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1.
Medicine (Baltimore) ; 99(4): e18944, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977911

RESUMO

INTRODUCTION: Direct repair of the pars defect in lumbar spondylolysis is an effective surgical procedure, but it is technically challenging. We assessed the feasibility of a new robotic system for intralaminar screw fixation of spondylolysis. PATIENT CONCERNS: A 26-year-old man complained about frequent low back pain after failed conservative treatments. DIAGNOSIS: The lumbar computed tomography images demonstrated the presence of bilateral spondylolysis at the L5 level, with no spondylolisthesis. INTERVENTIONS: We performed one surgery of direct intralaminar screw fixation under the guidance of the TiRobot system. The trajectory of the screw was planned based on intraoperative 3-dimensional radiographic images. Then, the robotic arm spontaneously moved to guide the guide wires and screw insertion. OUTCOMES: Bilateral L5 intralaminar screws were safely and accurately placed. No intraoperative complications occurred. Postoperative computed tomography showed good radiological results, without cortical perforation. CONCLUSION: We report the first case of robot-assisted direct intralaminar screw fixation for spondylolysis using the TiRobot system. Robotic guidance for direct repair of spondylolysis could be feasible.


Assuntos
Procedimentos Cirúrgicos Robóticos/métodos , Espondilólise/cirurgia , Adulto , Parafusos Ósseos , Humanos , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Espondilólise/diagnóstico por imagem
2.
Plast Reconstr Surg ; 145(2): 340-343, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985617

RESUMO

The history of autologous breast reconstruction has been characterized by the desire for progressively increasing reliability with decreasing donor-site morbidity. The robotic deep inferior epigastric artery perforator flap permits the longest possible pedicle harvest through the smallest possible fascial incision and, for this reason, may be the next stage in the evolution of minimally invasive, autologous breast reconstruction.


Assuntos
Mamoplastia/métodos , Retalho Perfurante , Procedimentos Cirúrgicos Robóticos/métodos , Feminino , Humanos , Pneumoperitônio Artificial/métodos , Reto do Abdome/transplante , Coleta de Tecidos e Órgãos/métodos , Sítio Doador de Transplante , Transplante Autólogo
3.
Urology ; 135: 57-65, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31618656

RESUMO

OBJECTIVE: To evaluate differences in the incidence of benign ureteroenteric stricture, we compared stricture rates of robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using Surveillance, Epidemiology, and End Results-Medicare data. METHODS: We identified 332 RARC and 1449 ORC performed between 2009 and 2014 to determine stricture rates at 6, 12, and 24 months following surgery. We defined ureteroenteric stricture as the need for procedural intervention. Additionally, we compared the incidence of stricture diagnosis. Multivariable proportional hazards regression was performed to determine factors associated with stricture development. RESULTS: The incidence of ureteroenteric stricture at 6 and 12 months was higher for RARC vs ORC at 12.1% vs 7.0% (P < .01) and 15.0% vs 9.5% (P = .01), respectively. RARC vs ORC stricture incidence at 2 years did not differ significantly at 14.6% vs 11.4% (P = .29). Similarly, the stricture diagnosis rates were significantly lower following ORC at 6, 12, and 24 months (P < .05). In adjusted analysis, RARC (HR 1.64, 95%CI 1.23-2.19) and preoperative hydronephrosis (HR 1.51, 95% CI 1.17-1.94) were associated with the development of stricture. Higher hospital volume was associated with a lower risk of stricture (HR 0.40, 95%CI 0.26-0.63). CONCLUSION: RARC is associated with a higher rate of ureteroenteric stricture diagnosis and intervention on a population-based level that is mitigated by higher hospital volume. A significant study limitation is inability to differentiate extracorporeal vs intracorporeal diversion. However, a stricture complication compounds the financial burden of care and efforts must be pursued to improve this surgical outcome.


