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Ayoub CH, El-Asmar JM, Abdulfattah S, El-Hajj A. Telemedicine and Telementoring in Urology: A Glimpse of the Past and a Leap Into the Future. Front Surg 2022; 9:811749. [PMID: 35273996 PMCID: PMC8901873 DOI: 10.3389/fsurg.2022.811749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/31/2022] [Indexed: 12/12/2022] Open
Abstract
Telemedicine is the process of utilizing telecommunications and digital relay to perform, teach, or share medical knowledge. The digital era eased the incorporation of telemedicine to different areas of medical care, including the surgical care of Urologic patient mainly through telementoring, telesurgery, and telerobotics. Over the years, Telemedicine has played an integral part in a physicians' ability to provide high quality medical care to remote patients, as well as serve as an educational tool for trainee physicians, in the form of telementoring. During the COVID-19 pandemic, telemedicine has played a vital role in combatting the health implications of confinements. Challenges of telemedicine implementation include cost, ethical considerations, security, bandwidth, latency, legal, and licensure difficulties. Nevertheless, the future of telemedicine, specifically telementoring, promises several improvements and innovative advancements that aim to bridge the gap in technological divides of urologic care. In this review, we build on what is already known about telemedicine focusing specifically on aspects related to telementoring, telestration, and telesurgery. Furthermore, we discuss its historical role in healthcare with a special emphasis on current and future use in urology.
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Affiliation(s)
- Christian Habib Ayoub
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jose M. El-Asmar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Suhaib Abdulfattah
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Albert El-Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
- *Correspondence: Albert El-Hajj
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Angotti R, Raffaele A, Molinaro F, Riccipetitoni G, Chiesa PL, Lisi G, Mattioli G, Alberti D, Boroni G, Mariscoli F, Martino A, Pelizzo G, Maffi M, Messina M, Lima M. Rise of pediatric robotic surgery in Italy: a multicenter observational retrospective study. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-021-00144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The minimally invasive surgery (MIS) in term of robot-assisted surgery changed in a dramatic way the surgical approach either in adults or children. For many specialties (urology, gynecology, general surgery) robotic surgery rapidly became the gold standard for some procedures, while the experience in pediatric population is not wide for some reasons. The aim of this study is to retrospective analyze trends of application of robotic surgery in pediatric patients across the country, focusing on indications, limitations, development, and training acquired by national experience and in comparison to the literature.
Methods
We made a retrospective multicenter study on behalf of Italian Society of Pediatric Surgery. We performed a census among all pediatric surgery units in the country to enroll those performing robotic surgery on children between 2013 and 2019.
Results
We enrolled 7 pediatric surgery referral Centers (Ancona, Bologna, Brescia, Genova, Pavia, Pescara, Siena). A total of 303 patients were included in the study, 164 males (54%) and 139 females (46%). The most commonly performed interventions for each anatomic area were respectively atypical pulmonary resection (38%), pyeloplasty (49%), and fundoplication (30%).
Conclusions
Since its first application in Italy, about 10 years ago, several considerations were made about application and feasibility of robotics in children.
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Bertolo R, Hung A, Porpiglia F, Bove P, Schleicher M, Dasgupta P. Systematic review of augmented reality in urological interventions: the evidences of an impact on surgical outcomes are yet to come. World J Urol 2019; 38:2167-2176. [PMID: 30826888 DOI: 10.1007/s00345-019-02711-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/26/2019] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To perform a systematic literature review on the clinical impact of augmented reality (AR) for urological interventions. METHODS As of June 21, 2018, systematic literature review was performed via Medline, Embase and Cochrane databases in accordance with the PRISMA guidelines and registered at PROSPERO (CRD42018102194). Only full text articles in English were included, without time restrictions. Articles were considered if they reported on the use of AR during urological intervention and the impact on the surgical outcomes. The risk of bias and the quality of each study included were independently assessed using the standard Cochrane Collaboration risk of bias tool and the Risk Of Bias In Non-randomised Studies-of Interventions Tool (ROBINS-I). RESULTS 131 articles were identified. 102 remained after duplicate removal and were critically reviewed for evidence synthesis. 20 studies reporting on the outcomes of the use of AR during urological interventions in a clinical setting were considered. Given the mostly non-comparative design of the studies identified, the evidence synthesis was performed in a descriptive and narrative manner. Only one comparative study was found, with the remaining 19 items being single-arm observational studies. Based on the existing evidence, we are unable to state that AR improves the outcomes of urological interventions. The major limitation of AR-assisted surgery is inaccuracy in registration, translating into a poor navigation precision. CONCLUSIONS To date, there is limited evidence showing superior therapeutic benefits of AR-guided surgery when compared with the conventional surgical approach to the respective disease.
