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1.
Urologiia ; (5): 54-60, 2020 Nov.
Artigo em Russo | MEDLINE | ID: mdl-33185348

RESUMO

INTRODUCTION: Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder formation is a complex surgical procedure. AIM: To describe the main stages of RARC and to analyze its short-term results. MATERIALS AND METHODS: RARC with ileocystoplasty was performed in 16 patients, most of whom were men (n=14). In 15 patients, the indication for surgery was bladder cancer (BCa), while one patient has radiation-induced sigmoid fistula with a formation of small, contracted bladder. During radical cystectomy (RC), the lower ureters were dissected, followed by posterior dissection of the bladder with mobilization from both sides to the pelvic fascia, clipping and transection of the vesical pedicles, and suturing of the dorsal venous complex with urethral dissection. After pelvic lymph node dissection, 40 cm of the ileum was resected, after that two distal segments of 15 cm were U-shaped, and a 1.5 cm incision was made in the lower part of the bowel, followed by a formation of the urethral anastomosis. Then bowel segments were detubularized, and continuous suture on the posterior and anterior walls of the neobladder was done. Ureters were implanted in the proximal tubular part of the resected colon according to the Nesbit technique. RESULTS: The mean operation time was 380 minutes. The blood loss ranged from 80 to 200 ml; however, blood transfusion was not performed. Complications during 30-days after RARC were observed in 7 (43.7%) patients, including 4 (25%) of class I-II according to Clavien - Dindo, and 3 (18.7%) of class III-IV. In patients with leakage at the uretero- intestinal anastomosis (n=2) and urethro-neobladder anastomosis (n=1), percutaneous drainage was performed, which allowed to resolve these complications. There were no cases of bowel obstruction. One patient with gastrointestinal bleeding required blood transfusion. The 90-day late complications occurred in 6 (37.5%) patients, including 2 cases of upper urinary tract infection. One patient died of acute myocardial infarction. CONCLUSION: RARC is a contemporary minimally invasive method for muscle-invasive BCa. Stepwise approach to RARC with intracorporeal neobladder formation may reduce the operation time and the rate of complications.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Estruturas Criadas Cirurgicamente , Neoplasias da Bexiga Urinária , Derivação Urinária , Cistectomia/efeitos adversos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos
2.
Bone Joint J ; 102-B(11): 1511-1518, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135443

RESUMO

AIMS: The aim of this study was to compare robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) in order to determine the changes in the anatomy of the knee and alignment of the lower limb following surgery. METHODS: An analysis of 38 patients who underwent TKA and 32 who underwent bi-UKA was performed as a secondary study from a prospective, single-centre, randomized controlled trial. CT imaging was used to measure coronal, sagittal, and axial alignment of the knee preoperatively and at three months postoperatively to determine changes in anatomy that had occurred as a result of the surgery. The hip-knee-ankle angle (HKAA) was also measured to identify any differences between the two groups. RESULTS: The pre- to postoperative changes in joint anatomy were significantly less in patients undergoing bi-UKA in all three planes in both the femur and tibia, except for femoral sagittal component orientation in which there was no difference. Overall, for the six parameters of alignment (three femoral and three tibial), 47% of bi-UKAs and 24% TKAs had a change of < 2° (p = 0.045). The change in HKAA towards neutral in varus and valgus knees was significantly less in patients undergoing bi-UKA compared with those undergoing TKA (p < 0.001). Alignment was neutral in those undergoing TKA (mean 179.5° (SD 3.2°)) while those undergoing bi-UKA had mild residual varus or valgus alignment (mean 177.8° (SD 3.4°)) (p < 0.001). CONCLUSION: Robotic-assisted, cruciate-sparing bi-UKA maintains the natural anatomy of the knee in the coronal, sagittal, and axial planes better, and may therefore preserve normal joint kinematics, compared with a mechanically aligned TKA. This includes preservation of coronal joint line obliquity. HKAA alignment was corrected towards neutral significantly less in patients undergoing bi-UKA, which may represent restoration of the pre-disease constitutional alignment (p < 0.001). Cite this article: Bone Joint J 2020;102-B(11):1511-1518.


