. However, imaginative solutions such as intraoperative clip modification may be inevitable in particular cases for safe clipping. We retrospectively analyzed clinical records of two patients who required clip modification intraoperatively. Case #1 underwent microsurgical clipping of a ruptured, 4-mm AcoA aneurysm. Unfortunately, given the short distance between the two A2s, it was not possible to clip the aneurysm without a compromise to the contralateral A2 with the available shortest 3mm-fenestrated clip. We then used the clip modification technique intraoperatively by shortening the clip tips with mesh-plaque cutter and smoothening the remaining sharp ends using cautery sanding. Eventually, the aneurysm was clipped successfully with the modified-fenestrated clip. Post-clipping imagings confirmed complete occlusion of the aneurysm and patency of parent arteries. Case 2# underwent microsurgical clipping for a ruptured, 1-mm AcoA aneurysm. Like Case 1#, the initial clipping attempt with the available shortest 4mm-fenestrated clip failed given the excessive length of the tips. The patient, thus, required clip modification as described above. The aneurysm was then clipped successfully using the modified-fenestrated clip, protecting bilateral A2s. Post-clipping imagings demonstrated patency of parent arteries with no residual aneurysm filling. Clip modification seems to be an effective option in clipping the AcoA aneurysms when available clips are too long to secure them safely.
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Aneurisma Intracraneal , Instrumentos Quirúrgicos , Humanos , Aneurisma Intracraneal/cirugía , Aneurisma Intracraneal/diagnóstico por imagen , Femenino , Persona de Mediana Edad , Masculino , Aneurisma Roto/cirugía , Aneurisma Roto/diagnóstico por imagen , Estudios Retrospectivos , Microcirugia/instrumentación , Microcirugia/métodos , Diseño de Equipo , Anciano , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/instrumentaciónRESUMEN
This chapter is intended to provide a brief overview of the optics of surgical microscopes and rigid endoscopes, with the aim of providing the reader with the principles dictating the nature of surgical visualization when either of the visual control systems is used. It is not by any means geared toward elaborating on the detailed optical physics of these systems, which is beyond the scope and objective of this chapter.
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Microscopía , Humanos , Microscopía/instrumentación , Microscopía/métodos , Procedimientos Neuroquirúrgicos/instrumentación , Procedimientos Neuroquirúrgicos/métodos , Microcirugia/instrumentación , Microcirugia/métodos , Endoscopios , NeuroendoscopiosRESUMEN
The development of novel robotic devices specifically designed for open microsurgery leads to increasing applications in reconstructive procedures. While initial studies revealed improved precision and surgical ergonomics upon robotic assistance, surgical time was consistently observed to be increased. This study compares two robotic suturing techniques using the Symani Surgical System and RoboticScope in a preclinical setting, to further leverage the benefits of novel robotic devices in microsurgery. Six experienced microsurgeons performed three microvascular anastomoses with a "steady-thread" suturing technique and a "switch-thread" technique on 1.0-mm-diameter artificial silicone vessels. Time for anastomosis and participant's satisfaction with the techniques and robotic setup were recorded. Anastomosis quality and microsurgical skills were assessed using the Anastomosis Lapse Index and Structured Assessment of Microsurgery Skills. Lastly, technical error messages and thread ruptures were quantified. Knot tying was significantly faster and evaluated significantly better by participants using the steady-thread technique (4.11 ± 0.85 vs. 6.40 ± 1.83 min per anastomosis). Moreover, microsurgical skills were rated significantly better using this technique, while both techniques consistently led to high levels of anastomosis quality (2.61 ± 1.21 vs. 3.0 ± 1.29 errors per anastomosis). In contrast, the switch-thread technique was associated with more technical error messages in total (14 vs. 12) and twice as many unintended thread ruptures per anastomosis (1.0 ± 0.88 vs. 0.5 ± 0.69). This study provides evidence for the enhanced performance of a steady-thread suturing technique, which is suggested to be applied upon robot-assisted microsurgical procedures for optimized efficiency.
