Cancers

Research

21 pages, 5498 KiB

Open AccessArticle

Design and Experimental Setup of a Robotic Medical Instrument for Brachytherapy in Non-Resectable Liver Tumors

by Paul Tucan, Calin Vaida, Daniel Horvath, Andrei Caprariu, Alin Burz, Bogdan Gherman, Stefan Iakab and Doina Pisla

Cancers 2022, 14(23), 5841; https://doi.org/10.3390/cancers14235841 - 26 Nov 2022

Cited by 14 | Viewed by 2524

Abstract

This paper presents a study regarding the design and the experimental setup of a medical robotic system for brachytherapy using tribology analysis. The robotic system is composed of a collaborative robotic arm and a multi-needle brachytherapy instrument controlled using a unified control system [...] Read more.

This paper presents a study regarding the design and the experimental setup of a medical robotic system for brachytherapy using tribology analysis. The robotic system is composed of a collaborative robotic arm and a multi-needle brachytherapy instrument controlled using a unified control system embedding a haptic device and force-feedback. This work is oriented towards identifying the technical characteristics of the system components to determine the accuracy of the procedure, as well as using different scenarios for needle insertion in ex vivo porcine liver tissue in order to determine the forces required for insertion and extraction of the needle and the friction coefficient that accompanies the previously mentioned forces. Subsequent to the computation of the friction forces, the normal forces and the wear during the needle insertion are determined with the scope of predicting the lifecycle of some components of the medical device. Full article

(This article belongs to the Special Issue Views and Perspectives of Robot-Assisted Liver Surgery)

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12 pages, 1168 KiB

Open AccessArticle

Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)

by Andrew A. Gumbs, Roland Croner, Eric Lorenz, Andrea Benedetti Cacciaguerra, Tzu-Jung Tsai, Lee Starker, Joe Flanagan, Ng Jing Yu, Elie Chouillard and Mohammad Abu Hilal

Cancers 2022, 14(17), 4190; https://doi.org/10.3390/cancers14174190 - 29 Aug 2022

Cited by 3 | Viewed by 2126

Abstract

Introduction: Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-CRLM) was a propensity score matched (PSM) study that reported short-term outcomes of patients with CRLM who met the Milan criteria and underwent either open (OLR), laparoscopic (LLR) or robotic liver [...] Read more.

Introduction: Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-CRLM) was a propensity score matched (PSM) study that reported short-term outcomes of patients with CRLM who met the Milan criteria and underwent either open (OLR), laparoscopic (LLR) or robotic liver resection (RLR). This study, designated as SIMMILR-2, reports the long-term outcomes from that initial study, now referred to as SIMMILR-1. Methods: Data regarding neoadjuvant chemotherapeutic (NC) and neoadjuvant biological (NB) treatments received were collected, and Kaplan–Meier curves reporting the 5-year overall (OS) and recurrence-free survival (RFS) for OLR, LLR and RLR were created for patients who presented with synchronous lesions only, as there was insufficient follow-up for patients with metachronous lesions. Results: A total of 73% of patients received NC and 38% received NB in the OLR group compared to 70% and 28% in the LLR group, respectively (p = 0.5 and p = 0.08). A total of 82% of patients received NC and 40% received NB in the OLR group compared to 86% and 32% in the RLR group, respectively (p > 0.05). A total of 71% of patients received NC and 53% received NB in the LLR group compared to 71% and 47% in the RLR group, respectively (p > 0.05). OS at 5 years was 34.8% after OLR compared to 37.1% after LLR (p = 0.4), 34.3% after OLR compared to 46.9% after RLR (p = 0.4) and 30.3% after LLR compared to 46.9% after RLR (p = 0.9). RFS at 5 years was 12.1% after OLR compared to 20.7% after LLR (p = 0.6), 33.3% after OLR compared to 26.3% after RLR (p = 0.6) and 22.7% after LLR compared to 34.6% after RLR (p = 0.6). Conclusions: When comparing OLR, LLR and RLR, the OS and RFS were all similar after utilization of the Milan criteria and PSM. Biological agents tended to be utilized more in the OLR group when compared to the LLR group, suggesting that highly aggressive tumors are still managed through an open approach. Full article

