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Navalesi P, Oddo CM, Chisci G, Frosolini A, Gennaro P, Abbate V, Prattichizzo D, Gabriele G. The Use of Tactile Sensors in Oral and Maxillofacial Surgery: An Overview. Bioengineering (Basel) 2023; 10:765. [PMID: 37508792 PMCID: PMC10376110 DOI: 10.3390/bioengineering10070765] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND This overview aimed to characterize the type, development, and use of haptic technologies for maxillofacial surgical purposes. The work aim is to summarize and evaluate current advantages, drawbacks, and design choices of presented technologies for each field of application in order to address and promote future research as well as to provide a global view of the issue. METHODS Relevant manuscripts were searched electronically through Scopus, MEDLINE/PubMed, and Cochrane Library databases until 1 November 2022. RESULTS After analyzing the available literature, 31 articles regarding tactile sensors and interfaces, sensorized tools, haptic technologies, and integrated platforms in oral and maxillofacial surgery have been included. Moreover, a quality rating is provided for each article following appropriate evaluation metrics. DISCUSSION Many efforts have been made to overcome the technological limits of computed assistant diagnosis, surgery, and teaching. Nonetheless, a research gap is evident between dental/maxillofacial surgery and other specialties such as endovascular, laparoscopic, and microsurgery; especially for what concerns electrical and optical-based sensors for instrumented tools and sensorized tools for contact forces detection. The application of existing technologies is mainly focused on digital simulation purposes, and the integration into Computer Assisted Surgery (CAS) is far from being widely actuated. Virtual reality, increasingly adopted in various fields of surgery (e.g., sino-nasal, traumatology, implantology) showed interesting results and has the potential to revolutionize teaching and learning. A major concern regarding the actual state of the art is the absence of randomized control trials and the prevalence of case reports, retrospective cohorts, and experimental studies. Nonetheless, as the research is fast growing, we can expect to see many developments be incorporated into maxillofacial surgery practice, after adequate evaluation by the scientific community.
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Affiliation(s)
- Pietro Navalesi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
- Department of Information Engineering, Università di Pisa, 56127 Pisa, Italy
| | - Calogero Maria Oddo
- Department of Information Engineering, Università di Pisa, 56127 Pisa, Italy
- Department of Excellence in Robotics & A.I., Scuola Superiore Sant'Anna, 56127 Pisa, Italy
- Interdisciplinary Research Center Health Science, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Glauco Chisci
- Department of Medical Biotechnologies, School of Oral Surgery, University of Siena, 53100 Siena, Italy
| | - Andrea Frosolini
- Maxillofacial Surgery Unit, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Paolo Gennaro
- Maxillofacial Surgery Unit, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Vincenzo Abbate
- Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science, Federico II University of Naples, 80013 Naples, Italy
| | - Domenico Prattichizzo
- Department of Information Engineering and Mathematics, University of Siena, 53100 Siena, Italy
| | - Guido Gabriele
- Maxillofacial Surgery Unit, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
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Zhang Z, Zhao Z, Han W, Kim BS, Yan Y, Chen X, Lin L, Shen W, Chai G. Accuracy and safety of robotic navigation-assisted distraction osteogenesis for hemifacial microsomia. Front Pediatr 2023; 11:1158078. [PMID: 37228439 PMCID: PMC10203510 DOI: 10.3389/fped.2023.1158078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/19/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction This study aimed to verify the accuracy and safety of distraction osteogenesis for hemifacial microsomia assisted by a robotic navigation system based on artificial intelligence. Methods The small sample early-phase single-arm clinical study, available at http://www.chictr.org.cn/index.aspx, included children aged three years and older diagnosed with unilateral hemifacial microsomia (Pruzansky-Kaban type II). A preoperative design was performed, and an intelligent robotic navigation system assisted in the intraoperative osteotomy. The primary outcome was the accuracy of distraction osteogenesis, including the positional and angular errors of the osteotomy plane and the distractor, by comparing the preoperative design plan with the actual images one week postoperatively. Perioperative indicators, pain scales, satisfaction scales, and complications at one week were also analyzed. Results Four cases (mean 6.5 years, 3 type IIa and 1 type IIb deformity) were included. According to the craniofacial images one week after surgery, the osteotomy plane positional error was 1.77 ± 0.12 mm, and the angular error was 8.94 ± 4.13°. The positional error of the distractor was 3.67 ± 0.23 mm, and the angular error was 8.13 ± 2.73°. Postoperative patient satisfaction was high, and no adverse events occurred. Discussion The robotic navigation-assisted distraction osteogenesis in hemifacial microsomia is safe, and the operational precision meets clinical requirements. Its clinical application potential is to be further explored and validated.