Assuntos
Artroplastia do Joelho , Articulação do Joelho/cirurgia , Procedimentos Cirúrgicos Robóticos , Idoso , Fenômenos Biomecânicos , Mau Alinhamento Ósseo/prevenção & controle , Feminino , Fêmur/cirurgia , Humanos , Articulação do Joelho/anatomia & histologia , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tíbia/cirurgia
4.
Rev Col Bras Cir ; 47: e20202622, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33053065

RESUMO

OBJECTIVES: described by Dr. Jorge Daes, principles of the enhanced view totally extraperitoneal (eTEP) has been widely used in the armamentarium of ventral hernia repair recently. Robotic assisted eTEP technique feasibility has been proved, however, a complete understanding of retromuscular abdominal wall planes and its landmarks still uncertain in a majority of general surgeons. The aim of this report is to propose a technical standardization and its anatomic concepts in the robotic-assisted eTEP ventral hernia repair. METHODS: our group describes 10 key steps in a structured step-by-step approach for a safe and reproducible repair based on well defined anatomic landmarks, identification of zones of dissection and correct restoration of the linea alba. RESULTS: the standardization has been developed 2 years ago and applied to all patients. A robotic-assisted surgery with 3 robotic arms is performed in a lateral docking setup. Feasibility is established and reproducibility is high among general surgeons. CONCLUSION: we present a standardized side docking robotic assisted eTEP approach for ventral hernia repairs with 10 key steps. We believe understanding the landmarks and a step-by-step guidance based on the concepts of retromuscular abdominal wall anatomy foment a safe learning of minimally invasive restoration of the abdominal wall integrity regarding non-expert surgeons.


Assuntos
Hérnia Ventral/cirurgia , Laparoscopia , Procedimentos Cirúrgicos Robóticos/métodos , Humanos , Reprodutibilidade dos Testes , Procedimentos Cirúrgicos Robóticos/normas , Telas Cirúrgicas , Resultado do Tratamento
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4680-4686, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019038

RESUMO

Passive elastic elements can contribute to stability, energetic efficiency, and impact absorption in both biological and robotic systems. They also add dynamical complexity which makes them more challenging to model and control. The impact of this added complexity to autonomous learning has not been thoroughly explored. This is especially relevant to tendon-driven limbs whose cables and tendons are inevitably elastic. Here, we explored the efficacy of autonomous learning and control on a simulated bio-plausible tendon-driven leg across different tendon stiffness values. We demonstrate that increasing stiffness of the simulated muscles can require more iterations for the inverse map to converge but can then perform more accurately, especially in discrete tasks. Moreover, the system is robust to subsequent changes in muscle stiffnesses and can adapt on-the-go within 5 attempts. Lastly, we test the system for the functional task of locomotion and found similar effects of muscle stiffness to learning and performance. Given that a range of stiffness values led to improved learning and maximized performance, we conclude the robot bodies and autonomous controllers-at least for tendon-driven systems-can be co-developed to take advantage of elastic elements. Importantly, this opens also the door to development efforts that recapitulate the beneficial aspects of the co-evolution of brains and bodies in vertebrates.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Animais , Elasticidade , Músculo Esquelético , Tendões
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4867-4872, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019080

RESUMO

We have developed HandMATE (Hand Movement Assisting Therapy Exoskeleton); a wearable motorized hand exoskeleton for home-based movement therapy following stroke. Each finger and the thumb is powered by a linear actuator which provides flexion and extension assistance. Force sensitive resistors integrated into the design measure grasp and extension initiation force. An assistive therapy mode is based on an admittance control strategy. We evaluated our control system via subject and bench testing. Errors during a grip force tracking task while using the HandMATE were minimal (<1%) and comparable to unassisted healthy hand performance. We also outline a dedicated app we have developed for optimal use of HandMATE at home. The exoskeleton communicates wirelessly with an Android tablet which features guided exercises, therapeutic games and performance feedback. We surveyed 5 chronic stroke patients who used the HandMATE device to further evaluate our system, receiving positive feedback on the exoskeleton and integrated app.