(This article belongs to the Special Issue Views and Perspectives of Robot-Assisted Liver Surgery)

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14 pages, 2027 KiB

Open AccessArticle

Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?—A Systematic Review and Meta-Analysis

by Mirhasan Rahimli, Aristotelis Perrakis, Mihailo Andric, Jessica Stockheim, Mareike Franz, Joerg Arend, Sara Al-Madhi, Mohammed Abu Hilal, Andrew A. Gumbs and Roland S. Croner

Cancers 2022, 14(14), 3360; https://doi.org/10.3390/cancers14143360 - 11 Jul 2022

Cited by 13 | Viewed by 1854

Abstract

Background: Robotic procedures are an integral part of modern liver surgery. However, the advantages of a robotic approach in comparison to the conventional laparoscopic approach are the subject of controversial debate. The aim of this systematic review and meta-analysis is to compare robotic [...] Read more.

Background: Robotic procedures are an integral part of modern liver surgery. However, the advantages of a robotic approach in comparison to the conventional laparoscopic approach are the subject of controversial debate. The aim of this systematic review and meta-analysis is to compare robotic and laparoscopic liver resection with particular attention to the resection margin status in malignant cases. Methods: A systematic literature search was performed using PubMed and Cochrane Library in accordance with the PRISMA guidelines. Only studies comparing robotic and laparoscopic liver resections were considered for this meta-analysis. Furthermore, the rate of the positive resection margin or R0 rate in malignant cases had to be clearly identifiable. We used fixed or random effects models according to heterogeneity. Results: Fourteen studies with a total number of 1530 cases were included in qualitative and quantitative synthesis. Malignancies were identified in 71.1% (n = 1088) of these cases. These included hepatocellular carcinoma, cholangiocarcinoma, colorectal liver metastases and other malignancies of the liver. Positive resection margins were noted in 24 cases (5.3%) in the robotic group and in 54 cases (8.6%) in the laparoscopic group (OR = 0.71; 95% CI (0.42–1.18); p = 0.18). Tumor size was significantly larger in the robotic group (MD = 6.92; 95% CI (2.93–10.91); p = 0.0007). The operation time was significantly longer in the robotic procedure (MD = 28.12; 95% CI (3.66–52.57); p = 0.02). There were no significant differences between the robotic and laparoscopic approaches regarding the intra-operative blood loss, length of hospital stay, overall and severe complications and conversion rate. Conclusion: Our meta-analysis showed no significant difference between the robotic and laparoscopic procedures regarding the resection margin status. Tumor size was significantly larger in the robotic group. However, randomized controlled trials with long-term follow-up are needed to demonstrate the benefits of robotics in liver surgery. Full article

(This article belongs to the Special Issue Views and Perspectives of Robot-Assisted Liver Surgery)

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13 pages, 446 KiB

Open AccessArticle

Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-CRLM)

by Andrew A. Gumbs, Eric Lorenz, Tzu-Jung Tsai, Lee Starker, Joe Flanagan, Andrea Benedetti Cacciaguerra, Ng Jing Yu, Melinda Bajul, Elie Chouillard, Roland Croner and Mohammad Abu Hilal

Cancers 2022, 14(6), 1379; https://doi.org/10.3390/cancers14061379 - 8 Mar 2022

Cited by 15 | Viewed by 2763

Abstract

(1) Background: Here we report on a retrospective study of an international multicentric cohort after minimally invasive liver resection (SIMMILR) of colorectal liver metastases (CRLM) from six centers. (2) Methods: Resections were divided by the approach used: open liver resection (OLR), laparoscopic liver [...] Read more.

