robotic-assisted-laparoscopic-splenic-artery-aneurysm-resection

Robotic Assisted Laparoscopic Splenic Artery Aneurysm Resection

Splenic artery aneurysms (SAA) are the most common visceral aneurysm and&#160;may develop significant risk for rupture and life-threatening complications ...

Semmelweis University

To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute and elective thoracic and abdominal aortic procedures.

Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions.

Corrigendum to 'Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions'.

Certain genetic factors, including single-nucleotide polymorphisms (SNPs) in the  gene, have been linked to medication-related osteonecrosis of the jaw (MRONJ). This study examined four SNPs in the  gene and implemented multivariate statistical analysis to analyze genetic and clinical factors in MRONJ patients. Genomic DNA was isolated from peripheral blood samples of 63 patients of European origin treated for MRONJ, and four SNP genotypes in the gene encoding the SIRT-1 protein were determined by Sanger sequencing. The allele frequencies measured in the MRONJ population were compared with allele frequencies measured in the European population in the National Center for Biotechnology Information Allele Frequency Aggregator (NCBI ALFA) database. Genetic and clinical factors were examined with multivariate statistical analysis. A C:A allele distribution ratio of 77.8:22.2 was measured in the rs932658 SNP. In the ALFA project, a C:A allele distribution ratio of 59.9:40.1 was detected in the European population, which was found to be a significant difference ( = 4.5 × 10). Multivariate statistical analysis revealed a positive correlation (0.275) between the genotype of SNP rs932658 and the number of stages improved during appropriate MRONJ therapy. It is concluded that allele A in SNP rs932658 in the  gene acts as a protective factor in MRONJ.

Analysis of SIRT1 Gene SNPs and Clinical Characteristics in Medication-Related Osteonecrosis of the Jaw.

This review aims to explore advancements in perioperative ischemic stroke risk estimation for asymptomatic patients with significant carotid artery stenosis, focusing on Circle of Willis (CoW) morphology based on the CTA or MR diagnostic imaging in the current preoperative diagnostic algorithm. Functional transcranial Doppler (fTCD), near-infrared spectroscopy (NIRS), and optical coherence tomography angiography (OCTA) are discussed in the context of evaluating cerebrovascular reserve capacity and collateral vascular systems, particularly the CoW. These non-invasive diagnostic tools provide additional valuable insights into the cerebral perfusion status. They support biomedical modeling as the gold standard for the prediction of the potential impact of carotid artery stenosis on the hemodynamic changes of cerebral perfusion. Intraoperative risk assessment strategies, including selective shunting, are explored with a focus on CoW variations and their implications for perioperative ischemic stroke and cognitive function decline. By synthesizing these insights, this review underscores the potential of non-invasive diagnostic methods to support clinical decision making and improve asymptomatic patient outcomes by reducing the risk of perioperative ischemic neurological events and preventing further cognitive decline.

Non-Invasive Tools in Perioperative Stroke Risk Assessment for Asymptomatic Carotid Artery Stenosis with a Focus on the Circle of Willis.

To evaluate the impact of anatomical variations in the Circle of Willis (CoW) on immediate neurological events (INEs) after carotid endarterectomy (CEA) without shunting in patients with contralateral carotid occlusion (CCO).

The Circle of Willis Status Influences Neurological Complications of Carotid Endarterectomy with Contralateral Carotid Occlusion.

Although robot-assisted surgical procedures using the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA) have been performed in more than 13 million procedures worldwide over the last two decades, the vascular surgical community has yet to fully embrace this approach (Intuitive Surgical Investor Presentation Q3 (2023) https://investor.intuitivesurgical.com/static-files/dd0f7e46-db67-4f10-90d9-d826df00554e . Accessed February 22, 2024). In the meantime, endovascular procedures revolutionized vascular care, serving as a minimally invasive alternative to traditional open surgery. In the pursuit of a percutaneous approach, shorter postoperative hospital stay, and fewer perioperative complications, the long-term durability of open surgical vascular reconstruction has been compromised (in Lancet 365:2179-2186, 2005; Patel in Lancet 388:2366-2374, 2016; Wanhainen in Eur J Vasc Endovasc Surg 57:8-93, 2019). The underlying question is whether the robotic-assisted laparoscopic vascular surgical approaches could deliver the robustness and longevity of open vascular surgical reconstruction, but with a minimally invasive delivery system. In the meantime, other surgical specialties have embraced robot-assisted laparoscopic technology and mastered the essential vascular skillsets along with minimally invasive robotic surgery. For example, surgical procedures such as renal transplantation, lung transplantation, and portal vein reconstruction are routinely being performed with robotic assistance that includes major vascular anastomoses (Emerson in J Heart Lung Transplant 43:158-161, 2024; Fei in J Vasc Surg Cases Innov Tech 9, 2023; Tzvetanov in Transplantation 106:479-488, 2022; Slagter in Int J Surg 99, 2022). Handling and dissection of major vascular structures come with the inherent risk of vascular injury, perhaps the most feared complication during such robotic procedures, possibly requiring emergent vascular surgical consultation. In this review article, we describe the impact of a minimally invasive, robotic approach covering the following topics: a brief history of robotic surgery, components and benefits of the robotic system as compared to laparoscopy, current literature on "vascular" applications of the robotic system, evolving training pathways and future perspectives.

