Browsing by Subject "robotic surgery"

Now showing 1 - 6 of 6
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    Expert Consensus Recommendations for Robotic Surgery Credentialing
    (Wolters Kluwer, 2020-11) Stefanidis, Dimitrios; Huffman, Elizabeth M.; Collins, Justin W.; Martino, Martin A.; Satava, Richard M.; Levy, Jeffrey S.; Surgery, School of Medicine
    Objective: To define criteria for robotic credentialing using expert consensus. Background: A recent review of institutional robotic credentialing policies identified significant variability and determined current policies are largely inadequate to ensure surgeon proficiency and may threaten patient safety. Methods: 28 national robotic surgery experts were invited to participate in a consensus conference. After review of available institutional policies and discussion, the group developed a 91 proposed criteria. Using a modified Delphi process the experts were asked to indicate their agreement with the proposed criteria in three electronic survey rounds after the conference. Criteria that achieved 80% or more in agreement (consensus) in all rounds were included in the final list. Results: All experts agreed that there is a need for standardized robotic surgery credentialing criteria across institutions that promote surgeon proficiency. 49 items reached consensus in the first round, 19 in the second, and 8 in the third for a total of 76 final items. Experts agreed that privileges should be granted based on video review of surgical performance and attainment of clearly defined objective proficiency benchmarks. Parameters for ongoing outcome monitoring were determined and recommendations for technical skills training, proctoring, and performance assessment were defined. Conclusions: Using a systematic approach, detailed credentialing criteria for robotic surgery were defined. Implementation of these criteria uniformly across institutions will promote proficiency of robotic surgeons and has the potential to positively impact patient outcomes.
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    Identifying Preoperative Predictors of Operative Time and Their Impact on Outcomes in Robot-Assisted Partial Nephrectomy
    (Liebert, 2022-01) Krishnan, Naveen K.; Zappia, Jason; Calaway, Adam C.; Nagle, Ramzy T.; Sundaram, Chandru P.; Boris, Ronald S.; Urology, School of Medicine
    Objective: To identify preoperative characteristics in patients with renal masses that influence operative time during robot-assisted partial nephrectomy (RAPN) and evaluate the relationship between operative time and length of stay (LOS), complication rates, and overall outcome. Materials and Methods: We queried our institutional database to identify a cohort of patients who underwent RAPN by two experienced robotic surgeons between 2012 and 2019. A multivariable regression model was developed to analyze operative time, LOS, and any grade complication within 30 days postoperatively using the bootstrap resampling technique. Results: A total of 392 patients were included. On multivariable analyses, prior abdominal surgery (p = 0.001) was associated with 22 minutes of increase in operating room time, as well as adhesive perirenal fat (22 minutes, p = 0.001). For each one unit increase in nephrometry score, there was a 4-minute increase in operating room time (p = 0.028), and for each one-cm increase in tumor size, there was an associated 12-minute increase in operating room time (p < 0.001). For each 1 year increase in age, there was an associated 0.024-day increase in LOS [odds ratio (OR) (0.013–0.035)]; in addition, for every one-cm increase in tumor size there was a 0.18-day associated increase in LOS [OR (0.070–0.28)]. Each 1-hour increase in operating room time was associated with a 0.25-day increased LOS [OR (0.092–0.41)]. Only tumor size was found to be associated with any grade complication. Conclusions: Patients with a history of abdominal surgery, larger complex tumors, and significant Gerota's fat undergoing robotic partial nephrectomy should anticipate longer operative times. Older patients with larger tumors and longer operative times can anticipate a longer LOS. Tumor size appears to be the common determinant of all three outcomes: operative time, LOS, and any grade Clavien complication.
