robotics in urology luke a mcguinness文献.pdf

该【robotics in urology luke a mcguinness文献 】是由【小舍儿】上传分享，文档一共【7】页，该文档可以免费在线阅读，需要了解更多关于【robotics in urology luke a mcguinness文献 】的内容，可以使用淘豆网的站内搜索功能，选择自己适合的文档，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此文档到您的设备，方便您编辑和打印。Robotics:AnnalsoftheRoyalCollegeofSurgeonsofEnglandRoboticsinurologyTwentyyearsafteritwasintroduced,roboticsurgerymonplaceinurology–weexamineitscurrentusesandcontroversiesLukeAMcGuinnessJamesCookherehasbeenasignifi-icitprovedwhenalmostacenturyUniversityHospital,Middlesbroughcantinterestinminimallylaterroboticsystemshavebeguninvasivesurgery(MIS),MiddlesbroughTattempttoreducemorbidity,expedite1DOI:.–bothconventionalusedarealmostsolelythosederivedlaparoscopyandrobot-assistedap-fromtheoriginaldaVinci?systemde-proaches–havereplacedasignificantvelopedbyIntuitiveSurgical(Sunny-,US).AlthoughothersystemshadDespiteitsobviousbenefits,conven-beenused,itwasthedaVinci?‘master–slave’-system,prisesofasur-botic-assistedlaparoscopicsurgerygeon’sconsole(master),apatient-side(RALS),withits3Dhigh-art(slave)andanimagepro-images,enhancedendo-wristdexter-cessingstack(Fig1).Theconsoleisity,precisehand–eyecoordination,pris-physiologicaltremorfiltering,andmo-inga3Dvideosystemandanin-linetion--defini-alternativeoption,;onearmcontrolsthecameraandthreeareusedforsurgicalTheterm‘robot’?CzechplaywrightKarelCapekintechnology(Fig2),whichprovides7his1921workRossum’sUniversaldegreesoffreedomand90-‘robota’,whichtranslatesasareloadedandintroducedtothebody‘forcedwork’.InCapek’,some2,500robotshelpedtheirhumanmastersdaVinci?-?robotwasinitiallyde-Figure1ThedaVinci?prisingsurgeonconsole,-,Sunnyvale,California,-dayRALSis,however,pre-dominantlydominatedbyurological,-,openretropubicradicalprostatectomywasconsideredthegoldstandardfortreatmentoflocal-isedprostatecancersinceTerrenceItisestimatedthatby2020intheUSFigure2Endowrist?instrumentwithMillin’%-IntuitiveSurgicalInc,Sunnyvale,degreeofmorbidityandpotentiallyedly,themainbenefitinitsuptakeCalifornia,,itwasn’tlongbeforethefirstreportedcasestoachieve4-hour-(LRP),8primarylimitationofLRPwasthechallengeofperformingthevesi-Withtheroboticplatform,prosta-co--?,thatcouldbepreservedandcoinedontemporaryunderstandingoftheterm‘VeilofAphrodite’–-paredwithproviding7degreesoffreedom,theomy–hasimprovedwithsuperiorstandardnerve-?-strat-marriageoftheminimallyinvasiveandthefirstdescriptionoftheprostateifiedincrementalnerve-,anumberofmodern-dayoflayersofperiprostaticfascialdis-’sRetzius-sparingrobot-(RALP),,thesurgeonpassesacceptedasthesurgicalmodalityoftodevelopimprovedtechniquesforthethroughtheDouglasspace,avoid-choiceforradicalprostatectomyinpreservationofneurovascularanato-partmentwithwell-,:AnnalsoftheRoyalCollegeofSurgeonsofEnglandesweresimilar8,,-6,,000Openalsoreportedsimilarperioperative,4,plica-3,,000Short-andlong-termcontinenceanderectilefunctionrateswere,howev-1,000er,,concludingsimilar2,,operatingtime,1,500Openintraoperativeadverseevents,estimat-edbloodlossandhospitalstaywere1,,-20062007200820092010201120122013201420152016geonhadperformed200and1,500prostatectomiesrespectivelybeforeFigure5Radicalcystectomythestartofthetrial,whichempha-2,,500LaparoscopicOpenSystematicreviews,whichincluded1,000cohortstudies,havefoundsignificantimprovementin12-monthincon-500tinencerates(%vs12%)andpotencyrates(60%vs48%)ofRALP0comparedwithopenprostatectomy–,-Despiteprobablythefastest-growingAnationwideseriesofalmost20,000proachmarksanotherlandmarkintheandevolvingroboticprocedure,.