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Cancers
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Robotic Cancer Surgery
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Robotic Cancer Surgery

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: closed (31 May 2023) | Viewed by 15570

Special Issue Editor

Prof. Dr. Jens Hoeppner

E-Mail Website
Guest Editor
Department of Surgery, University Medical Center of Schleswig-Holstein-Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
Interests: surgical oncology; HPB surgery; robotic surgery; minimally invasive surgery; clinical trials; multidisciplinary oncology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cancer kills thousands of people around the world. The current view is that the surgical removal of malignant tumors should also aim to minimize surgical trauma to the patient in order to reduce postoperative morbidity and to improve postoperative quality of life. Therefore, minimally invasive surgery techniques in which special surgical instruments are used, which are inserted through small incisions into the patient's skin. Minimally invasive robotic surgery can further improve surgical outcomes in treating cancer through improved and highly magnified 3DHD visualization, intra-operative near-infrared fluorescence imaging with the visual assessment of tumor tissue and related tissue perfusion. In addition, improving the visualization and high-precision instrument control and movement is a major improvement obtained by robotic instrumentation. Today, robotic operations are performed on tumor diseases of the lung, prostate, esophagus, pancreas, intestine, cervix, and some other organs. However, surgical and technical challenges remain. Clear long-term evidence of the superior curative results of robotic surgery over traditional approaches is controversial. This Special Issue shows the current results of robotic cancer surgery, discusses the limits and shows future possibilities for improving surgical results through the use of surgical robots.

Prof. Dr. Jens Hoeppner
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • robotic surgical procedures
  • cancer surgery
  • minimally invasive surgery
  • surgical oncology
  • prostate cancer
  • lung cancer
  • esophageal cancer
  • gastric cancer
  • pancreatic neoplasms
  • colorectal cancer

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Published Papers (8 papers)

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Editorial

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3 pages, 182 KiB  
Editorial
Multidisciplinary Application of Robotic Surgery in Cancer Disease
by Jens Hoeppner and Michael Thomaschewski
Cancers 2023, 15(20), 4937; https://doi.org/10.3390/cancers15204937 - 11 Oct 2023
Cited by 1 | Viewed by 804
Abstract
Robotic assistance systems are utilized in minimally invasive surgery with a rapidly increasing frequency [...] Full article
(This article belongs to the Special Issue Robotic Cancer Surgery)
2 pages, 153 KiB  
Editorial
Robotic Cancer Surgery
by Jens Hoeppner
Cancers 2021, 13(19), 4931; https://doi.org/10.3390/cancers13194931 - 30 Sep 2021
Cited by 2 | Viewed by 1423
Abstract
Cancer kills millions of people around the world every year [...] Full article
(This article belongs to the Special Issue Robotic Cancer Surgery)

