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In urological surgery, the Da Vinci Xi robotic system has many advantages, but it also has limitations such as high equipment costs and the need for professional training. Kangduo is a laparoscopic surgical robot developed in China, and SR2000 is its newly approved four-arm laparoscopic surgical robot. This study compares the short-term outcomes of the two in radical cystectomy. Data from a centre-based randomised non-inferiority trial were used and patients between March 2023 and June 2024 were enrolled and randomised according to criteria. The primary outcome was surgical success, and secondary outcomes included intraoperative variables, surgical outcomes, pathological outcomes, and postoperative outcomes. A total of 34 patients, 16 in the KD group and 18 in the DV group, had no intermediate open or conventional laparoscopic surgery, and the surgical success rate was 100%, with no significant differences between the two groups in many aspects. The effectiveness and safety of the KangDuo SR2000 system were demonstrated. Experienced surgeons confirmed that performing radical cystectomy using the KangDuo SR2000 system yielded results comparable to those achieved using the Da Vinci robotic system.

There is a clinical need to better understand and improve post-operative pain for patients undergoing laparoscopic repair of incisional hernia. The aim of this single-centre, double-blind, randomised controlled trial was to compare post-operative pain between absorbable and non-absorbable tack fixation in patients undergoing IPOM + repair. Patients with primary incisional hernia (size 3–10 cm), were randomised to either Reliatack™ ( n  = 27), an articulating-arm device deploying absorbable polymer tacks, or Protack™ ( n  = 36), a straight-arm device deploying permanent titanium tacks. The primary outcome was reported pain on activity using a visual analogue scale at post-operative day 30. Clinical and patient-reported outcome measures (PROMs) were assessed pre-operatively (day 0), and at 1-, 6-, 30- and 365-days post-surgery. No significant differences in reported pain ‘on activity’ were found at any timepoint. Less reported pain ‘at rest’ was found on post-operative day-1 with absorbable tacks ( p  = 0.020). Significantly longer mesh-fixation time ( p  < 0.001) and the use of more knots for fascial closure ( p  = 0.006) and tacks for mesh-fixation ( p  = 0.001) were found for the absorbable tack group. There were no differences in other clinical and PROMs between groups. For the whole trial cohort ( n  = 63) several domains in the Short-Form-36 showed a reduction from baseline scores at day 30 that improved at day 365. At post-operative day 30, 75.0% of patients reported ‘a lot of pain’ since discharge. This study found no difference in reported pain when choosing absorbable or non-absorbable tack fixation. The utility of “early” post-operative pain assessment as a comparator following incisional hernia repair needs clarification.

Laparoscopic appendectomy (LA) traditionally uses 3 ports: 2 for the videoscope and 3 for the procedure. 1 More recently a large single port technique groups the 3 ports in a single site that uses a larger incision. 2 As an alternative to the 3-port and single-port methods, we developed a laparoscopic traction device to pull the appendix to facilitate its removal. See PDF] After approval of a study protocol by our hospital ethics committee, we randomly assigned 74 patients to the 2-port technique plus the traction device and 75 patients to the standard 3-port procedure. Analysis of the postoperative pain score revealed that the 2-port LA significantly reduced pain level compared with the 3-port LA (mean score 1.33 vs 3.27), and more than 98% of the individuals in the 2-port group had a score between 0 and 2 and about 93% in the 3-port group had a score between 3 and 5 (Mann-Whitney U = 199.5, P < .0001).

BackgroundIt remains unclear whether use of self-fixating mesh during laparoscopic inguinal hernia repair (LIHR) impacts postoperative quality of life (QoL). We hypothesize patients receiving self-fixating mesh during totally extraperitoneal (TEP) LIHR will report less pain and improved QoL compared to those receiving non-fixating mesh.MethodsAn IRB-approved, single-blinded randomized controlled trial was conducted. Patients with primary, unilateral inguinal hernias were randomized to receive either non-fixating (control) or self-fixating mesh. Clinical visits were conducted 3 weeks and 1 year after LIHR. A validated Surgical Outcomes Measurement System (SOMS) instrument was used to assess patients’ QoL preoperatively and postoperatively along with Carolinas Comfort Scale (CCS) at 3 weeks and 1 year after surgery. Comparisons between self-fixating and non-fixating mesh groups were made using Chi-square, Wilcoxon rank-sum or independent samples t tests.ResultsTwo hundred and seventy patients were enrolled (137 non-fixating vs 133 self-fixating). Preoperatively, there was no difference in mean age, BMI, or median hernia duration between groups (57.9 vs 56.6 years, p = 0.550; 26.1 vs 26.8, p = 0.534; 3.0 vs 3.0 months, p = 0.846). Median operative times (34 vs 34 min, p = 0.545) and LOS were similar. More patients in the non-fixating group received tacks (43 vs 19, p = 0.001). Patients receiving non-fixating mesh recorded better mean SOMS scores for the first 3 days following surgery (Day 1: p = 0.005; Day 2: p = 0.002; Day 3: p = 0.024, Table 1) indicating less pain. No differences in pain were seen 3 weeks or 1 year postoperatively. There were zero recurrences found during clinical follow-up in either of the groups.ConclusionsPatients receiving self-fixating mesh report worse postoperative pain in the first 2–3 days than those receiving non-fixating mesh. The groups showed no differences across QoL metrics (SOMS and CCS) at 3 weeks or 1 year postoperatively. Self-fixating mesh does not appear to positively impact QoL after TEP LIHR.