Assuntos
Cistectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Obstrução Ureteral/epidemiologia , Derivação Urinária/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Carcinoma de Células de Transição/cirurgia , Constrição Patológica/epidemiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Cistectomia/métodos , Feminino , Humanos , Incidência , Intestinos/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , Ureter/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos
4.
J Urol ; 203(1): 137-144, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31347951

RESUMO

PURPOSE: We compared early continence recovery after surgical treatment of prostate cancer with Retzius sparing robot-assisted radical prostatectomy and conventional robot-assisted radical prostatectomy. MATERIALS AND METHODS: Robot-assisted radical prostatectomy was done by a single surgeon in 1,863 cases between October 2005 and May 2018 using the conventional and the Retzius sparing technique in 1,150 and 713, respectively. To compare continence outcomes between the groups propensity score matching was performed using 9 preoperative variables, including age, body mass index, prostate specific antigen, biopsy Gleason Grade Group, clinical T stage, prostate volume on transrectal ultrasound, and the I-PSS (International Prostate Symptom Score), I-PSS quality of life score and International Index of Erectile Function-5 scores. Continence was assessed by the pad count every month postoperatively until month 6 and was converted to a binary outcome. RESULTS: After propensity score matching 609 cases per group were matched with no significant difference in all 9 variables. The Kaplan-Meier curve analysis revealed that Retzius sparing robot-assisted radical prostatectomy was associated with a significantly better continence recovery rate than conventional robot-assisted radical prostatectomy during the 6-month study period (p <0.001). CONCLUSIONS: Based on propensity score matching with multiple variables and a large case series, Retzius sparing robot-assisted radical prostatectomy can be a candidate for future robot-assisted radical prostatectomy. It achieves better early continence recovery, a short operative time and early recovery compared to conventional robot-assisted radical prostatectomy.


Assuntos
Complicações Pós-Operatórias/fisiopatologia , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Incontinência Urinária/fisiopatologia , Idoso , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Pontuação de Propensão , Neoplasias da Próstata/patologia , Qualidade de Vida , Recuperação de Função Fisiológica
5.
Int Braz J Urol ; 45(6): 1122-1128, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808399

RESUMO

INTRODUCTION: To evaluate the influence of previous experience as bedside assistants on patient selection, perioperative and pathological results in robot assisted laparoscopic radical prostatectomy. MATERIALS AND METHODS: The first 50 cases of two robotic surgeons were reviewed retrospectively. Group 1 consisted of the first 50 cases of the surgeon with previous experience as a robotic bedside assistant between September 2016-July 2018, while group 2 included the first 50 cases of the surgeon with no bedside assistant experience between February 2009-December 2009. Groups were examined in terms of demographics, prostate volume, presence of median lobe, prostate specific antigen (PSA), preoperative Gleason score, positive core number, clinical stage, console surgery time, estimated blood loss, postoperative Gleason score, pathological stage, positive surgical margin rate, postoperative complications, length of hospital stay and biochemical recurrence rate. RESULTS: Previous abdominal surgery and the presence of median lobe hypertrophy rates were higher in Group 1 than in Group 2 (20% vs. 4%, p=0.014; 24% vs. 6%, p=0.012; respectively). In addition, patients in Group 1 were in a higher clinical stage than those in Group 2 (cT2: 70% vs. 28%, p=0.001). Median console surgery time and median length of hospital stay was significantly shorter in Group 1 than in Group 2 (170 min vs. 240 min, p=0.001; 3 vs. 4, p=0.022; respectively). Clavien grade 3 complication rate was higher in Group 2 but was statistically insignificant. CONCLUSION: Our findings might reflect that previous bedside assistant experience led to an increase in self-confidence and the ability to manage troubleshooting and made it more likely for surgeons to start with more difficult cases with more challenging patients. It is recommended that novice surgeons serve as bedside assistants before moving on to consoles.


Assuntos
Competência Clínica , Prostatectomia/educação , Procedimentos Cirúrgicos Robóticos/educação , Idoso , Humanos , Curva de Aprendizado , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Duração da Cirurgia , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Autoimagem , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
6.
Int Braz J Urol ; 45(6): 1136-1143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808401

