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Central pncreatectomy (CP) can be one of procedures for function-preserving pancreatectomy for patients with benign or low grade malignant pancreatic tumors. Surgeons have to deal with two cut surface of the pancreas when performing CP, which can be associated with severe complication, such as postoperative pancreatic fistula. Fine and delicate surgical skill is highly required for safe CP. With the advance of minimally invasive surgery, CP is now thought to be one of appropriate procedures for function-preserving minimally invasive pancreatectomy. Robotic surgery is thought to make complicated surgical procedure easy and effective. Recently, Korean robotic surgical system, Revo-i, was successfully developed by Meeraecompany and have been proved its safety and feasibility in several recent reports. A 56-year old woman was referred for a body of pancreatic lesion. Contrast abdominopelvic CT revealed a pancreatic body tumor measuring around 1.2 cm in diameter. The patient underwent a robot-assisted central pancreatectomy using Revo-i. The patient endured the procedure well and was discharged to home at postoperative day 9. This report showed a successful case of central pancreatectomy performed with the Korean robotic surgical system Revo-i.

The robotic surgical system has been widely used in surgeries in various fields for its advantages over human eyes and hands with a magnified, stereoscopic view, flexible manipulation and ability to filter tiny tremors. The application of the robotic surgical system in vascular surgery is still in its infancy, and many issues concerning the operation techniques and safety need to be explored, especially in terms of the indications, key techniques, standardized procedures and management of intra- and post-operative complications. Of greater importance are the promotion of clinical studies that compare robotic surgical system versus open or laparoscopic surgery in vascular surgery and the collection and analysis of the long-term follow-up data. The evidence obtained from these studies will facilitate the wide application of robotic surgical system in vascular surgery. In addition, the defects in the current robotic surgical system need be improved, such as the lack of tactile feedback, the large size of the mechanical arm, and the interference between the arms. The era of robotic surgery has come, which urges greater efforts in both technical development and clinical studies of the robotic surgical system.

В работе проведен анализ особенностей развития высокотехнологичной медицинской робототехники, в том числе с учетом последних разработок на фоне пандемии COVID-19. Повышенный интерес вызывают разработки, связанные с применением медицинских роботов в больницах, при автоматизации тестирования, обеспечения общественной безопасности и др. Также проведен анализ данных для оценки показателей развития медицинских роботов по странам (на примере хирургической системы da Vinci)., The paper analyzes the features of the development of high-tech medical robotics, including considering the latest developments against the backdrop of the COVID-19 pandemic. Developments related to the use of medical robots in hospitals in the automation of testing and ensuring public safety are of great interest. A data analysis was also carried out to assess the development indicators of medical robots by country (using the da Vinci surgical system as an example)., Концепции, Выпуск 1 (39) 2020, Pages 27-33

В работе проведен анализ мирового рынка медицинских роботов, с выделением наиболее быстро растущего направления хирургических роботизированных систем, обусловленного в настоящее время спросом на минимально инвазивные операции. Выделены поколения хирургической системы da Vinci, которая является доминирующей на мировом рынке медицинской хирургической робототехники. В работе также проведен анализ динамики основных показателей деятельности компании Intuitive и особенностей распространения хирургической системы da Vinci по странам, The paper analyzes the global market for medical robots, highlighting the fastest growing area surgical robotic systems, which is due to the current demand for minimally invasive operations. Generations of the da Vinci surgical system, which is a key player in the global market for medical robotics, are highlighted. The paper also analyzes the dynamics of the main performance indicators of Intuitive and the characteristics of the distribution of the da Vinci surgical system in countries., №1(38) (2019)

Objective: to compare short-term and long-term results of laparoscopic and robotic mesorectal excisions. Material and methods. Our multi-center cohort study based on prospectively collected data included patients with rectal cancer (RC) who underwent laparoscopic and robotic surgeries between 2010 and 2016. Study participants were divided into 3 groups: laparoscopic surgery group (L), 1st robotic surgery group (R1, surgeries were performed during the 1st year after the implementation of the equipment) and 2nd robotic surgery group (R2, surgeries were performed later). We evaluated the quality of mesorectal excision conducted using laparoscopic and robotic surgical techniques on different stages of their implementation. Additionally, we estimated intra- and postoperative complications, duration of surgery, intraoperative blood loss, overall survival and relapse-free survival. Results. Our groups consisted of 101 (L), 31 (R1) and 82 (R2) patients. Median surgery duration was 235 (110–465), 270 (130–420) and 193 (105–365) min in groups L, R1 and R2 respectively. The frequency of complications in these groups was 12 (11.9 %), 8 (25.8 %) and 9 (11.0 %) respectively. The frequency of R0-resections was 95.0 % (L), 90.3 % (R1) and 98.8 % (R2). The G2–3 mesorectal excision was performed in 87.9 % (L), 96.9 % (R1) and 96.1 % (R2) patients. Relapses were registered in 8 (8.6 %), 2 (6.5 %), and 2 (2.6 %) patients from groups L, R1 and R2 respectively. We observed no differences in relapse-free survival across the groups R1 and R2 (р = 0.131), L and R1 (р = 0.088), L and R2 (р = 0.794). Conclusions. Robotic surgery can safely be used in patients with RC; however, it should be implemented into routine practice under the supervision of an expert within special training programs. The use of a robotic surgical system with an optimized docking system controlled by an experienced specialist allows reducing the duration of rectal surgery, does not increase the risk of postoperative complications and ensures a higher quality of mesorectal excision.