Robot-assisted vascular surgery: literature review, clinical applications, and future perspectives.

Genetic alterations are well known to be related to the pathogenesis and prognosis of papillary thyroid carcinoma (PTC). Some miRNA expression dysregulations have previously been described in the context of cancer development including thyroid carcinoma. In our study, we performed original molecular diagnostics on tissue samples related to our own patients. We aimed to identify all dysregulated miRNAs in potential association with PTC development via sequencing much higher numbers of control-matched PTC tissue samples and analyzing a wider variety of miRNA types than previous studies. We analyzed the expression levels of 2656 different human miRNAs in the context of 236 thyroid tissue samples (118 tumor and control pairs) related to anonymized PTC cases. Also, KEGG pathway enrichment analysis and GO framework analysis were used to establish the links between miRNA dysregulation and certain biological processes, pathways of signaling, molecular functions, and cellular components. A total of 30 significant differential miRNA expressions with at least ±1 log fold change were found related to PTC including, e.g., miR-551b, miR-146b, miR-221, miR-222, and miR-375, among others, being highly upregulated, as well as miR-873 and miR-204 being downregulated. In addition, we identified miRNA patterns in vast databases (KEGG and GO) closely similar to that of PTC including, e.g., miRNA patterns of prostate cancer, HTLV infection, HIF-1 signaling, cellular responses to growth factor stimulus and organic substance, and negative regulation of gene expression. We also found 352 potential associations between certain miRNA expressions and states of clinicopathological variables. Our findings-supported by the largest case number of original matched-control PTC-miRNA relation research-suggest a distinct miRNA expression profile in PTC that could contribute to a deeper understanding of the underlying molecular mechanisms promoting the pathogenesis of the disease. Moreover, significant miRNA expression deviations and their signaling pathways in PTC presented in our study may serve as potential biomarkers for PTC diagnosis and prognosis or even therapeutic targets in the future.

MicroRNA Profiling in Papillary Thyroid Cancer.

Pulmonary arteriovenous malformations create continuous shunting of unoxygenated blood through the lungs into the systemic circulation. These malformations are asymptomatic if small, but cause serious symptoms as they grow in size. Treatment primarily consists of endovascular embolization; lobectomy is preserved for recurring or endovascularly untreatable cases. We describe a case of a 24-year-old man who was first treated with coil embolization 10 years previously, with complete symptom resolution. However, more recently he noted recurrent exercise intolerance, with shortness of breath and hypoxemia. After repeat re-embolization, a computed tomography scan noted some persistent flow. Given the patient's young age, we considered resection as a definite therapy. The patient underwent an uncomplicated robot-assisted right lower lobectomy. Afterward, his symptoms resolved completely. In selected cases, robotic lobectomy for pulmonary arteriovenous malformation is feasible and safe.

Robotic right lower lobectomy for a persistent large pulmonary arteriovenous malformation following repeated coil embolization.

Inspired by the quality of computer-rendered images in the animated movie industry, cinematic rendering (CR) is a novel image visualization technique using proprietary rendering algorithms that simulate the propagation and interaction of light rays passing through 3-dimensional (3D) volumetric data, resulting in a photorealistic representation of bodily organs and vasculature. Due to its more realistic representative and intuitive format, it has become part of medical education, especially 3D anatomy teaching, patient education, and communication. It also plays an important role in the diagnostics and treatment planning for complex vascular pathologies, especially malformations. This short report highlights the additional diagnostic and clinical value of this image visualization technique by showing its value in treatment planning in a case of arteriovenous malformation (Figure 1).

