The Experts below are selected from a list of 4302 Experts worldwide ranked by ideXlab platform
Seung Hyuk Baik - One of the best experts on this subject based on the ideXlab platform.
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Robotic total mesorectal excision for rectal cancer: it may improve survival as well as quality of life
Surgical endoscopy, 2008Co-Authors: Seung Hyuk BaikAbstract:I read with great interest the letter by Ziogas et al. [1]. Their first question is why the da Vinci System in rectal cancer surgery may provide a survival benefit and the second is why this benefit cannot occur for other cancer sites in the gastrointestinal tract. For the first question, the answer lies with the technological advantages of the da Vinci System. In rectal cancer surgery, total mesorectal excision (TME) has become the surgical treatment of choice [2]. However, TME is a technically demanding procedure since it is performed in a narrow pelvic cavity. Therefore, macroscopic completeness of a resected rectal specimen is variable according to the patient’s anatomic factors and the type of surgical procedures. The macroscopic completeness of a resected rectal specimen is a predictive factor of a patient’s prognosis [3]. In my experience of robotic TME, pathologic results with macroscopic grading were excellent [4]. I postulate that these pathologic results account for improving long-term survival even though there is, as of yet, no study about long-term survival in robotic rectal cancer surgery. The second question can be similarly answered when one reflects on the specific technological advantage of the da Vinci System. Except the rectum, surgical view is excellent in the rest of the gastrointestinal tract and the concept of macroscopic completeness of a resected specimen does not exist in gastrointestinal tract surgeries other than rectal surgery. The important thing for a better survival is en bloc and proper lymph node dissection. Thus, the technical advantage of the da Vinci System does not contribute to a better survival benefit compared to the open procedures in the era of proper lymph node dissection in gastrointestinal tract cancer surgeries beyond quality of life. The general advantages of da Vinci robotic System are a three-dimensional view, hand-tremor filtering, fine dexterity, and motion scaling. These advantages are more helpful for secure dissection in a narrow surgical field. Therefore, da Vinci System may provide a greater advantage in rectal cancer surgery than other gastrointestinal tract surgeries. However, further large-scale prospective studies to evaluate these issues would be helpful.
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robotic total mesorectal excision for rectal cancer using four robotic arms
Surgical Endoscopy and Other Interventional Techniques, 2008Co-Authors: Woo Jung Lee, Seung Hyuk Baik, Koon Ho Rha, Nam Kyu Kim, Seung Kook Sohn, Hoon Sang ChiAbstract:The da Vinci System is a newly developed device for colorectal surgery, therefore experience of its use for rectal cancer surgery is limited and there are no reports describing the use of four robotic arms with this System. The aim of this study is to evaluate the safety and feasibility of the four-arm da Vinci System for total mesorectal excision in rectal cancer patients. Clinicopathologic data were prospectively collected on nine patients who underwent robotic total mesorectal excision using four robotic arms for the treatment of mid or low rectal cancer between November 2006 and Febuary 2007. Patient demographics, perioperative clinical outcomes, and pathology results with macroscopic grading (complete, nearly complete, incomplete) were evaluated. nine patients with mid or low rectal cancer underwent robotic total mesorectal excison using four robotic arms without serious complications. The mean length of hospital stay was 7.4 ± 1.3 days (range 5.0–10.0 days) and the mean operating time was 220.8 ± 49.4 min (range 153–315 min). Macroscopic grading of the specimen was complete in eight patients and nearly complete in one patient. There were no cases of conversion. In the present study, we accomplished nine robot-assisted rectal resections safely and effectively.
Fabio Cautiero - One of the best experts on this subject based on the ideXlab platform.