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Anastomosis Quirúrgica , Microcirugia , Procedimientos Quirúrgicos Robotizados , Técnicas de Sutura , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/instrumentación , Microcirugia/métodos , Microcirugia/instrumentación , Técnicas de Sutura/instrumentación , Anastomosis Quirúrgica/métodos , Humanos , Competencia Clínica , Tempo OperativoAsunto(s)
Procedimientos Endovasculares , Aneurisma Intracraneal , Microcirugia , Humanos , Aneurisma Intracraneal/cirugía , Procedimientos Endovasculares/métodos , Microcirugia/métodos , Microcirugia/instrumentación , Instrumentos Quirúrgicos , Metaanálisis como Asunto , Procedimientos Neuroquirúrgicos/métodosRESUMEN
PURPOSE: To evaluate the use of the latest generation smartphone camera in performing arterial microanastomosis in rats. METHODS: Ten Wistar rats were divided into 2 groups and underwent anastomosis of the right carotid artery with the aid of magnification from a microscope (group M) and a smartphone camera (group S), to compare patency in 72 hours, as well as to measure the weight of the animals, diameter of the carotid arteries and anastomosis time. RESULTS: There was no statistical difference between the weight of the animals or the diameter of the carotid arteries. There was a statistical difference for the time spent on anastomoses, which was greater in group S, with higher rates of thrombosis (p < 0.05). CONCLUSIONS: Although our patency and anastomosis time results were statistically lower in the smartphone group, there was success in some cases. As the segment continues to progress, it is likely that the results will improve in line with the evolution of camera technology.
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Anastomosis Quirúrgica , Arterias Carótidas , Microscopía , Microcirugia , Ratas Wistar , Teléfono Inteligente , Animales , Microcirugia/instrumentación , Microcirugia/métodos , Microscopía/instrumentación , Microscopía/métodos , Anastomosis Quirúrgica/instrumentación , Anastomosis Quirúrgica/métodos , Arterias Carótidas/cirugía , Masculino , Factores de Tiempo , Grado de Desobstrucción Vascular , Ratas , Reproducibilidad de los ResultadosRESUMEN
Objective: To evaluate the efficacy of transoral laser exoscopic surgery (TOLES) in a unicentric series of patients affected by benign and malignant glottic and supraglottic lesions, and compare outcomes with those of transoral laser microsurgery (TOLMS). Methods: To demonstrate the non-inferiority of TOLES in terms of operative time, margin status and complication rates, we compared outcomes of 93 patients treated by TOLES between July 2021 and July 2023 with those of a match-paired group of 107 historical patients treated by TOLMS. To perform a multiparametric ergonomic evaluation of TOLES vs TOLMS, we used observational methods for biomechanical overload risk assessment and wearable technologies comparing 15 procedures with TOLES vs a paired match of 13 surgeries performed with TOLMS by the same surgeon. Results: No significant differences were found in terms of surgical duration, positive margins, or complications between TOLES and TOLMS. Ergonomics assessment by inertial measurement units and electromyographic surface electrodes demonstrated a reduced biomechanical overload with TOLES compared to TOLMS. Conclusions: The many advantages of TOLES, such as its superior didactic value, better digital control of light even through small-bored laryngoscopes, improved binocular vision, and increase in surgical performance by 3 or 4-hand techniques, are difficult to be quantified. In contrast, its non-inferiority in terms of oncological results and better ergonomics compared to TOLMS are demonstrated herein.
