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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (25 October 2019) | Viewed by 31726

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Special Issue Editors

Dr. Giulia Veronesi

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Guest Editor

Thoracic Surgery Department, IRCCS San Raffaele Hospital, 20132 Milan, Italy
Interests: robotic and minimally invasive surgery; lung cancer limited resection; lung cancer screening; mediastinal disease; robotic thoracic surgery; pneumonectomy; lung resection

Dr. Pierluigi Novellis

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Guest Editor

Division of Thoracic and General Surgery, Humanitas Cancer Center, Via Manzoni 56, 20089 Rozzano, Milan, Italy
Interests: lung cancer; thoracic diseases; mediastinal diseases; robotic surgery; thoracic surgery

Special Issue Information

Dear Colleagues,

Robotic surgery in these first 20 years of experience has acquired many new information and found application in many fields. In the treatment of certain diseases, as in urological tumors, robotics has become the standard treatment in many indications. In many other fields it is still unclear if there are clinical advantage in comparison with laparoscopic surgery or thoracoscopy. So far the advantages shown by robotic surgery are mainly related to some indisputable technical advantages over manual minimally invasive techniques due to sophisticated technology. Surgical robot arises from the need to reproduce the same movements and type of dissection performed in open surgery maintaining the advantages of minimally invasive surgery. This is made possible by the instruments capable of performing 360° movements thanks to the degrees of freedom of the robotic arms and articulated tools. Moreover, by means of robotics it is possible to limit the tremor of the hands, amplify the vision 10 times in 3 dimensions and therefore perform movements of extreme precision. Robots currently on the market have shown the advantage of having a mobile arm that allows faster docking, but in the imminent future we will see the presentation on the market of new robots, for example the single-port, capable of further limiting the surgical insult. In thoracic surgery, numerous studies have shown an equivalence of minimally invasive surgery compared to open surgery in terms of oncological radicality, however, other studies have confirmed that the minimally invasive approach is superior in terms of post-operative quality of life and earlier resumption of normal life. If in the initial stages of lung cancer, minimally invasive surgery, manual and robotic, is today the standard of treatment, the new interests for robotic surgeons in the coming years will be addressed to more complex procedures including the treatment of locally advanced cancers after chemotherapy, or segmental resections, perhaps associated with techniques of augmented reality. In this special issue we will review techniques, indications and results of the application of robotic approach in different surgical disciplines, focusing not only on the current standard, but also evaluating future applications and new perspectives.

Dr. Giulia Veronesi
Dr. Pierluigi Novellis
Guest Editors

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Keywords

Robotic surgery
Digital surgery
Da Vinci
Lung cancer
Cervical cancer
Prostate cancer
Colorectal surgery
Esophageal cancer

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Published Papers (7 papers)

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Research

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10 pages, 253 KiB

Open AccessArticle

Incidence and Risk Factors of Pulmonary Complications after Robot-Assisted Laparoscopic Prostatectomy: A Retrospective Observational Analysis of 2208 Patients at a Large Single Center

by Jihion Yu, Jun-Young Park, Doo-Hwan Kim, Sungwon Kim, Jai-Hyun Hwang, Hyungseok Seo and Young-Kug Kim