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Affiliation(s)
- Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, 2050 E 96th St, Q Building, Cleveland, OH, 44195, USA. .,Urology Department, "San Carlo di Nancy" Hospital, Rome, Italy.
| | - Andrew Hung
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Pierluigi Bove
- Urology Department, "San Carlo di Nancy" Hospital, Rome, Italy
| | - Mary Schleicher
- Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, OH, USA
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Abstract
SUMMARYThis paper introduces a novel kinematic of a four degrees of freedom (DoFs) device based on Delta architecture. This new device is expected to be used as a haptic device for tele-operation applications. The challenging task was to obtain orientation DoFs from the Delta structure. A fourth leg is added to the Delta structure to convert translations into rotations and to provide translation of the handle. The fourth leg is linked to the base and to the moving platform by two universal joints. The architecture as well as the kinematic model of the new structure, called 4haptic, are presented. Comparisons in terms of kinematic behavior between the 4haptic device and the existing device developed based on spherical parallel manipulator architecture are presented. The results prove the improved behavior of the 4haptic device offering a singularity-free useful workspace, which makes it a suitable candidate to tele-operated system for Minimally Invasive Surgery. The dimensions of the 4haptic device, having the smallest workspace containing a prespecified region in space, are identified based on an optimal dimensional synthesis method.
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Edwards TL, Xue K, Meenink HCM, Beelen MJ, Naus GJL, Simunovic MP, Latasiewicz M, Farmery AD, de Smet MD, MacLaren RE. First-in-human study of the safety and viability of intraocular robotic surgery. Nat Biomed Eng 2018; 2:649-656. [PMID: 30263872 DOI: 10.1038/s41551-018-0248-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Microsurgery of the retina would be dramatically improved by instruments that offer supra-human precision. Here, we report the results of a first-in-human study of remotely controlled robot-assisted retinal surgery performed through a telemanipulation device. Specifically, 12 patients requiring dissection of the epiretinal or inner limiting membrane over the macula were randomly assigned to either undergo robot-assisted-surgery or manual surgery, under general anaesthesia. We evaluated surgical success, duration of surgery and amount of retinal microtrauma as a proxy for safety. Surgical outcomes were equally successful in the robotic-surgery and manual-surgery groups. Differences in the amount of retinal microtrauma between the two groups were statistically insignificant, yet dissection took longer with robotic surgery (median time, 4 min 5 s) than with manual surgery (1 min 20 s). We also show the feasibility of using the robot to inject recombinant tissue plasminogen activator under the retina to displace sight-threatening haemorrhage in three patients under local anaesthesia. A safe and viable robotic system for intraocular surgery would enable precise and minimally traumatic delivery of gene therapy or cell therapy to the retina.
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Affiliation(s)
- T L Edwards
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K Xue
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | | | - M P Simunovic
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Latasiewicz
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A D Farmery
- Nuffield Division of Anaesthetics, University of Oxford, Oxford, UK
| | | | - R E MacLaren
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, UK. .,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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Deshpande SV. Innovation in robotic surgery: the Indian scenario. J Minim Access Surg 2015; 11:106-10. [PMID: 25598610 PMCID: PMC4290110 DOI: 10.4103/0972-9941.147724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/28/2014] [Indexed: 11/17/2022] Open
Abstract
Robotics is the science. In scientific words a “Robot” is an electromechanical arm device with a computer interface, a combination of electrical, mechanical, and computer engineering. It is a mechanical arm that performs tasks in Industries, space exploration, and science. One such idea was to make an automated arm — A robot — In laparoscopy to control the telescope-camera unit electromechanically and then with a computer interface using voice control. It took us 5 long years from 2004 to bring it to the level of obtaining a patent. That was the birth of the Swarup Robotic Arm (SWARM) which is the first and the only Indian contribution in the field of robotics in laparoscopy as a total voice controlled camera holding robotic arm developed without any support by industry or research institutes.