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Terapia por Láser , Microcirugia , Humanos , Microcirugia/métodos , Microcirugia/instrumentación , Terapia por Láser/métodos , Terapia por Láser/instrumentación , Masculino , Femenino , Persona de Mediana Edad , Anciano , Boca , Neoplasias Laríngeas/cirugía , Resultado del Tratamiento , Cirugía Endoscópica por Orificios Naturales/métodos , Cirugía Endoscópica por Orificios Naturales/instrumentación , Ergonomía , Adulto , Laringe/cirugíaAsunto(s)
Anastomosis Quirúrgica , Colgajos Tisulares Libres , Neoplasias de Cabeza y Cuello , Procedimientos de Cirugía Plástica , Procedimientos Quirúrgicos Robotizados , Humanos , Colgajos Tisulares Libres/irrigación sanguínea , Anastomosis Quirúrgica/métodos , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/instrumentación , Neoplasias de Cabeza y Cuello/cirugía , Masculino , Persona de Mediana Edad , Microcirugia/métodos , Microcirugia/instrumentación , Anciano , FemeninoRESUMEN
OBJECTIVE: This work aims to review the existing use of robotics in plastic surgery. METHODS: A meticulous selection process identified 22 articles relevant to this scoping review. RESULTS: The literature on the use of robotics in plastic surgery is sparse. Nonetheless, this review highlights emerging benefits in microsurgery, breast reconstruction, and transoral surgery. CONCLUSION: This scoping review identifies critical articles reporting the emerging use of robotics in plastic surgery. While the scientific medical community has yet to extensively document its use, the available evidence suggests a promising future for robotics in this field.
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Procedimientos Quirúrgicos Robotizados , Humanos , Procedimientos Quirúrgicos Robotizados/tendencias , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos de Cirugía Plástica/tendencias , Procedimientos de Cirugía Plástica/métodos , Cirugía Plástica/tendencias , Cirugía Plástica/métodos , Microcirugia/tendencias , Microcirugia/métodos , Microcirugia/instrumentación , Mamoplastia/métodos , Mamoplastia/tendenciasRESUMEN
In robot-assisted microsurgery (RAMS), surgeons often face the challenge of operating with minimal feedback, particularly lacking in haptic feedback. However, most traditional desktop haptic devices have restricted operational areas and limited dexterity. This report describes a novel, lightweight, and low-budget wearable haptic controller for teleoperated microsurgical robotic systems. We designed a wearable haptic interface entirely made using off-the-shelf material-PolyJet Photopolymer, fabricated using liquid and solid hybrid 3D co-printing technology. This interface was designed to resemble human soft tissues and can be wrapped around the fingertips, offering direct contact feedback to the operator. We also demonstrated that the device can be easily integrated with our motion tracking system for remote microsurgery. Two motion tracking methods, marker-based and marker-less, were compared in trajectory-tracking experiments at different depths to find the most effective motion tracking method for our RAMS system. The results indicate that within the 4 to 8 cm tracking range, the marker-based method achieved exceptional detection rates. Furthermore, the performance of three fusion algorithms was compared to establish the unscented Kalman filter as the most accurate and reliable. The effectiveness of the wearable haptic controller was evaluated through user studies focusing on the usefulness of haptic feedback. The results revealed that haptic feedback significantly enhances depth perception for operators during teleoperated RAMS.
