Robotic versus Laparoscopic versus Open Gastrectomy: A Meta-Analysis

Marano, Alessandra,Choi, Yoon Young,Hyung, Woo Jin,Kim, Yoo Min,Kim, Jieun,Noh, Sung Hoon The Korean Gastric Cancer Association 2013 Journal of gastric cancer Vol.13 No.3

Purpose: To define the role of robotic gastrectomy for the treatment of gastric cancer, the present systematic review with meta-analysis was performed. Materials and Methods: A comprehensive search up to July 2012 was conducted on PubMed, EMBASE, and the Cochrane Library. All eligible studies comparing robotic gastrectomy versus laparoscopic gastrectomy or open gastrectomy were included. Results: Included in our meta-analysis were seven studies of 1,967 patients that compared robotic (n=404) with open (n=718) or laparoscopic (n=845) gastrectomy. In the complete analysis, a shorter hospital stay was noted with robotic gastrectomy than with open gastrectomy (weighted mean difference: -2.92, 95% confidence interval: -4.94 to -0.89, P=0.005). Additionally, there was a significant reduction in intraoperative blood loss with robotic gastrectomy compared with laparoscopic gastrectomy (weighted mean difference: -35.53, 95% confidence interval: -66.98 to -4.09, P=0.03). These advantages were at the price of a significantly prolonged operative time for both robotic gastrectomy versus laparoscopic gastrectomy (weighted mean difference: 63.70, 95% confidence interval: 44.22 to 83.17, P<0.00001) and robotic gastrectomy versus open gastrectomy (weighted mean difference: 95.83, 95% confidence interval: 54.48 to 137.18, P<0.00001). Analysis of the number of lymph nodes retrieved and overall complication rates revealed that these outcomes did not differ significantly between the groups. Conclusions: Robotic gastrectomy for gastric cancer reduces intraoperative blood loss and the postoperative hospital length of stay compared with laparoscopic gastrectomy and open gastrectomy at a cost of a longer operating time. Robotic gastrectomy also provides an oncologically adequate lymphadenectomy. Additional high-quality prospective studies are recommended to better evaluate both short and long-term outcomes.

Robotic Gastrectomy: The Current State of the Art

Marano, Alessandra,Hyung, Woo-Jin The Korean Gastric Cancer Association 2012 Journal of gastric cancer Vol.12 No.2

Since the first laparoscopic gastrectomy for cancer was reported in 1994, minimally invasive surgery is enjoying its wide acceptance. Numerous procedures of this approach have developed, and many patients have benefited from its effectiveness, which has been recently demonstrated for early gastric cancer. However, since laparoscopic surgery is not exempt from some limitations, the robotic surgery system was introduced as a solution by the late 1990's. Many experienced surgeons have embraced this new emerging method that provides undoubted technical and minimally invasive advantages. To date, several studies have concentrated to this new system, and have compared it with open and laparoscopic approach. Most of them have reported satisfactory results concerning the post-operative short-term outcomes, but almost all believe that the role of robotic gastrectomy is still out of focus, especially because long-term outcomes that can prove robotic oncologic equivalency are lacking, and operative costs and time are higher in comparison to the open and laparoscopic ones. This article is a review about the current status of robotic surgery for the treatment of gastric cancer, especially, focusing on the technical aspects, comparisons to other approaches and future prospects.

Robotic Gastrectomy: The Current State of the Art

Alessandra Marano,형우진 대한위암학회 2012 Journal of gastric cancer Vol.12 No.2

Since the first laparoscopic gastrectomy for cancer was reported in 1994, minimally invasive surgery is enjoying its wide acceptance. Numerous procedures of this approach have developed, and many patients have benefited from its effectiveness, which has been recently demonstrated for early gastric cancer. However, since laparoscopic surgery is not exempt from some limitations, the robotic surgery system was introduced as a solution by the late 1990's. Many experienced surgeons have embraced this new emerging method that provides undoubted technical and minimally invasive advantages. To date, several studies have concentrated to this new system, and have compared it with open and laparoscopic approach. Most of them have reported satisfactory results concerning the post-operative short-term outcomes, but almost all believe that the role of robotic gastrectomy is still out of focus, especially because long-term outcomes that can prove robotic oncologic equivalency are lacking, and operative costs and time are higher in comparison to the open and laparoscopic ones. This article is a review about the current status of robotic surgery for the treatment of gastric cancer, especially, focusing on the technical aspects, comparisons to other approaches and future prospects.

