Robotic urologic surgery: trends in litigation over the last decade

Nik‐Ahd, Farnoosh; Souders, Colby P.; Zhao, Hanson; Houman, Justin; McClelland, Lynn; Chughtai, Bilal; Anger, Jennifer T.

doi:10.1007/s11701-018-00905-y

Cited by 20 publications

(13 citation statements)

References 4 publications

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“…However, surgical robots have a very different operating system than conventional laparoscopic surgery, and without adequate training in their operation, dangerous operations can lead to severe complications. 2 Particularly, since the da Vinci robot does not have tactile feedback, the possibility of severe tissue damage cannot be ruled out if the forceps are moved outside the eld of view. 18 Therefore, it is strongly recommended that su cient time for adequate training is given before the start of surgery to ensure safe surgical procedures are performed.…”

Section: Discussionmentioning

confidence: 99%

“…1 However, the increase in RASs augmented the number of iatrogenic injuries caused by improper use of the da Vinci robot. 2 Since a lack of experience has caused 53% of surgical errors, 3 strict training before use of RAS is needed to evaluate and improve the surgeon's competence. 4 In Japan, the Japanese Urological Association has formulated an educational program for performing RAS, which requires more than 20 hours of training on the da Vinci robot.…”

Section: Introductionmentioning

confidence: 99%

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Improvement of three-dimensional motion sickness using a virtual reality simulator for robot-assisted surgery in undergraduate medical students: a prospective observational study

Takata

Kanehira

Kato

et al. 2021

Preprint

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Background A virtual reality (VR) simulator is utilized as an inexpensive tool for gaining basic technical competence in robotic-assisted surgery (RAS). We evaluated operator 3D motion sickness while using a VR simulator and assessed whether it can be reduced by repeating the training. Methods This prospective observational study was conducted at the Department of Urology, Iwate Medical University, a tertiary level training hospital in an urban setting. A total of 30 undergraduate medical students participated in the study. We compared whether the VR simulator improved the students’ skills in operating the da Vinci robot. Fifteen students underwent training with a VR simulator for 4 hours a day for 5 days. Then, motion sickness was ascertained using the Visual Analog Scale and Simulator Sickness Questionnaire (SSQ) before and after the training. Results Manipulation time significantly improved after training compared to before training (293.9 ± 72.4 versus 143.6 ± 18.4 seconds, p < 0.001). Although motion sickness worsened after each training session, continuous practice with the VR simulator gradually reduced this. SSQ subscores showed that the VR simulator elicited nausea, disorientation, and oculomotor strain, and oculomotor strain was significantly improved with repeated training. Conclusion In undergraduate students, practice with the VR simulator improved the technique of RAS and operator 3D motion sickness caused by 3D manipulation of the da Vinci robot.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improvement of three-dimensional motion sickness using a virtual reality simulator for robot-assisted surgery in undergraduate medical students: a prospective observational study

Takata

Kanehira

Kato

et al. 2021

Preprint

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“…Sotelo et al 11 pointed out that instrument exchange during robotic surgery caused bowel injuries that might not be detected during surgery. Jara et al 12 highlighted the importance of team training to reduce the complications of robotic surgery. The results of our present study can be applied to robotic surgery; that is, bedside surgeons should insert laparoscopic instruments slowly with a soft grip to prevent organ injuries.…”

Section: Discussionmentioning

confidence: 99%

How to reduce the risk of organ injuries during surgical instrument insertion in laparoscopic surgery: Pushing/pressing force analysis using forceps with sensors