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Da Vinci System: clinical experience with complex proximal humerus fractures
MUSCULOSKELETAL SURGERY, 2010Co-Authors: Raffaele Russo, Valeria Visconti, Luigi Vernaglia Lombardi, Michele Ciccarelli, Fabio CautieroAbstract:The purpose of this study is to report the clinical and radiographic outcomes after open reduction and internal fixation of displaced proximal humerus fractures with the “Da Vinci System^®”. It is a triangle-shaped cage whose opposite faces are pierced, and it represents the evolution of a triangle-shaped bone block technique performed in a previous series of 33 patients. The new device is an interesting innovation to treat the difficult problem of fracture fragments reconstruction and stability, metaphyseal bone loss and proximal humerus revascularization. According to the technique, authors position the correct size titanium cage into the metaepiphysis, so that the fragments are reduced upon the cage, and they are stabilized with a minimal osteosynthesis by Kirschner wires, titanium screws or transosseous sutures. If the fracture line involves the proximal portion of the diaphysis, it is possible to use a short low profile plate. Between May 2005 and November 2009, we treated 71 patients (34 men and 37 women), even though we included in our study only 59 patients, who had a minimum follow-up of 12 months. The first patient has been treated in May 2005 and the last one in September 2008. The mean age was 60.8 years (minimum 27, maximum 78). There were 8 displaced 3-part fractures, 20 displaced 4-part fractures, 10 4-part fracture-dislocations, 5 head splitting, 12 unclassified multifragmentary fractures, 1 2-part fracture with multifragmentary calcar and 3 malunions of 4-part fracture. The functional results were evaluated by the Constant score. With a mean follow-up of 24 months (minimum 12, maximum 36 months), the mean Constant score was 80.25. The results were excellent or good in 48 cases, bad in 2 cases and satisfactory in 9; the mean active anterior elevation (AAE) was 160°. All fractures but one healed; in one case, we had a deep infection after 80 days since the operation, treated with a preformed cement spacer.
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Da Vinci System: clinical experience with complex proximal humerus fractures.
Musculoskeletal surgery, 2010Co-Authors: Raffaele Russo, Valeria Visconti, Michele Ciccarelli, Luigi Vernaglia Lombardi, Fabio CautieroAbstract:The purpose of this study is to report the clinical and radiographic outcomes after open reduction and internal fixation of displaced proximal humerus fractures with the "Da Vinci System". It is a triangle-shaped cage whose opposite faces are pierced, and it represents the evolution of a triangle-shaped bone block technique performed in a previous series of 33 patients. The new device is an interesting innovation to treat the difficult problem of fracture fragments reconstruction and stability, metaphyseal bone loss and proximal humerus revascularization. According to the technique, authors position the correct size titanium cage into the metaepiphysis, so that the fragments are reduced upon the cage, and they are stabilized with a minimal osteosynthesis by Kirschner wires, titanium screws or transosseous sutures. If the fracture line involves the proximal portion of the diaphysis, it is possible to use a short low profile plate. Between May 2005 and November 2009, we treated 71 patients (34 men and 37 women), even though we included in our study only 59 patients, who had a minimum follow-up of 12 months. The first patient has been treated in May 2005 and the last one in September 2008. The mean age was 60.8 years (minimum 27, maximum 78). There were 8 displaced 3-part fractures, 20 displaced 4-part fractures, 10 4-part fracture-dislocations, 5 head splitting, 12 unclassified multifragmentary fractures, 1 2-part fracture with multifragmentary calcar and 3 malunions of 4-part fracture. The functional results were evaluated by the Constant score. With a mean follow-up of 24 months (minimum 12, maximum 36 months), the mean Constant score was 80.25. The results were excellent or good in 48 cases, bad in 2 cases and satisfactory in 9; the mean active anterior elevation (AAE) was 160 degrees . All fractures but one healed; in one case, we had a deep infection after 80 days since the operation, treated with a preformed cement spacer.
Inderbir S Gill - One of the best experts on this subject based on the ideXlab platform.