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Microcirugia , Procedimientos Quirúrgicos Robotizados , Dispositivos Electrónicos Vestibles , Humanos , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Microcirugia/instrumentación , Algoritmos , Robótica/instrumentación , Diseño de Equipo , Impresión TridimensionalRESUMEN
PURPOSE: To evaluate a system for otomicrosurgery based on 4K three-dimensional (3D) exoscope technology and apply it to cochlear implantation. METHODS: An open stereoscopic vision-based surgical system, which differs from traditional surgical microscopes, was created by utilizing 4K stereo imaging technology and combining it with low-latency 4K ultra-high-definition 3D display. The system underwent evaluation based on 57 cochlear implantation operations, three designed microscopic manipulations, and a questionnaire survey. RESULTS: The surgical images displayed by the 4K-3D exoscope system (4K-3D-ES) are stereoscopic, clear, and smooth. The use of 4K-3D-ES in cochlear implantation is not inferior to traditional microscopes in terms of intraoperative bleeding and surgical complications, and the surgical duration is not slower or may even be faster than when using traditional microscopes. The results of micromanipulation experiments conducted on 16 students also confirmed this and demonstrated that 4K-3D-ES can be easily adapted. Furthermore, additional advantages of 4K-3D-ES were gathered. Significantly enlarged and high-definition stereoscopic images contribute to the visualization of finer anatomical microstructures such as chordae tympani, ensuring safer surgery. Users feel more comfortable in their necks, shoulders, waists, and backs. Real-time shared stereoscopic view for multiple people, convenient for collaboration and teaching. The ear endoscope and 4K-3D-ES enable seamless switching on the same screen. High-definition 3D images and videos can be saved with just one click, making future publication and communication convenient. CONCLUSION: The feasibility and safety of 4K-3D-ES for cochlear implantation surgery have been demonstrated. The 4K-3D-ES also offers numerous unique advantages and holds clinical application and promotional value.
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Implantación Coclear , Humanos , Implantación Coclear/métodos , Implantación Coclear/instrumentación , Masculino , Femenino , Niño , Imagenología Tridimensional/métodos , Adulto , Persona de Mediana Edad , Microcirugia/métodos , Microcirugia/instrumentación , Preescolar , Adolescente , Adulto Joven , Anciano , LactanteAsunto(s)
Procedimientos Endovasculares , Aneurisma Intracraneal , Microcirugia , Humanos , Aneurisma Intracraneal/cirugía , Microcirugia/métodos , Microcirugia/instrumentación , Procedimientos Endovasculares/métodos , Instrumentos Quirúrgicos , Metaanálisis como Asunto , Procedimientos Neuroquirúrgicos/métodosRESUMEN
Millimeter-scale soft continuum robots offer safety and adaptability in transluminal procedures due to their passive compliance, but this feature necessitates interactions with surrounding lumina, leading to potential medical risks and restricted mobility. Here, we introduce a millimeter-scale continuum robot, enabling apical extension while maintaining structural stability. Utilizing phase transition components, the robot executes cycles of tip-based elongation, steered accurately through programmable magnetic fields. Each motion cycle features a solid-like backbone for stability, and a liquid-like component for advancement, thereby enabling autonomous shaping without reliance on environmental interactions. Together with clinical imaging technologies, we demonstrate the capability of navigating through tortuous and fragile lumina to transport microsurgical tools. Once it reaches larger anatomical spaces such as stomach, it can morph into functional 3D structures that serve as surgical tools or sensing units, overcoming the constraints of initially narrow pathways. By leveraging this design paradigm, we anticipate enhanced safety, multi-functionality, and cooperative capabilities among millimeter-scale continuum robots, opening new avenues for transluminal robotic surgery.
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Procedimientos Quirúrgicos Robotizados , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Humanos , Diseño de Equipo , Robótica/instrumentación , Robótica/métodos , Campos Magnéticos , Microcirugia/instrumentación , Microcirugia/métodos , Animales , MagnetismoRESUMEN
PURPOSE: The aim of this study is to compare the outcomes of vascular anastomosis using loupes magnification versus operative microscope magnification in reconstructive surgery. METHODS: We performed a systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library database according to the PRISMA guidelines. Comparative studies between the two techniques and single arm studies reporting on loupes reconstruction were included. Random-effects model meta-analyses were performed. RESULTS: Twelve studies, reporting a total of 3908 of flaps, 3409 of which were performed under loupes magnification and 499 under the operative microscope magnification were selected for analysis. No statistically significant differences were observed regarding total flap loss and vascular complication between the two arms. In the Loupes group the rate of total flap loss was 2.65% (95% CI: 1.15-4.63) and the rate of vascular complications 4.49% (95% CI: 2.58-6.84). CONCLUSION: Loupes magnification under circumstances can provide a safe and effective alternative to microvascular reconstruction in reconstructive surgery. With respect to flap failure and vascular complication rates, there appear to be no statistically significant differences between the anastomoses conducted under Loupes magnification and the standard operative microscope.
