ObjectiveTo investigate the effects of robotic versus thoracoscopic lobectomy on body trauma and lymphocyte subsets in patients with non-small cell lung cancer (NSCLC).MethodsThe clinical data of 120 patients with NSCLC who underwent lobectomy in the same operation group at the same period were collected and divided into a robot group (n=60) and a thoracoscope group (n=60) according to different surgical methods. The operation time, intraoperative blood loss, postoperative drainage time, drainage volume, postoperative hospital stay, complication rate, pain visual analogue scale (VAS) and other perioperative indicators were recorded in the two groups. Inflammatory markers: C-reactive protein (CRP), interleukin-6 (IL-6) and lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) levels were measured before and 1 d, 3 d after surgery. The effects of the two surgical methods on the body trauma and lymphocyte subsets were compared.ResultsThe operation time, intraoperative blood loss, postoperative drainage time, drainage volume and VAS of the robot group were lower than those of the thoracoscope group, and the differences were statistically significant (P<0.05). On the 1st day after surgery, IL-6 of the thoracoscope group was higher than that of the robot group, while CD3+, CD4+ and CD8+ were lower than those of the robot group, with statistically significant differences (P<0.05).ConclusionCompared with thoracoscopic lobectomy, robotic lobectomy has less trauma, less inflammatory response, faster recovery, less inhibitory effect on lymphocyte subsets, and has clinical advantages.
Objective To explore the effectiveness of reduction robot combined with navigation robot-assisted minimally invasive treatment for Tile type B pelvic fractures. Methods Between January 2022 and February 2023, 10 patients with Tile type B pelvic fractures were admitted. There were 6 males and 4 females with an average age of 45.5 years (range, 30-71 years). The fractures were caused by traffic accident in 5 cases, bruising by heavy object in 3 cases, and falling from height in 2 cases. The interval between injury and operation ranged from 4-13 days (mean, 6.8 days). There were 2 cases of Tile type B1 fractures, 1 case of Tile type B2 fracture, and 7 cases of Tile type B3 fractures. After closed reduction under assistance of reduction robot, the anterior ring was fixed with percutaneous screws with or without internal fixator, and the posterior ring was fixed with sacroiliac joint screws under assistance of navigation robot. The time of fracture reduction assisted by the reduction robot was recorded and the quality of fracture reduction was evaluated according to the Matta scoring criteria. The operation time, intraoperative fluoroscopy frequency and time, intraoperative bleeding volume, and incidence of complications were also recorded. During follow-up, the X-ray film of pelvis was taken to review the fracture healing, and the Majeed score was used to evaluate hip joint function. Results The time of fracture reduction was 42-62 minutes (mean, 52.3 minutes). The quality of fracture reduction according to the Matta scoring criteria was rated as excellent in 4 cases, good in 5 cases, and poor in 1 case, with excellent and good rate of 90%. The operation time was 180-235 minutes (mean, 215.5 minutes). Intraoperative fluoroscopy was performed 18-66 times (mean, 31.8 times). Intraoperative fluoroscopy time was 16-59 seconds (mean, 28.6 seconds). The intraoperative bleeding volume was 50-200 mL (range, 110.0 mL). No significant vascular or nerve injury occurred during operation. All patients were followed up 13-18 months (mean, 16 months). X-ray films showed that all fractures healed with the healing time of 11-14 weeks (mean, 12.3 weeks). One case of ectopic ossification occurred during follow-up. At last follow-up, the Majeed score was 70-92 (mean, 72.7), and the hip joint function was rated as excellent in 2 cases and good in 8 cases, with the excellent and good rate of 100%. Conclusion The reduction robot combined with navigation robot-assisted minimally invasive treatment for Tile type B pelvic fractures has the characteristics of intelligence, high safety, convenient operation, and minimally invasive treatment, which can achieve reliable effectiveness.
Robotic gastric cancer surgery had developed rapidly in recent years, and its clinical application had come a long way. More and more studies had demonstrated that the robotic gastric cancer surgery was a safe and feasible procedure, and showed the technical advantages in the lymph node dissection, bleeding control, precise surgery, and postoperative recovery over laparoscopic surgery. However, some limitations such as the high surgical costs, lack of high-quality evidence, insufficient intelligence limited the development of robotic gastric cancer surgery. In the future, with more high-quality evidence-based medicine research and the development of intelligent surgical robots, the robotic gastric cancer surgery will be further standardized and promoted. We believe that robotic gastric cancer surgery will become the mainstream of minimally invasive surgery for the treatment of gastric cancer.
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.