(1) Background: Here we report on a retrospective study of an international multicentric cohort after minimally invasive liver resection (SIMMILR) of colorectal liver metastases (CRLM) from six centers. (2) Methods: Resections were divided by the approach used: open liver resection (OLR), laparoscopic liver resection (LLR) and robotic liver resection (RLR). Patients with macrovascular invasion, more than three metastases measuring more than 3 cm or a solitary metastasis more than 5 cm were excluded, and any remaining heterogeneity found was further analyzed after propensity score matching (PSM) to decrease any potential bias. (3) Results: Prior to matching, 566 patients underwent OLR, 462 LLR and 36 RLR for CRLM. After PSM, 142 patients were in each group of the OLR vs. LLR group and 22 in the OLR vs. RLR and 21 in the LLR vs. RLR groups. Blood loss, hospital stay, and morbidity rates were all highly statistically significantly increased in the OLR compared to the LLR group, 636 mL vs. 353 mL, 9 vs. 5 days and 25% vs. 6%, respectively (p < 0.001). Only blood loss was significantly decreased when RLR was compared to OLR and LLR, 250 mL vs. 597 mL, and 224 mL vs. 778 mL, p < 0.008 and p < 0.04, respectively. (4) Conclusions: SIMMILR indicates that minimally invasive approaches for CRLM that follow the Milan criteria may have short term advantages. Notably, larger studies with long-term follow-up comparing robotic resections to both OLR and LLR are still needed. Full article

(This article belongs to the Special Issue Views and Perspectives of Robot-Assisted Liver Surgery)

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Review

Jump to: Research, Other

14 pages, 1557 KiB

Open AccessReview

What Is the Current Role and What Are the Prospects of the Robotic Approach in Liver Surgery?

by Emre Bozkurt, Jasper P. Sijberden and Mohammed Abu Hilal

Cancers 2022, 14(17), 4268; https://doi.org/10.3390/cancers14174268 - 31 Aug 2022

Cited by 10 | Viewed by 2846

Abstract

In parallel with the historical development of minimally invasive surgery, the laparoscopic and robotic approaches are now frequently utilized to perform major abdominal surgical procedures. Nevertheless, the role of the robotic approach in liver surgery is still controversial, and a standardized, safe technique [...] Read more.

In parallel with the historical development of minimally invasive surgery, the laparoscopic and robotic approaches are now frequently utilized to perform major abdominal surgical procedures. Nevertheless, the role of the robotic approach in liver surgery is still controversial, and a standardized, safe technique has not been defined yet. This review aims to summarize the currently available evidence and prospects of robotic liver surgery. Minimally invasive liver surgery has been extensively associated with benefits, in terms of less blood loss, and lower complication rates, including liver-specific complications such as clinically relevant bile leakage and post hepatectomy liver failure, when compared to open liver surgery. Furthermore, comparable R0 resection rates to open liver surgery have been reported, thus, demonstrating the safety and oncological efficiency of the minimally invasive approach. However, whether robotic liver surgery has merits over laparoscopic liver surgery is still a matter of debate. In the current literature, robotic liver surgery has mainly been associated with non-inferior outcomes compared to laparoscopy, although it is suggested that the robotic approach has a shorter learning curve, lower conversion rates, and less intraoperative blood loss. Robotic surgical systems offer a more realistic image with integrated 3D systems. In addition, the improved dexterity offered by robotic surgical systems can lead to improved intra and postoperative outcomes. In the future, integrated and improved haptic feedback mechanisms, artificial intelligence, and the introduction of more liver-specific dissectors will likely be implemented, further enhancing the robots’ abilities. Full article

(This article belongs to the Special Issue Views and Perspectives of Robot-Assisted Liver Surgery)

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8 pages, 475 KiB

Open AccessReview

Multivisceral Resection in Robotic Liver Surgery

by Kevin M. Sullivan and Yuman Fong

Cancers 2022, 14(2), 355; https://doi.org/10.3390/cancers14020355 - 12 Jan 2022

Viewed by 1705

Abstract

Minimally invasive surgery techniques are expanding in utilization in liver resections and now include robotic approaches. Robotic liver resection has been demonstrated to have several benefits, including surgeon ergonomics, wrist articulation, and 3D visualization. Similarly, for multivisceral liver resections, the use of minimally [...] Read more.

