Objective To summary the early experience of Dixon procedures with Da Vinci robotics surgical system for rectal cancer. Methods Eleven patients with rectal cancer underwent the combination of laparoscope and Da Vinci robotics surgical system with 4 trocars in our hospital from May. 2011 to Jan. 2012. Laparoscopy was firstly used to identify the possibility of the surgical procedure， then placed the 4 trocars， and maked sure the suspension of the sigmoid colon and the uterus. Transections of rectum were performed by a conventional laparoscopic method， and endoscopic separations were performed by Da Vinci robotics surgical system. The clinical data were retrospectively analyzed and the experience was summarized. Results The Da Vinci robotics-assisted Dixon procedures were successfully performed in 11 patients and no one turned to laparotomy. The operating time was 210-330min （mean 288.6min）；the blood loss was 20-100ml （mean 40ml）； The number of lymph nodes dissected was 12-21 per case （mean 13.9 per case）；the duration of bowel movement and hospital stay were 18-26h （mean 22h） and 7-16d （mean 11.5d）， respectively. There were no intraoperative or postoperative complications related to the use of robotics， and no residual cancer cells at resection margin. Conclusions Da Vinci robotics-assisted Dixion procedure with 4 trocars and suspension of sigmoid colon are safe and feasible， and it is beneficial to the recovery of patients
Robotic catheter minimally invasive operation requires that the driver control system has the advantages of quick response, strong anti-jamming and real-time tracking of target trajectory. Since the catheter parameters of itself and movement environment and other factors continuously change, when the driver is controlled using traditional proportional-integral-derivative (PID), the controller gain becomes fixed once the PID parameters are set. It can not change with the change of the parameters of the object and environmental disturbance so that its change affects the position tracking accuracy, and may bring a large overshoot endangering patients' vessel. Therefore, this paper adopts fuzzy PID control method to adjust PID gain parameters in the tracking process in order to improve the system anti-interference ability, dynamic performance and tracking accuracy. The simulation results showed that the fuzzy PID control method had a fast tracking performance and a strong robustness. Compared with those of traditional PID control, the feasibility and practicability of fuzzy PID control are verified in a robotic catheter minimally invasive operation.
ObjectiveTo summarize the research progress of peripheral nerve surgery assisted by Da Vinci robotic system. MethodsThe recent domestic and international articles about peripheral nerve surgery assisted by Da Vinci robotic system were reviewed and summarized. ResultsCompared with conventional microsurgery, peripheral nerve surgery assisted by Da Vinci robotic system has distinctive advantages, such as elimination of physiological tremors and three-dimensional high-resolution vision. It is possible to perform robot assisted limb nerve surgery using either the traditional brachial plexus approach or the mini-invasive approach. ConclusionThe development of Da Vinci robotic system has revealed new perspectives in peripheral nerve surgery. But it has still been at the initial stage, more basic and clinical researches are still needed.
ObjectiveTo investigate the effect of pressure control ventilation-volume guaranteed (PCV-VG) for patients undergoing da Vinci robotic-assisted pulmonary lobotomy. MethodA total of 40 patients undergoing Da Vinci robotic-assisted pulmonary lobotomy were randomly divided into two groups:a PCV-VG group (G group) and a volume-controlled ventilation (VCV) group (V group). There were 20 patients in each group with 13 males and 7 females at age of 49.0±5.5 years in the G group, 16 males and 4 females at age of 51.0±3.9 years in the V group. Haemodynamics indexes and oxygenation parameters were recorded at different times and compared between the two groups. ResultsDuring one-lung ventilation (OLV) period, the peak inspiratory pressure (Ppeak), respiratory index (RI) and arterial partial pressure of carbon dioxide (PaCO2) in the G group were statistically lower than those in the V group (P<0.05). While the Cdyn and inspired oxygen fraction(OI) were higher in the G group than those in the V group (P<0.05). ConclusionCompared with the traditional VCV ventilation mode, the PCV-VG ventilation mode improves Ppeak, Cdyn, OI, and RI of the patients undergoing da Vinci robotic-assisted pulmonary lobotomy.
ObjectiveTo estimate postoperative pain and use of analgesic of patients who underwent video-assisted thoracoscopic surgery(VATS) or robotic assisted thoracoscopic surgery(RATS). MethodsFrom October 2014 through August 2015, 339 patients were treated by surgery in Shanghai Chest Hospital. Among them, 116 patients with intrathoracic lesions who underwent RATS with the da Vinci? Surgical System were as a RATS group with 51 males and 65 females at age of 52.59±11.49 years. Another 223 patients by VATS were as a VATS group with 93 males and 130 females at age of 58.00±10.56 years. We recorded the data of the VAS score and use analgesic of the patients after surgery. ResultsThere was a significant difference in VAS score between the RATS group and the VATS group(3.01±0.18 vs. 5.19±0.14, P<0.05). Astatistical difference of analgesic use between RATS and VATS was also found(1.09±0.12 vs. 1.77±0.10, P<0.05). ConclusionCompared with VATS, the postoperative pain of the patients who underwent RATS is lighter. And the use of analgesic is less.