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Affiliation(s)
- Suresh V Deshpande
- Department of Surgery, Swarup Hospital, 154, Dudhali, Kolhapur, Maharashtra, India
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Samavedi S, Abdul-Muhsin H, Pigilam S, Sivaraman A, Patel VR. Handling difficult anastomosis. Tips and tricks in obese patients and narrow pelvis. Indian J Urol 2014; 30:418-22. [PMID: 25378824 PMCID: PMC4220382 DOI: 10.4103/0970-1591.142070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Vesico-urethral anastomosis (VUA) is a technically challenging step in robotic-assisted laparoscopic prostatectomy (RALP) in obese individuals. We describe technical modifications to facilitate VUA encountered in obese individuals and in patients with a narrow pelvis. A Pubmed literature search was performed between 2000 and 2012 to review all articles related to RALP, obesity and VUA for evaluation of technique, complications and outcomes of VUA in obese individuals. In addition to the technical modifications described in the literature, we describe our own experience to encounter the technical challenges induced by obesity and narrow pelvis. In obese patients, technical modifications like use of air seal trocar technology, steep Trendlenburg positioning, bariatric trocars, alterations in trocar placement, barbed suture and use of modified posterior reconstruction facilitate VUA in robotic-assisted radical prostatectomy. The dexterity of the robot and the technical modifications help to perform the VUA in challenging patients with lesser difficulty. The experience of the surgeon is a critical factor in outcomes in these technically challenging patients, and obese individuals are best avoided during the initial phase of the learning curve.
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Affiliation(s)
- Srinivas Samavedi
- Department of Urology, Global Robotic Institute, Celebration Health Florida Hospital, Celebration, FL, USA
| | - Haidar Abdul-Muhsin
- Department of Urology, Global Robotic Institute, Celebration Health Florida Hospital, Celebration, FL, USA
| | - Suneel Pigilam
- Department of Urology, Global Robotic Institute, Celebration Health Florida Hospital, Celebration, FL, USA
| | | | - Vipul R Patel
- Department of Urology, Global Robotic Institute, Celebration Health Florida Hospital, Celebration, FL, USA
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He C, Wang S, Sang H, Li J, Zhang L. Force sensing of multiple-DOF cable-driven instruments for minimally invasive robotic surgery. Int J Med Robot 2013; 10:314-24. [DOI: 10.1002/rcs.1532] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 08/05/2013] [Accepted: 08/08/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Chao He
- Beijing Institute of Spacecraft System Engineering; People's Republic of China
| | - Shuxin Wang
- Key Laboratory for Mechanism Theory and Equipment Design of Ministry of Education; Tianjin University, People's Republic of China
| | - Hongqiang Sang
- Key Laboratory for Mechanism Theory and Equipment Design of Ministry of Education; Tianjin University, People's Republic of China
| | - Jinhua Li
- Key Laboratory for Mechanism Theory and Equipment Design of Ministry of Education; Tianjin University, People's Republic of China
| | - Linan Zhang
- Key Laboratory for Mechanism Theory and Equipment Design of Ministry of Education; Tianjin University, People's Republic of China
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Abstract
• Robotics of the current day have advanced significantly from early computer-aided design/manufacturing systems to modern master-slave robotic systems that replicate the surgeon's exact movements onto robotic instruments in the patient. • Globally >300,000 robotic procedures were completed in 2010, including ≈98,000 robot-assisted radical prostatectomies. • Broadening applications of robotics for urological procedures are being investigated in both adult and paediatric urology. • The use of the current robotic system continues to be further refined. Increasing experience has optimized port placement reducing arm collisions to allow for more expedient surgery. Improved three-dimensional camera magnification provides improved intraoperative identification of structures. • Robotics has probably improved the learning curve of laparoscopic surgery while still maintaining its patient recovery advantages and outcomes. • The future of robotic surgery will take this current platform forward by improving haptic (touch) feedback, improving vision beyond even the magnified eye, improving robot accessibility with a reduction of entry ports and miniaturizing the slave robot. • Here, we focus on the possible advancements that may change the future landscape of robotic surgery.