-bladderneckpreservation,periure-Asimakopoulosetalreportedtheplicationsratesandshorterlengththralsuspensionandreconstruction,firstrandomisedcontroltrial(RCT)ofstaybutnodifferenceinmortal-preservationofurethrallength,-upinexistingprostaticligamentsandendopelvicstudyreportedsignificantlybetterstudiesisrelativelyshort,whichfasica–,%%-uprecruited350patientsandwillbeEvenallowingfortheshorterhospital-of67months,paringthe2isation,RALPstillincursanadditional5-yearrecurrence-pleted.￡1,paredwithopencancer-specificsurvivalof67%andThepreliminaryresultsfromthetrialprostatectomy;althoughitispossible75%-equivalenceinhigh-vol-theroboticapproachwastheabilitytoandbloodtransfusionratesweresig-umecentres(>10cases/week).8,20performagood-qualityextendedpel--alsoreportatrendtowardlesserhos-,majorThegoldstandardtreatmentforthan80%and40%plications(GradeIIIandabove),muscle-invasiveandhigh-risksu-fromtheconsortiumhad≥10andnumberoflymphnodessampled,perficialbladdercancerinvolvesa≥20lymphnodessampledrespec-overallpositivemarginstatus,positiveradicalcystectomy,extendedpelvictively;itconcludedthattherateofbladdersoft--yearrecurrence-freesur-surgicaltechniquesandhospitalcare,seriesofRARC,theurinarydiversionvivalratesareyettomatureandaretheopenradicalcystectomy(ORC)-daysurgeons–withareportedmorbidityandperformtheurinarydiversionwithanAswithRALP,costisanissuewithmortalityof50%and5%respective-,22Theurinarydiversion,withitstheproportionofpatientsreceivingilealconduitaddsanadditional￡1,200reconstructiveaspects,eo-contributestothemorbidityandpro-increasedfrom9%in2005to97%bladderadds￡2,,33Undoubtedly,itThisstepisparticularlychallengingoperatingtime,lowerestimatedbloodisanexpandingprocedureandassur-withtheconventionallaparoscopicloss,;thequestionofwhetherinitialseriesofrobotic-paredwithtotallyintracorporealcystectomyiscystectomy(RARC)-,thetechniquesincethisinitialreport-RCTshaven’tconclusivelyconferredPartialnephrectomyedseries,,35TheprocedureinvolvesThetrialrandomised118patientandexcisionoftherenalmassandsubse-ystectomyreportedsimilar90-dayClavienGradequentrenorrhaphyoftherenaldefectConsortium(),aretrospective2–5complicationsof62%and66%-,therefore,needstobeperformedcystectomiessince2003,ispossiblyFurthermore,thetrialfailedtodemon-withinacertaintimelimit,dependingtheworld’slargestdatabaseonroboticstratesuperiorityofRARCoverORConischemiatechniques,inordertopli-forhospitalstay,--of-life(QoL)(OPN)TheconsortiumreportaClavieninvolveslargemuscle-cuttingabdom-plicationrateTheRAZORtrial–thefirstphase3,inalorflankincisionsthatmayinvolveof19%,prospectiverandomisedribremovaland,assuch,canhave30-and90-paringORCandRARC–islonghospitalstaysandrecoveryperi-41Robotics:-Robot-,53Meta-analyseshaveshownmy(LPN)wasfirstperformedin1993,Pelvicouretericjunctionobstruc-thatrobot-assistedpyeloplastyhassim-withthegoalofavoidingmorbiditytion(PUJO),--paredwithbothlaparoscopicandopenabilitytoperformaneffectiverenor-loplastyhasbeenthestandardofcare,,54,55,56Furthermore,%.46Aswithotheropenrenalashorteroperatingtimethanlaparo-esofasinglesurgeonsurgery,itwasassociatedwithlongscopic–butlongerthanopenap-,-scenarioofredopyeloplasty,withsmallminuteswasachievedinonly15%