RESUMO

PURPOSE: To prospectively evaluate the association of adherent perinephric fat (APF) on perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) following elimination of the surgical learning curve. MATERIALS AND METHODS: 305 consecutive RAPNs performed by a single experienced surgeon were analyzed. The fi rst 100 RAPNs were considered the learning curve and therefore excluded. APF was defined as the necessity of subcapsular renal dissection to mobilize the tumor from surrounding perinephric fat. Perioperative outcomes were evaluated including operative time, warm ischemia time (WIT), postoperative complications, length of stay, margins, ischemia, and complications score (MIC), estimated blood loss (EBL), and change in pre-operative to postoperative day 1 (POD 1) laboratory values. After correction for multiple comparisons, P values ≤0.0045 were considered statistically signifi cant but associations with P values ≤0.05 were also mentioned in the study results. RESULTS: Fifty-eight (28.3%) patients had APF. Patients with APF had longer operative times compared to those without APF (median, 213 vs. 192 minutes, P <0.001). There was some evidence of higher increase in change in creatinine from preoperative to POD 1 among those with APF compared to those without APF, although this was not statistically signifi cant (median, 0.2 vs. 0.1mg/dL, P=0.03). There were no other statistically significant associations between presence of APF and perioperative outcomes. CONCLUSIONS: APF is associated with increased operative time but no change in other perioperative outcomes. Surgeon experience does not affect perioperative outcomes associated with APF.


Assuntos
Tecido Adiposo Branco/cirurgia , Competência Clínica , Curva de Aprendizado , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Duração da Cirurgia , Período Perioperatório , Complicações Pós-Operatórias , Estudos Prospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Estatísticas não Paramétricas , Resultado do Tratamento , Adulto Jovem
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1124-1130, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874527

RESUMO

Objective: To explore the short-term clinical efficacy of robotic radical resection for high rectal cancer with transvaginal specimen extraction. Methods: A cohort study was carried out. The clinical data of consecutive patients with high rectal cancer who underwent robotic radical resection at the Department of General Surgery of The First Affiliated Hospital of Nanchang University from June 2017 to January 2018 were retrospectively analyzed. Inclusion criteria: (1) preoperative diagnosis of rectal cancer, and distance from tumor to anal margin≥10 cm undercolonoscopy; (2) T1-3 assessed by preoperative imaging examination, and no distant metastasis; (3) female, age≥50 years old, body mass index ≤ 30 kg/m(2); (4) without radiotherapy and chemotherapy before surgery; (5) implementation of robotic radical surgery for high rectal cancer. Fourteen female patients undergoing transvaginal removal of specimen without abdominal incision were included in the no incision group with age of (62.2±9.3) years old and distance from tumor to anal verge of (12.5±0.9) cm. As the match of 1:2, 28 simultaneous patients of high rectal cancer undergoing traditional robotic surgery (surgery interval <8 months) were enrolled to the control group, with age of (60.6±12.8) years old and distance from tumor to anal verge of (11.3±3.8) cm. Short-term efficacy and safty were compared between two groups. Follow-up ended in September 2018. Results: There was no significant difference in baseline data between the two groups (all P>0.05). Compared with the control group, the no incision group had longer operation time [(149.6±15.6) minutes vs. (130.9±12.9) minutes, t=-4.135, P<0.001], shorter time to postoperative flatus [(40.9 ±2.6) hours vs. (51.9±2.9) hours, t=12.049, P<0.001], lower pain score on the operation day and the first day after surgery (using Changhaipainstick) [(3.1±0.4) points vs. (4.6±0.7) points, t=7.458, P<0.001; (2.5±0.3) points vs. (3.3±0.5) points, t=6.142, P<0.001], shorter time to ground activity [(15.6±2.0) hours vs. (24.3±2.5) hours, t=11.102, P=0.030], and shorter postoperative hospital stay [(6.1±0.8) days vs. (7.2±1.3) days, t=2.806, P=0.008], whose differences were statistically significant. There were no significant differences in intraoperative blood loss, proportion of postoperative analgesia patients, and complication within 30 days after surgery (all P>0.05). In the no incision group and the control group,the tumor size was (3.1±0.4) cm and (3.6±0.9) cm, the proximal margin distance was (9.1±1.5) cm and (9.8±1.5) cm, the distal margin distance was (4.3±0.4) cm and (4.5±0.4) cm, the number of harvested lymph node was 15.8±2.4 and 15.2 ± 2.5, and the number of positive lymph node was 0.6±1.3 and 1.1±2.4, respectively, whose differences were not statistically significant (all P>0.05). The mean followed-up period was 10 months (7-14 months) in the no incision group, and 14 months (10-18 months) in the control group. No local recurrence and distant metastasis were found in both groups. Conclusion: Robotic radical resection for high rectal cancer with transvaginal specimen extraction is safe and feasible with advantages of rapid postoperative recovery, less postoperative pain and short hospital stay.


