Keeping surgeons in the loop: are handheld robotics the best path towards more autonomous actions? (A comparison of complete vs. handheld robotic hepatectomy for colorectal liver metastases)

Gumbs, Andrew A.; Abu-Hilal, Mohammed; Tsai, Tzu-Jung; Starker, Lee F.; Chouillard, Élie; Croner, Roland S.

doi:10.20517/ais.2021.07

Cited by 8 publications

(9 citation statements)

References 45 publications

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“…The lack of data on adjuvant chemotherapy in this trial is a limitation, but as mentioned, the heterogeneity in treatments given precludes any meaningful comments and again highlights the need for large randomized controlled trials. This is particularly true because survival has been shown to have improved with newer chemotherapeutic agents, with one study showing an improvement in 5-year OS from 33.3% to 49.0% since 2005 due to changes in modern adjuvant treatments [ 59 ].…”

Section: Discussionmentioning

confidence: 99%

“…Newer collaborative robots that are handheld or do not use a console may also become useful in the surgeon’s armamentarium against CRLM and may actually permit a safer adoption of more automatic and autonomous actions in the operating room [ 58 , 59 , 60 , 61 ]. Modern-day liver surgeons will need expertise in open, laparoscopic and robotic-assisted techniques to offer the best personalized surgical care to their patients with CRLM.…”

Section: Future Directionsmentioning

confidence: 99%

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Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)

Gumbs

Croner

Lorenz

et al. 2022

Cancers

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Introduction: Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-CRLM) was a propensity score matched (PSM) study that reported short-term outcomes of patients with CRLM who met the Milan criteria and underwent either open (OLR), laparoscopic (LLR) or robotic liver resection (RLR). This study, designated as SIMMILR-2, reports the long-term outcomes from that initial study, now referred to as SIMMILR-1. Methods: Data regarding neoadjuvant chemotherapeutic (NC) and neoadjuvant biological (NB) treatments received were collected, and Kaplan–Meier curves reporting the 5-year overall (OS) and recurrence-free survival (RFS) for OLR, LLR and RLR were created for patients who presented with synchronous lesions only, as there was insufficient follow-up for patients with metachronous lesions. Results: A total of 73% of patients received NC and 38% received NB in the OLR group compared to 70% and 28% in the LLR group, respectively (p = 0.5 and p = 0.08). A total of 82% of patients received NC and 40% received NB in the OLR group compared to 86% and 32% in the RLR group, respectively (p > 0.05). A total of 71% of patients received NC and 53% received NB in the LLR group compared to 71% and 47% in the RLR group, respectively (p > 0.05). OS at 5 years was 34.8% after OLR compared to 37.1% after LLR (p = 0.4), 34.3% after OLR compared to 46.9% after RLR (p = 0.4) and 30.3% after LLR compared to 46.9% after RLR (p = 0.9). RFS at 5 years was 12.1% after OLR compared to 20.7% after LLR (p = 0.6), 33.3% after OLR compared to 26.3% after RLR (p = 0.6) and 22.7% after LLR compared to 34.6% after RLR (p = 0.6). Conclusions: When comparing OLR, LLR and RLR, the OS and RFS were all similar after utilization of the Milan criteria and PSM. Biological agents tended to be utilized more in the OLR group when compared to the LLR group, suggesting that highly aggressive tumors are still managed through an open approach.

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Section: Discussionmentioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)

Gumbs

Croner

Lorenz

et al. 2022

Cancers

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“…A true example of strong AI or level 5 autonomy where a robot or device acts completely independently does not exist in surgery; however, an example does exist in healthcare. An automatic implantable cardioverter-defibrillator (AICD) autonomously diagnoses an arrhythmia and potentially gives a life-saving shock treatment to the patient without any input from a human [6]. As researchers have grappled with the intricacies of autonomy, six levels of surgical autonomy have been designated.…”