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Anastomosis Quirúrgica , Microscopía , Procedimientos de Cirugía Plástica , Humanos , Anastomosis Quirúrgica/métodos , Anastomosis Quirúrgica/instrumentación , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/efectos adversos , Microscopía/métodos , Microscopía/instrumentación , Microcirugia/métodos , Microcirugia/instrumentación , Procedimientos Quirúrgicos Vasculares/métodos , Procedimientos Quirúrgicos Vasculares/instrumentación , Procedimientos Quirúrgicos Vasculares/efectos adversos , Colgajos QuirúrgicosRESUMEN
Many surgical fields profit from robotic support devices. After the first case reports about the use of a special microsurgical roboter (Symani Sugrical System, Medical Microinstruments, Pisa, Italy) we evaluated the potential of such a device in cranio- and maxillofacial surgery in a world's first single-center case series. This novel piece of equipment is meant to assist the surgeon anastomosing small vessels, nerves and lymphatic vessels. In total 30 free flaps were performed and compared to another 30 conventionally anastomosed free flaps. In total 127 anastomoses were surveyed. We encountered a lot of potential for robotic supported operations in the field of cranio- and maxillofacial surgery. However, the surgery time for robotic supported anastomosis with an average time of 32.5 min to perform arterial anastomosis was significant longer than the conventional ones, which needed 11.8 min on average. Tremor Filter and Motion Scaling are promising features for future microsurgery but the grip of the microinstruments has to be improved. It remains to be seen if the potential will be validated after the upcoming learning period and if robotic support devices will prevail in cranio- and maxillofacial surgery.
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Anastomosis Quirúrgica , Colgajos Tisulares Libres , Microcirugia , Procedimientos Quirúrgicos Robotizados , Humanos , Microcirugia/instrumentación , Anastomosis Quirúrgica/instrumentación , Procedimientos Quirúrgicos Robotizados/instrumentación , Masculino , Femenino , Persona de Mediana Edad , Adulto , Tempo Operativo , Anciano , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/métodos , Robótica/instrumentaciónRESUMEN
BACKGROUND: With the introduction of novel surgical robots and surgical microscopes for the special needs of open microsurgery, the concept of robotic-assisted microsurgery is gaining popularity. While initial preclinical studies indicate a steep learning curve, favourable ergonomics and improved precision, albeit with an increased operating time, data on the clinical application of the new systems is still limited. This study describes our first clinical experience with robotic-assisted autologous breast reconstruction and outlines the opportunities and limitations of the approach. PATIENTS AND METHODS: Our retrospective data analysis included a total of 28 patients who underwent unilateral robotic-assisted autologous breast reconstruction between July 2022 and August 2023. We applied a combined approach using the Symani Surgical System together with the RoboticScope. Descriptive evaluation of patient characteristics, surgical data and complications was performed. RESULTS: Average patient age was 54.3±11.1 years and average BMI was 26.5±3.5 kg/m2. Twenty-six patients received a DIEP flap and 2 patients received a PAP flap, the flaps being connected to the internal mammary artery in 22 cases, to a perforator of the internal mammary artery in 5 cases, and to a branch of the thoracodorsal artery in one case. The average incision-suture time was 267±89 min, with an average ischaemia time of 86±20 min and duration of the arterial anastomosis of 29±12 min. In two cases, immediate intraoperative anastomosis revision was performed, but no flap loss occurred. CONCLUSION: The results of this study demonstrate the safe feasibility of robot-assisted autologous breast reconstruction using a combination of Symani and RoboticScope. In the future, special attention should be paid to minimally invasive techniques of flap harvest and connecting vessel preparation.