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Affiliation(s)
- Alexei Wedmid
- Division of Urology, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA 19104, USA
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Gao M, Hu C, Chen Z, Zhang H, Liu S. Design and fabrication of a magnetic propulsion system for self-propelled capsule endoscope. IEEE Trans Biomed Eng 2010; 57:2891-902. [PMID: 20542758 DOI: 10.1109/tbme.2010.2051947] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This paper investigates design, modeling, simulation, and control issues related to self-propelled endoscopic capsule navigated inside the human body through external magnetic fields. A novel magnetic propulsion system is proposed and fabricated, which has great potential of being used in the field of noninvasive gastrointestinal endoscopy. Magnetic-analysis model is established and finite-element simulations as well as orthogonal design are performed for obtaining optimized mechanical and control parameters for generating appropriate external magnetic field. Simulated intestinal tract experiments are conducted, demonstrating controllable movement of the capsule under the developed magnetic propulsion system.
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Affiliation(s)
- Mingyuan Gao
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, China.
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11
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Abstract
SUMMARYSurgical robotics is a growing discipline, continuously expanding with an influx of new ideas and research. However, it is important that the development of new devices take account of past mistakes and successes. A structured approach is necessary, as with proliferation of such research, there is a danger that these lessons will be obscured, resulting in the repetition of mistakes and wasted effort and energy. There are several research paths for surgical robotics, each with different risks and opportunities and different methodologies to reach a profitable outcome. The main emphasis of this paper is on a methodology for ‘applied research’ in surgical robotics. The methodology sets out a hierarchy of criteria consisting of three tiers, with the most important being the bottom tier and the least being the top tier. It is argued that a robotic system must adhere to these criteria in order to achieve acceptability. Recent commercial systems are reviewed against these criteria, and are found to conform up to at least the bottom and intermediate tiers, the most important first two tiers, and thus gain some acceptability. However, the lack of conformity to the criteria in the top tier, and the inability to conclusively prove increased clinical benefit, is shown to be hampering their potential in gaining wide establishment.
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Lum MJH, Friedman DCW, Sankaranarayanan G, King H, Fodero K, Leuschke R, Hannaford B, Rosen J, Sinanan MN. The RAVEN: Design and Validation of a Telesurgery System. Int J Rob Res 2009. [DOI: 10.1177/0278364909101795] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The collaborative effort between fundamental science, engineering and medicine provides physicians with improved tools and techniques for delivering effective health care. Minimally invasive surgery (MIS) techniques have revolutionized the way a number of surgical procedures are performed. Recent advances in surgical robotics are once again revolutionizing MIS interventions and open surgery. In an earlier research endeavor, 30 surgeons performed 7 different MIS tasks using the Blue Dragon system to collect measurements of position, force, and torque on a porcine model. This data served as the foundation for a kinematic optimization of a spherical surgical robotic manipulator. Following the optimization, a seven-degree-of-freedom cable-actuated surgical manipulator was designed and integrated, providing all degrees of freedom present in manual MIS as well as wrist joints located at the surgical end-effector. The RAVEN surgical robot system has the ability to teleoperate utilizing a single bi-directional UDP socket via a remote master device. Preliminary telesurgery experiments were conducted using the RAVEN. The experiments illustrated the system’s ability to operate in extreme conditions using a variety of network settings.
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Affiliation(s)
- Mitchell J. H. Lum
- Department of Electrical Engineering, BioRobotics Lab University of Washington, Seattle, WA 98195, USA,
| | - Diana C. W. Friedman
- Department of Electrical Engineering, BioRobotics Lab University of Washington, Seattle, WA 98195, USA,
| | - Ganesh Sankaranarayanan
- Department of Electrical Engineering, BioRobotics Lab University of Washington, Seattle, WA 98195, USA,
| | - Hawkeye King
- Department of Electrical Engineering, BioRobotics Lab University of Washington, Seattle, WA 98195, USA,
| | - Kenneth Fodero
- Department of Electrical Engineering, BioRobotics Lab University of Washington, Seattle, WA 98195, USA,
| | - Rainer Leuschke
- Department of Electrical Engineering, BioRobotics Lab University of Washington, Seattle, WA 98195, USA,
| | - Blake Hannaford
- Department of Electrical Engineering, BioRobotics Lab University of Washington, Seattle, WA 98195, USA,
| | - Jacob Rosen
- Department of Computer Engineering Baskin School of Engineering University of California Santa Cruz, CA 95064, USA, ,
| | - Mika N. Sinanan
- Department of Surgery, Center for Video Endoscopic Surgery, University of Washington, Seattle, WA 98195, USA,
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15
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Westebring-van der Putten EP, Goossens RHM, Jakimowicz JJ, Dankelman J. Haptics in minimally invasive surgery--a review. MINIM INVASIV THER 2008; 17:3-16. [PMID: 18270873 DOI: 10.1080/13645700701820242] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article gives an overview of research performed in the field of haptic information feedback during minimally invasive surgery (MIS). Literature has been consulted from 1985 to present. The studies show that currently, haptic information feedback is rare, but promising, in MIS. Surgeons benefit from additional feedback about force information. When it comes to grasping forces and perceiving slip, little is known about the advantages additional haptic information can give to prevent tissue trauma during manipulation. Improvement of haptic perception through augmented haptic information feedback in MIS might be promising.