Endoscopic and robotic surgeries feature small incision and reducing surgical trauma, and minimized incision scars. However, the oncological safety of their application in breast-conserving surgery and breast reconstruction for breast cancer has always been a focal clinical concern. The breast-conserving surgery and breast reconstruction using the suspension, insufflation, and lipolysis methods could achieve precise tumor resection in the selected patients and under the specific surgical conditions, with the support of appropriate instruments. Meanwhile, the innovative application of the reverse-sequence method and auxiliary port technique has further enhanced surgical efficiency and the precision of tumor resection. Current studies suggest that endoscopic and robotic-assited breast-conserving surgery and breast reconstruction yield in terms of oncological outcomes comparable to those of conventional open breast-conserving surgery, including positive margins, local recurrence, regional recurrence, distant metastasis, and overall survival. These approaches offered advantages in minimally invasive techniques and aesthetic outcomes. However, existing research was limited by short follow-up period and small sample sizes. Future large-scale, long-term prospective randomized controlled trials are needed to further validate their oncological safety and long-term efficacy. These studies could help establish novel techniques as standard surgical approaches for breast cancer, particularly the efficient and streamlined reverse-sequence endoscopic and auxiliary port-assisted techniques.
The technical combination of artificial intelligence (AI) and thoracic surgery is increasingly close, especially in the field of image recognition and pathology diagnosis. Additionally, robotic surgery, as a representative of high-end technology in minimally invasive surgery is flourishing. What progress has been or will be made in robotic surgery in the era of AI? This article aims to summarize the application status of AI in thoracic surgery and progress in robotic surgery, and looks ahead the future.
Objective To investigate the feasibility and effectiveness of robot-assisted posterior minimally invasive access in treatment of thoracolumbar tuberculosis via transforaminal expansion approach. Methods A clinical data of 40 patients with thoracolumbar tuberculosis admitted between January 2017 and May 2022 and met the selection criteria was retrospectively analyzed. Among them, 15 cases were treated with robot-assisted and minimally invasive access via transforaminal expansion approach for lesion removal, bone graft, and internal fixation (robotic group), and 25 cases were treated with traditional transforaminal posterior approach for lesion removal and intervertebral bone grafting (traditional group). There was no significant difference in the baseline data between the two groups (P>0.05) in terms of gender, age, lesion segment, and preoperative American Spinal Injury Association (ASIA) grading, Cobb angle, visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), and C reactive protein (CRP). The outcome indicators were recorded and compared between the two groups, including operation time, intraoperative bleeding volume, hospital stay, postoperative bedtime, complications, ESR and CRP before operation and at 1 week after operation, the level of serum albumin at 3 days after operation, VAS score and ASIA grading of neurological function before operation and at 6 months after operation, the implant fusion, fusion time, Cobb angle of the lesion, and the loss of Cobb angle observed by X-ray films and CT. The differences of ESR, CRP, and VAS score (change values) between pre- and post-operation were calculated and compared. Results Compared with the traditional group, the operation time and intraoperative bleeding volume in the robotic group were significantly lower and the serum albumin level at 3 days after operation was significantly higher (P<0.05); the postoperative bedtime and the length of hospital stay were also shorter, but the difference was not significant (P>0.05). There were 2 cases of poor incision healing in the traditional group, but no complication occurred in the robotic group, and the difference in the incidence of complication between the two groups was not significant (P>0.05). There were significant differences in the change values of ESR and CRP between the two groups (P<0.05). All Patients were followed up, and the follow-up time was 12-18 months (mean, 13.0 months) in the traditional group and 12-16 months (mean, 13.0 months) in the robotic group. Imaging review showed that all bone grafts fused, and the difference in fusion time between the two groups was not significant (P>0.05). The difference in Cobb angle between the pre- and post-operation in the two groups was significant (P<0.05); and the Cobb angle loss was significant more in the traditional group than in the robotic group (P<0.05). The VAS scores of the two groups significantly decreased at 6 months after operation when compared with those before operation (P<0.05); the difference in the change values of VAS scores between the two groups was not significant (P>0.05). There was no occurrence or aggravation of spinal cord neurological impairment in the two groups after operation. There was a significant difference in ASIA grading between the two groups at 6 months after operation compared to that before operation (P<0.05), while there was no significant difference between the two groups (P>0.05). Conclusion Compared with traditional posterior open operation, the use of robot-assisted minimally invasive access via transforaminal approach for lesion removal and bone grafting internal fixation in the treatment of thoracolumbar tuberculosis can reduce the operation time and intraoperative bleeding, minimizes surgical trauma, and obtain definite effectiveness.
