By Colm Gorey, Science Communications Manager

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From robotic surgeons to ultra-detailed imaging technology, the field of surgery is going through rapid change. To help us understand what the latest research is in this world of dissection, Frontiers highlights just some of the top articles we’ve recently published.  

The robot takeover of the workforce is nowhere more apparent than in the medical world, where many delicate surgical procedures are either aided by a robotic assistant, or in some cases performed entirely by a machine.

But advances in surgery are not just limited to robotics, with new imaging technologies helping us peer inside the human body like never before.

Here are five recent Frontiers articles published as part of the research topic ‘Anatomical Fundamentals of Advanced Surgical Techniques’ that may greatly influence even more breakthroughs in the future.

Robotic pelvic exenteration for gynecologic malignancies, anatomic landmarks, and surgical steps: a systematic review

Pelvic exenteration – a surgical operation to remove multiple organs in the pelvis – represents the last resort procedure for patients with advanced primary or recurrent gynecological malignancy, such as endometrial cancer. However, since 2009, the advent of robotic surgery resulted in a new spur to the worldwide spread of minimally invasive pelvic exenteration.

In a review article published to Frontiers in Surgery, researchers in Italy said the growing application of the minimally invasive surgical approach, particularly in urologic and oncological colorectal surgery, unlocked new perspectives for gynecologic oncology surgery.

Looking at 13 articles, they showed anterior exenteration was pursued in 42 patients (79.2%), two patients underwent posterior exenteration (3.8%), while nine patients (17%) were subjected to total exenteration. The most common urinary reconstruction was non-continent urinary diversion (90.2%). Among the 11 women who underwent to total or posterior exenteration, eight (72.7%) received a terminal colostomy.

They stated that an important step forward should be to investigate the potential equivalence between robotic approaches and the laparotomic one, in terms of long-term oncological outcomes.

Article link: https://www.frontiersin.org/articles/10.3389/fsurg.2021.790152/full

Lymph node dissection during radical nephro-ureterectomy for upper tract urothelial carcinoma: a review

Although lymphonodal dissection is well-accepted for muscle-invasive bladder cancer management, its role is still debated during radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).

The aim of a study published to Frontiers in Surgery was to summarize the current knowledge concerning the indication, anatomical template, prognostic, and therapeutic roles of lymph node dissection performed at the time of RNU.

Quality control markers, such as the number of lymph nodes (LN) removed, lymph node density, and safety of the different surgical approaches, were assessed. The authors performed a narrative review using the PubMed and ClinicalTrials.gov databases to identify and analyze articles based on the practice and the role of lymph node dissection for non-metastatic UTUC. 

They surmised that an extended lymphadenectomy may provide therapeutic advantages as a higher number of nodes removed may be related to the removal of undetected LNs micrometastases and a subsequent improvement in recurrence rate and cancer-specific survival. Therefore, clear anatomical templates are needed based on the location and the laterality of the primary tumor.

Article link: https://www.frontiersin.org/articles/10.3389/fsurg.2022.852969/full

Application research of 3D printing technology and 3D computed tomography in segmentectomy

With the widespread application of low-dose computed tomography (CT) in physical examinations, more and more cases with early non-small cell lung cancer (NSCLC) have been reported. At present, the standard surgical treatment for early NSCLC is lobectomy plus lymph node dissection.

However, a randomized controlled trial involving 1,106 people showed that except for more air leakage in the segmentectomy group, there are no differences in intraoperative and postoperative complications and any other postoperative indicators between the segmentectomy group and lobectomy group which is why more and more hospitals choose segmentectomy for patients with early NSCLC.

Now, researchers in China have published a paper to Frontiers in Surgery with the aim of comparing the application of the emerging 3D printing technology and 3D-CT in segmentectomy and explore the advantages of 3D printing technology in thoracoscopic segmentectomy.

After collecting the clinical data of 118 patients undergoing thoracoscopic segmentectomy – of which 61 patients were in the 3D printing group and 57 patients were in the 3D-CT group – they found that 3D printing technology shortens the operation time, reduces intraoperative fluid input and output, guides the operation more safely and effectively, and has better clinical application value.

Article link: https://www.frontiersin.org/articles/10.3389/fsurg.2022.881076/full

Anatomical fundamentals and current surgical knowledge of prostate anatomy related to functional and oncological outcomes for robotic-assisted radical prostatectomy

Several decades ago, landmark anatomical studies set the foundations for the current knowledge of the periprostatic anatomy. Since then, several minor and major modifications have been proposed and established, aiming to improve the oncological and functional outcomes of patients who underwent radical prostatectomy.

With the advent of robotic-assisted surgery, a more detailed understanding of the prostate anatomy and its surrounding tissue has been achieved owing to the technical magnification and precise robotic instruments.

In a study published to Frontiers in Surgery, an international team of researchers searched the PubMed database for terms including ‘robotic-assisted radical prostatectomy’ and ‘erectile dysfunction’ highlight currently available literature regarding prostate anatomy and to help in improving oncological and functional outcomes in robotic-assisted laparoscopic radical prostatectomy (RALP).

They found several notable changes and improvements have been recorded in the last two decades during the advent and establishment of RALP. Among those, a better understanding of the interplay of the periprostatic anatomy and its influence on continence and erectile function have been achieved in the last two decades.

Article link: https://www.frontiersin.org/articles/10.3389/fsurg.2021.825183/full

Endografts for the treatment of abdominal aortic aneurysms with a hostile neck anatomy: A systematic review

Since endovascular aortic repair (EVAR) was first pioneered more than 30 years ago, it emerged as a less invasive alternative to conventional open surgery for the treatment of infrarenal abdominal aortic aneurysm.

In fact, the authors of a review paper published to Frontiers in Surgery have said that the application rate of EVAR and its clinical results have improved thanks to the evolution of stent-grafts and endovascular delivery systems.

Engineering developments in endovascular materials, along with the acquisition of improved technical skills by vascular surgeons and radiologists, have made EVAR results in patients with appropriate anatomy comparable to those of conventional open surgical repair

Looking at 640 records describing Alto, Ovation iX, Treovance, Aorfix, Anaconda, Conformable, and Endurant II/IIs endografts, the authors analyzed the results of these different devices when used for different scenarios. They concluded that is a lack of comparative studies for newer endografts and postmarket clinical studies with long-term results concerning the most recently approved devices described, Alto and Conformable.

Article link: https://www.frontiersin.org/articles/10.3389/ fsurg.2022.872705/full

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