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Affiliation(s)
- Ziwei Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Zhijie Zhao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wenqing Han
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Byeong Seop Kim
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yingjie Yan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiaojun Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Li Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Weimin Shen
- Department of Burn and Plastic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Chai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Feasibility of a Robot-Assisted Surgical Navigation System for Mandibular Distraction Osteogenesis in Hemifacial Microsomia: A Model Experiment. J Craniofac Surg 2023; 34:525-531. [PMID: 36173942 DOI: 10.1097/scs.0000000000009028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022] Open
Abstract
This study aimed to investigate the feasibility and accuracy of osteotomy and distractor placement using a robotic navigation system in a model surgical experiment of mandibular distraction osteogenesis for hemifacial microsomia. Imaging data from 5 patients with Pruzansky-Kaban type II (IIa: 4; IIb: 1) mandibular deformities were used to print 3D models for simulated mandibular distraction osteogenesis. In the experimental group, a robot-assisted surgical navigation system was used to perform the surgery under robotic guidance following registration, according to the preoperative design. Conventional surgery was performed in the control group, in which the operation was based on intraoperative estimations of the preoperative design by experienced surgeons. The accuracies of the osteotomy and distractor placement were assessed based on distance and angular error. Osteotomy accuracy was higher in the experimental group than in the control group, and the distance error ( t =9.311, P <0.001) and angular error ( t =5.385, P =0.001) were significantly reduced. The accuracy of distractor placement was also significantly higher in the experimental group, while the distance error ( t =3.048, P =0.016) and angular error ( t =3.524, P =0.024) were significantly reduced. The present results highlight the feasibility of robot-assisted distraction osteogenesis combined with electromagnetic navigation for improved surgical precision in clinical settings.
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The Flex Robotic System in Head and Neck Surgery: A Review. Cancers (Basel) 2022; 14:cancers14225541. [PMID: 36428635 PMCID: PMC9688167 DOI: 10.3390/cancers14225541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
The Flex Robotic System is a device intended for robot-assisted visualization and surgical site access to the head and neck. The aim of this review is to summarize the current knowledge about the Flex Robotic System in head and neck transoral robotic surgery (TORS). The primary search was performed using the term "Flex Robot" across several databases (PubMed, Embase, Cochrane, Scopus). Patients were treated for both benign and malignant diseases. The oropharynx was the most frequent site of disease, followed by the supraglottic larynx, hypopharynx, glottic larynx, oral cavity, and salivary glands. Most of the studies did not reveal major intra- or post-operative complications. Bleeding incidence was low (1.4-15.7%). Visualization of the lesion was 95-100%, while surgical success was 91-100%. In conclusion, lesions of the oropharynx, hypopharynx, or larynx can be successfully resected, thus making the Flex Robotic System a safe and effective tool, reducing the morbidity associated with traditional open surgery.
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Mehta A, Cheng Ng J, Andrew Awuah W, Huang H, Kalmanovich J, Agrawal A, Abdul-Rahman T, Hasan MM, Sikora V, Isik A. Embracing robotic surgery in low- and middle-income countries: Potential benefits, challenges, and scope in the future. Ann Med Surg (Lond) 2022; 84:104803. [PMID: 36582867 PMCID: PMC9793116 DOI: 10.1016/j.amsu.2022.104803] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/23/2022] [Indexed: 11/25/2022] Open
Abstract
Robotic surgery has applications in many medical specialties, including urology, general surgery, and surgical oncology. In the context of a widespread resource and personnel shortage in Low- and Middle-Income Countries (LMICs), the use of robotics in surgery may help to reduce physician burnout, surgical site infections, and hospital stays. However, a lack of haptic feedback and potential socioeconomic factors such as high implementation costs and a lack of trained personnel may limit its accessibility and application. Specific improvements focused on improved financial and technical support to LMICs can help improve access and have the potential to transform the surgical experience for both surgeons and patients in LMICs. This review focuses on the evolution of robotic surgery, with an emphasis on challenges and recommendations to facilitate wider implementation and improved patient outcomes.
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Affiliation(s)
- Aashna Mehta
- University of Debrecen-Faculty of Medicine, Debrecen, 4032, Hungary
| | - Jyi Cheng Ng
- Faculty of Medicine and Health Sciences, University of Putra Malaysia, Serdang, Malaysia
| | | | - Helen Huang
- Royal College of Surgeons in Ireland, University of Medicine and Health Science, Dublin, Ireland
| | | | - Aniket Agrawal
- Department of Pediatric Surgery, Center for Children, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh,Corresponding author.