Background Haptic feedback, which enables surgeons to perceive information on interaction forces between instrument and tissue, is deficient in laparoscopic surgery. This information, however, is essential for accurate tissue manipulation and recognition of tissue consistencies. To this end, a laparoscopic grasper with enhanced haptic feedback has been developed: the force reflecting operation instrument (FROI). This study tested the effects of enhanced haptic feedback on force control, tissue consistency interpretation, and the associated surgeons’ level of confidence through a randomized controlled crossover experiment. Methods A randomized three-period crossover trial was conducted, in which seven surgical residents and 13 medical students participated. The setup involved a box trainer in which slices of porcine organs (lung, small intestine, or liver) were presented. Participants performed three series of blinded palpation tasks involving three different graspers: the conventional grasper, the FROI with enhanced haptic feedback activated, and the FROI with enhanced haptic feedback deactivated. In each series, nine pairs of organ tissues were palpated to compare consistencies. The orders of presenting both instruments and tissues were randomized. Results The force applied during tissue palpation significantly decreased, by a mean factor of 3.1 with enhanced haptic feedback. Tissue consistency interpretation was significantly improved with more correct assessments and participants answered with significantly more confidence when enhanced haptic feedback was available. Conclusion The availability of enhanced haptic feedback enabled participants to operate with significantly reduced interaction force between instrument and tissues. This observation is expected to have multiple important clinical implications, such as less tissue damage, fewer complications, shorter operation times, and improved ergonomics.

OBJECTIVES: To compare the Vcare and SecuFix uterine manipulators (UM) used in total laparoscopic hysterectomy (TLH) with regard to operating time, duration of hospital stay, the time for insertion of the manipulator, time for completion of colpotomy, and maintenance of pneumoperitoneum, estimated blood loss, and perioperative complications. MATERIAL AND METHODS: This prospective, single-center, randomized controlled trial was conducted on patients who underwent TLH for benign indications between June 2023 and January 2024. Patients were randomized to either the Vcare UM or SecuFix UM group. Both groups were compared for operative time, colpotomy time, intrauterine manipulator insertion time, pneumoperitoneum maintenance, blood loss, complications, and length of hospital stay. RESULTS: A total of 100 patients were enrolled, 50 with VcareUM and 50 with SecuFix UM. SecuFix UM demonstrated shorter colpotomy time (p < 0.001) and better pneumoperitoneum maintenance (p = 0.008) compared to VCare. VCare had shorter insertion time (p = 0.001) but a higher uterine rupture rate (p = 0.001). No significant differences were found in operative time, blood loss, complications, or length of hospital stay (p > 0.05). CONCLUSIONS: SecuFix may offer advantages in colpotomy and pneumoperitoneum maintenance during TLH compared to VCare. The Vcare UM demonstrated a shorter insertion time than the SecuFix UMs, yet a higher rate of uterine rupture was observed with its placement.

Objectives: To compare the effects of using 11 mm trocar and 5 mm trocar as primary ports on postoperative pain in benign gynecological laparoscopic surgeries. Material and methods: The patients were divided into two groups as the primary port, group I (5 mm trocar) and group II (11 mm trocar) by block randomization. Results: In the 5 mm trocar group, postoperative pain score and need for analgesia were less in level I and level II operations. Patient satisfaction was significantly higher in the 5 mm trocar group. The postoperative pain score was higher in patients who had trocar insertion attempts 3 times with the direct trocar method compared to patients with 1 or 2 trocar entry attempts. Conclusions: The use of a 5 mm laparoscope in benign gynecological operations is an advantageous method due to low postoperative pain score, analgesic requirement, and high patient satisfaction.