Section: Automatic Vs Autonomous Actionsmentioning

confidence: 99%

“…However, maybe we should be asking ourselves which is the best way forward, more specifically, are complete robotic surgical systems with tele-manipulation really the best way forward? Maybe the surgeon needs to be kept in the loop by keeping the surgeon at the bedside and developing more handheld collaborative robots [6,72].…”

Section: Robotic-assisted Surgery and Autonomous Actionsmentioning

confidence: 99%

The Advances in Computer Vision That Are Enabling More Autonomous Actions in Surgery: A Systematic Review of the Literature

Gumbs

Grasso²,

Bourdel

et al. 2022

Sensors

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This is a review focused on advances and current limitations of computer vision (CV) and how CV can help us obtain to more autonomous actions in surgery. It is a follow-up article to one that we previously published in Sensors entitled, “Artificial Intelligence Surgery: How Do We Get to Autonomous Actions in Surgery?” As opposed to that article that also discussed issues of machine learning, deep learning and natural language processing, this review will delve deeper into the field of CV. Additionally, non-visual forms of data that can aid computerized robots in the performance of more autonomous actions, such as instrument priors and audio haptics, will also be highlighted. Furthermore, the current existential crisis for surgeons, endoscopists and interventional radiologists regarding more autonomy during procedures will be discussed. In summary, this paper will discuss how to harness the power of CV to keep doctors who do interventions in the loop.

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“…The oncological result can be optimized in this way [ 15 , 24 ]. Although laparoscopy has the theoretical advantage of haptics, this limitation in robotic-assisted surgery may be able to be overcome via visual cues [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?—A Systematic Review and Meta-Analysis

Rahimli

Perrakis

Andric

et al. 2022

Cancers

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Background: Robotic procedures are an integral part of modern liver surgery. However, the advantages of a robotic approach in comparison to the conventional laparoscopic approach are the subject of controversial debate. The aim of this systematic review and meta-analysis is to compare robotic and laparoscopic liver resection with particular attention to the resection margin status in malignant cases. Methods: A systematic literature search was performed using PubMed and Cochrane Library in accordance with the PRISMA guidelines. Only studies comparing robotic and laparoscopic liver resections were considered for this meta-analysis. Furthermore, the rate of the positive resection margin or R0 rate in malignant cases had to be clearly identifiable. We used fixed or random effects models according to heterogeneity. Results: Fourteen studies with a total number of 1530 cases were included in qualitative and quantitative synthesis. Malignancies were identified in 71.1% (n = 1088) of these cases. These included hepatocellular carcinoma, cholangiocarcinoma, colorectal liver metastases and other malignancies of the liver. Positive resection margins were noted in 24 cases (5.3%) in the robotic group and in 54 cases (8.6%) in the laparoscopic group (OR = 0.71; 95% CI (0.42–1.18); p = 0.18). Tumor size was significantly larger in the robotic group (MD = 6.92; 95% CI (2.93–10.91); p = 0.0007). The operation time was significantly longer in the robotic procedure (MD = 28.12; 95% CI (3.66–52.57); p = 0.02). There were no significant differences between the robotic and laparoscopic approaches regarding the intra-operative blood loss, length of hospital stay, overall and severe complications and conversion rate. Conclusion: Our meta-analysis showed no significant difference between the robotic and laparoscopic procedures regarding the resection margin status. Tumor size was significantly larger in the robotic group. However, randomized controlled trials with long-term follow-up are needed to demonstrate the benefits of robotics in liver surgery.

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Keeping surgeons in the loop: are handheld robotics the best path towards more autonomous actions? (A comparison of complete vs. handheld robotic hepatectomy for colorectal liver metastases)

Abstract: Keeping surgeons in the loop: are handheld robotics the best path towards more autonomous actions? (A comparison of complete vs. handheld robotic hepatectomy for colorectal liver metastases).

Cited by 8 publications

References 45 publications

Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)

Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)

The Advances in Computer Vision That Are Enabling More Autonomous Actions in Surgery: A Systematic Review of the Literature

Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?—A Systematic Review and Meta-Analysis

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