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    Outcomes of open versus robotic partial nephrectomy: a 20-year single institution experience
    (Springer Nature, 2024-08) Love, Harrison; Yong, Courtney; Slaven, James E.; Mahenthiran, Ashorne K.; Roper, Chinade; Black, Morgan; Zhang, William; Patrick, Elise; DeMichael, Kelly; Wesson, Troy; O'Brien, Sean; Farrell, Rowan; Gardner, Thomas; Masterson, Timothy A.; Boris, Ronald S.; Sundaram, Chandru P.; Urology, School of Medicine
    Robotic assisted partial nephrectomy (RPN) has emerged in urologic practice for the management of appropriately sized renal masses. We provide a 20-year comparison of the outcomes of open partial nephrectomy (OPN) versus RPN for renal cell carcinoma (RCC) at our institution. An IRB-approved retrospective review was conducted of RCC patients at a single institution from 2000 to 2022 who underwent RPN or OPN. In addition to demographics, procedural details including ischemia and operative time were collected. Oncologic outcomes were evaluated through Kaplan–Meier statistical analysis to determine recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) analysis. 849 patients underwent RPN while 385 underwent OPN. 61% were male with average age of 58.8 ± 12.8 years. Operative time was shorter in the open group (184 vs 200 min, p = 0.002), as was ischemia time (16 vs 19 min, p = 0.047). However, after 2012, RPN became more common than OPN with improving ischemia time. RPN patients had significantly improved RFS (HR 0.45, p = 0.0004) and OS (HR 0.51, p = 0.0016) when controlled for T-stage and margin status. More > pT1 masses were managed with OPN than RPN (11.2 vs 5.4%, p < 0.0001). At our institution, RPN had an increasing incidence with reduced ischemia time compared to OPN over the last 10 years. While higher stage renal masses were more often managed with OPN, selective use of RPN does offer improved oncologic outcomes. Further investigation is needed to evaluate optimization of the selection of RPN versus OPN in the nephron-sparing management of renal masses.
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    Response to “Proving the Effectiveness of the Fundamentals of Robotic Surgery (FRS) Skills Curriculum A Single-blinded, Multispecialty, Multi-institutional Randomized Control Trial” Not only surgeon's manual skills...”
    (Wolters Kluwer, 2020-12) Satava, Richard M.; Stefanidis, Dimitrios; Levy, Jeffrey S.; Smith, Roger; Martin, John R.; Monfared, Sara; Timsina, Lava R.; Wardkes Darzi, Ara; Moglia, Andrea; Brand, Timothy C.; Dorin, Ryan P.; Dumon, Kristoffel R.; Francone, Todd D.; Georgiou, Evangelos; Goh, Alvin C.; Marcet, Jorge E.; Martino, Martin A.; Sudan, Ranjan; Vale, Justin; Gallagher, Anthony G.; Surgery, School of Medicine
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    Robotic Approach to Colon Resection
    (Elsevier, 2016-09) Waters, Joshua A.; Francone, Todd D.; Department of Surgery, IU School of Medicine
    Robotic surgical techniques are being increasingly adopted as a tool in the minimally invasive armamentarium of the colorectal surgeon. These platforms present numerous potential advantages in visualization, precise dissection, and tissue manipulation while potentially reducing operator fatigue. They may also reduce the learning curve and rate of conversion, though the short- and long-term benefits of this approach in non-pelvic colorectal surgery, and the cost–benefit balance remain an ongoing debate. Adherence to established principles of laparoscopic colon surgery, a robust understanding of the operative anatomy, and proper patient preparation and setup are critical for the efficient and effective utilization of a robotic approach for colon resection.
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    Robotic Partial Nephrectomy for a Peripheral Renal Tumor
    (Liebert, 2018-05) Cooper, Caleb A.; Shum, Cheuk Fan; Sundaram, Chandru P.; Urology, School of Medicine
    Partial nephrectomy (PN) is the preferred surgical treatment for T1 renal tumors whenever technically feasible. When properly performed, it allows preservation of nephron mass without compromising oncologic outcomes. This reduces the postoperative risk of renal insufficiency, which translates into better overall survival for the patients. PN can be technically challenging, because it requires the surgeon to complete the tasks of tumor excision, hemostasis and renorrhaphy, all within an ischemic time of preferably below 30 minutes. The surgeon needs to avoid violating the tumor margins while leaving behind the maximal parenchymal volume at the same time. Variations such as zero ischemia, early unclamping, and selective clamping have been developed in an attempt to reduce the negative impact of renal ischemia, but inevitably add to the steep learning curves for any surgeon. Being able to appreciate the fine details of each surgical step in PN is the fundamental basis to the success of this surgery. The use of the robotic assistance allows a good combination of the minimally invasive nature of laparoscopic surgery and the surgical exposure and dexterity of open surgery. It also allows the use of adjuncts such as concurrent ultrasound assessment of the renal mass and intraoperative fluorescence to aid the identification of tumor margins, all with a simple hand switch at the console. Robot-assisted laparoscopic PN is now the most commonly performed type of PN in the United States and is gaining acceptance on the global scale. In this video, we illustrate the steps of robot-assisted laparoscopic PN and highlight the technical key points for success.