J. Clin. Med. 2019, 8(10), 1509; https://doi.org/10.3390/jcm8101509 - 20 Sep 2019

Cited by 21 | Viewed by 3020

Abstract

Robot-assisted laparoscopic prostatectomy (RALP) is a minimally invasive technique for the treatment of prostate cancer. RALP requires the patient to be placed in the steep Trendelenburg position, along with pneumoperitoneum, which may increase the risk of postoperative pulmonary complications (PPCs). This large single-center retrospective study evaluated the incidence and risk factors of PPCs in 2208 patients who underwent RALP between 2014 and 2017. Patients were divided into those with (PPC group) and without (non-PPC group) PPCs. Postoperative outcomes were evaluated, and univariate and multivariate logistic regression analyses were performed to assess risk factors of PPCs. PPCs occurred in 682 patients (30.9%). Risk factors of PPCs included age (odds ratio [OR], 1.023; p = 0.001), body mass index (OR, 1.061; p = 0.001), hypoalbuminemia (OR, 1.653; p = 0.008), and positive end-expiratory pressure (PEEP) application (OR, 0.283; p < 0.001). The incidence of postoperative complications, rate of intensive care unit (ICU) admission, and duration of ICU stay were significantly greater in the PPC group than in the non-PPC group. In conclusion, the incidence of PPCs in patients who underwent RALP under pneumoperitoneum in the steep Trendelenburg position was 30.9%. Factors associated with PPCs included older age, higher body mass index, hypoalbuminemia, and lack of PEEP. Full article

(This article belongs to the Special Issue Robotic Surgery)

24 pages, 3179 KiB

Open AccessArticle

Distinct Chemokine Dynamics in Early Postoperative Period after Open and Robotic Colorectal Surgery

by Malgorzata Krzystek-Korpacka, Marek Zawadzki, Paulina Lewandowska, Krzysztof Szufnarowski, Iwona Bednarz-Misa, Krzysztof Jacyna, Wojciech Witkiewicz and Andrzej Gamian

J. Clin. Med. 2019, 8(6), 879; https://doi.org/10.3390/jcm8060879 - 19 Jun 2019

Cited by 12 | Viewed by 2978

Abstract

Stress response to robot-assisted colorectal surgery is largely unknown. Therefore, we conducted a prospective comparative nonrandomized study evaluating the perioperative dynamics of chemokines: IL-8/CXCL8, MCP-1/CCL2, MIP-1α/CCL3, MIP-1β/CCL4, RANTES/CCL5, and eotaxin-1/CCL11 in 61 colorectal cancer patients following open colorectal surgery (OCS) or robot-assisted surgery (RACS) in reference to clinical data. Postoperative IL-8 and MCP-1 increase was reduced in RACS with a magnitude of blood loss, length of surgery, and concomitant up-regulation of IL-6 and TNFα as its independent predictors. RANTES at 8 h dropped in RACS and RANTES, and MIP1α/β at 24 h were more elevated in RACS than OCS. IL-8 and MCP-1 at 72 h remained higher in patients subsequently developing surgical site infections, in whom a 2.6- and 2.5-fold increase was observed. IL-8 up-regulation at 24 h in patients undergoing open procedure was predictive of anastomotic leak (AL; 94% accuracy). Changes in MCP-1 and RANTES were predictive of delayed restoration of bowel function. Chemokines behave differently depending on procedure. A robot-assisted approach may be beneficial in terms of chemokine dynamics by favoring Th1 immunity and attenuated angiogenic potential and postoperative ileus. Monitoring chemokine dynamics may prove useful for predicting adverse clinical events. Attenuated chemokine up-regulation results from less severe blood loss and diminished inflammatory response. Full article

(This article belongs to the Special Issue Robotic Surgery)

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10 pages, 996 KiB

Open AccessArticle

Quantitative Assessment of the Learning Curve for Robotic Thyroid Surgery

by HyunGoo Kim, Hyungju Kwon, Woosung Lim, Byung-In Moon and Nam Sun Paik

J. Clin. Med. 2019, 8(3), 402; https://doi.org/10.3390/jcm8030402 - 22 Mar 2019

Cited by 20 | Viewed by 3551

Abstract

With the increased utilization of robot thyroidectomy in recent years, surgical proficiency is the paramount consideration. However, there is no single perfect or ideal method for measuring surgical proficiency. In this study, we evaluated the learning curve of robotic thyroidectomy using various parameters. A total of 172 robotic total thyroidectomies were performed by a single surgeon between March 2014 and February 2018. Cumulative summation analysis revealed that it took 50 cases for the surgeon to significantly improve the operation time. Mean operation time was significantly shorter in the group that included the 51st to the 172nd case, than in the group that included only the first 50 cases (132.8 ± 27.7 min vs. 166.9 ± 29.5 min; p < 0.001). On the other hand, the surgeon was competent after the 75th case when postoperative transient hypoparathyroidism was used as the outcome measure. The incidence of hypoparathyroidism gradually decreased from 52.0%, for the first 75 cases, to 40.2% after the 76th case. These results indicated that the criteria used to assess proficiency greatly influenced the interpretation of the learning curve. Incorporation of the operation time, complications, and oncologic outcomes should be considered in learning curve assessment. Full article