Assuntos
Colectomia/métodos , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Feminino , Humanos , Laparoscopia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Vagina/cirurgia
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1137-1143, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874529

RESUMO

Objective: To explore the technical characteristics and short-term clinical efficacy of robotic-assisted intersphincteric resection (ISR) for patients with low rectal cancer. Methods: A retrospective cohort study was used. Inclusion criteria: (1) rigid colonoscopy showed lower margin of the tumor ≤5 cm from the anal verge; (2) preoperative rectal MRI or endorectal ultrasound revealed staging T1-2, or T3 patients receiving concurrent chemoradiotherapy; (3) patients less than 70 years old with good function of anal sphincter before surgery; (4) no synchronous multiple primary carcinoma, and no distant metastasis; (5) the method of operation was agreed by the patient. Exclusion criteria: (1) T4 stage tumors; (2) sphincter dysfunction before operation; (3) recurrent tumors; (4) lower edge of tumors beyond the dentate line; (5) death due to non-rectal cancer during follow-up and unsatisfactory follow-up data. The clinical data of 21 patients with low rectal cancer meeting inclusion criteria undergoing robotic-assisted ISR at our department from January 2015 to June 2018 were collected. Parameters during and after operation were observed. Anorectal manometry was performed at 3, 6, and 12 months after the operation, and anal function was evaluated at 3, 6, and 12 months after the closure of the stoma by Kirwan classification and Wexner fecal incontinence score. The key steps of the operation are as follows: according to the principle of total mesorectal excision, the robot continued to enter into the levator ani hiatusdistally, and dissectin the sphincter space; according to the scope of sphincter resection, ISRwas divided into partial ISR, subtotal ISR, and total ISR; subtotal and total ISR usually needed to be combined with transanal pathway. The reconstruction of digestive tract was performed by double stapler anastomosis under laparoscope orhand-sewnanastomosis under direct vision, and preventive ileostomy was completed in the right lower abdomen. Results: Of 21 patients, 13 were male and 8 were female with mean age of (57.5±16.3) years. All the patients successfully completed the operation without conversion to laparotomy. Fourteen cases (66.7%) adopted partial ISR through complete transabdominal approach, 6 cases (28.6%) adopted the subtotal ISR through combined transabdominal and transanal approachs, and 1 case (4.8%) adopted the total ISR through the combined transabdominal and transanal approachs. The total operation time was (213.1±56.3) minutes, including (27.3±5.4) minutes for mechanical arm installation and (175.7±51.6) minutes for robotic operation. The amount of intraoperative hemorrhage was (62.8±23.2) ml, and no blood transfusion was performed in any patient. All patients underwent prophylactic ileostomy, and the stoma was closed 3-6 months after the operation. Except one case of anastomotic leakage, all other stomas were closed successfully. The postoperative hospitalization time was (7.6±2.2) days, and time to fluid intake was (3.3±0.9) days. One case of anastomotic leakage, one case of anastomotic stenosis, one case of inflammatory external hemorrhoids and one case of urinary retention occurred after surgery,and all of them were cured by conservative treatment. The mean diameter of tumors was (2.9±1.2) cm, and the number of harvested lymph node was 12.8 ± 3.3. In the whole group, the circumcision margin was negative, the proximal margin was (12.2 ± 2.1) cm, the distal margin was (1.1 ± 0.4) with all negative, and the R0 resection rate was 100%. The results of anorectal manometry showed that the preoperative rest pressure, rectal maximum squeeze pressure, initial sensory volume and maximum tolerated volume were (45.19±8.46) mmHg, (128.18±18.80) mmHg, (44.33±10.11) ml and (119.00±19.28) ml, respectively;these parameters reduced significantly 3 months after operation and they were (23.44±5.54) mmHg, (93.72±12.15) mmHg, (17.72±5.32) ml and (70.44±10.9) ml, respectively. The differences were statistically significant (all P<0.001). The resting pressure and the rectal maximum squeeze pressure returned to preoperative levels 12 months after operation, which were (39.33±6.64) mmHg and (120.58±16.47) mmHg, respectively (both P>0.05), while the initial sensory volume and the maximum tolerated volume failed to reach the preoperative state, which were (30.67±7.45) ml and (92.25±10.32) ml, respectively (both P<0.05). The patients were followed up for (22.1±10.6) months without local recurrence and distant metastasis. Eighteen patients were evaluated for anal function: Kirwan classification was grade I for 6 cases, grade II for 7 cases, grade III for 4 cases, and grade IV for 1 case; Wexner incontinence score was 8.6±0.8; 14 cases had good defecation control. Conclusion: The clinical efficacy of ISR with Da Vinci robot in the treatment of low rectal cancer is satisfactory.