Assuntos
Exoesqueleto Energizado , Procedimentos Cirúrgicos Robóticos , Reabilitação do Acidente Vascular Cerebral , Dispositivos Eletrônicos Vestíveis , Mãos , Humanos
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4878-4881, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019082

RESUMO

Significant hand and upper-limb impairment is common post-stroke. Robotic training can administer a high-dose of repetitive movement training to stroke survivors, but its efficacy can be further improved by targeting specific impairments of individual patients. In this study, we developed a new robotic training protocol that identifies specific impairment patterns that degrade functional performance of individual patients and provide joint-specific assistance to counteract subject-specific impairments. The target tasks were also adjusted based on their task performance during training. Two chronic stroke survivors participated in a pilot training study to demonstrate the efficacy of the proposed impairment-based robotic training. Upper limb function of the participants was improved by the proposed training as shown in the clinical tests (6.5 ± 4.5 increase in Fugl-Meyer; 10 ± 6.9 increase in Action Research Arm Test), and the laboratory tests also showed improvement in their range of motion (hand) and voluntary reaching distance (arm). The impairment-based robotic training targeted (and improved) specific deficits of individual patients that hampered their task performance, which could have contributed to the observed functional improvement. The proposed training can enhance the rehabilitative outcome of robotic training by emphasizing the key components of effective rehabilitation, i.e., subject-specific, impairment-based training.Clinical Relevance- This study shows that impairment-based, 'subject-specific' robotic trainings can improve upper extremity function of stroke survivors.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Reabilitação do Acidente Vascular Cerebral , Humanos , Movimento , Extremidade Superior
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5171-5175, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019150

RESUMO

We examined different methods of robotic proprioception assessment and provided comparison with the wrist position sense test gold standard assessment. The aim is to determine which of the assessments are the most reliable and would be acceptable for clinical evaluation. 31 children between six and sixteen participated in a pilot assessment trial and completed all four of the assessments. The assessments included the manual and robotic versions of the wrist position sense test, the joint position matching assessment and the psychometric threshold determination assessment. There was not a significant difference between the manual and robotic wrist position sense tests but there were significant differences with the other assessments. The study also examined the effect of age on the different assessments and found that three of the assessments, excluding the joint position matching assessment, can differentiate between children of different ages. This study concludes that the significant differences between the assessments indicates that proprioception in the wrist is complex and multifaceted. Further studies will likely need to include multiple assessments to gain a more complete understanding of proprioception.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Criança , Humanos , Propriocepção , Punho , Articulação do Punho
9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3224-3227, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018691

RESUMO

Traumatic brain injury (TBI), is one of the leading causes of motor deficits in children and adults, affecting motor control, coordination, and acuity. This results in reduced functional ambulation and quality of life. Robotic exoskeletons (REs) are quickly becoming an effective method for gait neurorehabilitation in individuals with TBI. Neurorehabilitation is based on the principle that the human brain is capable of reorganization due to high dose motor training. Understanding the underlying mechanisms of cortical reorganization will help improve current rehabilitation. The objective of the study is to understand the cortical activity differences due to RE training and recovery of functional ambulation for individuals with chronic TBI, using functional near-infrared spectroscopy. There was an increase in cortical activation in the prefrontal cortex (PFC), bilateral premotor cortex (PMC) and motor cortex (M1) while walking with RE versus without RE at follow-up. Furthermore, decreased activation was observed in PFC, bilateral PMC and M1 from baseline to follow-up while walking without RE with a corresponding improvement in functional ambulation. These preliminary results for one participant provide initial evidence to understand the cortical mechanisms during RE gait training and the recovery induced due to the training.


Assuntos
Lesões Encefálicas Traumáticas , Procedimentos Cirúrgicos Robóticos , Adulto , Criança , Marcha , Humanos , Qualidade de Vida , Caminhada
10.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3654-3657, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018793

RESUMO

Motor function and coordination improve as children age. Robotic assessments of motor function and coordination have been shown to be repeatable, objective, and accurate. Additionally, robotic assessments have been used to measure and quantify deficits in motor function and coordination in children with cerebral palsy (CP). Normative models of motor function and coordination based on age have not been used widely to differentiate impaired performance from typical performance. This study presents preliminary results of identifying deficits in motor function and coordination assessed with a robotic reaching task and using a normative model of typical performance that accounts for age, sex, and handedness. The models were compared with data from three participants with CP to evaluate whether the models could be used to identify deficits in motor function. The models indicated motor deficits in one participant when performing a visually guided reaching task with respect to initial speed and distance ratios. There was no evidence of motor control deficits in the other two participants. Future work will refine the models to be able to better identify and quantify motor control impairments with the potential to target therapy around quantifiable goals.