| | - Vladyslav Sikora
- Sumy State University and Toufik's World Medical Association, Sumy, Ukraine
| | - Arda Isik
- Istanbul Medeniyet University, Department of General Surgery, Istanbul, Turkey
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6
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Shimizu A, Ito M, Lefor AK. Laparoscopic and Robot-Assisted Hepatic Surgery: An Historical Review. J Clin Med 2022; 11:jcm11123254. [PMID: 35743324 PMCID: PMC9225080 DOI: 10.3390/jcm11123254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/28/2022] [Accepted: 06/05/2022] [Indexed: 12/07/2022] Open
Abstract
Hepatic surgery is a rapidly expanding component of abdominal surgery and is performed for a wide range of indications. The introduction of laparoscopic cholecystectomy in 1987 was a major change in abdominal surgery. Laparoscopic surgery was widely and rapidly adopted throughout the world for cholecystectomy initially and then applied to a variety of other procedures. Laparoscopic surgery became regularly applied to hepatic surgery, including segmental and major resections as well as organ donation. Many operations progressed from open surgery to laparoscopy to robot-assisted surgery, including colon resection, pancreatectomy, splenectomy thyroidectomy, adrenalectomy, prostatectomy, gastrectomy, and others. It is difficult to prove a data-based benefit using robot-assisted surgery, although laparoscopic and robot-assisted surgery of the liver are not inferior regarding major outcomes. When laparoscopic surgery initially became popular, many had concerns about its use to treat malignancies. Robot-assisted surgery is being used to treat a variety of benign and malignant conditions, and studies have shown no deterioration in outcomes. Robot-assisted surgery for the treatment of malignancies has become accepted and is now being used at more centers. The outcomes after robot-assisted surgery depend on its use at specialized centers, the surgeon's personal experience backed up by extensive training and maintenance of international registries. Robot-assisted hepatic surgery has been shown to be associated with slightly less intraoperative blood loss and shorter hospital lengths of stay compared to open surgery. Oncologic outcomes have been maintained, and some studies show higher rates of R0 resections. Patients who need surgery for liver lesions should identify a surgeon they trust and should not be concerned with the specific operative approach used. The growth of robot-assisted surgery of the liver has occurred in a stepwise approach which is very different from the frenzy that was seen with the introduction of laparoscopic cholecystectomy. This approach allowed the identification of areas for improvement, many of which are at the nexus of engineering and medicine. Further improvements in robot-assisted surgery depend on the combined efforts of engineers and surgeons.
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Riepl R, Greve J, Schild LR, Böhm F, Goldberg-Bockhorn E, Hoffmann TK, Schuler PJ. Application of a new computer-assisted robotic visualization system in cochlear implantation-Proof of concept. Int J Med Robot 2021; 17:e2301. [PMID: 34111318 DOI: 10.1002/rcs.2301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Over the last decades conventional cochlear implant (CI) surgery has remained essentially unchanged. Nevertheless, alternative implantation techniques to further improve patient outcomes such as endaural implantation or robot-assisted surgery have been proposed in recent years. However, none of these have gained acceptance in clinical routine, thus confirming a demand for new developments. METHODS Cochlear implant surgery was performed in two mastoid bones obtained from body donors using a novel hands-free exoscope. Advantages and disadvantages of the system were evaluated. RESULTS In all cases, implantation of the electrode was feasible. The system allowed for hands-free movement and adjustment of the exoscope by the head-mounted display. Network connectivity of the system leaves room for improvement. CONCLUSION The RoboticScope is an innovative tool and can be used supportively in conventional CI surgery in the experimental setting. Although operating the device requires a certain learning curve, the usability is intuitive for every ear surgeon.
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Affiliation(s)
- Ricarda Riepl
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Leon R Schild
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Felix Böhm
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Eva Goldberg-Bockhorn
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Patrick J Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
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8
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D'Andréa G, Vairel B, Vandersteen C, Chabrillac E, Vergez S, Bonnecaze GD. Is Transoral Robotic Surgery the Best Surgical Treatment for Lingual Thyroid?: A Case-Report and Literature Review. Ann Otol Rhinol Laryngol 2021; 131:39-51. [PMID: 33843266 DOI: 10.1177/00034894211007251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To highlight the specific outcomes of the current surgical procedures for lingual thyroid excision, for benign and malignant lesions. METHODS We carried out a systematic review of surgical treatments of lingual thyroid, according to the PRISMA method. We conducted our literature search in PubMed and Ovid. Data was collected concerning patient demographics, tumor characteristics, types of surgery performed, and specific intra- and postoperative outcomes of each procedure. Surgical procedures were classified in 4 categories: transcervical approaches, "invasive" transoral approaches (transmandibular and/or tongue splitting), "non-invasive" transoral approaches, and transoral robotic surgery. We detailed the transoral robotic surgical technique through a case report, along with a surgical video. RESULTS Of 373 peer-reviewed articles found, 40 provided adequate information on surgical management and outcomes for patients with lingual thyroid. "Non-invasive" transoral approaches and transoral robotic surgeries required significantly fewer tracheostomies than "invasive" transoral and transcervical approaches (P < .001), while there was no statistical difference in the rate of surgical complications between each procedure. CONCLUSIONS Transoral robotic surgery appears to be a feasible, effective, and fast solution for lingual thyroid excision, with excellent short- and long-term surgical outcomes.