Minimally invasive surgery techniques are expanding in utilization in liver resections and now include robotic approaches. Robotic liver resection has been demonstrated to have several benefits, including surgeon ergonomics, wrist articulation, and 3D visualization. Similarly, for multivisceral liver resections, the use of minimally invasive techniques has evolved and expanded from laparoscopy to robotics. The aim of this article is to review the literature and describe multivisceral resections, including hepatectomy, using a robotic technique. We describe over 50 published cases of simultaneous robotic liver resection with colon or rectal resection. In addition, we describe several pancreatectomies performed with liver resection and one extra-abdominal pulmonary resection with liver resection. In total, these select reported cases at experienced centers demonstrate the safety of robotic multivisceral resection in liver surgery with acceptable morbidity and rare conversion to open surgery. As robotic technology advances and experience with robotic techniques grows, robotic multivisceral resection in liver surgery should continue to be investigated in future studies. Full article

(This article belongs to the Special Issue Views and Perspectives of Robot-Assisted Liver Surgery)

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11 pages, 11845 KiB

Open AccessReview

Augmented Reality and Image-Guided Robotic Liver Surgery

by Fabio Giannone, Emanuele Felli, Zineb Cherkaoui, Pietro Mascagni and Patrick Pessaux

Cancers 2021, 13(24), 6268; https://doi.org/10.3390/cancers13246268 - 14 Dec 2021

Cited by 37 | Viewed by 5850

Abstract

Artificial intelligence makes surgical resection easier and safer, and, at the same time, can improve oncological results. The robotic system fits perfectly with these more or less diffused technologies, and it seems that this benefit is mutual. In liver surgery, robotic systems help [...] Read more.

Artificial intelligence makes surgical resection easier and safer, and, at the same time, can improve oncological results. The robotic system fits perfectly with these more or less diffused technologies, and it seems that this benefit is mutual. In liver surgery, robotic systems help surgeons to localize tumors and improve surgical results with well-defined preoperative planning or increased intraoperative detection. Furthermore, they can balance the absence of tactile feedback and help recognize intrahepatic biliary or vascular structures during parenchymal transection. Some of these systems are well known and are already widely diffused in open and laparoscopic hepatectomies, such as indocyanine green fluorescence or ultrasound-guided resections, whereas other tools, such as Augmented Reality, are far from being standardized because of the high complexity and elevated costs. In this paper, we review all the experiences in the literature on the use of artificial intelligence systems in robotic liver resections, describing all their practical applications and their weaknesses. Full article

(This article belongs to the Special Issue Views and Perspectives of Robot-Assisted Liver Surgery)

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Other

Jump to: Research, Review

11 pages, 1569 KiB

Open AccessSystematic Review

Robotic Surgery for Biliary Tract Cancer

by Lyonell B. Kone, Philip V. Bystrom and Ajay V. Maker

Cancers 2022, 14(4), 1046; https://doi.org/10.3390/cancers14041046 - 18 Feb 2022

Cited by 10 | Viewed by 2212

Abstract

Biliary tract cancer consists of cholangiocarcinoma (CC) and gallbladder cancer (GBC). When resectable, surgery provides the best chance at long-term survival. Unfortunately, surgery for these tumors is associated with long operative times, high morbidities, and prolonged hospital stays. Minimally invasive surgery has been [...] Read more.

Biliary tract cancer consists of cholangiocarcinoma (CC) and gallbladder cancer (GBC). When resectable, surgery provides the best chance at long-term survival. Unfortunately, surgery for these tumors is associated with long operative times, high morbidities, and prolonged hospital stays. Minimally invasive surgery has been shown to impact selected outcomes, including length of stay, in other diseases, and robotic surgery may offer additional advantages compared to laparoscopic surgery in treating bile duct cancers. This is a systematic review of robotic surgery for biliary tract cancer. Predetermined selection criteria were used to appraise the literature. The PRISMA guidelines were followed. In total, 20 unique articles with a total of 259 patients with biliary tract cancer undergoing robotic surgery met the inclusion criteria. For CC and GBC, respectively, the weighted average operative time was 401 and 277 min, the estimated blood loss was 348 and 260 mL, the conversion rate to open was 7 and 3.5%, the all-cause morbidity was 52 and 9.7%, the major morbidity was 12 and 4.4%, the perioperative mortality was 1.4 and 0%, the length of stay was 15 and 4.8 days, the positive margin rate was 27 and 9%, and the number of lymph nodes retrieved was 4.2 and 8. Robotic surgery for biliary tract cancer appears non-inferior to open surgery when compared to the published contemporary data. However, the current literature on the topic is of low quality, and future prospective/randomized studies are needed. Full article

(This article belongs to the Special Issue Views and Perspectives of Robot-Assisted Liver Surgery)

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