Assuntos
Paralisia Cerebral , Procedimentos Cirúrgicos Robóticos , Robótica , Criança , Humanos , Propriocepção , Desempenho Psicomotor
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3860-3863, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018843

RESUMO

Spasticity is a common ailment following stroke, which can cause pain, contracture, abnormal limb posture and functional limitation. Early management of post-stroke spasticity is vital to reduce these complications, and improve function and help patients become independent. We propose a therapeutic program based on applying a series of vibrations to the ankle joints at specific ankle position as well as over the range of motion using a rehabilitation robotic system to reduce the neural and muscular abnormalities associated with spasticity. We provided a 30-minute perturbation training, 3 times a week for 10 sessions for 8 stroke survivor subjects. Ankle stiffness was calculated using the hysteresis curves. Other kinematic and kinetic parameters were also used to evaluate the mechanical abnormalities. We evaluated participants before starting the therapeutic program, immediately after first session of training and after 10 sessions of training.Our results showed that all subjects had substantial improvements in stiffness, max voluntary contraction, energy loss, passive range of motion, and voluntary movement after both short- and long-term therapeutic program. Surprisingly, for most of these measures the maximum improvement obtained at short-term training. Interestingly, these improvements became persistent over the long-term training. These findings suggest that vibration therapy can be considered as an effective rehabilitation intervention to reduce neuromuscular abnormalities associated with the spasticity in stroke.


Assuntos
Procedimentos Cirúrgicos Robóticos , Acidente Vascular Cerebral , Tornozelo , Articulação do Tornozelo , Humanos , Espasticidade Muscular/etiologia , Acidente Vascular Cerebral/complicações , Sobreviventes
12.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(8. Vyp. 2): 73-80, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33016680

RESUMO

OBJECTIVE: To compare the efficacy of walking function recovery in patients in the early recovery period of ischemic stroke (IS) using an exoskeleton for the lower extremities and an active-passive pedal exercise bike. MATERIAL AND METHODS: An open randomized study of 47 patients in the early recovery period of IS was conducted. The rehabilitation course included exercises on an ExoAtlet exoskeleton in group 1 and exercises on a pedal simulator for active-passive training (5 days a week for 2 weeks) in group 2. Several tests were used to evaluate treatment results, including the Hauser walking index, the 10-meter walking test, the Berg balance scale, stabilometry, and biomechanics of walking. The complete training course was completed by 20 patients of group 1 and 21 of group 2. RESULTS: There was a significant increase in strength in paretic muscles, postural stability, functional level and walking speed in patients of both groups, but in patients of group 1, the dynamics of recovery was more pronounced (p<0.05). In group 1, there was a significant decrease in the level of disability and an increase in daily activity, which was higher compared to group 2. An analysis of the main indicators of the statokinesiogram showed the more pronounced positive shifts in patients of group 1, but significant differences were found only in the dynamics of the length and area of the curve in the test with eyes open. When studying the biomechanics of walking, it was found that the function of walking was changed: there was a significant decrease in the speed of movement by 2.2 times, the length of a double step by 1.6 times, and the pace of walking by 1.3 times compared to normal indicators. After the end of exercises, a significant increase in the length of the double step, speed and pace of walking as well as a decrease in the period of the locomotor cycle were found in group 1. CONCLUSION: The study revealed a positive impact of hardware rehabilitation on locomotion, both with the use of an exoskeleton and an active-passive pedal simulator. The use of an exoskeleton, have the advantages resulting in a significantly greater recovery of strength, stability, speed and symmetry of walking over the same period of training. A significant increase in postural stability in vertical position was revealed.