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Affiliation(s)
- Grégoire D'Andréa
- Otorhinolaryngology and Head and Neck Surgery Department, Institut Universitaire de la Face et du Cou, CHU de Nice, University Hospital, Côte d'Azur University, Nice, Provence-Alpes-Côte d'Azu, France
| | - Benjamin Vairel
- Otorhinolaryngology and Head and Neck Surgery Department, Toulouse University Hospital, Hôpital Larrey, Toulouse, France.,Otorhinolaryngology and Head and Neck Surgery Department, University Cancer Institute of Toulouse-Oncopole, Toulouse, France
| | - Clair Vandersteen
- Otorhinolaryngology and Head and Neck Surgery Department, Institut Universitaire de la Face et du Cou, CHU de Nice, University Hospital, Côte d'Azur University, Nice, Provence-Alpes-Côte d'Azu, France
| | - Emilien Chabrillac
- Otorhinolaryngology and Head and Neck Surgery Department, Toulouse University Hospital, Hôpital Larrey, Toulouse, France.,Otorhinolaryngology and Head and Neck Surgery Department, University Cancer Institute of Toulouse-Oncopole, Toulouse, France
| | - Sébastien Vergez
- Otorhinolaryngology and Head and Neck Surgery Department, Toulouse University Hospital, Hôpital Larrey, Toulouse, France.,Otorhinolaryngology and Head and Neck Surgery Department, University Cancer Institute of Toulouse-Oncopole, Toulouse, France
| | - Guillaume De Bonnecaze
- Otorhinolaryngology and Head and Neck Surgery Department, Toulouse University Hospital, Hôpital Larrey, Toulouse, France
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Abstract
Transoral robotic surgery (TORS) is a rapidly growing diagnostic and therapeutic modality in otolaryngology-head and neck surgery, having already made a large impact in the short time since its inception. Cost-effectiveness analysis is complex, and a thorough cost-effectiveness inquiry should analyze not only financial consequences but also impact on the health state of the patient. The cost-effectiveness of TORS is still under scrutiny, but the early data suggest that TORS is a cost-effective method compared with other available options when used in appropriately selected patients.
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Affiliation(s)
- James Kenneth Byrd
- Otolaryngology - Head and Neck Surgery, Medical College of Georgia, Augusta University, 1120 15th Street BP 4132, Augusta, GA, USA.
| | - Rebecca Paquin
- Otolaryngology - Head and Neck Surgery, Medical College of Georgia, Augusta University, 1120 15th Street BP 4132, Augusta, GA, USA
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Kundrat D, Graesslin R, Schoob A, Friedrich DT, Scheithauer MO, Hoffmann TK, Ortmaier T, Kahrs LA, Schuler PJ. Preclinical Performance Evaluation of a Robotic Endoscope for Non-Contact Laser Surgery. Ann Biomed Eng 2020; 49:585-600. [PMID: 32785862 PMCID: PMC7851027 DOI: 10.1007/s10439-020-02577-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022]
Abstract
Despite great efforts, transoral robotic laser surgery has not been established clinically. Patient benefits are yet to be proven to accept shortcomings of robotic systems. In particular, laryngeal reachability and transition from microscope to accurate endoscopic laser ablation have not been achieved. We have addressed those challenges with a highly integrated robotic endoscope for non-contact endolaryngeal laser surgery. The current performance status has been assessed in multi-level user studies. In addition, the system was deployed to an ex vivo porcine larynx. The robotic design comprises an extensible continuum manipulator with multifunctional tip. The latter features laser optics, stereo vision, and illumination. Vision-based performance assessment is derived from depth estimation and scene tracking. Novices and experts (n = 20) conducted teleoperated delineation tasks to mimic laser ablation of delicate anatomy. Delineation with motion-compensated and raw endoscopic visualisation was carried out on planar and non-planar nominal patterns. Root mean square tracing errors of less than 0.75 mm were feasible with task completion times below 45 s. Relevant anatomy in the porcine larynx was exposed successfully. Accuracy and usability of the integrated platform bear potential for dexterous laser manipulation in clinical settings. Cadaver and in vivo animal studies may translate ex vivo findings.