Robotic versus Laparoscopic versus Open Gastrectomy: A Meta-Analysis

Alessandra Marano,형우진,최윤영,김유민,김지은,노성훈 대한위암학회 2013 Journal of gastric cancer Vol.13 No.3

Purpose: To define the role of robotic gastrectomy for the treatment of gastric cancer, the present systematic review with meta-analysis was performed. Materials and Methods: A comprehensive search up to July 2012 was conducted on PubMed, EMBASE, and the Cochrane Library. All eligible studies comparing robotic gastrectomy versus laparoscopic gastrectomy or open gastrectomy were included. Results: Included in our meta-analysis were seven studies of 1,967 patients that compared robotic (n=404) with open (n=718) or laparoscopic (n=845) gastrectomy. In the complete analysis, a shorter hospital stay was noted with robotic gastrectomy than with open gastrectomy (weighted mean difference: -2.92, 95% confidence interval: -4.94 to -0.89, P=0.005). Additionally, there was a significant reduction in intraoperative blood loss with robotic gastrectomy compared with laparoscopic gastrectomy (weighted mean difference:-35.53, 95% confidence interval: -66.98 to -4.09, P=0.03). These advantages were at the price of a significantly prolonged operative time for both robotic gastrectomy versus laparoscopic gastrectomy (weighted mean difference: 63.70, 95% confidence interval: 44.22to 83.17, P<0.00001) and robotic gastrectomy versus open gastrectomy (weighted mean difference: 95.83, 95% confidence interval:54.48 to 137.18, P<0.00001). Analysis of the number of lymph nodes retrieved and overall complication rates revealed that these outcomes did not differ significantly between the groups. Conclusions: Robotic gastrectomy for gastric cancer reduces intraoperative blood loss and the postoperative hospital length of stay compared with laparoscopic gastrectomy and open gastrectomy at a cost of a longer operating time. Robotic gastrectomy also provides an oncologically adequate lymphadenectomy. Additional high-quality prospective studies are recommended to better evaluate both short and long-term outcomes.

Robotic Intraoperative Tracheobronchial Repair during Minimally Invasive 3-Stage Esophagectomy

Alessandra Marano,Silvia Palagi,Luca Pellegrino,Felice Borghi 대한흉부외과학회 2021 Journal of Chest Surgery (J Chest Surg) Vol.54 No.2

Tracheobronchial injury (TBI) is an uncommon but potentially fatal event. Iatrogenic le- sions during bronchoscopy, endotracheal intubation, or thoracic surgery are considered the most common causes of TBI. When TBI is detected during surgery, concomitant sur- gical treatment is recommended. Herein we present a case of successful robotic primary repair of iatrogenic tracheal and left bronchial branch tears during a robot-assisted hybrid 3-stage esophagectomy after neoadjuvant chemoradiotherapy. A robotic approach can facilitate the repair of this injury while reducing both the potential risk of conversion to open surgery and the associated increased risk of postoperative respiratory complications.

Structural Optimization of Hollow-section Steel Trusses by Differential Evolution Algorithm

Alessandra Fiore,Giuseppe Carlo Marano,Rita Greco,Erika Mastromarino 한국강구조학회 2016 International Journal of Steel Structures Vol.16 No.2

This paper deals with the weight minimization of planar steel trusses by adopting a differential evolution-based algorithm. Square hollow sections are considered. The design optimization refers to size, shape and topology. The design variables are represented by the geometrical dimensions of the cross sections of the different components of the truss, directly involving the size of the structure, and by some geometrical parameters affecting the outer shape of the truss. The topology is included in the optimization search in a particular way, since the designer at different runs of the algorithm can change the number of bays keeping constant the total length of the truss, to successively choose the best optimal solution. The minimum weight optimum design is posed as a single-objective optimization problem subject to constraints formulated in accordance with the current Eurocode 3. The optimal solution is obtained by a Differential Evolutionary (DE) algorithm. In the DE algorithm, a particular combination of mutation and crossover operators is adopted in order to achieve the best solutions and a specific way for dealing with constraints is introduced. The effectiveness of the proposed approach is shown with reference to two case-studies. The analysis results prove the versatility of the optimizer algorithm with regard to the three optimization categories of sizing, shape, topology as well as its high computational performances and its efficacy for practical applications. In particular useful practical indications concerning the geometrical dimensions of the various involved structural elements can be deduced by the optimal solutions: in a truss girder the cross section of the top chord should be bigger than the one of the bottom chord as well as diagonals should be characterized by smaller cross sections with respect to the top and bottom chords in order to simultaneously optimize the weight and ensure an optimal structural behaviour.