Factors supporting and constraining the implementation of robot-assisted surgery: a realist interview study

YesTo capture stakeholders’ theories concerning how and in what contexts robot-assisted surgery becomes integrated into routine practice. A literature review provided tentative theories that were revised through a realist interview study. Literature-based theories were presented to the interviewees, who were asked to describe to what extent and in what ways those theories reflected their experience. Analysis focused on identifying mechanisms through which robot-assisted surgery becomes integrated into practice and contexts in which those mechanisms are triggered. Nine hospitals in England where robot-assisted surgery is used for colorectal operations. Forty-four theatre staff with experience of robot-assisted colorectal surgery, including surgeons, surgical trainees, theatre nurses, operating department practitioners and anaesthetists. Interviewees emphasised the importance of support from hospital management, team leaders and surgical colleagues. Training together as a team was seen as beneficial, increasing trust in each other’s knowledge and supporting team bonding, in turn leading to improved teamwork. When first introducing robot-assisted surgery, it is beneficial to have a handpicked dedicated robotic team who are able to quickly gain experience and confidence. A suitably sized operating theatre can reduce operation duration and the risk of de-sterilisation. Motivation among team members to persist with robot-assisted surgery can be achieved without involvement in the initial decision to purchase a robot, but training that enables team members to feel confident as they take on the new tasks is essential. We captured accounts of how robot-assisted surgery has been introduced into a range of hospitals. Using a realist approach, we were also able to capture perceptions of the factors that support and constrain the integration of robot-assisted surgery into routine practice. We have translated these into recommendations that can inform future implementations of robot-assisted surgery

Identifying barriers in telesurgery by studying current team practices in robot-assisted surgery

This paper investigates challenges in current practices in robot-assisted surgery. In addition, by using the method of proxy technology assessment, we provide insights into the current barriers to wider application of robot-assisted telesurgery, where the surgeon and console are physically remote from the patient and operating team. Research in this field has focused on the financial and technological constraints that limit such application; less has been done to clarify the complex dynamics of an operating team that traditionally works in close symbiosis. Results suggest that there are implications for working practices in transitioning from traditional robot-assisted surgery to remote robotic surgery that need to be addressed, such as possible communication problems which might have a negative impact on patient outcomes

Two Cases of Rectal Cancer with Retzius Shunt Treated with Robot-Assisted Surgery

The retroperitoneal intestinal vein-general circulation anastomotic pathway is referred to as a Retzius shunt; however, it is not a well-recognized condition. Here, we describe two patients with a Retzius shunt who underwent robot-assisted surgery for rectal cancer. The first case was an 81-year-old woman who had tested positive for fecal occult blood. A type 0-Is tumor was found in the middle rectum, and we used robot-assisted surgery for resection. Intraoperative findings included a dilated vein between the inferior mesenteric artery (IMA) and inferior mesenteric vein (IMV); further, computed tomography (CT) revealed flow into the inferior vena cava (IVC). We clipped the vein without major bleeding and the tumor-specific mesorectal excision was completed. Thereafter, we reviewed relevant literature and identified the structure to be a Retzius shunt. The second case was 77-year-old man with type 1 advanced cancer in the middle rectum who underwent robot-assisted surgery. In this case, we recognized the Retzius shunt on preoperative CT due to our experience with the first case and surgery was completed without any problems. Preoperative recognition of vascular malformations, such as the Retzius shunt by CT is critical to ensure the safety of robot-assisted surgery

Robot-assisted surgery in ENT

Our specialty, like many others, has observed the emergence of new technologies, which tend towards more autonomy and artificial intelligence over the past twenty years, and in particular, the introduction of the robot in the operating room. The aim of this presentation is to take stock of head and neck robotic surgery in 2021. The indications as well as the advantages and disadvantages of these new technologies will be discussed, which also raise general and ethical questions including the role of the surgeon and its medico-legal responsibility

Clinical outcomes of transoral robotic surgery for head and neck tumors

OBJECTIVES: In order to reduce treatment-related morbidity rates and increase patients' quality of life, robot-assisted surgery using the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, California) has been studied actively in the field of head and neck surgery. This study analyzes our experiences therewith in order to evaluate the feasibility and efficacy of robot-assisted surgery via a transoral approach in the head and neck area. METHODS: Between April 2008 and December 2011, 141 patients were treated with robot-assisted surgery via a transoral approach. RESULTS: Robot-assisted surgeries were successfully completed via a transoral approach in all patients. The mean robotic operative time was 69.3 minutes, and the mean time for setup of the robotic system was 10.4 minutes. The average blood loss during the operation was 29.6 mL (range, 0 to 300 mL). Patients who underwent robot-assisted surgery were satisfied with their cosmetic results and treatment outcomes. CONCLUSIONS: Robot-assisted surgery via a transoral approach was confirmed to be feasible and efficient in the field of head and neck surgery. Further research is needed to investigate the long-term functional and oncological results of robot-assisted surgery.ope