Assuntos
Protectomia/métodos , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Canal Anal/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
Ann R Coll Surg Engl ; 101(8): 606-608, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31672035

RESUMO

INTRODUCTION: The 12-mm AirSeal® port is widely used in robotically assisted laparoscopic prostatectomy due to its ability to maintain stable pneumoperitoneal pressures and smoke evacuation. However, it creates a potential risk of port site hernia. We have traditionally used EndoClose™ to perform full thickness closure of this port, but noted that patients experienced increased pain related to this procedure, which sometimes persisted for several months. Using the Da Vinci Si we performed peritoneal closure with 2-0 vicryl by switching the fourth arm to the right master controller. The external oblique sheath was closed outside with 1 Ethibond. MATERIALS AND METHODS: We performed this closure in 20 consecutive patients (group 1). Postoperative day 1, 2 and post-discharge telephone consultation pain scores (1-10) were recorded and compared with the previous 20 consecutive patients who had the EndoClose closure (group 2). RESULTS: We recorded an instructional video to enable reproduction of the new technique. The mean length of stay was 1.5 days for patients in group 1 and 1.9 days for those in group 2 (P = 0.04). There was no difference in operating time or average day 1 pain scores. Post-discharge follow-up call revealed 1 of 20 patients who had AirSeal port site pain in group 1 and 5 of 17 in group 2 (P = 0.04). Pain scores also tended to be higher for group 2. CONCLUSIONS: Our preliminary analysis of this novel technique to close the AirSeal port in two separate layers improves postoperative pain related to this port site.


Assuntos
Laparoscopia/métodos , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Técnicas de Fechamento de Ferimentos , Idoso , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Medição da Dor/métodos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/efeitos adversos
12.
Medicine (Baltimore) ; 98(46): e18011, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725673

RESUMO

RATIONALE: Robot-assisted laparoscopic prostatectomy (RALP) is the most frequent strategy used for the surgical remedy of patients with localized prostate cancer. Although there is awareness about potential patient positioning nerve injuries, iatrogenic nerve lesions are less described in the literature. Here, we report 3 cases of patients who presented with neuropathic painful complications due to RALP-associated nerve lesions. PATIENT CONCERNS: A 62-year-old patient (case 1), a 72-year-old male (case 2), and a 57-year-old patient (case 3) presented at the clinic with symptoms of neuropathic pain after RALP surgery. DIAGNOSIS: Patients were diagnosed with a potential injury of different branches of the pudendal nerve (cases 1 and 2), and left obturator nerve (case 3). INTERVENTIONS: Patients underwent multimodal pharmacologic treatment through pregabalin, weak opioids, strong opioid, paracetamol, and adjuvants. In cases 2 and 3, a multidisciplinary approach was needed. As the patients responded to conservative treatment, invasive approaches were not necessary. OUTCOMES: After treatment, the patients of case 1 showed pain relief after 4 days, paresthesia resolved in 15 days, whereas the anal crushing sensation lasted for approximately 1 month. In case 2, after 4 weeks of treatment, the patient experienced a considerable decrement in pain intensity with complete response after 4 months. In case 3, pain relief was achieved after 2 days, motor symptoms recovery after 2 weeks, and neuropathic features resolved completely after 5 weeks although the obturator sign resolved within 2 months. LESSONS: The RALP-associated neurologic injuries may occur even when performed by highly experienced surgeons. A better understanding of the potential iatrogenic nerve lesions can surely allow an improvement in the surgical technique. A multidisciplinary approach and early multimodal pain strategy are mandatory for managing these complications.