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Affiliation(s)
- D. Kundrat
- Leibniz Universität Hannover, Institute of Mechatronic Systems, Appelstraße 11a, 30167 Hannover, Germany
- Hamlyn Centre for Robotic Surgery, Imperial College London, London, SW7 2AZ UK
| | - R. Graesslin
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075 Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - A. Schoob
- Leibniz Universität Hannover, Institute of Mechatronic Systems, Appelstraße 11a, 30167 Hannover, Germany
| | - D. T. Friedrich
- Department of Otorhinolaryngology, Head and Neck Surgery, Augsburg University Medical Center, Stenglinstr. 2, 86156 Augsburg, Germany
| | - M. O. Scheithauer
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075 Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - T. K. Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075 Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - T. Ortmaier
- Leibniz Universität Hannover, Institute of Mechatronic Systems, Appelstraße 11a, 30167 Hannover, Germany
| | - L. A. Kahrs
- Leibniz Universität Hannover, Institute of Mechatronic Systems, Appelstraße 11a, 30167 Hannover, Germany
- Department of Mathematical and Computational Sciences, University of Toronto Mississauga, Mississauga, ON L5L 1C6 Canada
| | - P. J. Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075 Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
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11
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Abstract
With the development of computer-assisted surgery, preoperational design is detailed in software. However, it is still a challenge for surgeons to realize the surgical plan in the craniofacial surgery. Robot-assisted surgery has advantages of high accuracy and stability. It is suitable for the high-stress procedures like drilling, milling, and cutting. This study aims to verify the feasibility for automatic drilling without soft tissues in model test based on an industrial robot platform.This study chose the data from digital laboratory in Shanghai 9th People's Hospital. The mandibular was reconstructed in software and surgical plan was also designed. Then, the coordinate data was input to the robot's software and matrix conversion was calculated by 4 marked points. The trajectory generation was calculated by inverse kinematics for target coordinates and robot coordinates. The model was fixed and calibrated for automatic drilling. At last, the accuracy was calculated by optic scanning instrument.The installment and preparation cost 10 minutes, the drilling procedure cost 12 minutes. The outside position error was (1.71 ± 0.16) mm, the inside position error was (1.37 ± 0.28) mm, the orientation error was (3.04 ± 1.02)°. Additionally, a total of 5 beagles were tested, with an accuracy error of (2.78 ± 1.52) mm. No postoperative complications occurred.This is the first study reported for robot-assisted automatic surgery in craniofacial surgery. The result shows it is possible to realize the automatic drilling procedure under the condition of no interference like soft tissues. With the development of artificial intelligence and machine vision, robot-assisted surgery may help surgeons to fulfill more automatic procedures for craniofacial surgery.
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12
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Zhao M, Vrielink TJCO, Kogkas AA, Runciman MS, Elson DS, Mylonas GP. LaryngoTORS: A Novel Cable-Driven Parallel Robotic System for Transoral Laser Phonosurgery. IEEE Robot Autom Lett 2020. [DOI: 10.1109/lra.2020.2969186] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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13
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Mattheis S, Schlüter A, Stähr K, Holtmann L, Höing B, Hussain T, Kanaan O, Eckstein A, Lang S. First Use of a New Robotic Endoscope Guiding System in Endoscopic Orbital Decompression. EAR, NOSE & THROAT JOURNAL 2019; 100:443S-448S. [PMID: 31690110 DOI: 10.1177/0145561319885803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Over the last years, robot-assisted surgery gained in importance in head and neck surgery. In our study, we used a new robotic endoscope guiding system in patients undergoing endoscopic balanced orbital decompression. The aim of the study is to evaluate the feasibility and benefit of a robotic arm in endoscopic orbital surgery. METHODS The Medineering Robotic Endoscope Guiding System is a robotic arm designed for holding an endoscope during interventions. An endoscope equipped with a 4K camera was attached at the tip of the robotic arm and placed in the surgical field. The surgeon controlled the movements of the endoscope with foot pedal. Eight patients underwent balanced endoscopic orbital decompression showing typical symptoms of Graves' orbitopathy preoperatively. Balanced decompression was performed via a combined approach transnasally and laterally via a small skin incision. RESULTS Attaching the endoscope to the robotic guiding system and placing it in the nasal cavity were relatively simple procedures. Setup time was less than 10 minutes. Tool motion and control using the foot pedal were comfortable and adequately precise. Movements of the attached endoscope inside the nose were feasible and allowed 2-hand surgery. The patients did not show any adverse events or complications. CONCLUSION The Medineering Robotic Endoscope Guiding System seems to be a safe and effective support in endoscopic skull base surgery especially for orbital decompression, thus allowing 2-hand or even 4-hand settings. To the best of our knowledge, this is the first study describing the successful application of a robotic system in orbital surgery.
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Affiliation(s)
- Stefan Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Anke Schlüter
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Kerstin Stähr
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Laura Holtmann
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Timon Hussain
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Oliver Kanaan
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Anja Eckstein
- Department of Ophthalmology, 39081University of Duisburg-Essen, Duisburg, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, 39081University of Duisburg-Essen, Duisburg, Germany
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Kundrat D, Schoob A, Piskon T, Grasslin R, Schuler PJ, Hoffmann TK, Kahrs LA, Ortmaier T. Toward Assistive Technologies for Focus Adjustment in Teleoperated Robotic Non-Contact Laser Surgery. ACTA ACUST UNITED AC 2019. [DOI: 10.1109/tmrb.2019.2931438] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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15
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Chang TH, Tian Y, Li C, Gu X, Li K, Yang H, Sanghani P, Lim CM, Ren H, Chen PY. Stretchable Graphene Pressure Sensors with Shar-Pei-like Hierarchical Wrinkles for Collision-Aware Surgical Robotics. ACS APPLIED MATERIALS & INTERFACES 2019; 11:10226-10236. [PMID: 30779548 DOI: 10.1021/acsami.9b00166] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Stretchable skin-like pressure sensing with minimized and distinguishable strain-induced interference is essential for the development of collision-aware surgical robotics to improve the safety and efficiency of minimally invasive surgery in a confined space. Inspired by the multidimensional wrinkles of Shar-Pei dog's skin for tactile sensing, we developed a stretchable pressure sensor consisting of reduced graphene oxide (rGO) electrodes with biomimetic topographies to improve the robot-tissue collision detections. A facile fabrication route for stretchable rGO electrodes was first demonstrated by harnessing the surface instability during the sequential deformation processes. The wrinkle-crumple rGO electrodes exhibited high stretchability (∼100%) and strain-insensitive resistance profiles [a gauge factor (GF) < 0.05], which were next utilized to fabricate piezoresistive pressure sensors. The rGO pressure sensors were highly stretchable and exhibited high sensitivity under uniaxial strains (1.37, 1.30, and 0.98 kPa-1 at 0, 30, and 50% stretching states, respectively) along with distinguishable and reduced stretching responsiveness (a small GF ∼0.2 under 40% strains). The stretchable pressure sensors were next integrated with two surgical robots for the transoral robotic surgery procedure. During the cadaveric testing, the rGO sensors can detect the robot-tissue contacts under joint stretches in real time to enhance the surgeon's awareness for collision avoidance. The stretchable rGO pressure sensor that is highly sensitive under large strains provides great potential in the fields of wearable sensing and collision-aware humanoid robots to improve the human-machine interactions.
