Robotic Aortic Surgery

Duran, Cassidy; Kashef, Elika; El-Sayed, Hosam F.; Bismuth, Jean

doi:10.14797/mdcj-7-3-32

Cited by 8 publications

(6 citation statements)

References 10 publications

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“…Such devices have been recently introduced into other surgical subspecialties. 7,10,11,21 However, as noted by Peter Jannetta, one of the first neurosurgeons to document and integrate the microscope into neurosurgery in 1968, "… the hand cannot perform if the eye cannot see…" (personal communication). 25 This may have been why the development of effector robots in neurosurgery has been profoundly limited; specifically, inadequate visualization has been a rate-limiting step.…”

mentioning

confidence: 99%

Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications

Gonen

Chakravarthi

Monroy-Sosa

et al. 2017

Neurosurgical Focus

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OBJECTIVEThe move toward better, more effective optical visualization in the field of neurosurgery has been a focus of technological innovation. In this study, the authors’ objectives are to describe the feasibility and safety of a new robotic optical platform, namely, the robotically operated video optical telescopic-microscope (ROVOT-m), in cranial microsurgical applications.METHODSA prospective database comprising patients who underwent a cranial procedure between April 2015 and September 2016 was queried, and the first 200 patients who met the inclusion criteria were selected as the cohort for a retrospective chart review. Only adults who underwent microsurgical procedures in which the ROVOT-m was used were considered for the study. Preoperative, intraoperative, and postoperative data were retrieved from electronic medical records. The authors address the feasibility and safety of the ROVOT-m by studying various intraoperative variables and by reporting perioperative morbidity and mortality, respectively. To assess the learning curve, cranial procedures were categorized into 6 progressively increasing complexity groups. The main categories of pathology were I) intracerebral hemorrhages (ICHs); II) intraaxial tumors involving noneloquent regions or noncomplex extraaxial tumors; III) intraaxial tumors involving eloquent regions; IV) skull base pathologies; V) intraventricular lesions; and VI) cerebrovascular lesions. In addition, the entire cohort was evenly divided into early and late cohorts.RESULTSThe patient cohort comprised 104 female (52%) and 96 male (48%) patients with a mean age of 56.7 years. The most common pathological entities encountered were neoplastic lesions (153, 76.5%), followed by ICH (20, 10%). The distribution of cases by complexity categories was 11.5%, 36.5%, 22%, 20%, 3.5%, and 6.5% for Categories I, II, II, IV, V, and VI, respectively. In all 200 cases, the surgical goal was achieved without the need for intraoperative conversion. Overall, the authors encountered 3 (1.5%) major neurological morbidities and 6 (3%) 30-day mortalities. Four of the 6 deaths were in the ICH group, resulting in a 1% mortality rate for the remainder of the cohort when excluding these patients. None of the intraoperative complications were considered to be attributable to the visualization provided by the ROVOT-m. When comparing the early and late cohorts, the authors noticed an increase in the proportion of higher-complexity surgeries (Categories IV–VI), from 23% in the early cohort, to 37% in the late cohort (p = 0.030). In addition, a significant reduction in operating room setup time was demonstrated (p < 0.01).CONCLUSIONSThe feasibility and safety of the ROVOT-m was demonstrated in a wide range of cranial microsurgical applications. The authors report a gradual increase in case complexity over time, representing an incremental acquisition of experience with this technology. A learning curve of both setup and execution phases should be anticipated by new adopters of the robot system. Further prospective studies are required to address the efficacy of ROVOT-m. This system may play a role in neurosurgery as an integrated platform that is applicable to a variety of cranial procedures.

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mentioning

confidence: 99%

Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications

Gonen

Chakravarthi

Monroy-Sosa

et al. 2017

Neurosurgical Focus

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“…Further clinical studies assessing the cost-effectiveness of the endovascular robotic system and the safety and performance in complex clinical cases involving fenestrated stent grafting are necessary to promote the usage of this new technique. 4,12 Although the only functional unit of this new system is in St. Mary's Hospital, Paddington, London, other countries are catching up, with Germany and France due to install a unit soon, and Singapore and Sydney having purchasing plans as well. Most recently, there has been a single case report of robot-assisted fenestrated endovascular aneurysm repair using the Magellan system in a patient.…”

