Ex Vivo Porcine Model for Robotic Assisted Partial Nephrectomy Simulation at a High Volume Tertiary Center: Resident Perception and Validation Assessment Using the Global Evaluative Assessment of Robotic Skills (GEARS) Tool

2020 ◽  
Author(s):  
Alexander K Chow ◽  
Ryan Wong ◽  
Steven Monda ◽  
Rohit Bhatt ◽  
Kenneth G Sands ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Porcine Model ◽  
Ex Vivo ◽  
High Volume ◽  
Robotic Assisted ◽  
Tertiary Center ◽  
Resident Perception ◽  
Robotic Skills ◽  
Robotic Assisted Partial Nephrectomy

scholarly journals Total robotic surgical volume influences outcomes of low-volume robotic-assisted partial nephrectomy over an extended duration

2021 ◽  
Vol 15 (9) ◽  
Author(s):  
Saad Aldousari ◽  
Said Yaiesh ◽  
Omar Alkandari
Keyword(s):  
Partial Nephrectomy ◽  
Operative Time ◽  
Fellowship Training ◽  
Perioperative Outcomes ◽  
Robotic Assisted ◽  
Tertiary Center ◽  
Surgeon Experience ◽  
Extended Duration ◽  
Low Volume ◽  
Robotic Assisted Partial Nephrectomy

Introduction: The objective of this study was to examine the surgeon’s experience of low-volume robotic-assisted partial nephrectomy (RAPN) over an extended duration, and whether a high-volume fellowship-training influenced the outcomes. Methods: Data on all RAPN at a tertiary center performed by a uro-oncologist were retrospectively collected. The surgeon experience was assessed by examining perioperative outcomes among three groups of consecutive patients (first=14, second=14, third=15 patients, respectively). Results: Between February 2014 and February 2020, 45 RAPNs were performed out of a total of 200 robotic procedures. The median tumor size was 3 cm, and 28 (65%) patients had a R.E.N.A.L nephrometry score (RNS) ≥7. The median operative time and warm ischemia time (WIT) were 190 and 16 minutes, respectively. The median estimated blood loss (EBL) was 100 mL. Two (4%) patients had a positive surgical margin (PSM). Overall, five (12%) complications were recorded. All except one were minor (Clavien I–II). The median followup was 26.2 months. Trifecta and pentafecta were achieved in 40 (93%) and 27 (81.8%) patients, respectively. Increased surgeon experience was significantly associated with a shorter operative time and less EBL. Furthermore, there was an independent association between surgeon experience and operative time and EBL, and between RNS and operative time and WIT. Conclusions: With fellowship training and subsequent adequate total number of robotic procedures during practice, it is possible to perform RAPN with favorable perioperative outcomes in the setting of low-volume of cases over an extended duration.

scholarly journals Robotic-assisted cholecystectomy is superior to laparoscopic cholecystectomy in the initial training for surgical novices in an ex vivo porcine model: a randomized crossover study

2021 ◽  
Author(s):  
E. Willuth ◽  
S. F. Hardon ◽  
F. Lang ◽  
C. M. Haney ◽  
E. A. Felinska ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Crossover Study ◽  
Porcine Model ◽  
Haptic Feedback ◽  
Ex Vivo ◽  
Operating Time ◽  
Surgical Performance ◽  
Robotic Assisted ◽  
Subjective Workload ◽  
Randomized Crossover Study

Abstract Background Robotic-assisted surgery (RAS) potentially reduces workload and shortens the surgical learning curve compared to conventional laparoscopy (CL). The present study aimed to compare robotic-assisted cholecystectomy (RAC) to laparoscopic cholecystectomy (LC) in the initial learning phase for novices. Methods In a randomized crossover study, medical students (n = 40) in their clinical years performed both LC and RAC on a cadaveric porcine model. After standardized instructions and basic skill training, group 1 started with RAC and then performed LC, while group 2 started with LC and then performed RAC. The primary endpoint was surgical performance measured with Objective Structured Assessment of Technical Skills (OSATS) score, secondary endpoints included operating time, complications (liver damage, gallbladder perforations, vessel damage), force applied to tissue, and subjective workload assessment. Results Surgical performance was better for RAC than for LC for total OSATS (RAC = 77.4 ± 7.9 vs. LC = 73.8 ± 9.4; p = 0.025, global OSATS (RAC = 27.2 ± 1.0 vs. LC = 26.5 ± 1.6; p = 0.012, and task specific OSATS score (RAC = 50.5 ± 7.5 vs. LC = 47.1 ± 8.5; p = 0.037). There were less complications with RAC than with LC (10 (25.6%) vs. 26 (65.0%), p = 0.006) but no difference in operating times (RAC = 77.0 ± 15.3 vs. LC = 75.5 ± 15.3 min; p = 0.517). Force applied to tissue was similar. Students found RAC less physical demanding and less frustrating than LC. Conclusions Novices performed their first cholecystectomies with better performance and less complications with RAS than with CL, while operating time showed no differences. Students perceived less subjective workload for RAS than for CL. Unlike our expectations, the lack of haptic feedback on the robotic system did not lead to higher force application during RAC than LC and did not increase tissue damage. These results show potential advantages for RAS over CL for surgical novices while performing their first RAC and LC using an ex vivo cadaveric porcine model. Registration number researchregistry6029 Graphic abstract