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three dimensional printed model of prostate anatomy and targeted biopsy proven index tumor to facilitate nerve sparing prostatectomy
European Urology, 2016Co-Authors: Toshitaka Shin, Osamu Ukimura, Inderbir S GillAbstract:dimension is the same as that for standard laparoscopy (5 mm) and smaller than that of the da Vinci System (8 mm). ALF-X has different safety tools: a go/no-go foot pedal to control movements, control of the highest usable force during surgery, a sensitive grip for precise manipulation, restricted movement speed, and an emergency stop with warning lights and sounds. ALF-X includes a large set of fully reusable instruments, which could offer specific advantages in terms of cost with respect to the da Vinci System, for which each instrument is designed for a limited number of procedures. In addition, different laparoscopic instruments can be adapted for ALF-X robotic arms. A possible limitation of ALF-X is the lack of wristed instrumentation (except for the RADIA needle driver), which represents the main strength of the da Vinci robot. We found no limitations in performing RALPN with ALF-X compared with a similar procedure using the da Vinci System, as the RADIA needle driver enabled a wristed suturing procedure. In our experience, the System was versatile during each step of RALPN, and the operative times reduced dramatically along the learning curve. According to these experimental experiences on pig models, we state that RALPN using ALF-X is a safe, feasible, and reproducible procedure. BecauseALF-X is currently on the market and is used in gynecology, colorectal surgery, and soon in the urologic field, further results on humans are needed and about to come.
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robotic laparoscopic surgery a comparison of the da Vinci and zeus Systems
Urology, 2001Co-Authors: Gyung Tak Sung, Inderbir S GillAbstract:Abstract Objectives. To evaluate two currently available robotic surgical Systems in performing various urologic laparoscopic procedures in an acute porcine model. Methods. Robotic laparoscopic surgery was performed in 14 swine. Data were compared between the da Vinci Robotic System and the Zeus Robotic System. Results. During laparoscopic nephrectomy, the da Vinci System (n = 6) had a significantly shorter total operating room time (51.3 versus 71.6 minutes; P = 0.02) and actual surgical time (42.1 versus 61.4 minutes; P = 0.03) compared with the Zeus System (n = 5). However, the blood loss and adequacy of surgical dissection were comparable between the two groups. For laparoscopic adrenalectomy, the da Vinci System (n = 5) had a shorter actual surgical time (12.2 versus 26.0 minutes; P = 0.006) than did the Zeus System (n = 5). For laparoscopic pyeloplasty, the da Vinci System had a shorter total operating room time (61.4 versus 83.4 minutes; P = 0.10) and anastomotic time (44.7 versus 66.4 minutes; P = 0.11). During pyeloplasty anastomosis, the total number of suture bites per ureter was 13.0 for the da Vinci System (n = 6) and 10.8 for the Zeus System (n = 6). The complications included an adrenal parenchymal tear each during a da Vinci System-based left adrenalectomy and a Zeus System-based right adrenalectomy. An inferior vena caval tear during a Zeus System-based right adrenalectomy occurred in 1 case, which was suture-repaired telerobotically. Conclusions. Robotic laparoscopic procedures can be performed effectively using either the da Vinci or Zeus System. In this limited study, the learning curve and operative times were shorter and the intraoperative technical movements appeared inherently more intuitive with the da Vinci System. Additional clinical experience is necessary.
Thomas Schmid - One of the best experts on this subject based on the ideXlab platform.
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Initial experience with robotic lung lobectomy: report of two different approaches
Surgical endoscopy, 2010Co-Authors: Florian Augustin, Johannes Bodner, Christoph Schwinghammer, H. Wykypiel, Thomas SchmidAbstract:Background Surgical resection is the gold standard for treatment of early-stage lung tumors. Different minimally invasive approaches are currently under investigation: In addition to conventional video-assisted thoracoscopic surgery (VATS), robotic technology with the da Vinci System has emerged over the past 10 years.