Research

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9 pages, 227 KiB  
Article
Development and Implementation of an Advanced Program for Robotic Treatment of Prostate Cancer—Is Surgical Quality Transferable?
by August Sigle, Cordula A. Jilg, Moritz Weishaar, Boris Schlenker, Christian Stief, Christian Gratzke and Markus Grabbert
Cancers 2022, 14(21), 5261; https://doi.org/10.3390/cancers14215261 - 26 Oct 2022
Cited by 1 | Viewed by 1196
Abstract
Introduction: Robot-assisted radical prostatectomy (RARP) is a surgical treatment option for prostate cancer (PC). Quality in RARP depends on the surgeon´s operative volume and expertise. When implementing RARP, it is standard practice to hire a pre-trained surgeon. The aim of our study was [...] Read more.
Introduction: Robot-assisted radical prostatectomy (RARP) is a surgical treatment option for prostate cancer (PC). Quality in RARP depends on the surgeon´s operative volume and expertise. When implementing RARP, it is standard practice to hire a pre-trained surgeon. The aim of our study was to investigate the transferability of quality in RARP. Patients and Methods: We analyzed two consecutive retrospective cohorts of 100 and 108 men, respectively, who underwent RARP at two different centers and on whom surgery was performed by the same surgeon. Results: There were more men with high-grade PC in Cohort 1: 25/100 (25.0%) vs. 9/108 (8.3%), p < 0.01, and infiltration of the seminal vesicles was more frequent (23/100 (23.0%) vs. 10/108 (9.2%), p < 0.01). In Cohort 2, the duration of surgery was shorter and blood loss was lower: 149 (134–174) vs. 172 min (150–196), p < 0.01 and 300 (200–400) vs. 131 (99–188) mL, p < 0.01. No difference was found in the proportion of positive surgical margins in the T2 cohort (8.8% vs. 8.2%, p = 1.00). Conclusion: The procedural and oncological outcome parameters of Cohort 2 do not appear to be inferior to the results obtained for the first cohort. The quality of RARP is transferable if a pre-trained surgeon is hired. Full article
(This article belongs to the Special Issue Robotic Cancer Surgery)
14 pages, 1524 KiB  
Article
Challenges and Learning Curves in Adopting TaTME and Robotic Surgery for Rectal Cancer: A Cusum Analysis
by Pere Planellas, Lídia Cornejo, Anna Pigem, Núria Gómez-Romeu, David Julià-Bergkvist, Nuria Ortega, José Ignacio Rodríguez-Hermosa and Ramon Farrés
Cancers 2022, 14(20), 5089; https://doi.org/10.3390/cancers14205089 - 18 Oct 2022
Cited by 7 | Viewed by 2154
Abstract
New techniques are being developed to improve the results of laparoscopic surgery for rectal cancer. This paper analyzes the learning curves for transanal total mesorectal excision (taTME) and robot-assisted surgery in our colorectal surgery department. We analyzed retrospectively data from patients undergoing curative [...] Read more.
New techniques are being developed to improve the results of laparoscopic surgery for rectal cancer. This paper analyzes the learning curves for transanal total mesorectal excision (taTME) and robot-assisted surgery in our colorectal surgery department. We analyzed retrospectively data from patients undergoing curative and elective surgery for rectal cancer ≤12 cm from the anal verge. We excluded extended surgeries. We used cumulative sum (CUSUM) curve analysis to identify inflection points. Between 2015 and 2021, 588 patients underwent surgery for rectal cancer at our center: 67 taTME and 79 robot-assisted surgeries. To overcome the operative time learning curve, 14 cases were needed for taTME and 53 for robot-assisted surgery. The morbidity rate started to decrease after the 17th case in taTME and after the 49th case in robot-assisted surgery, but it is much less abrupt in robot-assisted group. During the initial learning phase, the rate of anastomotic leakage was higher in taTME (35.7% vs. 5.7%). Two Urological lesions occurred in taTME but not in robot-assisted surgery. The conversion rate was higher in robot-assisted surgery (1.5% vs. 10.1%). Incorporating new techniques is complex and entails a transition period. In our experience, taTME involved a higher rate of serious complications than robot-assisted surgery during initial learning period but required a shorter learning curve. Full article
(This article belongs to the Special Issue Robotic Cancer Surgery)
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8 pages, 1156 KiB  
Article
Development and In Vitro Assessment of a Novel Vacuum-Based Tissue-Holding Device for Laparoscopic and Robotic Kidney Cancer Operations
by Michael Gabi, Uwe Bieri, Venkat Ramakrishnan, Tilo Niemann, Antonio Nocito, Nadine Brader, Caroline Maake and Lukas John Hefermehl
Cancers 2022, 14(19), 4618; https://doi.org/10.3390/cancers14194618 - 23 Sep 2022
Cited by 1 | Viewed by 1691