Assuntos
Exoesqueleto Energizado , Procedimentos Cirúrgicos Robóticos , Robótica , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Caminhada
14.
Medicine (Baltimore) ; 99(33): e21603, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872015

RESUMO

RATIONALE: Schwannomas of the seminal vesicles are extremely rare, and only cases of single seminal vesicle schwannomas have been reported. Here, we report a case of multiple schwannoma of the seminal vesicle. PATIENT CONCERNS: We report a rare case of multiple schwannoma of the seminal vesicle that occurred in a 48-year-old man during physical examination. Multiple mixed masses in the left region of the seminal vesicle were documented with transrectal ultrasonography and magnetic resonance imaging. The patient presented no clinical symptoms, no family history of the disease and no history of genetic disease. DIAGNOSIS: Postoperative pathology revealed a diagnosis of seminal vesical schwannoma. INTERVENTIONS: The patient underwent robotic-assisted laparoscopic surgery to remove the mass. OUTCOMES: The patient recovered rapidly and the length of hospitalization was 6 days after operation. At present, there is no recurrence in 10 month follow up. LESSONS: Whether benign or malignant, single or multiple, schwannomas still need to be diagnosed by pathology because of the limitations of examination methods. Surgical resection is still the preferred treatment.


Assuntos
Neoplasias dos Genitais Masculinos/patologia , Neurilemoma/patologia , Glândulas Seminais/patologia , Neoplasias dos Genitais Masculinos/diagnóstico por imagem , Neoplasias dos Genitais Masculinos/cirurgia , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Glândulas Seminais/diagnóstico por imagem
15.
Surg Clin North Am ; 100(5): 909-920, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882173

RESUMO

Advanced technology has resulted in major changes in surgery and medicine over the past three decades. There are many barriers to the adoption of advanced technologies, which can be more prevalent in rural hospitals and surgical practices. Despite barriers to implementation of new technologies in rural communities, many rural hospitals have endorsed and invested in these technologies for the benefit of the hospital and community. The rural surgeon is often the driving force in evaluating and deciding on new technologies for their surgical program. This article discusses advantages, challenges, and limitations in the use of advanced technologies in rural locations.


Assuntos
Tecnologia Biomédica , Cirurgia Geral/métodos , Serviços de Saúde Rural , Procedimentos Cirúrgicos Operatórios/métodos , Hospitais Rurais , Humanos , Procedimentos Cirúrgicos Robóticos , Telemedicina , Estados Unidos
16.
Kyobu Geka ; 73(9): 663-666, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32879268

RESUMO

A man was diagnosed with a left upper mediastinal mass. The mass was located near the left subclavian vein, phrenic nerve, vagus nerve, left subclavian artery, and left brachiocephalic vein. He underwent a robotic surgery without additional approaches such as cervical approach on transmanubrial approach. Robotic surgery enabled to remove the tumor safely due to the highly flexible robot forceps under a 3-dimensional visual field. Robotic surgery may be effective for tumors in the upper mediastinum, where important blood vessels and nerves are closely present.


Assuntos
Neoplasias do Mediastino , Procedimentos Cirúrgicos Robóticos , Robótica , Veias Braquiocefálicas , Humanos , Masculino , Mediastino
17.
PLoS One ; 15(9): e0239027, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32931510

RESUMO

INTRODUCTION: After the outbreak of COVID-19 unprecedented changes in the healthcare systems worldwide were necessary resulting in a reduction of urological capacities with postponements of consultations and surgeries. MATERIAL AND METHODS: An email was sent to 66 urological hospitals with focus on robotic surgery (RS) including a link to a questionnaire (e.g. bed/staff capacity, surgical caseload, protection measures during RS) that covered three time points: a representative baseline week prior to COVID-19, the week of March 16th-22nd and April 20th-26th 2020. The results were evaluated using descriptive analyses. RESULTS: 27 out of 66 questionnaires were analyzed (response rate: 41%). We found a decrease of 11% in hospital beds and 25% in OR capacity with equal reductions for endourological, open and robotic procedures. Primary surgical treatment of urolithiasis and benign prostate syndrome (BPS) but also of testicular and penile cancer dropped by at least 50% while the decrease of surgeries for prostate, renal and urothelial cancer (TUR-B and cystectomies) ranged from 15 to 37%. The use of personal protection equipment (PPE), screening of staff and patients and protection during RS was unevenly distributed in the different centers-however, the number of COVID-19 patients and urologists did not reach double digits. CONCLUSION: The German urological landscape has changed since the outbreak of COVID-19 with a significant shift of high priority surgeries but also continuation of elective surgical treatments. While screening and staff protection is employed heterogeneously, the number of infected German urologists stays low.


