Obturator Nerve Injury in Robotic Pelvic Surgery: Scenarios and Management Strategies

Riva, Anibal La; Sayegh, Aref S.; Pérez, Laura Crespo; Poncel, Jaime; Medina, Luis G.; Adamic, Brittany; Powers, Ryan; Cacciamani, Giovanni; Aron, Monish; Gill, Inderbir S.; Sotelo, René

doi:10.1016/j.eururo.2022.12.034

Cited by 7 publications

(3 citation statements)

References 23 publications

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“…With regards to surgical quality, automated detection of intraoperative events facilitates analysis of adherence to established safety milestones. Figure 3 demonstrates rates of successfully viewing the obturator nerve during pelvic lymphadenectomy, a well-established safety maneuver, 13 for individual surgeons as well as for the overall study cohort. Similar data were collected for automatically quantifying the frequency of acute hemorrhage events during RARP (data not shown).…”

Section: Discussionmentioning

confidence: 99%

Automated Identification of Key Steps in Robotic-Assisted Radical Prostatectomy Using Artificial Intelligence

Khanna,

Antolin,

Bar

et al. 2024

Journal of Urology

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Purpose: The widespread use of minimally invasive surgery generates vast amounts of potentially useful data in the form of surgical video. However, raw video footage is often unstructured and unlabeled, thereby limiting its use. We developed a novel computer-vision algorithm for automated identification and labeling of surgical steps during robotic-assisted radical prostatectomy (RARP). Materials and Methods: Surgical videos from RARP were manually annotated by a team of image annotators under the supervision of 2 urologic oncologists. Full-length surgical videos were labeled to identify all steps of surgery. These manually annotated videos were then utilized to train a computer vision algorithm to perform automated video annotation of RARP surgical video. Accuracy of automated video annotation was determined by comparing to manual human annotations as the reference standard. Results: A total of 474 full-length RARP videos (median 149 minutes; IQR 81 minutes) were manually annotated with surgical steps. Of these, 292 cases served as a training dataset for algorithm development, 69 cases were used for internal validation, and 113 were used as a separate testing cohort for evaluating algorithm accuracy. Concordance between artificial intelligence-enabled automated video analysis and manual human video annotation was 92.8%. Algorithm accuracy was highest for the vesicourethral anastomosis step (97.3%) and lowest for the final inspection and extraction step (76.8%). Conclusions: We developed a fully automated artificial intelligence tool for annotation of RARP surgical video. Automated surgical video analysis has immediate practical applications in surgeon video review, surgical training and education, quality and safety benchmarking, medical billing and documentation, and operating room logistics.

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Section: Discussionmentioning

confidence: 99%

Automated Identification of Key Steps in Robotic-Assisted Radical Prostatectomy Using Artificial Intelligence

Khanna,

Antolin,

Bar

et al. 2024

Journal of Urology

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“…We read with interest the excellent article by A. La Riva et al [1]. The authors represented five type of obturator nerve injury (ONI) that may occur during robotic pelvic surgery, included crush injury with a clip, transection injury, partial or complete transection with feasible approximation, complete transection with challenging approximation, complete ransection injury with hidden proximal nerve ending, and the corresponding management strategies, and the principle that the obturator nerve should be skeletonized and well identifified from its surrounding structures no matter what processes were preformed.…”

Section: Editorialmentioning

confidence: 98%

Repairing the Obturator Nerve in Robotic Pelvic Surgery: Make the Procedure more Perfect

Ye¹

2023

J Clin Med Surgery

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We read with interest the excellent article by A. La Riva et al [1]. The authors represented five type of obturator nerve injury (ONI) that may occur during robotic pelvic surgery, included crush injury with a clip, transection injury, partial or complete transection with feasible approximation, complete transection with challenging approximation, complete ransection injury with hidden proximal nerve ending, and the corresponding management strategies, and the principle that the obturator nerve should be skeletonized and well identifified from its surrounding structures no matter what processes were preformed.

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“…After the axonotmesis, the spontaneous recovery process would undergo gradually after the Wallerian degeneration, to encourage axon fiber to grow into their original endoneurial tubes. [ 5 ] Neurotmesis is the most severe type PNI. Neurotmesis is defined as the whole peripheral nerve being structurally broken, from the inner axon fiber to the outer epineurium, and it is the main focus of this review because of its clinical significance.…”

Section: Introductionmentioning

confidence: 99%

Perspectives on the Novel Multifunctional Nerve Guidance Conduits: From Specific Regenerative Procedures to Motor Function Rebuilding

Zhou,

Rahman,

Sun

et al. 2024

Advanced Materials

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Peripheral nerve injury potentially destroys the quality of life by inducing functional movement disorders and sensory capacity loss, which results in severe disability and substantial psychological, social, and financial burdens. Autologous nerve grafting has been commonly used as treatment in the clinic; however, its rare donor availability limits its application. A series of artificial nerve guidance conduits (NGC) with advanced architectures have also been proposed to promote injured peripheral nerve regeneration, which is a complicated process from axon sprouting to targeted muscle reinnervation. Therefore, exploring the interactions between sophisticated NGC complexes and versatile cells during each process including axon sprouting, Schwann cell dedifferentiation, nerve myelination, and muscle reinnervation is necessary. This review highlights the contribution of functional NGCs and the influence of microscale biomaterial architecture on biological processes of nerve repair. Progressive NGCs with chemical molecule induction, heterogeneous topographical morphology, electroactive, anisotropic assembly microstructure, and self‐powered electroactive and magnetic‐sensitive NGCs were also collected, and they are expected to be pioneering features in future multifunctional and effective NGCs.This article is protected by copyright. All rights reserved

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Obturator Nerve Injury in Robotic Pelvic Surgery: Scenarios and Management Strategies

Cited by 7 publications

References 23 publications

Automated Identification of Key Steps in Robotic-Assisted Radical Prostatectomy Using Artificial Intelligence

Automated Identification of Key Steps in Robotic-Assisted Radical Prostatectomy Using Artificial Intelligence

Repairing the Obturator Nerve in Robotic Pelvic Surgery: Make the Procedure more Perfect

Perspectives on the Novel Multifunctional Nerve Guidance Conduits: From Specific Regenerative Procedures to Motor Function Rebuilding

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