Makiyama

Osaka

Araki

et al. 2020

Asian J Endoscop Surgery

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Introduction In laparoscopic surgery, surgical instruments are inserted from a trocar to the target organ in a blind fashion, which carries a risk of organ injury. To clarify the risks associated with surgical instrument insertion, we measured grip strength and pushing/pressing force during surgical instrument insertion in laparoscopic surgery. Methods Using forceps with sensors inside a trocar, 10 urologists performed a laparoscopic procedure in pigs, in which they were asked to touch the abdominal wall. The surgeons closed their eyes during the procedure and stopped moving the forceps when they felt them come into contact with the abdominal wall. They were ordered to grip the forceps strongly or softly and to move them rapidly or slowly during the procedure. Grip strength and the pushing/pressing force when the forceps hit the abdominal wall were measured and analyzed. Results The mean pushing/pressing force when the surgeons gripped the forceps strongly and moved them rapidly (strong/rapid), strongly/slowly, softly/rapidly, and softly/slowly were 2.8, 2.0, 1.7, and 1.1 N, respectively. The pushing/pressing force was significantly greater when the surgeons gripped the forceps strongly, regardless of the forceps speed (P < .001). The pushing/pressing force was significantly greater when the surgeons moved the forceps rapidly, regardless of grip strength (P < .001). Conclusions When surgeons insert laparoscopic instruments through trocars, the instruments should be gripped softly and moved slowly to avoid organ injuries.

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“…Nonetheless, the lack of this kind of experimental research misses the opportunity for innovation and probably for higher evidence-based literature that consolidates a safer path for the safe and efficient use of this novel tool. It is interesting to see that early adopters of RAS had the highest risk of litigation ( 30 ). But after the amount of procedures performed increased, the risks dropped.…”

Section: Discussionmentioning

confidence: 99%

A Comprehensive Analysis of Robot-Assisted Surgery Uptake in the Pediatric Surgical Discipline

Fernández

Farhat

2019

Front. Surg.

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Introduction: Robotic assisted surgery (RAS) is one of the most recent surgical approaches that has quickly been adopted by the pediatric urology community. Over the last decade, a vast amount of manuscripts has been published, supporting the safety and applicability of RAS in the pediatric population. The quality of published literature about this innovative technology remains supported by case-reports and retrospective case-series. Historical behavior of literature productivity and implementation of laparoscopy followed a similar trend. We present the historical publication uptake of RAS in pediatric urology and other surgical disciplines using a bibliometric comparison of the most cited manuscripts.Materials and Methods: A systematic search and review of the literature was undertaken by the authors. Literature search was performed in OVID, PubMed, EMBASE, Scopus, Web of Science, and Google Scholar. The search period included all publications between 1985 and June 2018. All languages were included. Data analysis for graphical representation was performed using VOSviewer® version 1.6.8 and Impact Index Analysis was used to adjust the citations by the time since publication.Results: A total of 1,014 titles were identified. After applying exclusion criteria, 200 papers were included for the RAS arm and 402 for the laparoscopic one. Case-series was the most common type of publication. Average citations for laparoscopic manuscripts was 23 (SD ± 31) and for RAS was 20 (SD ± 31.5). The impact index analysis showed an average of 95 (SD ± 167) for laparoscopic manuscripts vs. 66 (SD ± 101) for RAS. The laparoscopic manuscript with the highest citation count had 199 citations with an impact index of 12.1. And the RAS manuscript with the highest citation count had 280 citations and an impact index of 4.3.Conclusion: Literature productivity in pediatric laparoscopic and RAS has quickly grown. Pediatric Urologists play a key role in the introduction of this innovative tool. Literature supporting its implementation and future consolidation requires to focus on increasing the level of evidence.

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Robotic urologic surgery: trends in litigation over the last decade

Cited by 20 publications

References 4 publications

Improvement of three-dimensional motion sickness using a virtual reality simulator for robot-assisted surgery in undergraduate medical students: a prospective observational study

Improvement of three-dimensional motion sickness using a virtual reality simulator for robot-assisted surgery in undergraduate medical students: a prospective observational study

How to reduce the risk of organ injuries during surgical instrument insertion in laparoscopic surgery: Pushing/pressing force analysis using forceps with sensors

A Comprehensive Analysis of Robot-Assisted Surgery Uptake in the Pediatric Surgical Discipline

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