Objective To summarize the computer assisted navigation and robotics in the classification of knee surgery, and the development, surgical indications and contraindication, effectiveness, and the research progress of computer assisted navigation and robotics in unicompartmental knee arthroplasty (UKA). Methods The related literature on computer assisted navigation and robotics in UKA was extensively reviewed, summarized, and analyzed. Results Recently, satisfactory results have been achieved in UKA for the treatment of single compartmental knee osteoarthritis. With the rapid development of computer navigation and robotic technology gradually combined with clinical practice, the great precision and accuracy of implant have been improved in computer navigation and robotics in UKA surgery. Postoperative function is well recovered, meanwhile, prosthesis survival can be significantly increased. Conclusion Computer assisted navigation and robotics in UKA can greatly improve the accuracy of the implant when compared with traditional UKA. The early effectiveness is satisfactory, but the long-term effectiveness still needs to be further observed.
ObjectiveTo explore the efficacy of da Vinci robotic surgical system-assisted radical resection of rectal cancer. MethodsThe clinical data of 456 patients who received radical resection of rectal cancer by the da Vinci robotic surgical system at the Southwest Hospital from March 2010 to March 2016 were retrospectively analyzed. Operative time, operative blood loss, number of harvested lymph nodes, hospital stay, and morbidity were evaluated. Resultsda Vinci robotic surgical system-assisted radical resection of rectal cancer were successfully carried out in 445 patients, and other 11 patients were converted to open surgery (2.4%). Of 456 patients, 322 patients underwent anterior resection of rectum procedure (70.6%), 126 patients underwent abdominoperineal excision procedure (27.6%), 8 patients underwent Hartmann procedure (1.8%). The mean operative time was (192±60) min, the mean operative blood loss was (110±93) mL, the mean number of harvested lymph nodes were 19±6, the mean length between distal resection margin and tumor were (3.5±1.8) cm, the mean time for patients taking normal activity was (2.9±1.5) d, the mean time of passage of the first flatus was (2.7±1.7) d, the mean hospital stay was (7.1±1.6) d. Surgical complications occurred in 40 patients (8.8%), and all the patients were recovery before leaving hospital. The mean follow-up time was 29.1-month (3-75 months). There were 70 patients suffered from occurrence or metastasis (16.2%), and 60 patients died (13.9%). Conclusionda Vinci robotic surgical system-assisted radical resection for rectal cancer is a feasible and safe surgical procedure with the minimal trauma, fast recovery, and satisfactory clinical efficacy.
Objective To summarize the history, status quo, and prospect of robotic surgery system in domestic department of hepatobiliary surgery. Methods Related papers published in many databases, such as CNKI, VIP, WanFang, PubMed, an so on, were collected to make a review. Results With the development by nearly 8 years in our country, robotic surgery system has been preliminary used in all kinds of complicated operation in domestic department of hepatobiliary surgery, and positive results has been achieved. Currently robotic surgery technique is still in the continuous improvement and innovation. With the progression of robotic surgery technique and development of related equipment, this system would be more widely applied in domestic department of hepatobiliary surgery. Conclusions Robotic surgery system is now in the stage of development and promotion, but robotic surgery system has its unique advantages and it also has great development potential in technology. We believe that the robotic surgery system will be widely used in department of hepatobiliary surgery.
Objective To present the preliminary clinical experience of robot assisted trans-subxiphoid (extended) thymectomy in patients with thymic neoplasms or myasthenia gravis. Methods A total of 62 patients (34 males and 28 females at an average age of 38±11 years) suffering from thymic neoplasms or myasthenia gravis who underwent robotic (extended) thymectomy via subxiphoid approach were included in our department between August 2016 and August 2017. All of the operation were completed through 4 ports. In details, the observation hole was created just below the xiphoid process, two ports for arm 1 and arm 2 were created below bilateral subcostal arch at the midclavicular line, and trocar for arm 3 was placed in the 5th or 6th intercostal space at the anterior axillary line, respectively. Patients with thymic neoplasms received thymectomy. Patients with myasthenia gravis received extended thymectomy. Results All the patients experienced uneventful operations. The mean operative time was 116.0±34.0 min. The mean intraoperative blood loss was 5.6±4.3 ml. The mean postoperative hospital stay was 4.0±2.2 days. There was no intra-operational massive hemorrhage, mortality, conversion or postoperative complication during the postoperative and follow-up period. Conclusion Robotic trans-subxiphoid thymectomy is safe and feasible, which is a promising technique for extensive application.
Surgery is the preferred treatment for early esophageal cancer. Minimally invasive esophagectomy (MIE) can significantly reduce the incidence of postoperative complications and mortality, but due to the complex esophageal anatomy, intraoperative esophageal exposure, separation, anastomosis and lymph node dissection are difficult. The da Vinci surgical system provides a 3D vision and a more flexible as well as stable robotic arm, which is very helpful in completing fine surgical procedures. Robot-assisted minimally invasive esophagectomy(RAMIE) has been carried out in a number of countries, including China. Robot-assisted Ivor-Lewis esophagectomy (RAILE) is a transthoracic approach of robots developed in recent years. This paper summarizes the current researches on RAILE.