(This article belongs to the Special Issue Robotic Surgery)

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11 pages, 4926 KiB

Open AccessArticle

Application of a Perception Neuron^® System in Simulation-Based Surgical Training

by Hyun Soo Kim, Nhayoung Hong, Myungjoon Kim, Sang Gab Yoon, Hyeong Won Yu, Hyoun-Joong Kong, Su-Jin Kim, Young Jun Chai, Hyung Jin Choi, June Young Choi, Kyu Eun Lee, Sungwan Kim and Hee Chan Kim

J. Clin. Med. 2019, 8(1), 124; https://doi.org/10.3390/jcm8010124 - 21 Jan 2019

Cited by 17 | Viewed by 5187

Abstract

While multiple studies show that simulation methods help in educating surgical trainees, few studies have focused on developing systems that help trainees to adopt the most effective body motions. This is the first study to use a Perception Neuron^® system to evaluate the relationship between body motions and simulation scores. Ten medical students participated in this study. All completed two standard tasks with da Vinci Skills Simulator (dVSS) and five standard tasks with thyroidectomy training model. This was repeated. Thyroidectomy training was conducted while participants wore a perception neuron. Motion capture (MC) score that indicated how long the tasks took to complete and each participant’s economy-of-motion that was used was calculated. Correlations between the three scores were assessed by Pearson’s correlation analyses. The 20 trials were categorized as low, moderate, and high overall-proficiency by summing the training model, dVSS, and MC scores. The difference between the low and high overall-proficiency trials in terms of economy-of-motion of the left or right hand was assessed by two-tailed t-test. Relative to cycle 1, the training model, dVSS, and MC scores all increased significantly in cycle 2. Three scores correlated significantly with each other. Six, eight, and six trials were classified as low, moderate, and high overall-proficiency, respectively. Low- and high-scoring trials differed significantly in terms of right (dominant) hand economy-of-motion (675.2 mm and 369.4 mm, respectively) (p = 0.043). Perception Neuron^® system can be applied to simulation-based training of surgical trainees. The motion analysis score is related to the traditional scoring system. Full article

(This article belongs to the Special Issue Robotic Surgery)

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Review

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10 pages, 575 KiB

Open AccessReview

Alternative Applications of Trans-Oral Robotic Surgery (TORS): A Systematic Review

by Giovanni Cammaroto, Luigi Marco Stringa, Henry Zhang, Pasquale Capaccio, Francesco Galletti, Bruno Galletti, Giuseppe Meccariello, Giannicola Iannella, Stefano Pelucchi, Ahmed Baghat and Claudio Vicini

J. Clin. Med. 2020, 9(1), 201; https://doi.org/10.3390/jcm9010201 - 11 Jan 2020

Cited by 18 | Viewed by 3608

Abstract

Background: The role of robotic surgery in the field of oncology has been widely described, in particular for the tumours of the oropharynx and larynx, but its efficacy for benign pathology is inconsistent. Methods: An exhaustive review of the English literature on trans-oral robotic surgery (TORS) for benign conditions was performed using PubMed electronic database. Results: The research was performed in March 2019 and yielded more than eight hundred articles, with 103 meeting the inclusion criteria and considered in the present study. Conclusions: The application of TORS for the treatment of obstructive sleep apnoea syndrome seems to be particularly well documented. Additionally, there exists a special interest in its use where high precision in limited anatomic space is required. There are still different structural and economic limitations for the application of TORS, however, the progressive technologic innovations and the increasing adoption of robotic surgery seem to encourage the uptake of this technique. Full article