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Affiliation(s)
- Ting-Hsiang Chang
- Department of Chemical and Biomolecular Engineering , National University of Singapore (NUS) , 117585 , Singapore
| | - Yuan Tian
- Department of Chemical and Biomolecular Engineering , National University of Singapore (NUS) , 117585 , Singapore
| | - Changsheng Li
- Department of Biomedical Engineering , National University of Singapore (NUS) , 117583 , Singapore
| | - Xiaoyi Gu
- Department of Biomedical Engineering , National University of Singapore (NUS) , 117583 , Singapore
| | - Kerui Li
- Department of Chemical and Biomolecular Engineering , National University of Singapore (NUS) , 117585 , Singapore
| | - Haitao Yang
- Department of Chemical and Biomolecular Engineering , National University of Singapore (NUS) , 117585 , Singapore
| | - Parita Sanghani
- Department of Biomedical Engineering , National University of Singapore (NUS) , 117583 , Singapore
| | - Chwee Ming Lim
- Department of Otolaryngology-Head and Neck Surgery , National University Hospital (NUH) , 119228 , Singapore
| | - Hongliang Ren
- Department of Biomedical Engineering , National University of Singapore (NUS) , 117583 , Singapore
| | - Po-Yen Chen
- Department of Chemical and Biomolecular Engineering , National University of Singapore (NUS) , 117585 , Singapore
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16
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Lefor AK. Robotic and laparoscopic surgery of the pancreas: an historical review. BMC Biomed Eng 2019; 1:2. [PMID: 32903347 PMCID: PMC7412643 DOI: 10.1186/s42490-019-0001-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
Surgery of the pancreas is a relatively new field, with operative series appearing only in the last 50 years. Surgery of the pancreas is technically challenging. The entire field of general surgery changed radically in 1987 with the introduction of the laparoscopic cholecystectomy. Minimally Invasive surgical techniques rapidly became utilized worldwide for gallbladder surgery and were then adapted to other abdominal operations. These techniques are used regularly for surgery of the pancreas including distal pancreatectomy and pancreatoduodenectomy. The progression from open surgery to laparoscopy to robotic surgery has occurred for many operations including adrenalectomy, thyroidectomy, colon resection, prostatectomy, gastrectomy and others. Data to show a benefit to the patient are scarce for robotic surgery, although both laparoscopic and robotic surgery of the pancreas have been shown not to be inferior with regard to major operative and oncologic outcomes. While there were serious concerns when laparoscopy was first used in patients with malignancies, robotic surgery has been used in many benign and malignant conditions with no obvious deterioration of outcomes. Robotic surgery for malignancies of the pancreas is well accepted and expanding to more centers. The importance of centers of excellence, surgeon experience supported by a codified mastery-based training program and international registries is widely accepted. Robotic pancreatic surgery is associated with slightly decreased blood loss and decreased length of stay compared to open surgery. Major oncologic outcomes appear to have been preserved, with some studies showing higher rates of R0 resection and tumor-free margins. Patients with lesions of the pancreas should find a surgeon they trust and do not need to be concerned with the operative approach used for their resection. The step-wise approach that has characterized the growth in robotic surgery of the pancreas, in contradistinction to the frenzy that accompanied the introduction of laparoscopic cholecystectomy, has allowed the identification of areas for improvement, many of which lie at the junction of engineering and medical practice. Refinements in robotic surgery depend on a partnership between engineers and clinicians.
