Abstract:

Optimized biocompatibility is a major requirement for alloplastic materials currently applied in surgical approaches for hernia, incontinence, and prolapse situations. Tissue ingrowth/adherence and formation of connective tissue seem to have important influence in mesh incorporation at the implant site. In an in vitro approach we randomly investigated 7 different mesh types currently used in surgeries with various indications with regard to their adherence performance. Using a tissue culture approach, meshes were incubated with tissue representative of fibroblasts, muscle cells, and endothelial cells originating from 10 different patients. After 6 weeks, the meshes were assessed microscopically and a ranking of their adherence performance was established. Tissue culture was successful in 100% of the probes. We did not remark on interindividual differences concerning the growth and adherence performance after incubation with the different meshes in the investigated 10 patients. The ranking was consistent in all patients. In this test system, PVDF Dynamesh® (FEG Textiltechnik, Aachen, Germany) was the mesh with the best growth-in score. The test system was feasible and reproducible. Pore size seems to be a predictor of adherence performance. The test system may be a helpful tool for further investigations, and the predictive value should be assessed in further in vitro and in vivo experiments.

Authors:

Holger Gerullis, MD, Specialist in Urology, Consultant, Department of Urology, Lukas Hospital, Neuss, Germany, Oncologist, West German Cancer Center, University of Essen, Essen, Germany, Research Associate, German Centre for Assessment and Evaluation of Innovative Techniques in Medicine, Neuss, Germany, Evangelos Georgas, MD, Resident, Department of Urology, Lukas Hospital, Neuss, Germany, Christoph Eimer, MD, Specialist in Urology, Department of Urology, Lukas Hospital, Neuss, Germany, Peter E. Goretzki, MD, Professor, Head of Department , Department of General Surgery, Lukas Hospital, Neuss, Germany, Bernhard J. Lammers, MD, Head of Department of Coloproctology and Hernia Repair, Department of General Surgery, Lukas Hospital, Neuss, Germany, Bernd Klosterhalfen, MD, Professor, Head of Department, German Centre for Implant-Pathology, Duren, Germany, Mihaly Boros, MD, Professor, Head of Department , Department of Experimental Surgery, University of Szeged, Szeged, Hungary, Mohamed Wishahi, MD, Professor, Consultant, Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt, Gerd Heusch, MD, Professor, Head of Department, Institute for Pathophysiology, University of Essen, Essen, Germany, Thomas Otto, MD, Professor, Head of Department , Department of Urology, Lukas Hospital, Neuss, Germany, Oncologist, West German Cancer Center, University of Essen, Essen, Germany, Director, German Centre for Assessment and Evaluation of Innovative Techniques in Medicine, Neuss, Germany

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Abstract:

Surgical robots were introduced to overcome the technical issues of limited operative dexterity and inadequate visualization in complex body areas. Current surgical robotic systems are based on a master-slave relationship in which the master-surgeon provides operative guidance for the slave-robot to perform operative tasks. Robotic operations are most frequently applied in urology (primarily focusing on prostatectomy) and cardiac surgery. The evolution of surgical robotics has made significant strides in the past decade. There are, however, some limitations to robotic surgical technology, including cost, learning curve requirements, intellectual property, the need for evidence, logistical factors, and technical constraints. The future of robotic surgery promises several augmentations to provide improvements in surgical visualization, somatosensory perception, and enhanced robot-surgeon interactions. These can be achieved through advances in robotic research and academic healthcare leadership to develop the next generation of surgical robots such as the novel flexible access bio-inspired (FAB) platforms. The drive to move toward ever less-invasive and safer procedures while maintaining high-quality treatment outcomes has maintained the momentum of progress since the initial birth of minimally invasive surgery, so that robotic surgery can be increasingly applied in a wider range of healthcare settings.

Authors:

Thanos Athanasiou, MD, PhD, FRCS, FETCS, Professor of Cardiovascular Sciences and Cardiac Surgery, Imperial College London, London, England, Hutan Ashrafian, BSc (Hons.), MBBS, MRCS, Clinical Lecturer in Surgery, Imperial College London, London, England, Christopher Rao, BSc (Hons.), MBBS, MRCS, Clinical Research Fellow, Imperial, College London, London, England, Guang-Zhong Yang, PhD, Director of Medical Imaging, Department of Computing, Director and Co-founder of the Hamlyn Centre for Robotic Surgery, Deputy Chairman of the Institute of Global Health Innovation, Director and Founder of the Royal Society/Wolfson Medical Image Computing Laboratory, Co-founder of the, Wolfson Surgical Technology Laboratory, Chairman of the Centre for Pervasive Sensing, Imperial College London, London, England, Ara Darzi, MD, FRCS, KBE, Paul Hamlyn Chair of Surgery, Head of the Division of Surgery, Honorary Consultant Surgeon, Co-founder of the Hamlyn Centre for Robotic Surgery, Chairman of the Institute of Global Health Innovation, Imperial College London, London, England

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Abstract:

Single-incision laparoscopic surgery (SILS) is a recent development in minimally invasive surgery. This is an initial SILS experience in reconstructive urology to prove feasibility and provide a comparison with conventional laparoscopy during perioperative and convalescent periods. A single surgeon performed two complex SILS operations (psoas bladder hitch with Boari flap for high ureteric stricture [SILS-PB] and nephropexy for severe nephroptosis [SILS-Np]). A group of 6 patients with previous experience with conventional laparoscopy by the same surgeon with the same operation complexity was selected for retrospective comparison. SILS was performed through multichannel port (intraumbilical or retroperitoneal). There was no conversion to laparoscopy. Operative time (Or-t) was 365 and 185 minutes for SILS-PB and SILS-Np, respectively. Blood loss was 100 ml for SILS-PB without any intraoperative complications. Baseline demographics, Or-t, blood loss, and hospital stay were comparable to the laparoscopic group. Except for prolonged Or-t, patients undergoing SILS had similar surgical outcomes and comparable convalescent periods. Follow-up was uneventful for both groups. Patients' global satisfaction and willingness to recommend their procedure to others were favorable and equivalent between groups. Thus, SILS-reconstructive operations for high ureteric strictures and severe nephroptosis are feasible. It seems equally as efficacious as conventional laparoscopy maintaining surgical standards without differences in perioperative outcomes and convalescence.

Authors:

Wael Y. Khoder, MD, MSc, Senior Staff Urologist, Department of Urology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany, Boris, Schlenker, MD, Senior Urologist, Department of Urology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany, Matthias Trottmann, MD, Senior Urologist, Department of Urology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany, Christian G Stief, MD, PhD, Professor and Chairman, Department of Urology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany, Armin J Becker, MD, Senior, Staff Urologist, Department of Urology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany

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