Abstracts from the 8th International Conference on cGMP Generators, Effectors and Therapeutic Implications

This work was supported by a restricted research grant of Bayer AG

Medicaroid robotic assisted surgery system: A feasibility study

The hinotori™ surgical robotic system, by Medicaroid (Medicaroid Corporation, Kobe, Japan), is a new robotic system for minimally invasive surgery. We aimed at evaluating its usability and accessibility in a preclinical setting. This was a preclinical feasibility study. Two groups of surgeons, one with three experienced robotic surgeons (group 1) and one with three robotic-surgery naive participants (group 2), performed the following tasks using the hinotori™ system in a simulated preclinical setting: console setup, docking, instrument exchange, undocking, and suturing. Each participant repeated each task three times. The time required for performing each repetition and the count of failed repetitions were the primary outcomes of the study. The subjectively perceived workload in performing the tasks, as measured by the NASA-TLX score, was the secondary outcome. The improvement of participants within the three repetitions as well as a comparison between the performances of group 1 and 2 were evaluated. The time required to perform each task decreased with repetitions for both groups, so did the subjective workload score. The time measures required to perform the tasks and the mental effort scores were comparable between the two groups for the console setup, docking, instrument exchange, and undocking tasks. The NASA-TLX score was also comparable between the two groups for the console setup and the emergency undocking tasks and decreased significantly within all tasks after the third repetition. The incidence of failed repetitions was higher in group 2 for the suturing task, however the difference was not statistically significant. The results confirmed the usability of the hinotori™ system in a preclinical setting for both highly trained surgeons and nonexperienced operators and its accessibility for both long-time users of other systems and first-time users

Feasibility of Transcervical Robotic-Assisted Esophagectomy (TC-RAMIE) in a Cadaver Study—A Future Outlook for an Extrapleural Approach

In recent years, the evolution of advanced robotic medical systems has increased rapidly. These technical developments have led to advanced robotic systems, such as the da Vinci Xi, which allows superior controlled complex procedures and innovative surgical strategies. In esophageal surgery, the robotic-assisted minimally invasive esophagectomy (RAMIE) procedure is being developed and carried out with increasing frequency at centers worldwide. Recently, a new single port robotic system was introduced (da Vinci Single Port (SP)), which may allow for the exploration of new routes, such as transcervical robotic assisted minimally invasive esophagectomy (TC-RAMIE). This approach avoids opening the pleura by entering the mediastinum through the jugular window. In this report, we describe the technical steps of the TC-RAMIE using the new da Vinci SP system and compare it to the da Vinci Xi system

Robot-Assisted Minimally Invasive Esophagectomy with Intrathoracic Anastomosis (Ivor Lewis): Promising Results in 100 Consecutive Patients (the European Experience)

Background!#!Robot-assisted minimally invasive esophagectomy (RAMIE) with intrathoracic anastomosis is gaining popularity as a treatment for esophageal cancer. The aim of this study was to describe postoperative complications and short-term oncologic outcomes for RAMIE procedures using the da Vinci Xi robotic system 4-arm technique.!##!Methods!#!Data of 100 consecutive patients with esophageal or gastro-esophageal junction carcinoma undergoing modified Ivor Lewis esophagectomy were prospectively collected. All operations were performed by the same surgeon using an identical intrathoracic anastomotic reconstruction technique with the same perioperative management. Intraoperative and postoperative complications were graded according to Esophagectomy Complications Consensus Group (ECCG) definitions.!##!Results!#!Mean duration was 416 min (±80); 70% of patients had an uncomplicated postoperative recovery. Pulmonary complications were observed in 17% of patients. Anastomotic leakage was observed in 8% of patients. Median ICU stay was 1 day and median overall postoperative hospital stay was 11 days. The 30-day mortality was 1%; 90-day mortality was 3%. A R0 resection was reached in 92% of patients with a median number of 29 dissected lymph nodes. All patients had at least 7 months of follow-up with a median follow-up of 17 months. Median overall survival was not reached yet.!##!Conclusion!#!RAMIE with intrathoracic anastomosis (Ivor Lewis) for esophageal or gastro-esophageal junction cancer was technically feasible and safe. Postoperative complications and short-term oncologic results were comparable to the highest international standards nowadays