Abstract
In this paper, we describe the development and evaluation of a novel tissue-holding device (THD) for use during robotic-assisted laparoscopic partial nephrectomy. The THD is a vacuum-based apparatus made of either 3D-printed polyethylene or stainless steel. The proximal end connects to suction tubing [...] Read more.
In this paper, we describe the development and evaluation of a novel tissue-holding device (THD) for use during robotic-assisted laparoscopic partial nephrectomy. The THD is a vacuum-based apparatus made of either 3D-printed polyethylene or stainless steel. The proximal end connects to suction tubing routed outside the body, while the distal end is conically shaped and designed to firmly interface with the tumor. Device feasibility studies were performed on six porcine kidneys, two porcine livers, and two embalmed human cadavers. A Likert-scale rating was used to assess device setup, suction, and tissue handling. Additional tests were performed using the daVinci Xi® robotic system. Finally, the holding force of the THD was assessed using different standard vacuum systems and pressure settings. In porcine tissue, the device setup, tissue suction, and handling were rated as “good”. THD insertion and removal was uncomplicated. In a simulated transabdominal approach on fixed human cadavers, the device setup, suction, and tissue handling were also rated as “good”. No macroscopic tissue compromise or device deterioration was noted. The handling and holding abilities using the daVinci Xi® robotic system were also rated “good”. The device was able to successfully hold over 300 g of tissue at a suction pressure of −600 mmHg. The preliminary evaluation of the THD demonstrated satisfactory results. Full article
(This article belongs to the Special Issue Robotic Cancer Surgery)
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12 pages, 456 KiB  
Article
Is Robotic Assisted Colorectal Cancer Surgery Equivalent Compared to Laparoscopic Procedures during the Introduction of a Robotic Program? A Propensity-Score Matched Analysis
by Peter Tschann, Markus P. Weigl, Daniel Lechner, Christa Mittelberger, Tarkan Jäger, Ricarda Gruber, Paolo N. C. Girotti, Christof Mittermair, Patrick Clemens, Christian Attenberger, Philipp Szeverinski, Thomas Brock, Jürgen Frick, Klaus Emmanuel, Ingmar Königsrainer and Jaroslav Presl
Cancers 2022, 14(13), 3208; https://doi.org/10.3390/cancers14133208 - 30 Jun 2022
Cited by 6 | Viewed by 2067
Abstract
Background: Robotic surgery represents a novel approach for the treatment of colorectal cancers and has been established as an important and effective method over the last years. The aim of this work was to evaluate the effect of a robotic program on oncological [...] Read more.
Background: Robotic surgery represents a novel approach for the treatment of colorectal cancers and has been established as an important and effective method over the last years. The aim of this work was to evaluate the effect of a robotic program on oncological findings compared to conventional laparoscopic surgery within the first three years after the introduction. Methods: All colorectal cancer patients from two centers that either received robotic-assisted or conventional laparoscopic surgery were included in a comparative study. A propensity-score-matched analysis was used to reduce confounding differences. Results: A laparoscopic resection (LR Group) was performed in 82 cases, and 93 patients were treated robotic-assisted surgery (RR Group). Patients’ characteristics did not differ between groups. In right-sided resections, an intracorporeal anastomosis was significantly more often performed in the RR Group (LR Group: 5 (26.31%) vs. RR Group: 10 (76.92%), p = 0.008). Operative time was shown to be significantly shorter in the LR Group (LR Group: 200 min (150–243) vs. 204 min (174–278), p = 0.045). Conversions to open surgery did occur more often in the LR Group (LR Group: 16 (19.51%) vs. RR Group: 5 (5.38%), p = 0.004). Postoperative morbidity, the number of harvested lymph nodes, quality of resection and postoperative tumor stage did not differ between groups. Conclusion: In this study, we could clearly demonstrate robotic-assisted colorectal cancer surgery as effective, feasible and safe regarding postoperative morbidity and oncological findings compared to conventional laparoscopy during the introduction of a robotic system. Full article
(This article belongs to the Special Issue Robotic Cancer Surgery)
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16 pages, 7292 KiB  
Article
Long-Term Survival Following Minimally Invasive Lung Cancer Surgery: Comparing Robotic-Assisted and Video-Assisted Surgery