Robotic surgery systems have been developed to overcome the limitations of laparoscopic surgery. Recently, Meerecompany Inc. in Korea successfully manufactured a robotic surgical system called Revo-i. A 65-year old woman was referred for a pancreatic head tumor, detected as an incidental finding during a routine check-up. Contrast abdominopelvic CT revealed a pancreatic uncinate tumor measuring around 13 mm in diameter, with no other focal lesions. The patient underwent a robot-assisted pancreaticoduodenectomy (laparoscopic resection and robotic reconstruction) using Revo-i. The patient's recovery was uneventful and discharged on postoperative day 7. Our case showed the technical feasibility of the Korean robotic surgical system Revo-i. Further experiences are mandatory to validate this finding.

Background. Robotic surgical systems are expensive to own and operate, and the purchase of such technology is an important decision for hospital administrators. Most prior literature focuses on the comparison of clinical outcomes between robotic surgery and other laparoscopic or open surgery. There is a knowledge gap about what drives hospitals’ decisions to purchase robotic systems. Objective. To identify factors associated with a hospital’s acquisition of advanced surgical systems. Method. We used 2002 to 2011 data from the State of California Office of Statewide Health Planning and Development to examine robotic surgical system purchase decisions of 476 hospitals. We used a probit estimation allowing heteroscedasticity in the error term including a set of two equations: one binary response equation and one heteroscedasticity equation. Results. During the study timeframe, there were 78 robotic surgical systems purchased by hospitals in the sample. Controlling for hospital characteristics such as number of available beds, teaching status, nonprofit status, and patient mix, the probit estimation showed that market-level directly relevant surgery volume in the previous year (excluding the hospital’s own volume) had the largest impact. More specifically, hospitals in high volume (>50,000 surgeries v. 0) markets were 12 percentage points more likely to purchase robotic systems. We also found that hospitals in less competitive markets (i.e., Herfindahl index above 2500) were 2 percentage points more likely to purchase robotic systems. Limitations. This study has limitations common to observational database studies. Certain characteristics such as cultural factors cannot be accurately quantified. Conclusions. Our findings imply that potential market demand is a strong driver for hospital purchase of robotic surgical systems. Market competition does not significantly increase the adoption of new expensive surgical technologies.

IntroductionThe aims of this study were to evaluate (1) grasping forces with the application of a tactile feedback system in vivo and (2) the incidence of tissue damage incurred during robotic tissue manipulation. Robotic-assisted minimally invasive surgery has been shown to be beneficial in a variety of surgical specialties, particularly radical prostatectomy. This innovative surgical tool offers advantages over traditional laparoscopic techniques, such as improved wrist-like maneuverability, stereoscopic video displays, and scaling of surgical gestures to increase precision. A widely cited disadvantage associated with robotic systems is the absence of tactile feedback.Methods and procedureNineteen subjects were categorized into two groups: 5 experts (six or more robotic cases) and 14 novices (five cases or less). The subjects used the da Vinci with integrated tactile feedback to run porcine bowel in the following conditions: (T1: deactivated tactile feedback; T2: activated tactile feedback; and T3: deactivated tactile feedback). The grasping force, incidence of tissue damage, and the correlation of grasping force and tissue damage were analyzed. Tissue damage was evaluated both grossly and histologically by a pathologist blinded to the sample.ResultsTactile feedback resulted in significantly decreased grasping forces for both experts and novices (P0.05 in all subjects).ConclusionThe in vivo application of integrated tactile feedback in the robotic system demonstrates significantly reduced grasping forces, resulting in significantly less tissue damage. This tactile feedback system may improve surgical outcomes and broaden the use of robotic-assisted minimally invasive surgery.