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Mamoplastia , Microcirugia , Complicaciones Posoperatorias , Procedimientos Quirúrgicos Robotizados , Humanos , Mamoplastia/métodos , Mamoplastia/instrumentación , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/métodos , Microcirugia/métodos , Microcirugia/instrumentación , Femenino , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Complicaciones Posoperatorias/etiología , Anciano , Tempo Operativo , Colgajos Tisulares Libres/cirugía , Neoplasias de la Mama/cirugíaRESUMEN
OBJECTIVE: In light of the recent US Food and Drug Administration (FDA) Class 2 safety recall notice for anastomotic coupling devices, it is important to understand related adverse events. The aim of this study was to characterize adverse events in anastomotic coupling devices for microvascular reconstruction. METHODS: A retrospective cross-sectional analysis using the 2011 to 2021 US FDA Manufacturer and User Facility Device Experience (MAUDE) database. All reports of adverse events involving anastomotic coupling devices were retrieved from the MAUDE database. Descriptive statistics were used to analyze categorized events. RESULTS: There were a total of 293 documented adverse events related to anastomotic coupling devices. These adverse events resulted in 91 (31.1 %) patient injuries and 239 (81.6 %) device malfunctions. The most frequent patient problems were thrombosis/hematoma (n = 38; 41.8 %), unspecified injury (n = 31; 34.1 %), and failure to anastomose (n = 13; 14.3 %). Free flap necrosis was reported in 42 % of thrombosis/hematoma cases (n = 16). The most common malfunctions were devices operating differently than expected (n = 74; 31.0 %), connection problems (n = 41; 17.2 %), and twisted/bent material (n = 19; 7.9 %). There was no significant trend in the number of adverse events over the study period (p > 0.05). CONCLUSIONS: Adverse events from anastomotic coupling devices represent an important and modifiable factor in free tissue failure. Adverse events are predominately related to devices operating differently than expected and may result in vascular compromise of the free flap. Reconstructive surgeons should be cognizant of defective anastomotic coupling devices and be prepared to utilize traditional hand-sewn anastomosis.
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Anastomosis Quirúrgica , Microcirugia , Procedimientos de Cirugía Plástica , Humanos , Estudios Retrospectivos , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/instrumentación , Estudios Transversales , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Microcirugia/instrumentación , Microcirugia/efectos adversos , Falla de Equipo/estadística & datos numéricos , Estados Unidos , Trombosis/etiología , United States Food and Drug Administration , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Colgajos Tisulares Libres/efectos adversos , Bases de Datos FactualesRESUMEN
INTRODUCTION: Video-assisted telescope operating monitor (VITOM®) with 3D Visualization technology was developed and has been used with favorable results by several surgical specialties. Our study aims to be a preliminary report for initial experience using the VITOM® 3D system for microsurgical varicocelectomy on varicocele patients. METHODS: We performed 35 microsurgical varicocelectomy procedures using the VITOM® 3D system on varying types and grades of varicoceles. The surgeon had the option of using either a 2.5 or 3.5 magnifying loupe in addition to the exoscope for each operation evaluated. The exoscope is a standalone camera head with an integrated 3D telescope and remote control with zoom and focus functions. It is connected to the 3D monitor via a mechanical holding arm. During the procedure, surgeons, assistants, and observers were able to view the 3D high-definition stream displayed on a 26-inch 3D monitor at a convenient viewing angle and distance. The varicocele ligation was performed using a Carl Zeiss Meditec AG microscope. RESULTS: There were 35 patients with varicocele aged 31.51 years old on average, which were included in this report. Most patients had grade 3 bilateral varicocele (n = 13, 37.1%). All procedures were performed without any intraoperative complications. After the procedures, only a few patients suffered from postoperative complications. Three patients suffered scrotal edema (8.6%), while another had hydrocele (2.9%). The postoperative pain results were also very minimal from .89 1 day after the operation to .26 3 days after the operation. CONCLUSION: The VITOM® 3D system showed promise in microsurgical varicocelectomy.