발표 논문
| 이달의 논문 2025년 9월 | ||
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| 등록일 : 2025.12.02 | ||
Further Validating the Robotic Microsurgery Platform through Preclinical Studies on Rat Femoral Artery and VeinAffiliations
AbstractThis research aims to validate the proficiency and accuracy of the robotic microsurgery platform using rat femoral vessel model.A total of 256 rat femoral vessels were performed, half using robotic and the other by manual microanastomosis by eight microsurgeons with less than 5 years of experience given eight trials (rats) each. Vessel demographics, proficiency (duration of suture and Structured Assessment of Robotic Microsurgical Skills [SARMS]), and accuracy (patency and scanning electron microscopic [SEM]) were analyzed between the two groups.Using the robot, an average of four trials was needed to reach a plateau in total anastomosis time and patency. Significant more time was required for each vessel anastomosis (34.33 vs. 21.63 minutes on the eighth trial, p < 0.001) one factor being a higher number of sutures compared with the handsewn group (artery: 7.86 ± 0.51 vs. 5.86 ± 0.67, p = 0.035, vein: 12.63 ± 0.49 vs. 9.57 ± 0.99, p = 0.055). The SARMS scores became nonsignificant between the two groups on the fourth trial. The SEM showed a higher tendency of unevenly spaced sutures, infolding, and tears in the vessel wall for the handsewn group.Using the robot, similar patency, accuracy, and proficiency can be reached through a fast but steep learning process within four trials (anastomosis of eight vessels) as the handsewn group. The robotic anastomosis may take longer time, but this is due to the increased number of sutures reflecting higher precision and accuracy. Further insight of precision and accuracy was found through the SEM demonstrating the possibility of the robot to prevent unexpected and unwanted complications.
The Confluence Point: A New Incision Strategy for Lymphaticovenular Anastomosis in Peripheral LymphedemaAffiliations
AbstractBackground: In the past 5 years, many advances have been made in preoperative planning using new imaging technologies. The high case load of lymphaticovenular anastomosis (LVA) performed using ultra-high-frequency ultrasound led to the discovery of a new incision site-the confluence point-where 2 major functional lymphatic channels merge into one, and then become sclerotic soon after. Methods: From October of 2021 to May of 2022, 60 consecutive patients with extremity lymphedema who underwent LVA were prospectively assessed. Preoperative planning included indocyanine green lymphography and ultra-high-frequency ultrasound. LVAs at the confluence points were evaluated in terms of operative time and LVA dynamics after the anastomosis, and compared with the incisions without confluence points. Results: The confluence point was detected preoperatively in 26 cases (43%). The lymphatics proximal to the confluence point showed similar calibers to the distal ones, with no significant size increase, and underwent a lumen obstruction 0.5 to 1 cm after the confluence point in 22 cases (92%). The mean operative time for LVA at the confluence points was 39 ± 8 minutes in upper limb lymphedema and 42 ± 6 minutes in lower limb lymphedema, significantly lower compared with incisions with 2 anastomoses (57 ± 8 minutes for upper limb lymphedema [ P < 0.0001] and 69 ± 15 minutes for lower limb lymphedema [ P < 0.0001]). Conclusion: LVA of confluence points derives from the anatomic findings detectable by ultra-high-frequency ultrasound, and proved to be an effective method to minimize the number of LVAs needed while maintaining the maximal lymph flow and the best dynamics through the anastomosis. |
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