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Affiliation(s)
- Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi Japan
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17
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Aaltonen IE, Wahlström M. Envisioning robotic surgery: Surgeons' needs and views on interacting with future technologies and interfaces. Int J Med Robot 2018; 14:e1941. [PMID: 29971897 DOI: 10.1002/rcs.1941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/30/2018] [Accepted: 06/11/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The development of technology in robotic surgery is typically presented from a technical perspective. This study considers the user perspective as an input to the development of technology by exploring potential solutions within and beyond the field of robotic surgery. METHODS Advanced technological solution concepts were selected based on a technology review and an ethnographic study. Using a future workshop method, these were rated and discussed by a group of surgeons from three perspectives: enhancing operation outcome, user experience and learning in the operating theatre. RESULTS Diverse technologies were considered to offer potential for supporting the surgeons' work. User experience and learning could be improved especially via solutions novel to robotic surgery. Robotic surgery technologies currently under development were mainly considered to support a good operation outcome. Suitability for practical work was elaborated upon, and related concerns were identified. CONCLUSIONS The results can support development of robotic surgery to enhance surgeons' work.
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Affiliation(s)
- Iina E Aaltonen
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
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18
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Friedrich D, Modes V, Hoffmann T, Greve J, Schuler P, Burgner-Kahrs J. Teleoperated tubular continuum robots for transoral surgery - feasibility in a porcine larynx model. Int J Med Robot 2018; 14:e1928. [DOI: 10.1002/rcs.1928] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 04/16/2018] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Affiliation(s)
- D.T. Friedrich
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Ulm Germany
| | - V. Modes
- Laboratory for Continuum Robotics; Leibniz Universität Hannover; Hanover Germany
| | - T.K. Hoffmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Ulm Germany
| | - J. Greve
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Ulm Germany
| | - P.J. Schuler
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Ulm Germany
| | - J. Burgner-Kahrs
- Laboratory for Continuum Robotics; Leibniz Universität Hannover; Hanover Germany
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19
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Zagzoog N, Yang VXD. State of Robotic Mastoidectomy: Literature Review. World Neurosurg 2018; 116:347-351. [PMID: 29870847 DOI: 10.1016/j.wneu.2018.05.194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
Abstract
Over the past 30 years, the application of robotics in the field of neurotology has grown. Robots are able to perform increasingly complex tasks with ever improving accuracy, allowing them to be used in a broad array of applications. A mastoidectomy, in which a drill is used to remove a portion of the mastoid part of the temporal bone at the base of the skull, is one such application. To determine the current state of neurotologic robotics in the specific context of mastoidectomy, a review of the literature was carried out. This qualitative review explores what has been done in this field to date, as well as what has yet to be done. Although the research suggests that robotics can be and has been successfully used to assist with mastoidectomy, it also suggests the incompleteness of robotic development in the field. At present, only 2 robotic systems have been approved by the U.S. Food and Drug Administration for neurosurgical use and the literature lacks evidence of meaningful clinical testing of new systems to change that. The cost of robotics also remains prohibitive. However, strides have been made, with at least 1 robot for mastoidectomy having reached the point of cadaveric trials. In addition, the research suggests some of the characteristics that should be considered when designing robots for mastoidectomy, such as burr size and the type of forces that should be applied. Overall, the outlook for robots in neurotology, particularly mastoidectomy, is bright but some hurdles still remain to be overcome.
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Affiliation(s)
- Nirmeen Zagzoog
- Institute of Medical Science, School of Graduate Studies, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Biophotonics and Bioengineering Laboratory, Ryerson University, Toronto, Ontario, Canada.
| | - Victor X D Yang
- Institute of Medical Science, School of Graduate Studies, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada; Biophotonics and Bioengineering Laboratory, Ryerson University, Toronto, Ontario, Canada; Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada
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Olivieri E, Barresi G, Caldwell DG, Mattos LS, Olivieri E, Barresi G, Caldwell DG, Mattos LS, Olivieri E, Caldwell DG, Barresi G, Mattos LS. Haptic Feedback for Control and Active Constraints in Contactless Laser Surgery: Concept, Implementation, and Evaluation. IEEE TRANSACTIONS ON HAPTICS 2018; 11:241-254. [PMID: 29911981 DOI: 10.1109/toh.2017.2786243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Haptics has proven to be highly beneficial in surgical robotics, bringing enhanced safety and precision by complementing the surgeon's visual channel. However, most of the research body in this context is dedicated to applications involving traditional "cold steel" surgical instruments. This paper proposes to bring the benefits of haptics to contactless surgeries, and presents a novel method to achieve this. The specific case of robot-assisted laser microsurgery is investigated. Here, a fictitious force feedback is created through stereoscopic visualization and 3D reconstruction, allowing the surgeon to sense the surgical area haptically while controlling a non-contact surgical laser. This is shown to significantly improve system usability and the accuracy of laser incisions, especially in applications involving several passes of the laser over the same incision line. Validation of the system is performed through two series of experiments involving both naive users and expert surgeons. The obtained results demonstrate that haptics can indeed be introduced in contactless laser surgery, allowing the exploitation of active constraints and guidance techniques that significantly enhance laser control accuracy both in static and dynamic environments. Furthermore, the proposed haptic technology shows good acceptance and high usability, indicating it has great potential to positively impact real surgeries.