Current status of robot-assisted surgery

The introduction of robot-assisted surgery, and specifically the da Vinci Surgical System, is one of the biggest breakthroughs in surgery since the introduction of anaesthesia, and represents the most significant advancement in minimally invasive surgery of this decade. One of the first surgical uses of the robot was in orthopaedics, neurosurgery, and cardiac surgery. However, it was the use in urology, and particularly in prostate surgery, that led to its widespread popularity. Robotic surgery, is also widely used in other surgical specialties including general surgery, gynaecology, and head and neck surgery. In this article, we reviewed the current applications of robot-assisted surgery in different surgical specialties with an emphasis on urology. Clinical results as compared with traditional open and/or laparoscopic surgery and a glimpse into the future development of robotics were also discussed. A short introduction of the emerging areas of robotic surgery were also briefly reviewed. Despite the increasing popularity of robotic surgery, except in robot-assisted radical prostatectomy, there is no unequivocal evidence to show its superiority over traditional laparoscopic surgery in other surgical procedures. Further trials are eagerly awaited to ascertain the long-term results and potential benefits of robotic surgery.published_or_final_versio

Recommendations for a standardised educational program in robot assisted gynaecological surgery: consensus from the Society of European Robotic Gynaecological Surgery (SERGS)

Background: the Society of European Robotic Gynaecological Surgery (SERGS) aims at developing a European consensus on core components of a curriculum for training and assessment in robot assisted gynaecological surgery. Methods: a Delphi process was initiated among a panel of 12 experts in robot assisted surgery invited through the SERGS. An online questionnaire survey was based on a literature search for standards in education in gynaecological robot assisted surgery. The survey was performed in three consecutive rounds to reach optimal consensus. The results of this survey were discussed by the panel and led to consensus recommendations on 39 issues, adhering to general principles of medical education. Results: on review there appeared to be no accredited training programs in Europe, and few in the USA. Recommendations for requirements of training centres, educational tools and assessment of proficiency varied widely. Stepwise and structured training together with validated assessment based on competencies rather than on volume emerged as prerequisites for adequate and safe learning. An appropriate educational environment and tools for training were defined. Although certification should be competence based, the panel recommended additional volume based criteria for both accreditation of training centres and certification of individual surgeons. Conclusions: consensus was reached on minimum criteria for training in robot assisted gynaecological surgery. To transfer results into clinical practice, experts recommended a curriculum and guidelines that have now been endorsed by SERGS to be used to establish training programmes for robot assisted surgery

Gender differences in understanding and acceptance of robot-assisted surgery

Robot-assisted surgery has numerous patient benefits compared to open surgery including smaller incisions, lower risk of infection, less post-operative pain, shorter hospital stays and a quicker return to the workforce. As such, it has become the first-choice surgical modality for several surgical procedures with the most common being prostatectomy and hysterectomy. However, research has identified that the perceptions of robot-assisted surgery among surgical patients and medical staff often do not accurately reflect the real-world situation. This study aimed to understand male and female perceptions of robot-assisted surgery with the objective of identifying the factors that might inhibit or facilitate the acceptance of robotic surgery. Semi-structured interviews were undertaken with 25 men/women from diverse social/ethnic backgrounds. The interviews were transcribed and analysed using thematic analysis. The majority of female participants expressed concerns in relation to the safety and perception of new technology in surgery, whereas many male participants appeared to be unfazed by the notion of robotic surgery. There were clear differences in how males and females understood and conceptualised the robot-assisted surgical process. Whilst male participants tended to humanise the process, female participants saw it as de-humanising. There is still a discrepancy between the public perceptions of robotic surgery and the clinical reality perceived by healthcare professionals. The findings will educate medical staff and support the development of current informative techniques given to patients prior to surgery

Robot-assisted surgery in horseshoe kidneys: A safety and feasibility multi-centre case series

OBJECTIVE: We assessed the safety and feasibility of minimally invasive robot-assisted surgery for horseshoe kidney (HSK). METHOD: A prospectively maintained data set for consecutive patients undergoing robotic kidney surgery was reviewed for patients with HSK. Cases were performed by experienced robotic surgeons, across two high-volume centres between 2016 and 2020. RESULTS: A prospectively maintained data set for consecutive patients undergoing robotic kidney surgery was reviewed for patients with HSK. Cases were performed by experienced robotic surgeons, across two high-volume centres between 2016 and 2020. CONCLUSION: We report one the largest series of robot-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in centralised high-volume centres with acceptable perioperative outcomes. Established benefits of minimally invasive surgery, such as reduced LOS and low complication rates, were demonstrated. LEVEL OF EVIDENCE: 4