(This article belongs to the Special Issue Robotic Surgery)

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13 pages, 1888 KiB

Open AccessReview

Effect of Bladder Neck Preservation on Long-Term Urinary Continence after Robot-Assisted Laparoscopic Prostatectomy: A Systematic Review and Meta-Analysis

by Jong Won Kim, Do Kyung Kim, Hyun Kyu Ahn, Hae Do Jung, Joo Yong Lee and Kang Su Cho

J. Clin. Med. 2019, 8(12), 2068; https://doi.org/10.3390/jcm8122068 - 24 Nov 2019

Cited by 20 | Viewed by 6911

Abstract

This study aimed to evaluate the effect of bladder neck preservation (BNP) on long-term urinary continence after robot-assisted laparoscopic prostatectomy (RALP). We systematically searched the PubMed, Embase, and Cochrane Library databases to identify studies that assessed the difference in urinary continence and oncologic outcomes between patients who underwent RALP with BNP and those who underwent RALP without BNP. Four trials (1880 cases with BNP, 727 controls without BNP) were considered suitable for meta-analysis. BNP was associated with significantly better urinary continence outcomes at 3–4 months (odds ratio (OR), 2.88; 95% confidence interval (CI), 1.52–5.48; p = 0.001), 12 months (OR, 2.03; 95% CI, 1.10–3.74; p = 0.02), and 24 months (OR, 3.23; 95% CI, 1.13–9.20; p = 0.03) after RALP. There was no difference in the rate of overall positive surgical margin (PSM) (OR, 1.00; 95% CI, 0.72–1.39; p = 0.99) and that of PSM at the prostate base (OR, 0.49; 95% CI, 0.21–1.13; p = 0.09) between the two groups. The BNP technique during RALP leads to early return of urinary continence and long-term urinary continence without compromising the oncologic outcomes. Full article

(This article belongs to the Special Issue Robotic Surgery)

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11 pages, 1758 KiB

Open AccessReview

The Emerging Role of Robotic Surgery among Minimally Invasive Surgical Approaches in the Treatment of Hypopharyngeal Carcinoma: Systematic Review and Meta-Analysis

by Armando De Virgilio, Oreste Iocca, Luca Malvezzi, Pasquale Di Maio, Raul Pellini, Fabio Ferreli, Giovanni Cugini, Giovanni Colombo and Giuseppe Spriano

J. Clin. Med. 2019, 8(2), 256; https://doi.org/10.3390/jcm8020256 - 18 Feb 2019

Cited by 19 | Viewed by 5487

Abstract

The aim of this systematic review with meta-analysis was to investigate the available literature on transoral approaches in the treatment of hypopharyngeal squamous cell carcinoma, with a special focus on transoral robotic surgery (TORS). A systematic review was conducted according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) check-list, and 15 studies were included. Five of the included studies evaluated TORS, while ten studies focused on transoral laser microsurgery (TLM) for the treatment of early or advanced stage hypopharyngeal cancer. Overall, survival rates of TLM and TORS studies, analyzed together in the cumulative meta-analysis, were 66.4% (95% confidence interval (CI) 54.3%–76.7%) at 36+ months of follow up. The TORS subgroup showed a higher cumulative survival rate (85.5%, 95% CI 55.8%–96.5%) compared to TLM (58.5%, 95% CI 46.6%–69.6%). Cumulative data showed that 29.3% (95% CI 24.0%–35.3%) of deaths were attributable to cancer. The results were similar between TLM and TORS studies. The larynx function preservation cumulative rate was 94.3% (95% CI 91.8%–96.1%). The results were similar among the two subgroups. The present review supports the use of transoral approaches in the treatment of hypopharyngeal cancer. TORS is oncologically sound and provides excellent functional results with low complication rates. Full article

(This article belongs to the Special Issue Robotic Surgery)

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