Assuntos
Infecções por Coronavirus/patologia , Pessoal de Saúde/psicologia , Pneumonia Viral/patologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Alemanha/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Internet , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Procedimentos Cirúrgicos Robóticos , Inquéritos e Questionários , Doenças Urológicas/cirurgia , Urologistas/psicologia
18.
Int J Oral Maxillofac Implants ; 35(5): e86-e90, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991657

RESUMO

Guided dental implant surgery can optimize implant placement positioning, increase predictability, and decrease surgical invasiveness through flapless techniques. Static surgical guides have been used to accomplish this task, though limitations of patient opening and lack of coolant contact with the surgical site have been clinically significant weaknesses. Technologic advances have allowed robotically guided implant placement using haptic guidance. The absence of a static stereolithographic guide over the surgical area allows for optimal access and adequate cooling during osteotomies. The aim of this case series was to present the workflows of both static and robotic guidance in the same patient and measure deviations from the presurgical planning software to determine the practicability and accuracy of robotic guidance. Based on this case series, it can be concluded that using robotically assisted implant surgery can yield deviation results that are comparable to static CAD/CAM stereolithographic surgical guides. Robotic surgery can be performed predictably with minimal deviation in both simple and complex clinical situations. Further testing and analysis are needed to confirm this case study's results in a larger cohort of patients.


Assuntos
Implantes Dentários , Procedimentos Cirúrgicos Robóticos , Cirurgia Assistida por Computador , Desenho Assistido por Computador , Implantação Dentária Endo-Óssea , Humanos
19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(9): 861-865, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32927510

RESUMO

The therapeutic choice of duodenal gastrointestinal stromal tumor (GIST) has always been the focus of surgeons because of its special anatomy location. So far, surgery is the preferable treatment for primary duodenal GIST, including pancreaticoduodenectomy (PD) and local resection (LR). Researches reveal that the prognosis of duodenal GIST is determined by the pathologic factors of the tumor itself, and is not significantly associated with the surgical procedure. The intervention with targeted drugs such as imatinib has given the duodenal GIST more opportunities for LR. Meanwhile, the technique development of the laparoscopy combined with endoscopic surgery and robotic surgery ensures the steps of minimally invasive treatment for duodenal GIST into a new era.


Assuntos
Neoplasias Duodenais/cirurgia , Duodeno/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Pancreaticoduodenectomia/métodos , Antineoplásicos/uso terapêutico , Terapia Combinada , Neoplasias Duodenais/patologia , Tumores do Estroma Gastrointestinal/patologia , Humanos , Mesilato de Imatinib/uso terapêutico , Procedimentos Cirúrgicos Minimamente Invasivos , Prognóstico , Procedimentos Cirúrgicos Robóticos
20.
Medicine (Baltimore) ; 99(36): e22057, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899070

RESUMO

INTRODUCTION: Based on existing literature, the juxtaglomerular cell tumor (JGCT) is a rare renal tumor, typically present with hypertension and hypokalemia. Nonfunctioning JGCT, without hypertension or hypokalemia, is extremely rare. PATIENT CONCERNS: Herein, we report a case of nonfunctioning JGCT mimicking renal cell carcinoma. The 29-year-old woman with an unremarkable past medical history presented with a left renal tumor without hypertension or hypokalemia. DIAGNOSIS: Both CT and 18F-FDG-PET/CT suggested a malignancy, possibly renal cell carcinoma. INTERVENTIONS: The tumor was then removed completely via robotic assistant laparoscopic partial nephrectomy; and pathology result was JGCT. Since the patient had no hypertension or hypokalemia, a nonfunctional JGCT was diagnosed. OUTCOMES: The patient recovered uneventfully, and was in good health in 6-months' follow-up period. CONCLUSION: Preoperative identification of JGCT is very difficult due to the lack of specific clinical manifestations. This case teaches us that for young patients with renal tumors whose CT enhancement is not obvious at the early phase, JGCT should be considered as a differential diagnosis. Radical nephrectomy should be avoided for JGCT in consideration of its relatively good prognosis.


Assuntos
Carcinoma de Células Renais/diagnóstico , Sistema Justaglomerular/patologia , Neoplasias Renais/patologia , Neoplasias/cirurgia , Adulto , Assistência ao Convalescente , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Neoplasias Renais/diagnóstico por imagem , Laparoscopia/instrumentação , Nefrectomia/métodos , Nefrectomia/tendências , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento
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