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21
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Carey RM, Hodnett BL, Rassekh CH, Weinstein GS. Transoral Robotic Surgery with Sialendoscopy for a Plunging Ranula. ORL J Otorhinolaryngol Relat Spec 2017; 79:306-313. [DOI: 10.1159/000481536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/11/2017] [Indexed: 01/28/2023]
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22
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Alessandrini M, Pavone I, Micarelli A, Caporale C. Transoral robotic surgery for the base of tongue squamous cell carcinoma: a preliminary comparison between da Vinci Xi and Si. J Robot Surg 2017; 12:417-423. [PMID: 28905287 DOI: 10.1007/s11701-017-0750-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 09/05/2017] [Indexed: 11/26/2022]
Abstract
Considering the emerging advantages related to da Vinci Xi robotic platform, the aim of this study is to compare for the first time the operative outcomes of this tool to the previous da Vinci Si during transoral robotic surgery (TORS), both performed for squamous cell carcinomas (SCC) of the base of tongue (BOT). Intra- and peri-operative outcomes of eight patients with early stage (T1-T2) of the BOT carcinoma and undergoing TORS by means of the da Vinci Xi robotic platform (Xi-TORS) are compared with the da Vinci Si group ones (Si-TORS). With respect to Si-TORS group, Xi-TORS group demonstrated a significantly shorter overall operative time, console time, and intraoperative blood loss, as well as peri-operative pain intensity and length of mean hospital stays and nasogastric tube positioning. Considering recent advantages offered by surgical robotic techniques, the da Vinci Xi Surgical System preliminary outcomes could suggest its possible future routine implementation in BOT squamous cell carcinoma procedures.
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Affiliation(s)
| | - Isabella Pavone
- Otolaryngology Unit, University of Rome Tor Vergata, Rome, Italy.
- Otolaryngology and Head and Neck Surgery Unit, "Santo Spirito" Hospital of Pescara, Renato Paolini 47, Pescara, Italy.
| | | | - Claudio Caporale
- Otolaryngology and Head and Neck Surgery Unit, "Santo Spirito" Hospital of Pescara, Renato Paolini 47, Pescara, Italy
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Akst LM, Olds KC, Balicki M, Chalasani P, Taylor RH. Robotic microlaryngeal phonosurgery: Testing of a "steady-hand" microsurgery platform. Laryngoscope 2017; 128:126-132. [PMID: 28498632 DOI: 10.1002/lary.26621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate gains in microlaryngeal precision achieved by using a novel robotic "steady hand" microsurgery platform in performing simulated phonosurgical tasks. STUDY DESIGN Crossover comparative study of surgical performance and descriptive analysis of surgeon feedback. METHODS A novel robotic ear, nose, and throat microsurgery system (REMS) was tested in simulated phonosurgery. Participants navigated a 0.4-mm-wide microlaryngeal needle through spirals of varying widths, both with and without robotic assistance. Fail time (time the needle contacted spiral edges) was measured, and statistical comparison was performed. Participants were surveyed to provide subjective feedback on the REMS. RESULTS Nine participants performed the task at three spiral widths, yielding 27 paired testing conditions. In 24 of 27 conditions, robot-assisted performance was better than unassisted; five trials were errorless, all achieved with the robot. Paired analysis of all conditions revealed fail time of 0.769 ± 0.568 seconds manually, improving to 0.284 ± 0.584 seconds with the robot (P = .003). Analysis of individual spiral sizes showed statistically better performance with the REMS at spiral widths of 2 mm (0.156 ± 0.226 seconds vs. 0.549 ± 0.545 seconds, P = .019) and 1.5 mm (0.075 ± 0.099 seconds vs. 0.890 ± 0.518 seconds, P = .002). At 1.2 mm, all nine participants together showed similar performance with and without robotic assistance (0.621 ± 0.923 seconds vs. 0.868 ± 0.634 seconds, P = .52), though subgroup analysis of five surgeons most familiar with microlaryngoscopy showed statistically better performance with the robot (0.204 ± 0.164 seconds vs. 0.664 ± 0.354 seconds, P = .036). CONCLUSIONS The REMS is a novel platform with potential applications in microlaryngeal phonosurgery. Further feasibility studies and preclinical testing should be pursued as a bridge to eventual clinical use. LEVEL OF EVIDENCE NA. Laryngoscope, 128:126-132, 2018.
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Affiliation(s)
- Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Kevin C Olds
- Department of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
- Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Marcin Balicki
- Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Preetham Chalasani
- Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Russell H Taylor
- Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, U.S.A
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Features of haptic and tactile feedback in TORS-a comparison of available surgical systems. J Robot Surg 2017; 12:103-108. [DOI: 10.1007/s11701-017-0702-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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25
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Friedrich DT, Scheithauer MO, Greve J, Rotter N, Doescher J, Hoffmann TK, Schuler PJ. Application of a computer-assisted flexible endoscope system for transoral surgery of the hypopharynx and upper esophagus. Eur Arch Otorhinolaryngol 2017; 274:2287-2293. [DOI: 10.1007/s00405-017-4498-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/04/2017] [Indexed: 12/21/2022]
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