Assuntos
Neuralgia/etiologia , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Idoso , Analgésicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/tratamento farmacológico , Nervo Obturador/lesões , Prostatectomia/métodos , Nervo Pudendo/lesões , Procedimentos Cirúrgicos Robóticos/métodos
13.
Mayo Clin Proc ; 94(11): 2263-2269, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31635830

RESUMO

OBJECTIVE: To evaluate the outcomes of robotic mitral valve repair (MVr) by primary indication per American Heart Association guidelines for surgery: class I vs class IIa. PATIENTS AND METHODS: From January 1, 2008, through September 30, 2016, 603 patients underwent robotic MVr for severe primary mitral regurgitation. Medical records of 576 consenting patients were retrospectively reviewed to determine the primary indication for surgery. Patients were stratified into class I or class IIa, and preoperative, intraoperative, and postoperative variables were compared. RESULTS: Of 516 patients, 428 (83%) had class I indication and 88 (17%) had class IIa indication for surgery. Preoperatively, no significant differences were observed between both cohorts. Importantly, a significantly higher number of patients with class I indication underwent MVr for bileaflet prolapse (172 of 428 [40%] vs 21 of 88 [25%]; P=.03). Early MVr outcomes indicated recurrent mitral regurgitation (moderate or greater) in only 12 of 576 (2%), and no significant differences were observed between classes (P=.23). Apart from parameters for ventricular size, all other intraoperative and postoperative variables were comparable between both cohorts. CONCLUSION: Comparable outcomes were indicated across all classes of indications for MVr surgery. These results continue to support the use of this surgical technique, even in less sick patients. Early referral along with more extensive robotic MVr experience will likely result in further improvements in long-term outcomes.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/instrumentação , Insuficiência da Valva Mitral/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/instrumentação , Resultado do Tratamento
14.
Am Surg ; 85(9): 978-984, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638510

RESUMO

Only a small percentage of patients fail laparoscopic fundoplications undertaken for gastroesophageal reflux disease. But because many laparoscopic fundoplications have been undertaken, surgeons frequently encounter patients in need of "redo" operations. This study was undertaken to evaluate the robotic approach versus laparoendoscopic single-site (LESS) approach for redo fundoplications. With an Institutional Review Board approval, 64 patients undergoing LESS (n = 32) or robotic (n = 32) redo antireflux operations were prospectively followed up. Data are presented as median (mean + SD). For LESS versus robotic redo operations, the operative duration was 145 (143 ± 33.5) versus 196 (208 ± 76.7) minutes (P < 0.01), estimated blood loss was 50 (80 ± 92.1) versus 20 (43 ± 57.1) mL (P = 0.07), and length of stay was 1 (3 ± 5.4) versus 1 (2 ± 1.9) day (P = 0.57); 1 LESS operation was converted to "open." Operative duration was longer for men (P = 0.01). Postoperative complications were not more frequent after Nissen (n = 36) or Toupet (n = 28) fundoplication, regardless of the approach. When matched by BMI, operative duration was prolonged by a large Type I to IV hiatal hernia (P = 0.01). Symptoms improved dramatically and were similar with both approaches, and patient satisfaction was high. Robotic redo antireflux operations take longer than LESS operations. LESS and robotic redo antireflux operations are both safe and offer significant and similar amelioration of symptoms after failed fundoplications.


Assuntos
Fundoplicatura/métodos , Hérnia Hiatal/cirurgia , Laparoscopia/métodos , Reoperação , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Perda Sanguínea Cirúrgica , Conversão para Cirurgia Aberta , Feminino , Seguimentos , Fundoplicatura/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento
15.
Am Surg ; 85(9): 1061-1065, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638525