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Affiliation(s)
- E P Westebring-van der Putten
- Department of Applied Ergonomics and Design, Faculty of Industrial Design Engineering, Delft University of Technology, The Netherlands.
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Hagen ME, Meehan JJ, Inan I, Morel P. Visual clues act as a substitute for haptic feedback in robotic surgery. Surg Endosc 2007; 22:1505-8. [DOI: 10.1007/s00464-007-9683-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 10/16/2007] [Indexed: 12/22/2022]
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Impact of body mass index on outcomes after robot assisted radical prostatectomy. World J Urol 2007; 26:91-5. [DOI: 10.1007/s00345-007-0217-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 09/22/2007] [Indexed: 12/14/2022] Open
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Buse S, Gilfrich C, Hohenfellner M. [Robotic surgery in urology]. Urologe A 2007; 46:1239-42. [PMID: 17665163 DOI: 10.1007/s00120-007-1487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S Buse
- Urologische Klinik, Ruprecht-Karls-Universität, Im Neuenheimer Feld 110, 69121 Heidelberg.
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Taylor GW, Jayne DG. Robotic applications in abdominal surgery: their limitations and future developments. Int J Med Robot 2007; 3:3-9. [PMID: 17441019 DOI: 10.1002/rcs.115] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In the past 20 years, the technical aspects of abdominal surgery have changed dramatically. Operations are now routinely performed by laparoscopic techniques utilizing small abdominal incisions, with less patient discomfort, earlier recovery, improved cosmesis, and in many cases reduced economic burden on the healthcare provider. These benefits have largely been seen in the application of laparoscopic techniques to relatively straightforward procedures. It is not clear whether the same benefits carry through to more complex abdominal operations, which are more technically demanding and for which current laparoscopic instrumentation is less well adapted. The aim of surgical robotics is to address these problems and allow the advantages of minimal access surgery to be seen in a greater range of operations. METHODS A literature search was performed to ascertain the current state of the art in surgical robotics for the abdomen, and the technologies emerging within this field. The reference lists of the sourced articles were also searched for further relevant papers. RESULTS Currently available robotic devices for abdominal surgery are limited to large, costly 'slave-master' or telemanipulator systems, such as the da Vinci (Intuitive Surgical, Sunny Vale, CA). In addition to their size and expense, these systems share the same limitation, by virtue of the fulcrum effect on instrument manipulation inherent in the use of ports by which external instruments gain access to the abdominal cavity. In order to overcome these limitations several smaller telemanipulator systems are being developed, and progress towards freely mobile intracorporeal devices is being made. CONCLUSIONS While current robotic systems have considerable advantages over conventional laparoscopic techniques, they are not without limitations. Miniaturisation of robotic components and systems is feasible and necessary to allow minimally invasive techniques to reach full potential. The ultimate extrapolation of this progress is the development of intracorporeal robotics, the feasibility of which has been demonstrated.
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Affiliation(s)
- G W Taylor
- Academic Surgical Unit, Clinical Sciences Building, St. James's University Hospital, Leeds, UK.
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Chandra V, Dutta S, Albanese CT. Surgical robotics and image guided therapy in pediatric surgery: emerging and converging minimal access technologies. Semin Pediatr Surg 2006; 15:267-75. [PMID: 17055957 DOI: 10.1053/j.sempedsurg.2006.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Minimal access surgery (MAS) is now commonplace in the armamentarium of the pediatric surgeon, and is being applied to a growing list of pediatric surgical diseases. Robot-assisted surgery and image guided therapy (IGT) have evolved as innovative minimal access approaches, and hold the promise of advancing MAS far beyond what is currently possible. The aims of this article are to describe the currently available robotic, and image guided therapy systems, review their present and potential applications, and discuss the future directions of these converging technologies.
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Affiliation(s)
- Venita Chandra
- Stanford University School of Medicine, Stanford, California 94305, USA
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