by François Montagne, Zied Chaari, Benjamin Bottet, Matthieu Sarsam, Frankie Mbadinga, Jean Selim, Florian Guisier, André Gillibert and Jean-Marc Baste
Cancers 2022, 14(11), 2611; https://doi.org/10.3390/cancers14112611 - 25 May 2022
Cited by 16 | Viewed by 2939
Abstract
Background: Nowadays, video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are known to be safe and efficient surgical procedures to treat early-stage non-small cell lung cancer (NSCLC). We assessed whether RATS increased disease-free survival (DFS) compared with VATS for lobectomy and segmentectomy. [...] Read more.
Background: Nowadays, video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are known to be safe and efficient surgical procedures to treat early-stage non-small cell lung cancer (NSCLC). We assessed whether RATS increased disease-free survival (DFS) compared with VATS for lobectomy and segmentectomy. Methods: This retrospective cohort study included patients treated for resectable NSCLC performed by RATS or VATS, in our tertiary care center from 2012 to 2019. Patients’ data were prospectively recorded and reviewed in the French EPITHOR database. Primary outcomes were 5-year DFS for lobectomy and 3-year DFS for segmentectomy, compared by propensity-score adjusted difference of Kaplan–Meier estimates. Results: Among 844 lung resections, 436 VATS and 234 RATS lobectomies and 46 VATS and 128 RATS segmentectomies were performed. For lobectomy, the adjusted 5-year DFS was 60.9% (95% confidence interval (CI) 52.9–68.8%) for VATS and 52.7% (95%CI 41.7–63.7%) for RATS, with a difference estimated at −8.3% (−22.2–+4.9%, p = 0.24). For segmentectomy, the adjusted 3-year DFS was 84.6% (95%CI 69.8–99.0%) for VATS and 72.9% (95%CI 50.6–92.4%) for RATS, with a difference estimated at −11.7% (−38.7–+7.8%, p = 0.21). Conclusions: RATS failed to show its superiority over VATS for resectable NSCLC. Full article
(This article belongs to the Special Issue Robotic Cancer Surgery)
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14 pages, 2517 KiB  
Article
Effects of Multimodal Bundle with Remote Ischemic Preconditioning and Intrathecal Analgesia on Early Recovery of Estimated Glomerular Filtration Rate after Robot-Assisted Laparoscopic Partial Nephrectomy for Renal Cell Carcinoma
by Min Suk Chae, Jung-Woo Shim, Hoon Choi, Sung Hoo Hong, Ji Youl Lee, Woohyung Jeong, Bongsung Lee, Eunji Kim and Sang Hyun Hong
Cancers 2022, 14(8), 1985; https://doi.org/10.3390/cancers14081985 - 14 Apr 2022
Cited by 6 | Viewed by 2175
Abstract
We investigated the effects of multimodal combined bundle therapy, consisting of remote ischemic preconditioning (RIPC) and intrathecal morphine block (ITMB), on the early recovery of kidney function after robot-assisted laparoscopic partial nephrectomy (RALPN) in patients with renal cell carcinoma (RCC). In addition, we [...] Read more.
We investigated the effects of multimodal combined bundle therapy, consisting of remote ischemic preconditioning (RIPC) and intrathecal morphine block (ITMB), on the early recovery of kidney function after robot-assisted laparoscopic partial nephrectomy (RALPN) in patients with renal cell carcinoma (RCC). In addition, we compared the surgical and analgesic outcomes between patients with and without bundle treatment. This prospective randomized double-blind controlled trial was performed in a cohort of 80 patients with RCC, who were divided into two groups: a bundle group (n = 40) and non-bundle group (n = 40). The primary outcome was postoperative kidney function, defined as the lowest estimated glomerular filtration rate (eGFR) on postoperative day (POD) 2. Surgical complications, pain, and length of hospital stay were assessed as secondary outcomes. The eGFR immediately after surgery was significantly lower in the bundle group compared to the preoperative baseline, but serial levels on PODs 1 and 2 and at three and six months after surgery were comparable to the preoperative baseline. The eGFR level immediately after surgery was lower in the non-bundle than bundle group, and serial levels on PODs 1 and 2 and at three months after surgery remained below the baseline. The eGFR level immediately after surgery was higher in the bundle group than in the non-bundle group. The eGFR changes immediately after surgery, and on POD 1, were smaller in the bundle than in the non-bundle group. The non-bundle group had longer hospital stays and more severe pain than the bundle group, but there were no severe surgical complications in either group. The combined RIPC and ITMB bundle may relieve ischemia–reperfusion- and pain-induced stress, as a safe and efficient means of improving renal outcomes following RALPN in patients with RCC. Full article
(This article belongs to the Special Issue Robotic Cancer Surgery)
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