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Robotic-Assisted Thoracoscopic Surgery (RATS) for Benign and Malignant Esophageal Tumors
The Annals of thoracic surgery, 2005Co-Authors: Johannes Bodner, H. Wykypiel, Matthias Zitt, Harald C. Ott, Gerold J. Wetscher, Paolo Lucciarini, Thomas SchmidAbstract:Background Robotic surgical Systems are most effective for operations in areas that are small and difficult to reach. Ideal indications for this new technology have yet to be established. The esophagus possesses attributes that are interesting for general thoracic robotic surgeons. Methods Robotic-assisted thoracoscopic surgery (RATS) using the da Vinci System (Intuitive Surgical, Inc, Mountain View, CA) was performed in six patients with esophageal tumors. This comprised the dissection of the intrathoracic esophagus including lymph node dissection in four patients suffering from esophageal cancer and the extirpation of a benign lesion (one leiomyoma and one foregut cyst) in the remaining two patients. Results All procedures were completed successfully with the robot. The median overall operating time was 173 (160–190) minutes in the oncologic cases and 121 minutes in the benign cases, including the robotic act of 147 (135–160) minutes and 94 minutes, respectively. There were no intraoperative complications. One patient had to undergo a redo thoracoscopy because of a persistent lymph fistula. One cancer patient died after 12 months due to tumor progression and another patient had to be stented due to local tumor recurrence 19 months postoperatively. Conclusions This first small series of various esophageal pathologies treated by robotic-assisted thoracoscopic surgery supports the impression that the esophagus is an ideal organ for a robotic approach. The potential of the da Vinci System, especially for oncologic indications, remains to be proven in future clinical trials.
Joachim M. Mueller - One of the best experts on this subject based on the ideXlab platform.
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Robotic-assisted laparoscopic and thoracoscopic surgery with the da Vinci System: a 4-year experience in a single institution.
Surgical laparoscopy endoscopy & percutaneous techniques, 2008Co-Authors: Chris Braumann, Christoph A. Jacobi, Charalambos Menenakos, Mahmoud Ismail, Jens C. Rueckert, Joachim M. MuellerAbstract:PurposeWe set up a pilot study to evaluate the efficacy of telerobotic surgery using the da Vinci System for several procedures for which traditional laparoscopy (or thoracoscopy) is a standard approach in a single institution.MethodsWe performed fundoplications (hiatal hernia repair and antireflux
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computer assisted laparoscopic colon resection with the da Vinci System our first experiences
Diseases of The Colon & Rectum, 2005Co-Authors: Chris Braumann, Charalambos Menenakos, Jens C. Rueckert, C A Jacobi, Ulrich Borchert, Joachim M. MuellerAbstract:PURPOSE:Telerobotic surgery is a developing and promising modality that highly improves the laparoscopic dexterity. We have performed more than 100 laparoscopic and thoracoscopic procedures since December 2002 with the aid of the Da Vinci® robotic System. This study was designed to assess the value
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Computer-assisted laparoscopic repair of "upside-down" stomach with the Da Vinci System.
Surgical laparoscopy endoscopy & percutaneous techniques, 2005Co-Authors: Chris Braumann, Charalambos Menenakos, Jens C. Rueckert, Joachim M. Mueller, Christoph A. JacobiAbstract:Recently introduced telerobotic surgical Systems attempt to elude the inherent limitations of traditional laparoscopic surgery. Four patients (3 male, 1 female) with mixed hiatal and paraesophageal hernias with fixed intrathoracic partial or complete displacement of the stomach were operatively treated using the Da Vinci robotic System. Tissue dissection, hiatoplasty, and anterior hemifundoplication (Dor) were performed with the telerobotic System. There were no surgical complications. The System broke down in the fourth patient due to a software defect. Advantages were seen in terms of the intrathoracic dissection of displaced stomach through a narrow hiatus, intracorporeal suturing due to 6 degrees of freedom plus grasping. At the moment, lack of the appropriate robotic instruments for abdominal surgery as well as the enormous functional cost of the robotic System are considered to be the most significant current impediment to the adoption of robotic abdominal surgery. The continuous evolution and upgrade of the System is quite promising so far. Telerobotic-assisted hiatal hernia operation is feasible with many advantages compared with the traditional laparoscopic approach, especially during the dissection in the mediastinum in patients with intrathoracic stomach. A prospective, randomized trial will be performed later to evaluate the advantages and limitations of robotic compared with traditional laparoscopy. Technological evolution will perhaps diminish the current problems and the cost associated with robotic surgery.