RESUMO

As minimally invasive operations evolve, it is imperative to evaluate the advantages and risks involved. The aim of our study was to evaluate our institution's experience in incorporating a robotic platform for transhiatal esophagectomy (THE). Patients undergoing robotic THE were prospectively followed. Data are presented as median (mean ± SD). Forty-five patients were of 67 (67 ± 6.9) years and BMI 26 (27 ± 5.5) kg/m². Nine per cent of operations were converted to "open," but none in the last 25 operations. Operative duration of robotic THE was 334 (364 ± 108.8) minutes and estimated blood loss was 200 (217 ± 144.0) mL, which decreased with time (P = 0.017). Length of stay was 8 (12 ± 11.1) days. Twenty per cent had respiratory failure requiring intubation that resolved, 4 per cent developed pneumonia, 11 per cent developed a surgical site infection, 2 per cent developed renal insufficiency, and 2 per cent developed a UTI. Two per cent (one patient) died within 30 days postoperatively, because of cardiac arrest. Our experience with robotic THE promotes robotic application because we endeavor to achieve high-level proficiency. With experience, we improved estimated blood loss and converted fewer transhiatal esophagectomies to "open." Our length of hospital stay seems long but reflects the ill-health of patients, as does the variety of complications. Our data support the evolving future of THE, which will integrally include a robotic approach.


Assuntos
Esofagectomia/efeitos adversos , Esofagectomia/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Perda Sanguínea Cirúrgica , Índice de Massa Corporal , Conversão para Cirurgia Aberta , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Intubação Intratraqueal , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pneumonia/diagnóstico , Complicações Pós-Operatórias , Estudos Prospectivos , Insuficiência Respiratória/terapia , Infecção da Ferida Cirúrgica , Infecções Urinárias
16.
J Cardiothorac Surg ; 14(1): 182, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31665049

RESUMO

BACKGROUND: The authors presented a 63-year old female synchronously complicated with a thymic tumor located at the left-side of the superior mediastinum, and a paravertebral tumor located at the right-side of the lower thorax. Conventional thoracoscopic surgical procedure using rigid instruments to simultaneously resect the two tumors via the same ports might be technically challenging. To our knowledge, the use of a surgical robot allowed the surgeon to perform precise dissection from extreme angles with the characteristic of articulating surgical instruments. CASE PRESENTATION: Two lesions were successfully dissected using the da Vinci Surgical System through the same four ports on the right side of the chest and two-step docking. Firstly, the patient cart came from the dorsal side of the patient and the paravertebral neoplasm was dissected. Afterwards, the patient cart was undocked and the operation table was rotated 180 degrees counterclockwise. The robot was re-introduced and the patient cart came from the ventral side of the patient and the whole thymus was resected. CONCLUSION: This case report suggests that two-step docking via the same four ports for these two tumors located at different directions of the thorax was safe and effective, demonstrating a clear advantage of the surgical robot.


Assuntos
Cisto Broncogênico/cirurgia , Neoplasias do Mediastino/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neurilemoma/cirurgia , Neoplasias do Timo/cirurgia , Cisto Broncogênico/diagnóstico por imagem , Cisto Broncogênico/patologia , Feminino , Humanos , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Procedimentos Cirúrgicos Robóticos/métodos , Vértebras Torácicas , Toracoscopia/métodos , Timectomia/métodos , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Tomografia Computadorizada por Raios X
18.
Medicine (Baltimore) ; 98(39): e17089, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574808

RESUMO

To determine if there are advantages to transitioning to Da Vinci robotics by a surgeon compared to the video-assisted thoracic surgical lobectomy.A systematic electronic search of online electronic databases: PubMed, Embase, and Cochrane library updated on December 2017. Publications on comparison Da Vinci-robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for non-small cell lung cancer were collected. Meta-analysis RevMan 5.3 software (The Cochrane collaboration, Oxford, UK) was used to analyze the combined pooled HRs using fixed or random-effects models according to the heterogeneity.Fourteen retrospective cohort studies were included. No statistical difference was found between the 2 groups with respect to conversion to open, dissected lymph nodes number, hospitalization time after surgery, duration of surgery, drainage volume after surgery, prolonged air leak, and morbidity (P > .05).Da Vinci-RATS lobectomy is a feasible and safe technique and can achieve an equivalent surgical efficacy when compared with VATS. There does not seem to be a significant advantage for an established VATS lobectomy surgeon to transition to robotics based on clinical outcomes.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Torácica Vídeoassistida/métodos , Conversão para Cirurgia Aberta , Humanos , Tempo de Internação , Excisão de Linfonodo , Duração da Cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Resultado do Tratamento
19.
Rev Col Bras Cir ; 46(4): e20192210, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31576987