Clinical experience of using virtual 3D modelling for pre and intraoperative guidance during robotic-assisted partial nephrectomy

2021 ◽  
pp. 205141582110002
Author(s):  
Lorenz Berger ◽  
Aziz Gulamhusein ◽  
Eoin Hyde ◽  
Matt Gibb ◽  
Teele Kuusk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Partial Nephrectomy ◽  
Surgical Outcome ◽  
Prospective Cohort ◽  
Three Dimensional ◽  
Two Dimensional ◽  
Dimensional Model ◽  
Three Dimensional Model ◽  
Robotic Assisted ◽  
Robotic Assisted Partial Nephrectomy

Objective: Surgical planning for robotic-assisted partial nephrectomy is widely performed using two-dimensional computed tomography images. It is unclear to what extent two-dimensional images fully simulate surgical anatomy and case complexity. To overcome these limitations, software has been developed to reconstruct three-dimensional models from computed tomography data. We present the results of a feasibility study, to explore the role and practicality of virtual three-dimensional modelling (by Innersight Labs) in the context of surgical utility for preoperative and intraoperative use, as well as improving patient involvement. Methods: A prospective study was conducted on patients undergoing robotic-assisted partial nephrectomy at our high volume kidney cancer centre. Approval from a research ethics committee was obtained. Patient demographics and tumour characteristics were collected. Surgical outcome measures were recorded. The value of the three-dimensional model to the surgeon and patient was assessed using a survey. The prospective cohort was compared against a retrospective cohort and cases were individually matched using RENAL (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, location relative to polar lines) scores. Results: This study included 22 patients. Three-dimensional modelling was found to be safe for this prospective cohort and resulted in good surgical outcome measures. The mean (standard deviation) console time was 158.6 (35) min and warm ischaemia time was 17.3 (6.3) min. The median (interquartile range) estimated blood loss was 125 (50–237.5) ml. Two procedures were converted to radical nephrectomy due to the risk of positive margins during resection. The median (interquartile range) length of stay was 2 (2–3) days. No postoperative complications were noted and all patients had negative surgical margins. Patients reported improved understanding of their procedure using the three-dimensional model. Conclusion: This study shows the potential benefit of three-dimensional modelling technology with positive uptake from surgeons and patients. Benefits are improved perception of vascular anatomy and resection approach, and procedure understanding by patients. A randomised controlled trial is needed to evaluate the technology further. Level of evidence: 2b

scholarly journals Zero-ischemia robotic assisted partial nephrectomy – Preliminary experience in a single institution

2016 ◽  
Vol 27 (2) ◽  
pp. S12
Author(s):  
Yi-Chia Lin ◽  
Chao-Yen Ho ◽  
Te-Fu Tsai ◽  
Chung-Hsin Yeh ◽  
Guang-Dar Juang ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Single Institution ◽  
Robotic Assisted ◽  
Zero Ischemia ◽  
Robotic Assisted Partial Nephrectomy

Robotic-assisted partial nephrectomy challenge case

2018 ◽  
Vol 17 (7) ◽  
pp. e2400
Author(s):  
M. Covas Moschovas ◽  
R. Ferreira Coelho ◽  
G. Xavier Ebaid ◽  
L. Henrique Tanure
Keyword(s):  
Partial Nephrectomy ◽  
Robotic Assisted ◽  
Robotic Assisted Partial Nephrectomy

Complication rates and renal function after robotic-assisted partial nephrectomy in elderly vs young patients

2018 ◽  
Vol 17 (8) ◽  
pp. 251-252
Author(s):  
G. Primiceri ◽  
M. Marchioni ◽  
C. D’Orta ◽  
A. Rizzoli ◽  
P. Castellan ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Young Patients ◽  
Complication Rates ◽  
Robotic Assisted ◽  
Robotic Assisted Partial Nephrectomy
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