American journal of surgery
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To examine early and late toxicities, evaluate cosmetic results, and determine the need for reoperation or additional diagnostic procedures in patients treated with accelerated partial breast irradiation (APBI) delivered by way of an interstitial implant in breast-conserving therapy. ⋯ In selected patients with early-stage breast cancer, APBI with targeted interstitial brachytherapy offers 5-year results comparable with conventional breast-conserving therapy employing whole-breast radiation therapy. Minimal long-term toxicities were noted, most of which demonstrated continued resolution over time. Acceptable acute (7%) and delayed (4%) infection rates were observed. Fat necrosis was identified with increasing frequency with time, but the majority was asymptomatic. Cosmetic results are good to excellent (>90%). Continued follow-up by the surgeon will be required to determine the long-term efficacy of this alternative treatment approach.
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Technological developments in imaging guidance, intraoperative imaging, and microscopy have pushed neurosurgeons to the limits of their dexterity and stamina. The introduction of robotically assisted surgery has provided surgeons with improved ergonomics and enhanced visualization, dexterity, and haptic capabilities. This article provides a historical perspective on neurosurgical robots, including image-guided stereotactic and microsurgery systems. The future of robot-assisted neurosurgery, including the use of surgical simulation tools and methods to evaluate surgeon performance, is discussed.
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This article reviews the current status of totally endoscopic coronary revascularization using telemanipulation systems for robotic assistance. Current challenges in implementing a robotic surgical program are discussed, and application of the technology in both arrested and beating heart procedures is considered.