ObjectiveTo explore the application of 5G remote robotic surgery in distal gastrectomy for gastric cancer and evaluate the feasibility and advantages of the “3+2” model “seven-step method”. MethodsThe situations at preoperative, intraoperative and postoperative follow-up of a patient who underwent 5G remote robotic distal gastrectomy for gastric cancer with “3+2” model “seven-step method” in Gansu Provincial People’s Hospital were summarized, and based on our experience of robotic surgery, the application advantages of “3+2” model “seven-step method” in 5G remote robotic distal gastrectomy for gastric cancer was explored. ResultsThe operative time of this case was 190 min, the intraoperative blood loss was 50 mL, the network delay was 43.554 ms, and no intraoperative adverse events occurred. After a one-year follow-up, the patient recovered well, with no complications, good diet and good quality of life. ConclusionsThe “3+2” model “seven-step method” is feasible for 5G remote robotic distal gastrectomy. Further research requires an increased sample size and extended follow-up period.
ObjectiveTo compare the effectiveness of robot-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open freehand TLIF for the treatment of single-level degenerative lumbar spondylolisthesis (DSL) and analyse the influence on postoperative adjacent segmental degeneration (ASD). Methods The clinical data of 116 patients with L4、5 DLS who were admitted between November 2019 and October 2021 and met the selection criteria were retrospectively analyzed. According to the surgical methods, they were divided into the robotic group (45 cases, who underwent robot-assisted MIS-TLIF) and the open group (71 cases, who underwent open freehand TLIF). There was no significant difference in baseline data such as gender, age, body mass index, DLS Meyerding grading, and preoperative Pfirrmann grading, Weishaupt grading, L3, 4 intervertebral disc height (DH), L3, 4 intervertebral mobility, sagittal parameters [including pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT)], and Cage height (P>0.05). The grade of facet joint violation (FJV) by pedicle screws on the superior articular process was assessed postoperatively. Sagittal parameters, L3, 4 DH, L3, 4 DH loss, and L3, 4 intervertebral mobility were measured preoperatively and at last follow-up in order to determine whether ASD occurred. Based on the occurrence of postoperative ASD, logistic regression analysis was used to identify the risk factors for ASD after TLIF. Results Patients in both groups were followed up 21-47 months, with a mean of 36.1 months; there was no significant difference in the follow-up time between the two groups (P>0.05). The occurrence of postoperative FJV was significantly better in the robotic group than in the open group (P<0.05). At last follow-up, the difference in the change values of sagittal parameters PI, PT, SS, and LL was not significant when comparing the two groups of patients (P>0.05); the change values of L3, 4 DH and L3, 4 DH loss in the robotic group were smaller than those in the open group, and the change value of L3, 4 intervertebral mobility was larger than that in the open group, and the differences were significant (P<0.05). At last follow-up, ASD occurred in 8 patients (17.8%) in the robotic group and 35 patients (49.3%) in the open group, and the difference in ASD incidence between the two groups was significant (P<0.05). logistic regression analysis showed that open surgery, preoperative Pfirrmann grading Ⅳ-Ⅴ, preoperative Weishaupt grading ≥2, and postoperative FJV grading ≥1 were risk factors for the development of ASD after TLIF (P<0.05). ConclusionCompared with traditional open surgery, orthopedic robot-assisted MIS-TLIF in the treatment of single-level DLS can more accurately insert pedicle screws, reduce the loss of DH and the occurrence of FJV, and effectively reduce the incidence of mid-postoperative ASD. Preoperative disc and synovial joint degeneration in adjacent segments, nonrobotic-assisted minimally invasive therapy, and FJV are risk factors for ASD after TLIF.
ObjectiveThe aim of this study was to evaluate the safety and feasibility of robot-assisted surgery in pancreatic cancer.MethodRecent literatures related to robot-assisted surgery in treatment of pancreatic cancer compared with traditional open surgery or traditional laparoscopic surgery were collected to make an review.ResultsCompared with the traditional laparoscopic surgery, the robot-assisted surgery was expensive, with the obvious advantages in terms of anastomosis and reconstruction. Compared with the open operation, both robot-assisted pancreaticoduodenectomy and robot-assisted distal pancreatectomy had longer operation time, but the length of hospital stay and intraoperative blood loss were obviously shortened, robot-assisted distal pancreatectomy also had higher spleen preservation rate. Compared with the traditional laparoscopic distal pancreatectomy, the number of lymph node retrieved, R0 resection rate, and splenic preservation rate were also higher in the robot-assisted group. Simultaneously, robot-assisted total pancreatectomy and midsection pancreatectomy were deemed as safe in some high-volume centers.ConclusionsRobot-assisted pancreatic cancer surgery is safe and feasible, but many surgeries are restricted to a small number of high-volume medical centers, and most cases selected to undergo robot-assisted surgery are often early stage patients with small tumor size. A lot of efforts should be made and problems should be solved.