Browsing by Subject "Robotic Surgical Procedures"
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Item 6-year Pulmonary Lobectomy Analysis Comparing Robotic to Thoracotomy and VATS: Impact to a State University Cardiothoracic Training Program(2017-01-17) Nawalaniec, James; Kernstine, Kemp; Elson, Matthew; Yuan, Chaofan; Madrigales, Alejandra; Lysikowski, JerzyOBJECTIVE: Current understanding of robotic lobectomy is largely from established thoracic surgical programs, often single-surgeon experience and does not involve trainees. Our objective is to assess the effect that a new robotic lobectomy program might have on a state university cardiothoracic (CT) training program to patient care, CT training, and the institution. METHODS: Our IRB-approved, prospectively maintained database and query of anatomic lung resections between 1/1/2006 to 6/30/2016 was verified with the medical center EMR and further verified with blinded double-entry. Inclusion criteria required a documented anatomic resection. Cost and oncologic data was obtained from the analytics department and tumor registry, respectively. Propensity scores were assigned based on age, sex, and five comorbidities. Lung cancer survival was analyzed by the Kaplan-Meier method and compared to the SEER database. Our robotic CT training method consists of a 6-month program over 3 years; the first 3 months focus on simulation and bedside-assist and the last 3 months, on complete case set-up and console training; adjustments made dependent upon the trainees' prior minimally invasive experience. RESULTS: 523 consecutive cases were identified, 91 cases were excluded. The query identified 212 robotic (179 non-small cell lung cancer (NSCLC)), 160 thoracotomy (117 NSCLC) and 60 video-assisted (VATS) (44 NSCLC) cases. Multiple surgeons performed each approach. Operative results and clinical outcomes favored robotic surgery compared to thoracotomy and showed little difference with VATS. Robotics increased lymph node stations, nodes, and upstaging rates, with similar R0 compared to thoracotomy and VATS; there was no significant difference in survival. A CT resident served as the console surgeon in 35% of all cases: 0% in the first two years increasing to 79% in the latest year. Minimally invasive surgeries increased from 32% of all cases in the first year of robotics to 89% in the latest year. The total volume of lung cancer treated at the center increased by 51%, surgical cases by 220%, and clinical trial accrual by 92%, since introducing robotics. CONCLUSION: A robotic surgery training component can be implemented at a state university cardiothoracic training program without sacrificing quality. Robotic surgery in this setting offers the same or better clinical results, is cost-effective, and is oncologically-sound. Additionally, a robotic program may increase an institution's lung cancer volume, enhancing both the CT resident training experience and clinical research. This analysis has also identified opportunities to further improve efficiency and reduce cost.Item Aspiration Pneumonia and Perioperative Antibiotic Use in Transoral Robotic and Laser Microsurgery(2015-01-26) Gajera, Prakash; Sumer, Baran D.INTRODUCTION: Aspiration pneumonia can follow transoral surgery for head and neck cancer due to abnormal swallowing function. While prophylactic post-operative antibiotics may decrease the incidence of this complication, excessive use can be costly, and lead to adverse reactions or antibiotic resistance. The objectives of this study are to 1) determine if the use post-op antibiotics prevent aspiration pneumonia. 2) Identify any complications related to the use of antibiotics. METHODS: A retrospective review of 155 patients who underwent transoral surgery for squamous cell carcinoma (SCCA) between May 2008 and June 2014 was conducted and demographic data was collected. The MD Anderson dysphagia inventory (MDADI) was used to assess swallowing function. RESULTS: Sixteen of 122 patients that received postoperative antibiotics (13.1%) developed pneumonia, compared to 4/32(12.5%) patients who did not receive antibiotics (p=0.925). Average antibiotic course was 39.2 days (median=23). Average time to infection was 290 days (median=217, range=11-979). Univariate analysis did not show a correlation between patients that developed pneumonia and antibiotic use (p=1.00), location (p=.1642), overall stage (p=.1599), comorbidity status (p=.5327), tobacco use (p=.6328), alcohol use (p=.351), and gastrostomy tube dependence (p=.254). Univariate analysis did show a correlation between pneumonia and tracheostomy placement (p=.0316), T stage (p=.0357), and days post-op of PEG placement (p=.0297). Multivariate analysis showed correlation with tracheostomy placement (p=.0236). No patients contracted C. difficile infection. No trend was observed in post-operative MDADI score. DISCUSSION: Routine use of post-operative prophylactic antibiotic does not correlate with a decreased rate of pneumonia or improved functional outcomes. Given that tracheostomies are performed mainly for pulmonary toilet, and a larger T stage results in larger resections, the significant correlation was expected. PEG placement in pneumonia patients was significantly later than patients with no pneumonia. This, and the fact that pneumonia generally developed outside of the 30-day perioperative period, supports the idea that aspiration pneumonia development reflects a chronic worsening swallowing dysfunction. Therefore, dysphagia immediately after surgery is probably not a significant risk factor for developing aspiration pneumonia and routine post-operative antibiotic use for pneumonia prevention is not indicated after transoral surgery.Item Efficacy and Safety Comparison of Robotic-Assisted Sacrocolpopexy Using Light-Weight and Heavy-Weight Polypropylene Mesh(2020-05-01T05:00:00.000Z) Huang, Emily You; Carmel, Maude; Lemack, Gary; Zimmern, Philippe E.AIMS: This study compares long-term surgical outcomes of light-weight polypropylene mesh (LWPPM) and heavy-weight polypropylene mesh (PPM) for robotic sacrocolpopexy (RSC). METHODS: Following IRB approval, a 2-surgeon POP database of women who underwent RSC at a single institution was reviewed. Minimum follow-up time was 6 months. Patients were stratified by mesh weight: Boston Scientific MarlexTM natural Trelex mesh or AtriumTM ProLite mesh (PPM) versus Caldera Medical Vertessa(r) Lite Y Polypropylene Mesh (LWPPM). Success was defined using a composite of absence of prolapse symptoms at the patient's most recent visit, no POP-Q point beyond the hymen, and no reoperation for POP. RESULTS: From 2007 to 2018, 110 patients met study criteria: 67 with LWPPM and 43 with PPM. The success rate of RSC using LWPPM at 12 months was 91.0% versus 90.7% for RSC with PPM (p =1). Over time, the mean follow-up length was 23.3 months in the LWPPM groups compared to 44.7 months in the PPM group (p <0.0002). The success rate at the last follow-up of RSC using LWPPM was significantly higher than that of RSC with PPM - 89.6% versus 72.1% (p =0.0221). Regarding complications, mesh extrusion rates varied (3.0% for LWPPM versus 11.6% for PPM at the last follow-up); however, this difference was not statistically significant (p=0.11) nor was the difference in management (p=0.15). CONCLUSIONS: RSC using LWPPM is a safe and effective procedure. Success rates using LWPPM are not inferior to those using PPM. Complication rates were low with either mesh.Item Robotic assisted bronchoscopy for the diagnosis of lung nodules(2022-06-17) Styrvoky, Kim