Cinematic Rendered Computed Tomography Imaging Enhances 3D Visualization of Upper Extremity Arteriovenous Malformation.

While other specialties embraced robotic technology, vascular surgery was revolutionized by endovascular techniques. The combination of open surgical techniques with endovascular solutions became standard practice; however, it is considered an unexplored frontier in the evolving field of robotic vascular procedures. One of the criticisms against robotics is the difficulty of vascular anastomosis. Hybrid grafts-although now discontinued-were once used for sutureless vascular anastomosis during open reconstructions. This article evaluates the feasibility of a sutureless anastomotic technique by reincarnating the idea of the hybrid vascular graft: a PTFE graft connected to a self-expanding covered stent.

Feasibility of a sutureless anastomotic technique in robot-assisted vascular surgery.

CT image guidance and navigation, although routinely used in complex endovascular procedures, is an unexplored territory in evolving vascular robotic procedures. In robotic surgery, it promises the better localization of vasculature, the optimization of port placement, less inadvertent tissue damage, and increased patient safety during the dissection of retroperitoneal structures. However, unknown tissue displacement resulting from induced pneumoperitoneum and positional changes compared to the preoperative CT scan can pose significant limitations to the reliability of image guidance. We aimed to study the displacement of retroperitoneal organs and vasculature due to factors such as increased intra-abdominal pressure (IAP) due to CO insufflation and patient positioning (PP) using intraoperative CT imaging in a cadaveric model.

Early Concepts in CT Image-Guided Robotic Vascular Surgery: The Displacement of Retroperitoneal Structures During Simulated Procedures in a Cadaveric Model.

Bird-beak configuration after endovascular arch repair refers to a gap between the proximal stent and the lesser curvature of the aortic arch that can potentially lead to life-threatening complications through the formation of a 1A endoleak. This case describes a patient who developed a symptomatic type 1A endoleak due to bird-beaking, years after thoracic endovascular aneurysm repair and a complex supra-aortic debranching. The case was further complicated by a stenosis of the left common carotid artery diagnosed with duplex ultrasound and intraoperative transcranial Doppler exam. Zone 0 thoracic endovascular aneurysm repair was performed with the Gore Thoracic Branch Endograft device with additional retrograde left carotid stenting. We demonstrate the importance and clinical applicability of multimodality imaging during preoperative and intraoperative evaluation, which can help in decision-making, troubleshooting, and to guide the procedure.

Article	Year
Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery\| PubMed ID: 33394040	2021
Corrigendum to 'Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions'. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery\| PubMed ID: 34378028	2021
Analysis of SIRT1 Gene SNPs and Clinical Characteristics in Medication-Related Osteonecrosis of the Jaw. International journal of molecular sciences\| PubMed ID: 38612458	2024
Non-Invasive Tools in Perioperative Stroke Risk Assessment for Asymptomatic Carotid Artery Stenosis with a Focus on the Circle of Willis. Journal of clinical medicine\| PubMed ID: 38731014	2024
The Circle of Willis Status Influences Neurological Complications of Carotid Endarterectomy with Contralateral Carotid Occlusion. Annals of vascular surgery\| PubMed ID: 39009123	2024
Robot-assisted vascular surgery: literature review, clinical applications, and future perspectives. Journal of robotic surgery\| PubMed ID: 39174843	2024
MicroRNA Profiling in Papillary Thyroid Cancer. International journal of molecular sciences\| PubMed ID: 39273308	2024
Robotic right lower lobectomy for a persistent large pulmonary arteriovenous malformation following repeated coil embolization. Journal of vascular surgery cases and innovative techniques\| PubMed ID: 39314857	2024
Cinematic Rendered Computed Tomography Imaging Enhances 3D Visualization of Upper Extremity Arteriovenous Malformation. Methodist DeBakey cardiovascular journal\| PubMed ID: 40060973	2025
Feasibility of a sutureless anastomotic technique in robot-assisted vascular surgery. Journal of vascular surgery cases and innovative techniques\| PubMed ID: 40521381	2025
Early Concepts in CT Image-Guided Robotic Vascular Surgery: The Displacement of Retroperitoneal Structures During Simulated Procedures in a Cadaveric Model. Tomography (Ann Arbor, Mich.)\| PubMed ID: 40560006	2025
Zone-0 Thoracic Branched Endograft Implantation in a Previously Debranched Aorta for Symptomatic Type 1A Endoleak. JACC. Case reports\| PubMed ID: 40780766	2025

Balazs Lengyel

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