RESUMO

OBJECTIVE: to report our initial experience with pulmonary robotic segmentectomy, describing the surgical technique, the preferred positioning of portals, initial results and outcomes. METHODS: we collected data, from a prospective robotic surgery database, on patients undergoing robotic segmentectomy between January 2017 and December 2018. All patients had lung cancer, primary or secondary, or benign diseases, and were operated on with the Da Vinci system, by the three portals technique plus one utilitarian incision of 3cm. We dissected the hilar structures individually and performed the ligatures of the arterial and venous branches, of the segmental bronchi, as well as a parenchymal transection, with endoscopic staplers. We carried out systematic dissection of mediastinal lymph nodes for non-small cell lung cancer (NSCLC) cases. RESULTS: forty-nine patients, of whom 33 were women, underwent robotic segmentectomy. The average age was of 68 years. Most patients had NSCLC (n=34), followed by metastatic disease (n=11) and benign disease (n=4). There was no conversion to laparoscopic or open surgery, or to lobectomy. The median total operative time was 160 minutes, and the median console time, 117 minutes. Postoperative complications occurred in nine patients (18.3%), of whom seven (14.2%) had prolonged hospitalization (>7 days) due to persistent air fistula (n=4; 8.1%) or abdominal complications (n=2.4%). CONCLUSION: robotic segmentectomy is a safe and viable procedure, offering a short period of hospitalization and low morbidity.


Assuntos
Mastectomia Segmentar/métodos , Pneumonectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Robótica/métodos , Adenocarcinoma/cirurgia , Idoso , Feminino , Humanos , Verde de Indocianina , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Prospectivos
20.
Bone Joint J ; 101-B(10): 1230-1237, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564152

RESUMO

AIMS: The aim of this study was to assess the effect of posterior cruciate ligament (PCL) resection on flexion-extension gaps, mediolateral soft-tissue laxity, fixed flexion deformity (FFD), and limb alignment during posterior-stabilized (PS) total knee arthroplasty (TKA). PATIENTS AND METHODS: This prospective study included 110 patients with symptomatic osteoarthritis of the knee undergoing primary robot-assisted PS TKA. All operations were performed by a single surgeon using a standard medial parapatellar approach. Optical motion capture technology with fixed femoral and tibial registration pins was used to assess gaps before and after PCL resection in extension and 90° knee flexion. Measurements were made after excision of the anterior cruciate ligament and prior to bone resection. There were 54 men (49.1%) and 56 women (50.9%) with a mean age of 68 years (sd 6.2) at the time of surgery. The mean preoperative hip-knee-ankle deformity was 4.1° varus (sd 3.4). RESULTS: PCL resection increased the mean flexion gap significantly more than the extension gap in the medial (2.4 mm (sd 1.5) vs 1.3 mm (sd 1.0); p < 0.001) and lateral (3.3 mm (sd 1.6) vs 1.2 mm (sd 0.9); p < 0.01) compartments. The mean gap differences after PCL resection created significant mediolateral laxity in flexion (gap difference: 1.1 mm (sd 2.5); p < 0.001) but not in extension (gap difference: 0.1 mm (sd 2.1); p = 0.51). PCL resection significantly improved the mean FFD (6.3° (sd 4.4) preoperatively vs 3.1° (sd 1.5) postoperatively; p < 0.001). There was a strong positive correlation between the preoperative FFD and change in FFD following PCL resection (Pearson's correlation coefficient = 0.81; p < 0.001). PCL resection did not significantly affect limb alignment (mean change in alignment: 0.2° valgus (sd 1.2); p = 0.60). CONCLUSION: PCL resection creates flexion-extension mismatch by increasing the flexion gap more than the extension gap. The increase in the lateral flexion gap is greater than the increase in the medial flexion gap, which creates mediolateral laxity in flexion. Improvements in FFD following PCL resection are dependent on the degree of deformity before PCL resection. Cite this article: Bone Joint J 2019;101-B:1230-1237.


Assuntos
Artroplastia do Joelho/métodos , Instabilidade Articular/prevenção & controle , Osteoartrite do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Amplitude de Movimento Articular/fisiologia , Procedimentos Cirúrgicos Robóticos/métodos , Fatores Etários , Idoso , Análise de Variância , Artroplastia do Joelho/efeitos adversos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Melhoria de Qualidade , Medição de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Fatores Sexuais , Resultado do Tratamento
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