Section: Discussionmentioning

confidence: 99%

“…It was first employed in 1985 for neurosurgical biopsies. 4 Since then, it has been applied in different specialties, especially by gynecologists, urologists and colorectal surgeons operating within the confined space of the pelvis. In recent years, robotic surgery has found applications in vascular surgery, which can potentially reduce the limitations of current endovascular techniques.…”

Section: Clinical Studies On the Feasibility Of Robotic Endovascular Surgerymentioning

confidence: 99%

Robotic endovascular surgery

Tsang

et al. 2013

Asian Cardiovasc Thorac Ann

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The purpose of this review is to compare conventional endovascular procedures and the robotic endovascular approach in aortic aneurysm repair. Despite advantages over open surgery, conventional endovascular surgery has limitations. To develop an alternative, efforts have been focused on robotic endovascular systems. Two of the 3 studies comparing procedure times demonstrated reduced procedure time in the robotic group, by 6 times (p < 0.05). One study demonstrated that robotic procedures reduced fluoroscopic exposure time by 12 minute (p < 0.001). Three in-vitro studies showed that the number of movements required in robotic surgery was reduced up to 10 times (p < 0.05). One of 2 studies measuring robotic performance score showed a better performance score in the robotic endovascular group (p = 0.007). These results demonstrate that the robotic technique has multiple advantages over the conventional procedure, including improved catheter stability, a shorter learning curve, reduced procedure time, and better performance in cannulating tortuous vessels. However, robotic endovascular technology may be limited by the cost of the system, the size of the catheter, and the setup time required preoperatively. Further comparative studies between conventional and robotic approaches regarding cost-effectiveness, safety, and performance in cases involving complex anatomy and fenestrated stent grafts are essential. Nevertheless, this revolutionary technology is increasingly popular and may be the next milestone in endovascular surgery.

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“…Robotic-assisted systems have developed increasingly over the past 2 decades and are currently applied in various clinical indications in orthopaedics, urology, gynaecology, general and thoracic surgery [ 1 ]. This has allowed surgeons to treat complex clinical syndromes while reducing morbidity and error rates, shortening operating times and improving the overall workflow [ 1 ]. Wisselink et al reported 2002 for the first time on robotic-assisted abdominal aortic surgery (RAAS) treating two patients with robotic-assisted aorto-iliac bypasses [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Robotic-assisted abdominal aortic surgery: evidence and techniques

et al. 2022

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In various disciplines, robotic-assisted surgery is a well-proven routine procedure, but have never been established in vascular surgery so far. This review summarizes the results to date of robotic-assisted abdominal aortic surgery (RAAS) in the treatment of aorto-iliac occlusive disease (AIOD) and abdominal aortic aneurysm (AAA). Web-based literature search of robotic-assisted surgical procedures on the abdominal aorta and iliac arteries between 1990 and 2020 including the Cochrane Library, OVID Medline, Embase, and PubMed medical databases. All studies conducting Robotic-assisted surgery were included in the quantitative analysis regarding operative and cross-clamping times, conversion rates, mortality and morbidity within the first 30 days, and in-hospital stay. Case reports and case studies (< 5 patients) were not included. Twenty-four studies were deemed thematically eligible for inclusion; after exclusion of duplicate publications, nine met the inclusion criteria for further analysis. A total of 850 patients who had either abdominal aortic aneurysm or aorto-iliac occlusive disease underwent RAAS. One study of abdominal aortic aneurysm, three of aorto-iliac occlusive disease, and five studies of both disease entities were analyzed quantitatively. For AAA, conversion rates ranged from 13.1 to 20% and perioperative mortality ranged from 0 to 1.6% with in-hospital stay of 7 days. For aorto-iliac occlusive disease, conversion rates ranged from 0 to 20%, and perioperative mortality ranged from 0 to 3.6% with in-hospital stay of 5–8 days. RAAS has been shown to be technically feasible with acceptable short-term outcomes and questionable benefits in terms of in-hospital stay and complication rates. RAAS is currently considered only an outsider procedure. Randomized-controlled trials are indispensable for regular use in vascular surgery as well as a clear approval situation for the vascular sector.

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Robotic Aortic Surgery

Cited by 8 publications

References 10 publications

Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications

Initial experience with a robotically operated video optical telescopic-microscope in cranial neurosurgery: feasibility, safety, and clinical applications

Robotic endovascular surgery

Robotic-assisted abdominal aortic surgery: evidence and techniques

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