BackgroundLaparoscopic surgery potentially increases the physical burden to operating theater personnel and can cause physical discomfort. This study aims to evaluate if a robotic camera holder (AutoLap™ system) can improve ergonomics for the surgeon and the camera assistant during laparoscopic procedures.MethodsA total of thirty cases were included and randomized (15 AutoLap™, 15 control). Five types of surgery were included: right hemicolectomy, fundoplication, sigmoid resection, rectopexy, and low anterior resection. The posture of the surgeon and assistant was photographed during predefined steps of the procedure. MATLAB was used to calculate angles relevant for the RULA score. The RULA score is a validated method to evaluate body posture, force and repetition of the upper extremities. Two investigators assessed the RULA score independently. Three subjective questionnaires (SMEQ, NASA TLX, and LED) were used to assess mental and physical discomfort.ResultsNo differences in patient characteristics were observed. Sixteen fundoplications, seven right hemicolectomies, five sigmoid resections, one rectopexy, and one low anterior resection were included. The mean RULA score of the surgeon was comparable in both groups, 2.58 (AutoLap™) versus 2.72 (control). The mean RULA score of the assistant was significantly different in both groups, with 2.55 (AutoLap™) versus 3.70 (control) (p = 0.001). The inter-observer variability (ICC) was excellent with 0.93 (surgeon) and 0.97 (assistant). The questionnaires showed a significant difference in physical discomfort for the assistant. The LED and SMEQ score were significantly lower in the robotic group. The NASA TLX demonstrated a significant reduction in scores in all domains when using robotics with the exception of the mental domain.ConclusionUse of the AutoLap™ system shows improvement in ergonomics and posture of the first assistant, and ergonomics of the surgeon are not affected. Furthermore, the subjective work load is significantly reduced by using a robotic camera holder.Trial registration numberNCT0339960, https://clinicaltrials.gov/ct2/show/study/NCT03339960?term=autolap&rank=5.

Background Laparoscopy generates technical and ergonomics difficulties due to limited degrees of freedom (DOF) of forceps. To reduce this limitation, a new 5-mm robotized needle holder with two intracorporeal DOF, Jaimy ® , has been developed. The aim of this study was to evaluate its effects on ergonomics and skills. Methods Fourteen surgeons including eight senior and six residents were crossover randomized and stratified based on experience. Three suturing tasks were performed with both Jaimy ® and a classic needle holder (NH): task 1: Peg-Board; task 2: hexagonal suture; task 3: frontal suture. Postural ergonomics of the dominant arm were evaluated with an ergonomics score (RULA score) thanks to motion capture, and muscular ergonomics with electromyography of six muscular groups (flexor and extensor carpis, biceps, triceps, deltoid, trapeze). Performance outcomes are a quantitative and qualitative score, and skills outcomes are the measurement of the number of movements and the path length travelled by the instrument. Results The RULA score showed a statistically improved posture with Jaimy ® ( p  < 0.001). The cumulative muscular workload (CMW) of four muscles was not different. However, the CMW was in favor of the NH for the flexor carpi ulnaris ( p  < 0.001) and the triceps ( p  = 0.027). The number of movements was not different ( p  = 0.39) although the path length was shorter with Jaimy ® ( p  = 0.012). The score for task 1 was in favor of the NH ( p  = 0.006) with a higher quantity score. Task 2 score was not different ( p  = 0.086): The quality part of the score was in favor of Jaimy ® ( p  = 0.009) and the quantity part was higher with the NH ( p  = 0.04). The score for task 3 was higher with Jaimy ® ( p  = 0.001). Conclusion This study suggests that the use of a robotized needle holder improves both posture and the quality of laparoscopic sutures.

Background The Kymerax© Precision-Drive Articulating Surgical System by Terumo© is a handheld laparoscopic robot which permits motion in two additional degrees of freedom (deflection and rotation in the instrument tip). In a pelvitrainer model, we compared the performance of participants with different laparoscopic experiences and compared Kymerax© to conventional laparoscopic instruments. Methods 20 expert surgeons, performing more than 50 laparoscopic procedures per year, and 25 medical students without any experience in surgery at all were selected. Each participant was randomized into two groups: Group TK performed the tasks using the traditional laparoscopic Instruments (TLI) first and Kymerax© thereafter, group KT vice versa. Six standardized tasks were used: Two instructional exercises and four tasks where time, number of mistakes, and overall precision were measured. Finally, a questionnaire had to be answered. Results All four tasks were performed significantly more slowly with the Kymerax© device. Improved needle control in stitches towards the surgeon, significantly less deviation while cutting along different lines as well as a significantly reduced fraying of the cutting edge were found when participants were using Kymerax©. By questionnaire more than 90% of the participants indicated clear advantages using Kymerax©. However, participants needed more training time and had an earlier loss of concentration with Kymerax©. Further complaints about Kymerax© were its limitations in rotation and deflection, the impaired view as well as the non-ergonomic instrument handle. Rotation force, instrument weight, digital instrument-tip control, and needle fixation were rated as accurate. Conclusions This study shows that more time is needed to solve tasks with Kymerax© compared to conventional laparoscopic instruments. Kymerax© is superior to conventional laparoscopy for suturing at difficult angles and cutting along complex structures. Kymerax© can potentially bring benefits for certain laparoscopic tasks, but as seen in this study, further developments are necessary. Terumo© meanwhile closed down its Kymerax© business.